Vitreous surgery is performed by retina surgeons to treat a number of disorders including retinal detachment, vitreous hemorrhage, macular hole, macular pucker, intraocular infection (endophthalmitis), trauma, and complications from previous eye surgery. It is an outpatient procedure done in the operating room most often under local (“twilight”) anesthesia, but occasionally under general anesthesia. As part of the procedure, the vitreous is removed, hence it is called a vitrectomy.
During a vitrectomy, instruments are passed through the white part of the eye (sclera) into the vitreous cavity. The openings are small – about the size of a needle used when you have a blood test. The surgeon inserts a fiberoptic light to illuminate the inside of the eye while working. A small cutting instrument is used to remove the vitreous and any blood, cataract fragments, or scar tissue that may be present. Other instruments such as small forceps and laser probes are also used for certain tasks. Sometimes a suture is needed to close the incisions, but recent developments have made it possible for most vitrectomies to be performed through tiny openings that close on their own.
The vitreous is replaced with a saline solution that is compatible with the eye. Within a day, the eye makes its own fluid to replace the saline. In some cases, a gas bubble is placed instead. The gas is absorbed by the body and replaced with the eye’s fluid gradually during the weeks following surgery. In other cases, silicone oil is used which cannot be absorbed by the body. A second surgery to remove the silicone oil is usually needed once the retina is completely healed. When gas or silicone oil are used, the patient is asked to maintain a certain position (often face-down or on one side) so that the gas or oil bubble can float up against the retina for proper healing.