Vitrectomy is microsurgery performed inside the eye. The vitreous gel that fills the eye is removed, giving the surgeon access to work directly on the retina, and it is the foundation of most modern retinal surgery.

The procedure is performed on an outpatient basis through incisions small enough that they usually seal themselves without stitches.

The vitreous occupies the space between the lens and the retina. It cannot simply be worked around: instruments cannot reach the retina without passing through it, and in many conditions the gel is itself part of the problem — pulling on the retina, clouded with blood, or providing the scaffold on which scar tissue forms.

Removing it allows the surgeon to relieve traction, clear opacity, work on the retinal surface, and fill the eye with a substance that holds the retina in position while it heals. The space left behind fills naturally with the eye’s own fluid over the following weeks.

• Retinal detachment — to relieve traction, flatten the retina and seal the breaks that caused it.
• Macular hole — with membrane peeling and a gas bubble to support closure.
• Epiretinal membrane (macular pucker) — to peel scar tissue from the retinal surface and relieve the wrinkling it causes.
• Vitreous hemorrhage — to clear blood that is obscuring vision and preventing examination of the retina, often in advanced diabetic disease.
• Tractional retinal detachment in proliferative diabetic retinopathy — to remove scar tissue pulling on the retina.
• Retained lens material or a dislocated intraocular lens following cataract surgery.
• Endophthalmitis — severe infection inside the eye, where the vitreous is removed and antibiotics delivered directly.
• Diagnostic sampling of vitreous where infection or inflammation of uncertain cause needs to be identified.

Vitrectomy is usually performed under local anesthesia with sedation, so patients are comfortable and generally not aware of the procedure, though general anesthesia is used in some circumstances. It typically takes between one and three hours depending on what is being addressed.

Three small openings are made in the white of the eye. One provides a continuous flow of fluid to keep the eye pressurized, one carries a light source, and one admits the instruments. A fine probe removes the vitreous gel, after which the surgeon carries out whatever the specific condition requires — peeling a membrane, applying laser, removing scar tissue, or flattening the retina.

At the end the eye is filled with a substance chosen for the case: saline solution, which is simply replaced by the eye’s own fluid; a gas bubble, which presses the retina into position and absorbs over weeks; or silicone oil, which provides longer support and is removed in a later procedure.

The incisions are usually small enough to seal without sutures. Most patients go home the same day.

What recovery looks like depends heavily on whether a gas bubble was placed.

• Positioning. Where gas is used, you may be asked to maintain a specific head position — often face-down — for a defined period so the bubble presses where it is needed. This is the most demanding part of recovery for most patients, and equipment can be rented to make it more manageable.
• Vision during recovery. With a gas bubble, vision in that eye is very poor initially and often described as looking through water. As the bubble absorbs, a dark line moves down across the vision and gradually disappears. This is expected.
• No air travel or high altitude while gas remains in the eye, as expanding gas can raise pressure inside the eye dangerously. Your surgeon will confirm when it is safe.
• Drops — antibiotic and anti-inflammatory drops are used for several weeks.
• Activity. Light activity is usually resumed within days, with heavier lifting and strenuous exercise restricted for a period. Specific guidance depends on what was done.

Discomfort is usually modest and manageable with simple analgesia. Visual recovery is gradual and often continues over months.

Vitrectomy is a well-established procedure, but as with any intraocular surgery it carries risks, which your surgeon will discuss in relation to your specific case.

• Cataract — the most common consequence. Most patients who have not already had cataract surgery develop a cataract within a year or two afterward, and it is treated with routine cataract surgery.
• Raised eye pressure, particularly where gas or silicone oil is used.
• Retinal tear or new detachment during or after surgery.
• Bleeding inside the eye.
• Infection — uncommon but serious.
• Incomplete resolution, with some conditions requiring more than one procedure.

The relevant comparison is not with a risk-free alternative but with the expected course of the condition if it is not treated. That balance is specific to each patient, and it is the substance of the conversation before consenting to surgery.

Questions about retinal surgery?

Vitrectomy is performed by our retina specialists for a range of retinal conditions. Call (602) 613-5473 to arrange a consultation at our Scottsdale office, or contact us.