Vitrectomy
Vitrectomy is a surgical procedure in which some or all of the vitreous humor (gel-like substance) is removed from the posterior chamber of the eye to treat various retinal and vitreous disorders.
Indications (Uses) of Vitrectomy
Vitrectomy is performed for several retinal and vitreous diseases, including:
- Retinal Detachment – To remove traction and reattach the retina.
- Diabetic Retinopathy – For proliferative diabetic retinopathy (PDR) with vitreous hemorrhage or tractional retinal detachment.
- Vitreous Hemorrhage – To clear the visual axis in cases of non-resolving hemorrhage.
- Macular Hole – To relieve traction and promote hole closure.
- Epiretinal Membrane – To remove membranes causing macular distortion and visual impairment.
- Endophthalmitis – To remove infective material and improve drug penetration.
- Intraocular Foreign Body (IOFB) Removal – In cases of ocular trauma.
- Complicated Cataract Surgery – For retained lens material or posterior capsule rupture.
- Macular Edema in Certain Cases – As part of treatment for refractory cases.
Types of Vitrectomy
- Anterior Vitrectomy – Performed to remove vitreous prolapsed into the anterior chamber, usually after cataract surgery complications.
- Pars Plana Vitrectomy (PPV) – The standard approach for posterior segment diseases, performed through the pars plana to avoid lens damage.
Vitrectomy Procedure
- Performed under local or general anesthesia.
- Small incisions (sclerotomies) are made in the sclera.
- A vitrectomy probe (cutter) is introduced to remove the vitreous.
- Infusion fluid maintains intraocular pressure (BSS - Balanced saline solution or gas/air exchange).
- Additional procedures like laser photocoagulation, membrane peeling, or gas/silicone oil injection may be done if needed.
- Incisions are self-sealing or sutured if necessary.
Complications
- Postoperative Cataract Formation (common in phakic eyes).
- Retinal Detachment (due to surgical traction).
- Glaucoma (due to gas/silicone oil or inflammation).
- Endophthalmitis (infection risk).
- Hypotony (low intraocular pressure post-surgery).
- Macular Edema (can occur postoperatively).
Postoperative Care
- Positioning instructions if gas/silicone oil is used.
- Topical antibiotics and steroids to prevent infection and inflammation.
- Monitoring intraocular pressure (IOP) regularly.
- Follow-up visits to check for retinal attachment and complications.
Important Points for Exam
- Vitrectomy is a common treatment for vitreoretinal disorders.
- Pars plana vitrectomy (PPV) is the most commonly used technique.
- Gas or silicone oil tamponade is often used in cases of retinal detachment.
- Complications include cataract formation, glaucoma, and retinal detachment.
- Postoperative care includes head positioning, IOP monitoring, and infection control.