Vitrectomy: everything you need to know about this eye surgery
Vitrectomy is one of the surgical procedures that have truly revolutionised the management of vitreous and retinal diseases. This delicate operation aims to treat various conditions, improve vision or prevent its deterioration. Often seen as a daunting prospect, it raises many questions regarding the procedure itself, the post-operative recovery and any potential complications. Let’s delve into the world of vitrectomy to better understand what is at stake, the surgical process and the key stages of recovery following vitrectomy. We also invite you to read this patient’s account of their vitrectomy experience.
What is a vitrectomy?
Vitrectomy is a specialised eye surgery performed on the eye to partially or completely remove the vitreous, the gel-like, transparent substance located between the retina and the lens. When the vitreous loses its properties or becomes a source of problems, it may be necessary to remove it in order to preserve vision.
This retinal surgery is carried out using miniature instruments inserted through fine incisions in the sclera (the white part of the eye). These instruments are used to cut, aspirate and replace the vitreous gel whilst preserving the delicate internal structures. Very often, a special fluid or a temporary gas is placed inside the eye to maintain the shape of the eyeball, thereby promoting healing and ensuring the retina is correctly positioned.
For which conditions is a vitrectomy performed?
Vitrectomy is indicated for a number of conditions affecting the vitreous or the retina. Among the most common are retinal detachments, intravitreal haemorrhages (particularly those associated with diabetes), serious infections such as endophthalmitis, and the presence of macular holes or folds causing a significant loss of vision.
Vitrectomy may also be recommended to remove persistent vitreous opacities or to extract foreign bodies following eye trauma. Thanks to technical advances and a better understanding of the role of the vitreous, the indications for this procedure continue to expand.
- Retinal detachment with vitreous traction
- Severe infections inside the eye (endophthalmitis)
- Macular hole or epimacular membrane
- Significant opacities impairing vision
- Vitreous haemorrhage associated with proliferative diabetic retinopathy
How is a vitrectomy performed?
Preparation before the procedure
Before any eye surgery, a thorough consultation is essential. This includes a detailed ophthalmological examination and, in some cases, imaging tests of the retina. The choice between local or general anaesthesia depends on the individual patient, the expected duration of the operation and their general state of health. Day surgery is often the preferred option, allowing patients to return home as soon as possible.
Adherence to pre-operative instructions, such as the use of antiseptic eye drops or the temporary suspension of certain treatments, remains essential to minimise the risk of infection or other complications during vitreous surgery.
During the operation
The procedure usually lasts between 30 minutes and two hours, depending on its complexity. After making three micro-incisions, the miniaturised instruments, the light source and the infusion system are put in place to maintain the eye’s internal pressure. The removal of the vitreous is then followed by procedures tailored to the specific condition: suctioning of blood, laser treatment of the retina or removal of membranes.
Depending on the requirements, the surgeon replaces the removed vitreous with saline solution, a mixture of air or gas, or even silicone oil, thereby providing optimal internal support for the retina during recovery.
What happens after a vitrectomy?
Recovery and post-operative precautions
Following this surgical procedure, patients are discharged home on the same day or the following day. It is common for the eye to be red, tender or slightly swollen in the early stages. It is essential to follow the post-operative recommendations carefully to ensure the best possible recovery and avoid complications. A series of follow-up appointments are scheduled to check healing, assess the stability of the retina and adjust treatment if necessary.
Antibiotic, anti-inflammatory and mydriatic eye drops are prescribed for a few weeks. As a precaution, you should avoid certain activities such as lifting heavy loads, swimming or wearing make-up until the operated area has fully healed.
Functional rehabilitation and specific aids
The quality of visual recovery depends on many factors: the underlying condition, the time elapsed before surgery, and the overall condition of the retina. When a gas tamponade is used, it is sometimes necessary to maintain a specific head position for several days to optimise support for the retina. To make this period more comfortable, specialised devices are available, such as MassMe cushions, which are designed specifically for recovery following vitrectomy. They help patients maintain the correct posture without prolonged discomfort and actively contribute to a better recovery.
What are the risks and complications associated with vitrectomy?
Like any surgical procedure, vitrectomy carries certain risks and complications. These include the rare but serious development of an intraocular infection, residual haemorrhage, or secondary retinal detachment, which may sometimes require further surgery.
In the medium term, cataracts frequently develop following vitrectomy, as the altered intraocular environment accelerates the ageing of the lens. Other side effects may include an acute glaucoma attack or fluctuations in intraocular pressure. Close monitoring by the medical team enables a rapid response in the event of any post-operative complications.
- Increased risk of cataracts
- Sudden fluctuations in intraocular pressure
- Recurrence of retinal detachment
- Persistent or impaired vision
- Appearance of floaters caused by temporary gas bubbles
When can you return to a normal life after retinal surgery?
The return to a normal daily routine varies depending on the extent of the procedure, the speed of healing and the nature of the condition being treated. Many patients gradually resume their usual activities from the second week onwards, although driving and contact sports are not recommended initially.
Sometimes, a full recovery requires more patience, particularly following complex retinal surgery or when the retina remains fragile. Support from healthcare professionals and strict adherence to post-operative precautions are essential to ensure a safe return to optimal visual independence.