Vitrectomy for retinal detachment is a common alternative to scleral buckle surgery for retinal detachment.
The vitrectomy surgical procedure was developed in late 1969 and early 1970. It was originally used to remove cloudy vitreous humor that usually contained blood. Many eye conditions, such as macular pucker, macular holes, vitreous hemorrhage, serious eye injuries, and severe vitreous floaters can be treated with a vitrectomy.
Vitrectomy has become a common method of repairing a detached retina. Removing the vitreous allows the surgeon access to the retina where tears can be repaired, and the retina reattached. The surgery has a 90% success rate and complications are rare.
Symptoms of a Detached Retina
One or more of these warning signs may signal the onset of a retinal detachment:
- Sudden appears of many floaters—tiny specks that drift through your field of vision
- Flashes of light in one or both eye
- Sudden onset of blurred or reduced vision
- Gradual reduced side (peripheral) vision
- A curtain-like shadow over your field of vision
Anesthesia for Vitrectomy
There are several options, ranging from local anesthesia, general anesthesia, to topical anesthesia with lidocaine injections. Each choice has its advantages and disadvantages. The selection depends on the patient’s choice and the surgeon’s recommendation depending on the patient’s condition.
Three very small incisions, each about the size of an eyelash, are made into the white part of the eye (sclera). One incision is used to allow a constant flow of fluid into the eye to maintain eye pressure. Another is used to insert a microscopic fiber-optic light to illuminate the inside of the eye, and the third is for the instruments that are used to remove the vitreous and seal the retinal tears.
After the tears have been sealed and the retina put back into place, a gas is used to replace the missing vitreous. The bubble of gas is used to prevent the subretinal fluid that naturally seeps from the inflamed tissues from reaching the area behind the repaired retina.
Depending on the complexity of the repair, the time for the vitrectomy for retinal detachment procedure varies.
The bubble of gas could be air or a mixture of air and one of the other common gasses used for retina surgery. The type of bubble depends on how long the healing process may take. A bubble of air consisting mostly of nitrogen and oxygen will dissipate in 5 to 7 days. Sulfur hexafluoride (SF6), dissipates in 10 to 14 days, and perfluoropropane (C3F8) dissipates in 55 to 65 days.
To keep the gas bubble in the proper position specific head positioning is required during the healing process. If the retina detached from the bottom, the head must be in a face-down position to keep the bubble against the place of detachment.
There are special pillows, chairs, and mirrors that allow you to see around the room while in a face-down position. Many insurance plans cover the cost of these assistive devices.
The gas bubble blurs your vision, but it will dissipate in time. As it does, a line will form across your vision where the newly forming eye fluid (aqueous humor) is gradually replacing the bubble of gas. Each day the gas bubble will reduce in size and your field of vision will get larger.
Gas Bubble Cautions
As long as the gas bubble remains in your eye, you must not fly in an aircraft. There is reduced pressure inside the cabin of an airplane that will cause the gas to expand. This would not only be extremely painful but could lead to loss of sight.
In addition, if you are planning to have general anesthesia for any surgical procedure while the gas bubble is still in your eye, tell you anesthesiologist about the gas bubble so you will not be given nitrous oxide, which would cause a dangerous rise in eye pressure in the eye with the gas bubble.
Complications are rare but can occur. If any of the following symptoms occur contact your doctor as soon as possible:
- Eye pain that is deep or aching
- Vision decline after follow-up visit
- Pus-like discharge from the eye
- New floaters, flashes of light, or shadows across your vision