Vitrectomy

A vitrectomy (pars plana vitrectomy, or PPV) is an operation to remove the clear gel, the vitreous, that fills the inside of the eye. Removing it lets a retina surgeon clear blood or debris that blocks vision, and reach the retina directly to repair it. The eye does not need the gel: once it is removed, the eye fills with its own fluid.

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Why it is done

• Bleeding into the gel that does not clear on its own, most often from diabetic eye disease
• Retinal detachment
• Scar tissue on the retina: a wrinkled membrane over the macula (epiretinal membrane, or macular pucker), or scar tissue pulling on the retina in advanced diabetic disease
• A macular hole, a small break in the center of the retina
• Severe infection inside the eye
• A lens or lens fragment that has fallen into the back of the eye during cataract surgery

The operation

It is done in an operating room as an outpatient, usually under a numbing injection beside the eye with sedation, and takes about one to two hours.

1. Three tiny ports are placed through the white of the eye, just behind the colored part. They are narrower than a pencil lead.
2. The gel is removed with a fine cutter, guided by a light inside the eye and a microscope. Clear fluid flows in to keep the eye's shape.
3. The retina is treated: laser, peeling scar tissue or a membrane off its surface, or flattening a detached retina and sealing its tears.
4. The eye is filled with clear fluid, air, a gas bubble, or silicone oil, depending on the repair.
5. The ports come out and usually seal without stitches.

Gas, oil and positioning

• A gas or air bubble presses the retina or a macular hole in place while it heals. It is absorbed gradually, over a period that depends on the gas used. You may need to keep your head in a set position, sometimes face down, for several days. It matters for the result.
• Flying and high altitude. With a gas bubble there is often a period when you should not fly or travel to high altitude, because the bubble expands as air pressure falls. Your surgeon will tell you how long. Tell any anesthetist you have gas in your eye.
• Silicone oil is used for complex detachments. It is not absorbed, so it is usually removed in a second operation a few months later.
• Vision through a bubble is very poor, like looking through water. As the gas is absorbed you see a line that moves down, then a small bubble, then it is gone.

Recovery

• Drops (an antibiotic and a steroid) are used for several weeks.
• The eye is red, scratchy and swollen for a week or two. Pain is usually mild.
• Avoid heavy lifting and bending for a couple of weeks, and do not rub the eye.
• Vision improves over weeks to months, depending on why the operation was done. After clearing blood, it can improve within days.

Risks

• Cataract. Most eyes that still have their natural lens develop a cataract within a year or two of a vitrectomy. Cataract surgery then works well.
• Raised eye pressure, from gas, oil or steroid drops. This matters most if you have glaucoma: tell your surgeon, keep using your drops, and expect pressure checks.
• Retinal tear or detachment, bleeding, and, rarely, infection.

Call the same day if pain is getting worse, vision drops after it had improved, or you notice a new shadow or curtain. See When to Call the Same Day.

Questions worth asking

• What will you be doing inside my eye?
• Will there be gas or oil, and will I need to position my head?
• When can I fly, drive and go back to work?
• How might this affect my glaucoma?