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Vitrectomy

A vitrectomy is an eye surgery where the vitreous humour – the gel-like substance that fills the eye – is removed and replaced with a temporary solution.

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Everything you need to know

A vitrectomy is an eye surgery where the vitreous humour – the gel-like substance that fills the eye – is removed and replaced with a temporary solution (such as an air bubble, gas bubble or silicone oil bubble). This procedure is performed to help treat issues with the retina or the vitreous humour.

The vitreous humour is situated in front of the retina (the back of the eye) and behind the iris (the front of the eye) and gives the eye definition. If the vitreous becomes cloudy, a person is not able to see clearly. Removing the vitreous humour can help restore your vision in this situation.

A vitrectomy can also be performed to treat various eye conditions, such as:

 

  • Retinal Detachment. This is an emergency situation where the retina detaches from the layer of blood vessels that provide it with oxygen and nutrients. Removing the vitreous allows the surgeon to access the retina and reattach it.

 

  • Macular Hole. In some cases, a vitrectomy is performed to treat a macular hole. This is when a small hole forms in the macula (the part of the retina responsible for central vision).

 

  • Epiretinal membrane scarring. Removing the vitreous allows a surgeon to access the retina at the back of the eye. Scarring on the retina can affect your vision. Surgeons can restore your vision by removing scar tissue that has formed on the surface of the retina, known as the epiretinal membrane.

 

  • Diabetic Retinopathy – for advanced cases of diabetic retinopathy, a vitrectomy may be recommended to remove blood or scar tissue that is affecting your vision.

 

  • Vitreous Haemorrhage – when there is bleeding into the vitreous humour, a vitrectomy may be performed to remove the blood and improve vision.

 

It’s important to note that a vitrectomy is not the only solution for issues with your vision. For instance, if you’re dealing with diabetic retinopathy, your doctor might recommend an alternative procedure known as laser photocoagulation.

In the case of a detached retina, there are alternative treatments like laser therapy or a procedure called pneumatic retinopexy. Nevertheless, for complex retinal detachments or instances where bleeding into the vitreous has occurred, a vitrectomy may be recommended. Consult with your eye doctor to thoroughly understand the advantages and risks associated with all available treatment options.

Before

Consultation

Firstly, you will need to book a consultation with one of our eye surgeons. At your appointment, the surgeon will ask you about your symptoms and medical history and conduct a comprehensive examination of your eyes.

If a vitrectomy is recommended, and depending on how urgently you need treatment, surgery could be booked immediately or in a few days. Either way, your doctor will explain the risks and benefits of surgery so you can make an informed decision.

Before surgery, you will need to have a pre-assessment, which is a ‘fitness for surgery’ check. This generally includes urine and blood tests. It’s also a good opportunity to ask any questions you may have.

Surgery day

After a vitrectomy, you should be able to go home the same day. However, some people may need to stay overnight. The procedure is usually performed under local anaesthetic, so you will be awake but will feel no pain. However, some people may choose to have general anaesthetic, where they are asleep.

If you are having general, you should stop eating six hours before surgery and stop drinking 2 hours before (including water). From 2 hours before, you should also not chew gum or suck hard sweets. If you are having local anaesthetic, you do not need to fast.

On surgery day, do not wear any facial make-up or contact lenses, wear loose, comfortable clothes and bring a small bag with things you might need during your stay. Items to remember include a toothbrush and toothpaste, your phone and a charger, and any prescription medications.

Once you have arrived and are settled in your room, a nurse will monitor your vital signs (such as body temperature and blood pressure) and run through your medical history, medications and emergency contacts.

Your doctor will then once again run you through the procedure and ask you to sign a consent form for surgery.

During

A vitrectomy typically takes between 1 – 2 hours. It is performed under local anaesthetic meaning you are awake but can’t feel any pain. If you are anxious, you could also have sedation, which will help you relax. Alternatively, you do have the option of having general anaesthesia where you will be asleep.

To start the procedure, eye drops will be applied to your eye, which will enlarge the pupil.  You will then have an injection around the eye to freeze it so it stays completely still for surgery. An instrument will keep your eye open to prevent you from blinking. After the injection, a firm pressure pad will be placed on your closed eye for around 15 minutes. This will enable the anaesthetic to penetrate the tissues around the eye and completely numb them.

You will lie on your back with your head in a special head-rest throughout the procedure.

Once you are ready, your eye doctor will make a three small cuts in the sclera, which is the white of the eye. One incision is made for a microscopic light source, the second for an instrument that cuts through and removes the vitreous and the third for the replacement substance (such as an air bubble), which will also maintain the pressure in the eye during the operation. Your surgeon will then repair any issues in the eye. Following surgery, the replacement substance in the eye will be absorbed into your body gradually over a period of weeks, giving your eye time to naturally produce its own clear fluid to re-fill the eye.

After

Once we’re happy you’re doing well, we will take you to your private room where you can start your recovery. Our nursing team will monitor your vital signs, such as blood pressure and oxygen levels, to make sure your recovery is going well.

Your eye will be firmly padded and will feel uncomfortable when the anaesthetic wears off. Don’t worry as we will give you pain relief to help with the discomfort. You should be able to leave hospital the same or next day – please ask a friend or relative to collect you as you will not be able to drive.

The next morning, you can remove your dressing. Expect your eye to be bruised and swollen. Your vision will also be blurry due to the temporary solution in your eye. Please do not rub it as it will be very tender.

Over the next few weeks, you should use the eye drops your doctor has prescribed. These will help prevent infection and reduce inflammation.

For two weeks post-surgery, you will need wear a clear eye shield over your eye at night to protect it whilst you are sleeping. You should also follow your doctor’s advice on posturing. This means placing your head in different positions to help direct the gas bubble in your eye to the area of the retina that needs additional support. This is very important to do if you have had any repairs on your retina.

You should take at least four weeks off work to recover and you will also not be able to fly for a few weeks after surgery. Your surgeon will be able to advise you on when you can return to air travel.

The air or gas bubble will take around 6-8 weeks to absorb. Over this time, your vision should become gradually clearer, though it may not return completely back to normal after surgery.

 

How to pay for your treatment

If you’re… paying for yourself

Did you know you don’t need private medical insurance to come to St John & St Elizabeth Hospital? As a self-pay patient, you can access safe, outstanding quality health care at times to suit you.

For scans and tests, as well as to see most consultants, you’ll still need to be referred by a medical professional like your GP, but as a self-pay patient, the process is more straightforward. You won’t need authorisation from an insurance provider, and you’ll have greater choice of consultant and appointment times.

If you’re… insured

St John & St Elizabeth Hospital is approved by all major medical insurance companies. If you have a personal private health insurance policy, or your company provide it for you, you can use it to pay for your care from your initial consultation through to treatment, surgery and aftercare such as physiotherapy. Not all private health insurance plans cover the same things. It’s very important to check exactly what you are covered for with your insurance provider.