The vitreous body protects blood vessels from damage and gives shape to the eyeballs. The transparent and gel-like structure conducts the sun's rays to the retina.
Against the background of ophthalmological diseases, the internal cavity of the organ fills with blood or becomes cloudy, causing loss of vision. People over 40 years of age are at risk.
The pathological process cannot be eliminated by conservative treatment methods, therefore surgery is used as the main method. Vitrectomy involves complete or partial removal of the vitreous.
What it is?
Vitrectomy is a microsurgical operation in which damaged areas of the vitreous body are removed. To maintain visual function, the gel-like concentrate is replaced with substances with similar physical parameters.
They are characterized by moderate viscosity and are completely transparent substances:
After the operation, the person restores visual functions, and the risk of retinal detachment is reduced. Vitrectomy is classified as a microinvasive technique because it does not harm the soft tissues of the eyeball. There is minimal interference in the internal environment of the organ.
In what cases is it prescribed?
There are several indications for surgical intervention:
- primary retinal dissection;
- hemorrhage into the vitreous cavity, accompanied by an increase in intraocular pressure;
- diabetic retinopathy with retinal detachment;
- lens displacement;
- epiretinal membrane on the surface of the retina;
- infectious lesion - endophthalmitis;
- mechanical eye injury.
IMPORTANT. The decision to perform an operation based on the diagnostics performed is made by the attending physician. The ophthalmologist is obliged to explain to the patient the need and benefits of the procedure, and talk about the negative consequences of the disease.
It is prohibited to perform surgery if retinoblastoma is suspected, a malignant tumor typical of children. A similar contraindication to vitrectomy is the presence of an active form of melanoma. The operation can damage the cancerous tumors, which will lead to the spread of metastases throughout the circulatory system.
It is not recommended to carry out the procedure while taking blood thinning medications. In this situation, before making a decision, the ophthalmologist should consult with the cardiologist who is treating the patient. If there is an urgent need for surgery, doctors adjust drug therapy.
Types of intervention
Depending on the severity and distribution of the pathological process, different changes in the morphological structure of the vitreous body are observed. The gel-like substance may completely lose transparency or partially fill with blood in certain areas, so surgery can also be complete or partial.
Total
Total vitrectomy involves complete removal of the vitreous.
The procedure is carried out when:
- dislocation of the lens into the intraocular cavity;
- extensive hemorrhages or severe injuries;
- clouding of the gel-like substance due to denaturation of collagen fibers;
- with the development of the epiretinal membrane on the neurosensory membrane.
After complete removal of the intraocular fluid, the capsule cavity is filled with PFOS, saline solution or gas. Silicone is not suitable for this procedure.
REFERENCE. When filling the intraocular cavity with gas, patients are not recommended to move in the underground metro.
Subtotal (anterior, posterior)
There are 2 forms of subtotal or partial vitrectomy: posterior and anterior. In the latter case, surgery is performed when the gel-like substance penetrates the anterior chamber of the eye. Pathology can be caused by injury or displacement of the lens. In rare cases, fluid inside the eye fills the chamber during cataract or glaucoma surgery.
During posterior closed vitrectomy, vitreous may leak into the posterior segment of the eye. This occurs when the gel-like liquid is highly elastic, when the concentration of hyaluronic acid and collagen fibers increases. When fluid flows into the back of the eyeball, the risk of retinal rupture increases and macular swelling develops.
Preparation
Before the operation, a thorough examination of the eyeball is performed. The ophthalmologist assesses the general condition and records the presence of concomitant pathologies.
The doctor performs the following procedures during a diagnostic examination:
8 hours before vitrectomy, you should avoid drinking and eating, especially when the operation is performed under general anesthesia. This precaution allows you to minimize the risk of asphyxia during the procedure with stomach contents.
Progress of the operation
The operation is performed under local anesthesia or general anesthesia. The latter is used for severe pathologies that require additional surgical procedures. To make a small incision, the doctor uses a special cylindrical scalpel - a vitreotome. An infusion cannula is used to replace the vitreous with an artificial analogue. The surgical intervention lasts about 2-3 hours.
The operation is carried out in several stages:
- After the anesthesia has taken effect, the eye is opened with an eyelid dilator.
- The surgeon makes punctures or incisions of 0.3-0.5 mm.
- An infusion cannula is inserted into the resulting hole. The vitreous is sucked out from the cavity of the eyeball completely or partially depending on the degree of damage. The blood is removed.
- After removing the gel-like substance, a bubble of air or gas is injected into the retina. It maintains the correct position of the membrane in the organ cavity. The gas bubble disappears on its own after recovery.
- A special solution is injected into the eye: silicone oil, saline solution, PFOS.
- The surgeon sutures or seals the incision using a laser.
An educational video about how the entire vitreous body of the eye or any part of it is removed - vitrectomy:
Attention! The video contains footage of a surgical operation.
REFERENCE. For severe retinal detachment, surgery is performed using silicone oil. Unlike other substitutes, the inorganic substance is removed during secondary surgery after the cornea has healed.
Additional surgical steps
In some cases, additional manipulations are required during vitrectomy. Each method uses auxiliary tools.
- Membrane peeling. Diseased tissue on the surface of the retina should not be suctioned because there is a risk of damage to the neurosensory membrane of the eye. During the procedure, the surgeon uses viscous-dissecting or pointed forceps. The operation is performed when an epiretinal membrane is formed.
- Photocoagulation. The operation is performed using a laser. Thermal radiation helps close holes in the retina, remove damaged tissue or blood vessels that form due to diabetes.
- Scleral screed. A belt-like support is installed inside the eye cavity along the walls of the capsule. The support allows you to fix the position of the retina.
- Retinal tamponade. To ensure that the neurosensory membrane remains in its normal position, air, sulfur hexafluoride, and octafluoropropane are injected into the posterior segment of the eye. The gas mixture is also used to seal the hole in the retina.
In rare cases, clouding of the vitreous affects the lens, causing cataracts to develop. To restore visual function, vitrectomy removes the clouded structure of the eye and replaces it with an artificial lens.
Rehabilitation period
The recovery period ranges from 3 to 6 months. In severe forms of pathology and the development of relapses of the disease, rehabilitation is delayed up to 1-1.5 years.
Restoring the function of the visual organs depends on the condition of the retina, artificial vitreous substitute and optic nerve. Damage to these structures leads to an irreversible decrease in visual acuity. During the postoperative period, the patient can take sick leave for 5-7 days if he feels severe discomfort.
When gas is introduced into the organ cavity, a darkened film may hang in front of the patient’s eyes for a week. The phenomenon goes away on its own. When using silicone liquid, vision correction with glasses is required. The lifestyle changes after the removal of the vitreous body: it is necessary to avoid physical overexertion and do not put stress on the organs of vision. After surgery, you need to visit an ophthalmologist 1-2 times a year.
Possible complications
After surgery, there is a risk of complications:
- inflammation of an infectious nature;
- increased intraocular pressure, especially in the presence of glaucoma;
- hemorrhage into the eye cavity;
- proliferation of capillaries on the surface of the iris;
- corneal dermis;
- retinal dissection.
Newly formed vessels, if not treated promptly, can lead to the development of acute neovascular glaucoma. The pathological process is accompanied by high-intensity pain and threatens vision loss.
IMPORTANT. It is necessary to monitor the expiration date of liquids or gases that replace the vitreous body. Once the implant wears out, further surgery will be required to replace it.
Vitrectomy allows you to quickly restore visual function in case of clouding of the intraocular fluid, heavy hemorrhages due to diabetes mellitus or long-term use of strong drugs. The high-tech method reduces the likelihood of relapse of the pathological process and minimizes the risk of new vessels growing along the iris. Additional surgical procedures prevent the development of bleeding in the intraocular cavity.
Vitrectomy is an operation to remove the vitreous humor from the inside of the eye to allow access to the retina.
Note! "Before you start reading the article, find out how Albina Guryeva was able to overcome problems with her vision by using...
About the vitreous body
The vitreous body is approximately 99% water and contains collagen fibers, proteins and hyaluronic acid. This clear, gel-like substance that makes up the center of the eye takes up about two-thirds of its volume and helps maintain its shape.
Due to its consistency, the vitreous body can be affected by various pathological processes, which lead to its clouding and filling with blood. This, in turn, makes it difficult for light to reach the retina correctly, causing decreased vision, clouded tears, detachment and other serious pathologies.
What is vitrectomy?
Modern plastic vitrectomy was developed by Robert McHamer in 1970. Machemer created a suction device that was the first closed-system vitrectomy device, which was necessary to control intraocular pressure levels during surgery. This achievement was monumental in ophthalmology as it allowed controlled access to the posterior segment of the eye for the first time.
Initially, vitrectomy was used primarily to clear opacity such as blood from the vitreous. In modern ophthalmology, technological development and improved equipment allow this procedure to be used much more widely. This intervention is now a fairly routine procedure for the vitreoretinal surgeon and can be performed as an outpatient procedure. Long gone are the days when 20 gauge vitrectomy was first introduced. Ophthalmologists now have 23, 25 and 27 gauge systems with improved duty cycles and cutting speeds.
Kinds
Vitrectomy of the eye can be of two types, depending on how the vitreous body is removed, completely or partially:
- Total (the entire vitreous body);
- Subtotal or partial (part of the vitreous).
Subtotal vitrectomy, in turn, is divided into anterior and posterior.
Front
In rare cases, the vitreous penetrates through the pupil into the anterior chamber of the eye.
This may happen:
- after ;
- during surgery with or;
- as a result of problems with the lens of the eye.
Because vitreous gel leakage can cause serious problems, anterior vitrectomy is necessary to minimize the risk of complications and promote vision restoration.
This operation is a critical tool in the skill set of the surgeon who operates on the anterior segment of the eye. Although planned anterior vitrectomy can be performed to remove traumatic cataracts or for glaucoma, this procedure is most often an unplanned and unwanted adjunct to cataract surgery.
Posterior Pars Plana vitrectomy
Vitrectomy performed for diseases of the posterior segment is called posterior or pars plana. This view is performed by a retina specialist.
Indications
Vitrectomy is sometimes necessary in the treatment of such diseases:
- Macular holes;
- Macular wrinkles;
- Retinal disinsertion;
- Diabetic retinopathy;
- Vitreous hemorrhage;
- Infection in the eye (endophthalmitis).
Retinopathy
Parsa plastic vitrectomy is suitable when treatment requires access to the posterior segment of the eye.
General indications are:
- Rhegmatogenous or traction retinal detachment;
- Hemorrhage into the vitreous body (hemophthalmos);
- Remaining lens fragments after cataract surgery;
- Endophthalmitis;
- Epiretinal membrane;
- Macular fossa;
- Vitreomacular traction;
- Intraocular.
Contraindications
Vitrectomy is contraindicated:
- in the presence of suspicious or active retinoblastoma;
- in some cases of active choroidal melanoma, since the incision of the eye may be associated with the spread of tumor cells through the circulatory system.
In some cases, such as removal of epiretinal membranes or treatment of a macular hole, the use of blood thinners (eg, aspirin or warfarin) is a relative contraindication.
Sometimes patients receiving an indirect anticoagulant (warfarin) cannot stop using it for health reasons. In such cases, the doctor prescribes heparin or enoxaparin before surgery, and warfarin can be resumed after the procedure. On the day of the procedure, such a patient must donate blood for a coagulogram. The prothrombin time should be determined, even if the drug has been discontinued, to ensure that the blood level is low enough for surgery to proceed.
Parsa plasma vitrectomy is often performed in emergency cases when:
- treatment of rhegmatogenous retinal detachment;
- management of endophthalmitis;
- removal of intraocular foreign body.
Under these conditions, the procedure can only be contraindicated if the eye does not have light perception and restoration of vision is impossible.
Anesthesia
In most cases, local anesthesia with intravenous sedation is appropriate. A retrobulbar block consisting of an equal mixture of short-acting lidocaine 2% and 0.75% can be used; longer acting bupivacaine.
Before performing a retrobulbar block, propofol may be prescribed by the anesthesiologist for short-term sedation (5-6 ml is usually sufficient).
In some cases, general anesthesia may be required. This should be considered by the anesthesiologist for pediatric patients and overly anxious patients. General anesthesia should also be given when the operating time is expected to be longer than usual or when the patient requests it.
In the operating room
Patients are taken to the operating room in a bed with an appropriate headrest. The bed is located next to the operating microscope. The patient is secured so that the head rests comfortably on the headrest.
The patient's arms should be properly secured so that they do not hang over the sides of the bed. The drape may be wrapped around the torso and secured to prevent unintentional movement during surgery.
Intervention Overview
This procedure involves removing all or part of the vitreous by cutting and sucking it out using tiny ophthalmic instruments that are inserted into the eye. Surgical removal of the vitreous is necessary for unobstructed access to the retina.
During the operation, the ophthalmologist acts on the retina with a laser, cuts out or removes scarred and pathologically altered tissue, gradually aligns its individual areas or restores holes in it.
Tools:
- Pneumatic high-speed vitreotome (disposable or reusable) – is a special cylinder with a knife (removes the vitreous slowly and in a controlled manner);
- Fiber optic luminaires;
- Infusion cannula (infusion port used to replace fluid in the eye with saline and maintain proper eye pressure);
- A 25 cm long flexible tube is attached to the infusion source.
Patients may experience mild discomfort for a few days after the procedure.
The removed vitreous does not grow back, but is replaced by fluid that is normally produced by the eye. This gel is very important during eye development, but is not essential for eye health or focus after birth.
Although the results of vitrectomy vary depending on the individual condition, most patients experience improvement in visual acuity after this procedure.
The surgery is considered safe, but there are certain risks associated with any surgical procedure. Some of these include retinal detachment, fluid build-up, new blood vessel growth, infection, and further bleeding (hemophthalmos). Education is often accelerated in those patients who have not previously undergone surgery.
Complications and consequences
The most common postoperative complications:
- Infection (about 0.039-0.07% of cases);
- Retinal detachment (5.5-10% of cases) can occur during vitrectomy if an iatrogenic retinal tear occurs during the procedure (eg, accidental touching).
Requirements
- The patient should stop taking indirect anticoagulants.
- During surgery, it is necessary to maintain adequate homeostasis and control intraocular pressure so as not to cause choroidal hemorrhage.
- Before the procedure, you should rinse thoroughly with a diluted povidone-iodine solution.
- A subconjunctival or topical antibiotic should be administered before surgery is completed. The doctor prescribes antibiotic eye drops to the patient, which must be used for at least 1 week.
Microinvasive vitrectomy
This ophthalmic operation involves the extraction (removal) of a small part or the entire vitreous. It is carried out through 3 main punctures measuring 0.3-0.5 mm. The peculiarity of this intervention is that the surgeon inserts much smaller instruments into the eye, while the operating frequency of a pneumatic or electric vitreotome during this procedure is much higher by 2 times - not 2500 per minute (as usual).
Microinvasive vitrectomy is performed using special self-fixing multipoint lamps.
Advantages:
- less traumatic;
- significantly reduces the risk of intra- and postoperative bleeding;
- can be carried out on an outpatient basis, this does not require hospitalization of the patient in a hospital;
- usually performed under local anesthesia with sedation (the patient is awake during the procedure, but does not feel pain or see the procedure being performed);
- patients go home with a patch on the eye, which is removed in the doctor's office the day after surgery;
- The duration of the rehabilitation period has been significantly reduced.
The duration of the operation varies from one to several hours, depending on the patient's condition. In certain situations, your doctor may perform other surgery, such as cataract removal.
Progress of the operation
- The vitreous body is removed.
- All existing scar tissue is eliminated (it is necessary to return the retina to its normal physiological position).
- A bubble of air or gas is placed in the patient's eye to help the retina stay in the correct position. The bubble is not removed, it will gradually disappear on its own.
- A special fluid (such as silicone oil) is then injected, which is later removed from the eye through another surgery.
- The silicone is removed as soon as the cornea heals.
Operation scheme
Postoperative period
The patient may experience slight discomfort during rehabilitation. Doctors recommend wearing a special bandage and avoiding any strain. For some, the doctor prescribes painkillers after surgery.
If a gas bubble has been placed in the eye, the specialist may recommend that the patient keep his head in a special position for some time. With a gas bubble or other substance in the eye, vision will be blurred. There are certain limitations after microinvasive vitrectomy. The patient is advised not to fly in an airplane or travel at high altitudes until the gas bubble disappears.
After the operation, it is prohibited for 6 months:
- lift weights more than 2 kilograms;
- visit the solarium;
- throw back your head and look up for a long time;
- read books and write for more than 30 minutes;
- stand near an open fire or lean over a fire (this includes a gas stove);
- rub your eyes and press on the eyeball;
- engage in professional sports;
- watch TV or work at the computer for a long time;
- bend over;
- exercise intensively;
- visit the bathhouse and sauna;
- You can wash your hair, but very carefully and avoid getting shampoo and soap into your eyes;
- In summer you need to wear sunglasses, you can’t look at the sun.
10.10.2017
Vitrectomy is a surgical procedure aimed at removing the vitreous humor. It looks like a transparent gel-like substance that is located in the cavity of the eyeball. Consists of 99% water, also contains collagen fibers, proteins and hyaluronic acid.
Such an operation is usually not associated with its changes. It is often necessary to gain access to the posterior segment of the eye in various pathological conditions of the retina. This microsurgical intervention was first performed in 1970. Vitrectomy has undergone many changes since then, but has not lost its relevance in modern ophthalmic surgery.
There are 2 types of vitrectomy based on the surgical approach used to remove the vitreous, namely anterior and posterior.
The most common method of intervention is the posterior or pars plana. This operation is sometimes the only method to restore a person’s vision.
When is eye vitrectomy indicated?
Microsurgical removal of the vitreous body of the eye is performed in the following pathological conditions:
Bleeding.
Infection.
Retinal disinsertion.
Formation of scar tissue.
Loss of vision.
Increased eye pressure or glaucoma.
Progression of cataracts requiring cataract surgery at a later stage.
Proliferative diabetic retinopathy (including vitreous hemorrhages).
Macular holes.
Epiretinal fibrosis.
Complicated, traction or recurrent retinal detachment.
Intraocular foreign body.
Displacement of the artificial lens after its implantation for cataracts.
Giant retinal tears.
Age-related macular degeneration.
Traumatic injuries.
Vitrectomy is often performed in emergency clinical situations. It may be contraindicated for a certain category of patients, for example, with a reliably known lack of light perception or the inability to restore vision. The presence or suspicion of active retinoblastoma or choroidal melanoma of the eye casts doubt on the operation due to the high risk of dissemination of the malignant tumor.
When removing the epiretinal membrane or treating macular holes, the use of drugs from the group of systemic anticoagulants and antiplatelet agents (for example, aspirin or warfarin) is a relative contraindication for vitrectomy. Severe systemic coagulopathies also require close attention from the doctor, therefore, during the vitrectomy operation, it is necessary to monitor the condition of the coagulation and anticoagulation systems, and, if necessary, make corrections.
Technical features of the operation
Vitrectomy is an outpatient procedure, that is, after its completion, short observation and receipt of recommendations, the patient can leave the clinic. Anesthesia is usually local using eye drops, supplemented by intravenous sedation. During the intervention, the patient is conscious, but does not feel pain; there may be slight discomfort. Sometimes during vitrectomy surgery, retrobulbar blockade is used as an anesthetic aid.
During surgery, vital signs such as pulse, blood pressure and ECG are carefully monitored.
In the area of the eyeball, called the pars plana in Latin, microscopic incisions are made and three trocars with a diameter of 27G are installed. These devices are conductors through which special surgical instruments are delivered into the eye.
One of the ports is used for the infusion line necessary to introduce a special solution into the eye cavity during surgery. The second port during vitrectomy is necessary for a video camera with a light, thanks to which the ophthalmic surgeon can monitor the progress of the work on a special monitor. The third trocar is used for a vitreotome, an instrument that performs basic operations with the vitreous body. All manipulations on the eye during vitrectomy are performed by a microsurgeon using a high-precision microscope.
A surgical microscope equipped with a special high-power lens provides a clear and magnified image of the inside of the eye.
During the vitrectomy operation, the vitreous body of the eye is aspirated, and the empty cavity is filled with sterile silicone oil or a special gas-air mixture. The vitreous does not return, and the eye can function normally without it.
If there is no retinal detachment, air or saline (which is absorbed after a couple of days) can be used. However, if the patient has a retinal detachment, then either sulfur hexafluoride (which stays in the eye for 10-14 days) is used to tamponade it, or in more complex cases, another gas is used, for example, fluorohexane or fluoropropane.
Recovery period
The duration of the vitrectomy operation depends on the underlying eye disease and the presence of concomitant ophthalmological pathology and averages from 1 to 3 hours. After the vitrectomy has been performed, the patient goes home with a bandage, which the ophthalmologist removes from the eyes at the first postoperative visit. Sometimes eye drops with glucocorticosteroids are prescribed to minimize inflammatory changes, as well as local antibiotics to reduce the risk of developing bacterial complications.
Doctors sometimes recommend postoperative positioning to patients. This means that after the operation has been completed, the patient will have to spend some time “head down” or lying on his stomach. This position helps to press the gas bubble to the back wall of the eye, which prevents retinal detachment. A certain head position must be maintained for at least 45 minutes every 60 minutes. These 15 minutes are intended for eating and visiting the rest room.
If during vitrectomy the eye cavity was filled with a gas-air mixture, vision in the early postoperative period will be sharply reduced. The doctor must warn the patient about this in advance. Restoration of visual function is observed as the gas dissolves. Double vision and glare after surgery are also acceptable.
In the postoperative period, you should not lift heavy objects and, if possible, avoid psycho-emotional stress, as this can lead to an increase in intraocular pressure and the development of various complications.
Complications
Although vitrectomy has revolutionized the treatment of posterior segment disorders and significantly improves vision in patients with retinal diseases requiring surgical intervention, it is also associated with comorbidities and complications.
Complications after vitrectomy:
Cataract formation or progression is believed to be the most common complication associated with vitrectomy.
Often, nuclear sclerotic cataracts that develop after vitrectomy reduce visual acuity and reach such an extent that it will lead to its surgical removal. The exact pathogenesis of cataract formation or acceleration of the pathological process in the lens after vitrectomy is still unknown.
If the surgical intervention was performed by a professional ophthalmic surgeon and the patient strictly followed all the doctor’s recommendations, then the risk of complications is minimized.
Vitrectomy is an integral part of many procedures aimed at treating retinal diseases and restoring vision. Modern technologies and equipment make vitrectomy surgery less traumatic for the eyes and comfortable for patients.
Prices for eye vitrectomy surgery
| № | Service name | Price in rubles | |
|---|---|---|---|
| 2011039 | Vitrectomy for uncomplicated hemophthalmos or vitreous opacities of the second category | 53 750 |
In the human eyeballs there is a vitreous body, which in its structure resembles a gel: it is this that gives the eye its spherical shape. In addition, there are other functions of this component of the human eye, for example, the refraction of light entering the retina. However, in the event of certain pathologies, it becomes necessary to remove the vitreous body or part of it. This operation is called vitrectomy.
Vitrectomy is a complex surgical procedure that should only be performed by an ophthalmic surgeon.
Vitrectomy became possible approximately 50 years ago when Robert Machemer invented a device that could reach the back of the eyeball and absorb the vitreous. Moreover, the scientist provided the ability to regulate during the procedure. This was the device with which the world's first vitrectomy was performed.
Initially, this procedure was aimed only at ridding the vitreous of opacities. However, subsequently the removed gel-like substance began to be filled with other substances, thus returning the eye to its original shape. Currently, the Machemer apparatus has been significantly modified, and now it is possible to set the device cutting parameters, the rate of vitreous absorption, and more accurately regulate the depth of immersion. With this, eye plastic surgery has become more effective.
During this operation, the doctor removes blood clots, scarring or other defects that have arisen from the eyeball that negatively affect the general condition of the eye. However, the removed part of the vitreous is replaced with special fillers. This is done to normalize internal pressure, in order to avoid repeated hemorrhages and pathological neoplasms. When the natural volume of the vitreous body is replenished, the retina returns to its natural position - close to the eye. Thus, removing tumors reduces tension in the retina, and filling it with polymers, a mixture of gases, water or silicone oil allows you to return it to its optimal position: without tension or sagging. Subsequently, these substances are absorbed or removed, the vitreous body grows to normal size, and the problem goes away. 
Indications for use
Currently, it is with the help of vitrectomy that it is possible to cure severe eye pathologies. The following diseases may be the reasons for the operation.
- Retinal pathologies, such as its detachment or disruption of its central part. Vitrectomy allows access to affected tissues for therapeutic surgical procedures.
- Macular hole in the center of the retina, caused by a detachment of the vitreous humor, causes empty spaces inside the eye that fill with unnecessary fluid. This negatively affects vision. The operation allows to partially restore it. After vitrectomy, a membranoectomy is performed to remove excess tissue.
- Vitrectomy is used to treat cloudy eyes.
- Inflammatory eye diseases, in particular, inflammation of the retina and blood vessels in a certain area of the eyeball.
- Destruction of the vitreous body causes visual impairment. If conservative treatment does not show the desired result, although this happens in rare cases, surgical intervention is resorted to. In most cases, the operation restores vision and has a positive effect on the vitreous body.
- Complications diabetes mellitus, such as, helps to increase the number of vessels in the retina. This leads to tension and subsequent peeling, which impairs vision.
- Diseases of cardio-vascular system, such as hypertension, cancer, vascular pathologies, can cause bleeding into the vitreous body.
Types of operations
During vitrectomy, either the entire vitreous body or a certain part of it can be removed. Resection of the area, depending on the location of the intervention, can be posterior or anterior.
Posterior vitrectomy
The vitreous body consists of collagens and hyaluronates - salts of hyaluronic acid. These components give this area a gel-like and plastic structure. However, the vitreous grains can only accept a small portion of the cohesion, so the vitreous may partially migrate to the back of the eye. This causes the retina to tear or a macular spot to form. In this case, posterior vitrectomy is used.
Anterior vitrectomy
An anterior vitrectomy may be indicated if the vitreous fluid leaks into the front of the eye. This can happen with mechanical damage to the eye or pathology of the lens. In some cases, such leakage of the gel-like substance occurs during surgical procedures aimed at eliminating cataracts. Thus, to minimize the danger and damage to the eye, vitrectomy is sometimes performed unscheduled - during the main operation.
Carrying out the operation
Only a qualified ophthalmologist can perform a vitrectomy operation, since the procedure requires precise and careful manipulation. The operation involves the following steps:
- The surgeon makes three small incisions (slightly less than 0.1 cm). Micro incisions are made on the outside of the eyeball to reach the vitreous.
- Devices of the required size are inserted into each of the incisions: a fiber optic light guide for illuminating the retina, a cannula for introducing the necessary polymer and creating the necessary pressure inside the eye, as well as a vitrector, which is designed to suction the vitreous or completely remove it.
- The vitreous body or part of it is removed, and a mixture of gases or silicone oil is injected into the eyeball to fix the retina. The gas is directed to the retinal tissue, promoting its regeneration. Silicone oil must be removed in the future, since it does not dissolve on its own. This will require a second operation. The doctor decides what to use: a mixture of gases or a silicone polymer.
The operation does not require general anesthesia; local anesthesia will suffice. The duration of the procedure depends on the disease; it usually lasts no longer than two hours. In some cases, the operation may be unplanned and performed in combination with another. 
Microinvasive vitrectomy
Today, a microinvasive vitrectomy operation is available, which does not require going to the hospital. Microinvasive vitrectomy is performed using three punctures of smaller diameter than during conventional surgery - 0.3 - 0.5 mm. These miniature punctures require appropriate equipment: special thin lamps, an electric or pneumovitreotomy, which sucks out the vitreous body at half the rate compared to a non-microinvasive operation. A microscope is also used.
The procedure is carried out in a similar way to conventional surgery, but the eye tissue is damaged significantly less. Minimizing intervention allows you to do the procedure faster and direct more efforts to eliminate the source of the problem.
Advantages of microinvasive surgical interventions:
- The quality of the procedure improves and access to the lesion becomes more accurate.
- Less traumatic compared to conventional operations.
- Does not require hospitalization.
- Local anesthesia that does not harm the body.
- The blindfold is removed one day after surgery.
- Almost complete lack of rehabilitation.
- Can be carried out simultaneously with other interventions.
However, in most clinics, such a procedure costs much more than a conventional operation, since more expensive and high-tech medical equipment is used.
Rehabilitation period after vitrectomy
The rehabilitation period after vitrectomy is accompanied by some difficulties. Immediately after surgery, the eye is fixed with a bandage, which in most cases is removed the next day. It is necessary to use eye drops for a month after surgery. At first it will be uncomfortable to blink: there will be a feeling of a foreign body in the eye.
Aesthetically, the operation will also not pass without a trace: for several days the eyes will be red and swollen. Otherwise, there is a risk of increased intraocular pressure.
You should not exercise or shake your head for the first ten days, but otherwise you can continue to live your normal life.
If a bubble of a gas mixture was placed inside the eye to fix the retina, then recovery will be more difficult: it will require almost constant support of the head in a certain position, for example, sleeping on a certain side of the body or head down. In this case, the ophthalmologist prescribes strict instructions that must be carefully followed. You should not use ground transportation, climb to high floors, or fly by air. Otherwise, intraocular pressure will increase, and the consequences will be disastrous.
The presence of a gas mixture or silicone-based polymer in the eye can partially impair vision, but after removing these substances, it gradually returns to normal. It is important to understand that rehabilitation after such a delicate procedure is long-term, so it will be possible to fully evaluate its results after a month or more.
In addition, vitrectomy may be performed to eliminate scar tissue in patients with gross opacities or repeated vitreous hemorrhages that do not resolve on their own. To assess the possibility of spontaneous resorption of vitreous hemorrhages, experts usually recommend monitoring the dynamics of hemorrhage regression for six months to a year. In cases where hemorrhage threatens irreversible vision loss, immediate surgery is indicated.
To carry out the manipulation, a special cutting microsurgical instrument, a vitreotome, is used. After removing part or all of the vitreous, the resulting cavity is filled with a special filler, which ensures the maintenance of a normal level of intraocular pressure.
How is the operation performed?
Usually, before performing a vitrectomy, the patient is routinely hospitalized, although as an exception, the operation can be performed on an outpatient basis. Both local and parenteral methods of administering anesthetics can be used to relieve pain during surgery. The duration of the operation to remove the vitreous body is usually 2 – 3 hours.
During the operation, the doctor removes the required amount of vitreous tissue through punctures, after which he carries out the required treatment: he burns areas of the retina with a laser, seals the areas of detachment, and restores the integrity of the retina of the affected eye.
Operation efficiency
Vitrectomy is an effective therapeutic procedure in patients with impaired transparency of the vitreous body, developing as a result of hemorrhages or proliferation of connective tissue, as well as neovascularization of the iris. Microinvasive surgery allows you to stop the process of tractional retinal detachment and partially restore lost vision.
At the same time, the procedure for removing the vitreous can be accompanied by various complications, including increased intraocular pressure (especially in patients with glaucoma), severe edema (corneal edema), retinal detachment, severe neovascular hematoma (due to neovascularization of the iris, the so-called rubeosisiridis), the addition of a secondary infection with the subsequent development of endophthalmitis. These complications pose a threat in terms of vision loss.
How is removed vitreous body replaced?
After removal, a special component is introduced into the resulting cavity of the orbit, which must meet certain requirements: have high transparency, a certain level of viscosity, atoxicity and hypoallergenicity, and, if possible, be used for a long time.
Most often, an artificial polymer (PFOS), balanced salt solutions, a vial of gas or silicone oil are used for this purpose. Vitreous substitutes such as saline solutions and gas are replaced over time by the eye's own intraocular fluid, so their replacement is not required. PFOS can be used for a period of up to 10 days; a vial of silicone oil can be left in the orbital cavity for up to several years.
To whom and why is vitrectomy performed?
When performing a vitrectomy, the doctor may pursue several goals:
eliminating tissue tension and preventing further detachment of the retina in the area;
providing access in cases requiring surgical intervention in the retinal area;
restoration of vision after heavy intraocular hemorrhages or hemorrhages into the vitreous body, which do not tend to resolve on their own;
therapy of severe degrees of proliferative retinopathy, accompanied by the formation of gross scar changes or neovascularization (sprouting of new blood vessels) that cannot be treated with laser;
Prognosis and recovery time after surgery
The prognosis and timing of vision restoration after vitrectomy depend on several factors: the extent of the lesion, the condition of the retina, and the type of vitreous substitute. In case of severe severe changes in the retina, complete restoration of vision even after surgery is not possible due to pronounced irreversible changes in the retina.
Price
The cost of vitrectomy in various ophthalmological clinics in Russia ranges from 30,000 to 100,000 rubles, depending on the scope of the intervention (microinvasive or subtotal), indications, conditions of the patient’s eyes, as well as the clinic where this manipulation is performed.
If you have already undergone surgery, we will be grateful if you leave your feedback about vitrectomy. This will help other people understand what awaits them or how they cope with the consequences of the operation.
