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Vitrectomy
Overview
The vitreous is a normally
clear, gel-like substance that fills the center of the eye. It makes up
approximately 2/3 of the eye's volume, giving it form and shape before birth. Certain
problems affecting the back of the eye may require a vitrectomy, or surgical
removal of the vitreous. After a vitrectomy, the vitreous is
replaced as the eye secretes aqueous
and nutritive fluids.
A vitrectomy may be performed to
clear blood and debris from the eye, to remove scar tissue, or to alleviate
traction on the retina. Blood, inflammatory cells, debris, and scar
tissue obscure light as it passes through the eye to the retina, resulting in
blurred vision. The vitreous is also removed if it is pulling or tugging
the retina from its normal position.
Some of the most common eye
conditions that require vitrectomy include:
The retinal surgeon performs the
procedure through a microscope and special lenses designed to provide a clear
image of the back of the eye. Several tiny incisions just a few
millimeters in length are made on the sclera. The retinal surgeon inserts
microsurgical instruments through the incisions such as:
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Fiber optic light source to
illuminate inside the eye
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Infusion line to maintain
the eye's shape during surgery
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Instruments to cut and
remove the vitreous.
Vitrectomy is often performed in
conjunction with other procedures such as retinal detachment repair, macular
hole surgery, and macular membrane peel. The length of the surgery
depends on whether additional procedures are required and the overall health
of the eye.
Special Techniques
The retinal surgeon may use
special techniques along with vitrectomy to treat the retina. Your
surgeon will determine if any of these are appropriate for your
eye:
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Sealing blood vessels -
Laser is sometimes used to stop tiny retinal vessels from bleeding inside
the eye
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Gas bubble - A small gas bubble may be placed inside the eye to help seal a macular hole.
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Silicone oil - After
reattachment surgery, the eye may be filled with silicone oil to keep the retina in position.
What to expect after surgery
The eye is patched after the first
postoperative checkup. This can usually be removed the same evening at
bedtime. Since the anesthesia numbs the lids and temporarily prevents
blinking, it is very important to keep the eye patch on until you are able to
blink the eye normally. Begin using drops after the patch has been
removed.
How should the eye feel?
It is common to experience some discomfort
immediately after the surgery and for several days afterward. This is
primarily related to swelling on the outside of the eye and around the
eyelids. A scratchy feeling or occasional sharp pain is normal.
Ice compresses gently placed on the swollen
areas (ice or frozen vegetables placed inside a resealable plastic bag work
well) reduce the aching and soreness. Tylenol E.S. is also helpful for
minor aching.
If you have a deep ache or throbbing
pain that does not respond to Tylenol or other over-the-counter pain
medication, please call St. Luke’s.
Redness is common and gradually diminishes
over time. Some patients may notice a patch of blood on the outside of
the eye. This is similar to bruising on the skin and slowly resolves on
its own.
When does the vision improve?
Because vitrectomy is performed for many
different problems and often in conjunction with other eye surgeries, the
recovery period varies with the individual. In some cases, such as
macular hole surgery, the surgeon may place a gas bubble inside the eye that
places gentle pressure on the macula. This may require special head
positioning to keep the bubble positioned correctly.
Dilating drops (red cap bottle) may be
prescribed that keep the pupil of the operated eye large, causing be light
sensitivity.
Postoperative Instructions
Since vitrectomy is often performed along
with other procedures, postoperative instructions may vary. Some general
guidelines are provided; however, please consult with your surgeon for
specific instructions.
1. Begin using any anti-inflammatory
and antibiotic drops prescribed by your physician immediately after your eye
patch has been removed.
2. Wear the plastic eye shield when
sleeping for the first 7 days following surgery. The shield should be
worn for the first 3 days following surgery when showering.
3. Avoid bending, stooping, lifting
objects over 5 pounds, or any strenuous activity for one week (unless directed
otherwise by your physician).
4. Take Tylenol E.S. or gently apply
ice compresses to the eye to relieve mild discomfort.
5. Follow any special instructions
given by your physician for head positioning (this is not necessary in all
cases).
Frequently Asked Questions
Q: May I read or watch TV. after
surgery?
A: Yes. Using your eye following
surgery will not damage or hurt the eye.
Q: Do I need to wear sunglasses?
A: Sunglasses are recommended for
everyone, but are especially encouraged after surgery. We recommend
wearing sunglasses with 100% UV protection.
Q: How long will my vision remained
blurred after surgery?
A: This is dependent on many individual
factors such as your overall eye health and the procedures performed along
with the vitrectomy. Most patients notice that their vision begins to
improve approximately 1 week after surgery.
We appreciate your confidence in St. Luke’s and wish you a speedy recovery.
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