Vitrectomy Posterior Eye Surgery

Vitrectomy (Posterior Eye Surgery): Precise Intervention on the Retina

Beyond simple problems in the eye’s anterior segment, complex disorders can occur in the deep tissues that fill the eyeball and protect the center of vision. To treat these disorders, vitrectomy surgery, commonly known as posterior eye surgery or retinal surgery, is necessary. It is a microsurgical eye surgery technique used in the treatment of conditions such as retinal detachment, macular hole, and diabetic retinopathy.

You can find answers to all the questions you may have, such as when vision improves after vitrectomy surgery and whether vitrectomy surgery is risky, in this article.

At Daviva Health Group’s Eye Diseases Department, even the most complex eye surgeries are performed successfully with the right technology and our expert team.

What Is Vitrectomy?

Vitrectomy is the process of surgically removing the gel-like fluid called vitreous from inside the eye. This fluid fills about 80% of the eyeball and is normally transparent and homogeneous. However, as a result of diseases, bleeding, or age-related changes, this fluid may lose its transparency. Sometimes it can also create traction on the retina behind it, leading to serious damage.

In vitrectomy surgery, the reason for removing the vitreous fluid is to give the surgeon easier access to the retina. Sometimes conditions such as diabetes can also impair the clarity of the vitreous fluid. This fluid may also be removed to sharpen the patient’s vision.

How Is Vitrectomy Surgery Performed?

Vitrectomy surgery may be performed under local or general anesthesia depending on the patient’s eye structure and the details of the procedure to be performed.
The surgeon performing your eye operation makes 3 small entry ports (micro-incisions) on the white part of the eye under a microscope.
Micro-surgical instruments are passed through these millimetric (0.4 mm – 0.6 mm) incisions to reach the area where the vitreous fluid is located.
With a delicate device capable of cutting and vacuuming thousands of times per second, the vitreous fluid inside the eye is removed.
Vitrectomy is usually performed together with other procedures such as retinal detachment repair, cataract surgery, macular hole surgery, or epiretinal membrane peeling.
After the vitreous fluid is removed and a clear access route to the retina is created, treatment is applied for the condition present.
Once the treatment is complete, a special substance is placed in the eye to maintain intraocular pressure in place of the removed vitreous fluid.
Because it is performed through millimetric incisions, stitches are usually not required.

In Which Diseases Is Vitrectomy Used?

Persistent Vitreous Bleeding: To remove bleeding that enters the eye due to diabetes, trauma, or vascular diseases and does not resolve on its own.
Vitreous Opacities: Situations in which the gel-like fluid inside the eye loses its transparency due to infection or inflammation.
Retinal Detachment: Situations in which the retinal layer separates from its place. Urgent intervention is especially needed when central vision has not yet been affected.
Retinal Tears and Holes: To repair holes or tears that occur in the retina.
Macular Hole: To close mechanical breaks or openings that occur at the center of vision (the macula).
Epiretinal Membrane: To peel thin membranes that form over the macula and distort vision.
Advanced Diabetic Retinopathy: To remove scar tissue and new vessel growth that cause traction in the retina.
Tractional Retinal Detachment: When the retina separates due to traction caused by diabetes.
Intraocular Foreign Bodies: To urgently remove foreign objects such as metal or glass that have entered the eye.
Penetrating or Blunt Injuries: To repair bleeding, tears, or tissue damage after trauma.
Endophthalmitis: To achieve source control in severe intraocular infections that do not respond to medication or are aggressive and carry a risk of blindness.
Uveitis: For both diagnosis and treatment in unexplained or resistant posterior segment inflammations.
Cataract Surgery Complications: To remove lens fragments that fall into the back of the eye during surgery or to correct displaced intraocular lenses.
Intraocular Tumors: To obtain a biopsy from a tumor or surgically remove certain tumors.
Submacular Hemorrhage: To relocate or remove blood accumulated beneath the center of vision due to causes such as age-related macular degeneration.

Advantages of Vitrectomy Surgery

Thanks to the use of very fine instruments, tissue damage is minimized. This method allows sutureless closure in most cases.
Since stitches are generally not used, the risk of postoperative pain, irritation, and inflammation is low. The recovery process is significantly faster.
The success rate is very high in procedures such as macular hole repair, retinal detachment, or membrane peeling.
Thanks to the integration of 3D heads-up imaging systems (heads-up surgery) and intraoperative optical coherence tomography (iOCT) used during the operation, the surgeon can work with millimetric precision even in the most complex cases. This maximizes surgical safety.
Persistent intraocular bleeding and tractional retinal detachments caused by diabetes can be treated successfully with vitrectomy surgery.
Vitrectomy is not only a treatment method, but also a diagnostic tool used to identify the source of infection in serious infections.
It enables the removal of foreign bodies inside the eye and all opacities that interfere with vision.

Things to Pay Attention to After Vitrectomy

When you leave vitrectomy surgery, watering, a feeling of irritation, blurred vision, or sensitivity to light in your eye is normal.
Gas or special substances will be placed in your eye in place of the vitreous fluid removed during surgery. In this case, you may need to lie face down or on your side for a few days after the operation.
You should not travel to high-altitude areas or take a flight until the gas or special substance in your eye is resolved.
Clean your eye with boiled and then cooled water using sterile cotton.
Instill your eye drops as recommended by your doctor.
If you are asked to wear an eye shield while sleeping at night, wear it for 1 week.
Do not apply pressure to the operated eye.
Avoid strenuous exercise for two weeks.
Do not wear eye makeup for two weeks.
Do not go swimming for 2 weeks.
Do not drive until your doctor says it is safe for you to drive.
If your job requires heavy lifting or you work in an unclean environment, do not go to work for 2 weeks.

Frequently Asked Questions About Vitrectomy

When Does Vision Improve After Vitrectomy Surgery?

The recovery process after vitrectomy surgery varies from person to person depending on the tamponade material used (gas, air, or silicone) and the reason for the operation.

First 24–48 Hours: The eye is covered with a protective shield. Vision is blurred, especially if gas was used, as if looking through frosted glass. Mild irritation and a gritty sensation are normal.
Week 1: Redness and swelling in the eye begin to decrease. If there is gas in the eye, you will start to see a wavy black line in your field of vision. This is a sign that the gas placed in the eye is slowly being absorbed.
Weeks 2–4: You can usually return to desk work and light daily activities during this period. As the gas bubble gets smaller, vision starts to become clearer.
Weeks 6–8: Vision usually reaches a stable point. Complete healing of the retina and settling of the eye tissues may continue for up to 3 months.

Does Vitrectomy Surgery Cause Blindness?

Vitrectomy is considered quite safe. The rate of serious complications such as infection or severe bleeding that could lead to blindness is less than 1 in 1,000 cases. In very rare cases, peripheral (side) vision loss may occur after the procedure.

Even though it is very unlikely, the following conditions can cause permanent vision loss:

Severe intraocular infections
Severe intraocular bleeding
Retinal vascular occlusions

Why Is Air Travel Prohibited After Vitrectomy Surgery?

As the aircraft ascends, the air pressure inside the cabin decreases. This causes the gas bubble placed in the eye during surgery to physically expand.
When the gas bubble expands uncontrollably, the pressure inside the eye can rise to very high levels.
A severe increase in intraocular pressure can cause the blood flow to the eye to stop, severe pain, and optic nerve damage, leading to permanent blindness.
The flight restriction remains in effect until the gas bubble is completely absorbed by the body (usually 2 to 8 weeks).
A similar risk also applies to land travel through high mountain passes, because changes in altitude can trigger the same dangerous expansion.
If silicone oil is used as the tamponade instead of gas, air travel is generally considered safe.

Does the Gas or Silicone in the Eye Need to Be Removed?

The air or gas placed in the eye is absorbed by the body on its own and is replaced by the eye’s natural fluid. Therefore, no repeat procedure is needed. However, silicone oil is not absorbed by the body. Depending on the condition, silicone usually needs to be removed with a minor procedure after 3 to 6 months.

Is the Surgery Painful?

Since the operation is performed under local or general anesthesia, no pain is felt during surgery.