Narciso F. Atienza, Jr. MD, MBA, FPCS, FPAO
EYE PHYSICIAN AND SURGEON
FELLOW, PHILIPPINE COLLEGE OF SURGEONS
FELLOW, PHILIPPINE ACADEMY OF OPHTHALMOLOGY
DIPLOMATE, PHILIPPINE BOARD OF OPHTHALMOLOGY
SUBSPECIALTY IN DISEASES AND SURGERY OF THE RETINA, VITREOUS, AND MACULA and OCULAR ONCOLOGY
FELLOW, PHILIPPINE COLLEGE OF SURGEONS
FELLOW, PHILIPPINE ACADEMY OF OPHTHALMOLOGY
DIPLOMATE, PHILIPPINE BOARD OF OPHTHALMOLOGY
SUBSPECIALTY IN DISEASES AND SURGERY OF THE RETINA, VITREOUS, AND MACULA and OCULAR ONCOLOGY
What is a vitrectomy?
Vitrectomy means to remove the vitreous humor. It is a surgical procedure where a special machine, called a vitrectomy machine is used to remove the vitreous, which is formed when we are born. The procedure is done inside the operating room where strict sterility procedures are followed. Other special instruments are also used during the surgery such as lenses, endo-ocular laser to ensure and increase success of the surgery. The surgery is usually done under local anesthesia with sedation by an anesthesiologist, however a general anesthesia may be indicated for some patients who have anxiety during surgery. The surgery can be done as out-patient but certain healthcare providers require the patient to stay overnight for the surgery
What happens to the vitreous once it is removed?
The vitreous never regenerates if it is removed, and the eye will have perfect vision and a normal shape without the vitreous. Patients often are concerned that the eye will collapse if the vitreous is removed or wonder what is used to replace it. Aqueous humor fills the former vitreous space within hours after surgery replacing the artificial aqueous humor (saline with additives called balanced salt solution) that is used to maintain eye pressure during and immediately after surgery. Vitreous removal reduces pulling (traction) on the retina, improves the surgeon's view, and provides space for a gas or silicone oil bubble.
When is vitrectomy indicated?
Previously, vitrectomy surgery was indicated in severe retinal problems. Because of the the advancement of technology and surgical technique, indications for vitrectomy have expanded and include:
1) Vitreous hemorrhage
2) Diabetic Traction Retinal Detachment
3) Rhegmatogenous Retinal Detachment
4) Macular Holes
5) Epiretinal membranes
6) Complications of Ocular Surgery
Are there any restrictions for patients who had vitrectomy?
Most restrictions will be explained by your retina specialist prior to your surgery. However, these restrictions are usually temporary and are lifted once you have fully recovered after surgery. Among the restrictions in after surgery will be to refrain from strenuous activities such as exercise, or lifting heavy objects immediately after surgery. Patients who had a gas bubble injection are advised NOT TO FLY IN AN AIRPLANE, GO SCUBA DIVING, OR HAVE A GENERAL INHALATION ANESTHETIC for the duration of the gas bubble, which may vary from 3 weeks to 8 weeks. there are no dietary restrictions except if you are diabetic, where diet is an integral part to control your blood sugar. Patients can take a bath immediately but are advised to keep the eye from being wet during bath time.
Are vitrectomy surgeries always successful?
Despite the advanced technology, surgery may not be successful in one sitting. Though majority of cases require only one surgery, depending on the complexity of the surgical case, some conditions may require 2 or more surgeries to attain the objective to vitrectomy surgery. Ultimately, some conditions may still have poor results despite the surgery, though this number is low, and the chances of your surgery to be successful are higher.
Are vitrectomy surgeries always done alone?
Vitrectomy surgeries are done as standalone procedures, but some cases may require that additional procedures be done at the same time as the vitrectomy surgery. Procedures, such as cataract surgery, scleral buckling, and glaucoma surgery have been done at the same time as vitrectomy surgery with a high success rate. Combined surgeries are usually done once your doctor has considered all the factors to minimize problems and to maximize the success of your surgery.
Are there any complications that I have to be aware of?
Yes. There is a significant incidence of cataract progression after vitreous surgery. Some doctors believe that patients with an absolutely clear lens develop cataracts as a result of vitreous surgery. Many of the patients requiring vitreous surgery for retinal detachment already have nuclear sclerotic cataracts (yellowing of the center of the lens), which often worsen after vitreous surgery. Surgeons differ widely on the percentage of patients that suffer cataract progression due to vitreous surgery.
Retinal detachment can occur after vitreous surgery performed for any reason, including repair of retinal detachment. Sometimes this is due to the method used but more often it is due to increasing traction on the retina from further contraction of the vitreous.
Proliferative vitreoretinopathy (PVR) is the most common cause of failure of retinal detachment surgery and often requires vitrectomy and silicone oil. Epiretinal membranes (ERM) occur after about 2.5% of otherwise successful retinal detachment procedures.
Pressure elevation (glaucoma) can occur after all forms of eye surgery including surgery for retinal detachment.
Infection is very rare after retinal detachment surgery (about 0.02%).
Vitrectomy means to remove the vitreous humor. It is a surgical procedure where a special machine, called a vitrectomy machine is used to remove the vitreous, which is formed when we are born. The procedure is done inside the operating room where strict sterility procedures are followed. Other special instruments are also used during the surgery such as lenses, endo-ocular laser to ensure and increase success of the surgery. The surgery is usually done under local anesthesia with sedation by an anesthesiologist, however a general anesthesia may be indicated for some patients who have anxiety during surgery. The surgery can be done as out-patient but certain healthcare providers require the patient to stay overnight for the surgery
What happens to the vitreous once it is removed?
The vitreous never regenerates if it is removed, and the eye will have perfect vision and a normal shape without the vitreous. Patients often are concerned that the eye will collapse if the vitreous is removed or wonder what is used to replace it. Aqueous humor fills the former vitreous space within hours after surgery replacing the artificial aqueous humor (saline with additives called balanced salt solution) that is used to maintain eye pressure during and immediately after surgery. Vitreous removal reduces pulling (traction) on the retina, improves the surgeon's view, and provides space for a gas or silicone oil bubble.
When is vitrectomy indicated?
Previously, vitrectomy surgery was indicated in severe retinal problems. Because of the the advancement of technology and surgical technique, indications for vitrectomy have expanded and include:
1) Vitreous hemorrhage
2) Diabetic Traction Retinal Detachment
3) Rhegmatogenous Retinal Detachment
4) Macular Holes
5) Epiretinal membranes
6) Complications of Ocular Surgery
Are there any restrictions for patients who had vitrectomy?
Most restrictions will be explained by your retina specialist prior to your surgery. However, these restrictions are usually temporary and are lifted once you have fully recovered after surgery. Among the restrictions in after surgery will be to refrain from strenuous activities such as exercise, or lifting heavy objects immediately after surgery. Patients who had a gas bubble injection are advised NOT TO FLY IN AN AIRPLANE, GO SCUBA DIVING, OR HAVE A GENERAL INHALATION ANESTHETIC for the duration of the gas bubble, which may vary from 3 weeks to 8 weeks. there are no dietary restrictions except if you are diabetic, where diet is an integral part to control your blood sugar. Patients can take a bath immediately but are advised to keep the eye from being wet during bath time.
Are vitrectomy surgeries always successful?
Despite the advanced technology, surgery may not be successful in one sitting. Though majority of cases require only one surgery, depending on the complexity of the surgical case, some conditions may require 2 or more surgeries to attain the objective to vitrectomy surgery. Ultimately, some conditions may still have poor results despite the surgery, though this number is low, and the chances of your surgery to be successful are higher.
Are vitrectomy surgeries always done alone?
Vitrectomy surgeries are done as standalone procedures, but some cases may require that additional procedures be done at the same time as the vitrectomy surgery. Procedures, such as cataract surgery, scleral buckling, and glaucoma surgery have been done at the same time as vitrectomy surgery with a high success rate. Combined surgeries are usually done once your doctor has considered all the factors to minimize problems and to maximize the success of your surgery.
Are there any complications that I have to be aware of?
Yes. There is a significant incidence of cataract progression after vitreous surgery. Some doctors believe that patients with an absolutely clear lens develop cataracts as a result of vitreous surgery. Many of the patients requiring vitreous surgery for retinal detachment already have nuclear sclerotic cataracts (yellowing of the center of the lens), which often worsen after vitreous surgery. Surgeons differ widely on the percentage of patients that suffer cataract progression due to vitreous surgery.
Retinal detachment can occur after vitreous surgery performed for any reason, including repair of retinal detachment. Sometimes this is due to the method used but more often it is due to increasing traction on the retina from further contraction of the vitreous.
Proliferative vitreoretinopathy (PVR) is the most common cause of failure of retinal detachment surgery and often requires vitrectomy and silicone oil. Epiretinal membranes (ERM) occur after about 2.5% of otherwise successful retinal detachment procedures.
Pressure elevation (glaucoma) can occur after all forms of eye surgery including surgery for retinal detachment.
Infection is very rare after retinal detachment surgery (about 0.02%).
