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Vitrectomy is a type of eye surgery that removes the vitreous in your eye in order to treat eye problems associated with the vitreous and retina. Vitrectomy can be used for the treatment of conditions, such as a detached or damaged retina, infection inside the eye, and serious injury to the eye.
Vitrectomy is the primary treatment for floaters that are severe enough to impact your vision. Removing the vitreous from your eye also removes the debris that is causing floaters to appear in your vision.
Floaters that causes few symptoms or discomfort in the patient are likely to be left untreated. Besides vitrectomy, laser therapy is the other treatment option for floaters.
Your doctor will prepare you for vitrectomy surgery by discussing the pros and cons with you, as well as instructing you on what to do before and after surgery.
Most people are awake during vitrectomy surgery, although anesthetic eye drops are given so you won’t feel anything. Small incisions are made in the eye to allow for the surgery, which can be over in less than an hour.
Most people respond well to vitrectomy surgery, but there are important points to remember during the recovery period. Carefully follow your doctor’s eye care instructions, and don’t be alarmed by minor pain following surgery. This will dissipate in a couple of days.
What Is Vitrectomy?
Vitrectomy is a type of eye surgery performed to treat a variety of problems associated with the retina and vitreous (a gel-like substance in the middle of your eye). In vitrectomy surgery, the vitreous is removed from your eye and replaced with a new solution.
The vitreous in your eye may need to be replaced if it is no longer clear, and light cannot pass through it sufficiently to your retina, which is essential for your ability to see clearly. Blood or debris in the vitreous can also block light from getting through. Additionally, scar tissue in the vitreous can cause damage to the retina.
Vitrectomy may also be performed to gain better access to the retina. In order to surgically repair a hole in the retina, for example, an ophthalmologist may remove the vitreous first, make the repair in the retina, and then complete the vitrectomy.
Vitrectomies can be performed to treat various eye conditions, including:
- Retinal detachment.
- Vitreous hemorrhage.
- Diabetic retinopathy.
- Infection inside the eye.
- Eye injury.
- Hole in the retina.
- Wrinkle in the retina.
- Problems encountered following cataract surgery.
Vitrectomy for the Treatment of Floaters
Floaters are small shapes that people see in their vision caused by debris floating in the vitreous. The debris casts shadows onto the retina, which causes people to see floaters.
Floaters may appear as small black dots, squiggly lines, or larger shapes. The occurrence of floaters increases with age. They are seen more commonly in people who are nearsighted.
Vitrectomy is a highly effective surgical option for removing floaters from the eye. Nearly all of the vitreous is removed during a vitrectomy, and with it, the debris that causes patients to see floaters is also removed.
Floaters that are mild and not very bothersome may not be treated at all because they don’t actually harm the eye. Many people’s brains are able to adapt to the presence of minor floaters in the eye and learn to filter them out. Floaters that are severe or interfere with vision too much can be removed through vitrectomy.
Other Treatment Options for Floaters
Although it is an effective procedure, vitrectomy is not automatically recommended for the treatment of floaters. As a surgical operation, eye doctors want to be sure there is a medical necessity to put their patients through surgery. If the floaters are so small that they can’t be seen with a clinical exam or if the floaters can be identified but the patient has no symptoms or complaints, then surgery is probably not warranted.
When floaters are mild, doctors may focus on reassuring their patients that the floaters cause no threat to their vision, and it is best to ignore the floaters for the time being. Ophthalmologists can evaluate the floaters and keep a close watch on them over time, but they prefer to avoid surgery when possible.
Aside from vitrectomy and ignoring your floaters, the other treatment option for floaters is laser therapy. Described as an extension of LASIK, lasers are aimed at the floaters in order to break them up and reduce your perception of them. Laser therapy for floaters is relatively new, however, so it is usually not the primary recommended course of treatment.
Preparing for Vitrectomy Surgery
Vitrectomy is a fairly straightforward procedure that most people do pretty well with, explain experts from Johns Hopkins University. Nonetheless, there are pros and cons that should be considered, as well as other factors regarding the surgery, such as how to prepare for surgery and the overall cost.
If you are considering vitrectomy surgery, it is important to consider the following aspects:
- Preparation: Speak with your doctor about whether you need to stop temporarily taking any medications prior to the surgery. You will also likely not be allowed to eat anything after midnight before your surgery. Procedures that your doctor may want to conduct prior to the surgery include pupil dilation and an ultrasound of your eye.
- Pros: Vitrectomy is a relatively quick procedure, taking as little as one hour. It is very effective at preventing vision from getting worse and improving it. If you have a lens implant already, you can still get a vitrectomy without causing damage to the lens.
- Cons: As with any procedure, there are some risks to vitrectomy. Risks include infection, bleeding, pressure in the high, retinal detachment caused by the surgery, damage to the lens, increase in cataract formation, and changes in refractive error problems with eye movement after surgery. There is also the possibility that the surgery will not be successful and will have to be done again.
- Costs: Vitrectomy procedures are typically covered by insurance. Consult with your vision plan provider and your eye surgeon to confirm coverage and expected expenses.
Vitrectomy Surgery: What to Expect
Vitrectomy surgery is a relatively standard procedure, though each individual presents with unique needs. In general, you can expect the following things to happen during your surgery:
- You will likely be awake, though you will receive anesthetic eye drops and injections so you won’t feel anything in your eye during the surgery. You may also receive additional medication to help you relax.
- Some people get general anesthesia to put them to sleep for the surgery.
- The procedure begins with an incision through the outer layer of your eye, followed by a cut in the white part of your eye (the sclera).
- Your doctor can then remove the vitreous and any debris or scar tissue that is affecting your vision.
- Once the vitreous is removed, any repairs to the retina can be done.
- Once the repairs are finished, the vitreous is replaced with a new fluid, such as saline or silicone oil.
- Often, the surgical incisions do not need to be closed with stitches, but your doctor may decide to put a few stitches in.
- Once the procedure is complete, antibiotic ointment is spread on the eye to prevent infection.
- Finally, an eye patch is placed over the eye.
The Recovery Process
Following vitrectomy, most people are able to go home the same day, though someone else will need to drive you. Your doctor will send you home with specific aftercare instructions about how to treat your eye.
Your doctor may prescribe antibiotic drops to fight off infection, which you may use for up to four weeks. Your eye could feel sore following the procedure, so your doctor may give you a prescription for a pain reliever. Over-the-counter pain relievers, however, are usually strong enough for the pain expected following vitrectomy. You will also likely need to wear an eye patch for a few days to protect the eye.
If you had a gas bubble placed in your eye during surgery, it is important that you do not fly until the bubble is entirely gone. Your doctor will also give you specific instructions about what position to keep your head in and for how long, so that you don’t encounter complications related to the gas bubble.
It is important to stay in close communication with your eye doctor following vitrectomy. Your first follow-up appointment may be the day after surgery.
Be sure to tell your doctor about any pain, swelling, or vision loss you experience. Your vision may not be perfect right after surgery, but it will improve in the coming weeks. Consult your eye doctor about vision expectations and eye care recommendations.
Floaters and Flashes Treatment. (August 2019). American Academy of Ophthalmology.
Vitrectomy for Floaters. (2016). American Society of Retina Specialists.
What Happens During a Vitrectomy? (May 2019). American Academy of Ophthalmology.
What Is Vitrectomy? Johns Hopkins Medicine.