Vitrectomy

The vitrectomy process begins with a careful evaluation of the patient's eye condition and identifying the cause of the vision problem. The surgery is usually performed under local anesthesia with sedation or under general anesthesia in some cases. The surgeon makes several small incisions (typically three incisions, each less than half a millimeter wide) in the white part of the eye (sclera). Very fine surgical instruments are inserted through these incisions, including a cutting and suction tool (vitrector) to remove the vitreous, a light source to see inside the eye, and another instrument to inject fluid to maintain eye pressure and shape during surgery. After removing the vitreous, the surgeon addresses the underlying retinal issue, such as removing hemorrhage or scar tissue, repairing a retinal detachment using laser or cryotherapy, or closing holes in the retina. At the end of the surgery, the cavity may be filled with sterile saline solution, a gas or air bubble, or silicone oil to help keep the retina in place during the healing period. The small incisions are closed with stitches if necessary, but they are often self-sealing. A patch or shield is placed over the eye after surgery.

Vitrectomy itself does not cause symptoms; rather, it is a treatment for pathological conditions that lead to vision-affecting symptoms. The symptoms that may necessitate a vitrectomy and their underlying causes include: Symptoms:

• Sudden or gradual vision loss: Can be partial or complete.
• Seeing "flashes": Sensation of sudden flashes of light in the peripheral vision.
• Sudden appearance or significant increase in "floaters": Seeing black spots, threads, or "cobwebs" moving in the field of vision.
• A dark curtain or shadow obscuring part of the field of vision: May indicate retinal detachment.
• Blurred or cloudy vision that does not improve with glasses.
• Distorted or wavy vision (Metamorphopsia): Especially in central vision.

Causes (Conditions that may require vitrectomy):

• Proliferative Diabetic Retinopathy: Growth of abnormal new blood vessels in the retina and vitreous that can cause bleeding and scar tissue pulling on the retina.
• Vitreous Hemorrhage: Accumulation of blood in the vitreous humor that blocks light and causes severe blurred vision. It can be caused by diabetic retinopathy, retinal tears, or eye injuries.
• Retinal Detachment: Separation of the retinal layer from the supporting layers beneath it, which threatens permanent vision loss if not treated promptly.
• Macular Hole: A hole that forms in the macula (the center of the retina responsible for sharp central vision), causing vision distortion and loss of central vision.
• Epiretinal Membrane: A thin layer of tissue that forms on the surface of the retina, causing it to wrinkle and distort vision.
• Endophthalmitis: A severe bacterial or fungal infection inside the eye that requires removal of the vitreous to clear the infectious agents and inject antibiotics directly.
• Severe eye injuries: Which may lead to foreign bodies inside the eye, severe bleeding, or damage to the retina and vitreous.
• Complications after cataract surgery: Such as pieces of the lens falling into the vitreous cavity.

Diagnosis of conditions that may require vitrectomy begins with a comprehensive eye examination and a detailed medical history. Diagnostic methods include:

• Dilated fundus examination: After dilating the pupil with special drops, the doctor examines the retina, optic nerve, and vitreous humor using magnifying tools and a light source.
• Ocular Ultrasound: Particularly useful when the retina cannot be clearly visualized due to dense hemorrhage or clouding in the vitreous.
• Optical Coherence Tomography (OCT): Provides high-resolution cross-sectional images of the retina, macula, and vitreous, essential for diagnosing macular holes, epiretinal membranes, and retinal swelling.
• Fluorescein Angiography: A dye is injected into a vein, and the retina is photographed to evaluate blood circulation and detect abnormal blood vessels or leaks.

The main treatment for these conditions is the vitrectomy procedure. Treatment stages include:

• Pre-operative evaluation: Includes necessary examinations, discussing the details of the surgery, potential risks and benefits, the type of anesthesia used, and the expected recovery period.
• Surgery: Performed in a sterile operating room under appropriate anesthesia. The surgeon makes small incisions, removes the vitreous humor, abnormal materials, or scar tissue, performs any necessary repairs to the retina, and then fills the cavity with a substitute substance (saline solution, gas, or silicone oil).
• Post-operative care: The patient is given eye drops (antibiotics and anti-inflammatories) and other medications as needed. Some patients may need to maintain a specific head position (e.g., face down) for several days or weeks if a gas bubble or silicone oil was used to help stabilize the retina.
• Recovery: The patient may experience some pain or mild discomfort and blurred vision in the first few days after surgery. Vision gradually improves over time as the gas bubble is absorbed (if used) or the silicone oil is removed (if necessary in a later surgery).
• Follow-up appointments: It is crucial to attend all follow-up appointments with the ophthalmologist to monitor the healing process, measure eye pressure, and evaluate the retina's response to treatment.
• Silicone oil removal (if used): If silicone oil is used, another surgical procedure is required to remove it after several months when the retina has stabilized.