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The middle portion of the eye is filled with a clear, gel-like substance. Surgery to remove and replace that fluid is called vitrectomy. (Learn more)
Blood within or behind your eye, holes in the back of your eye, or infections within your eye could all be repaired with vitrectomy. (Learn more) Sometimes, the procedure cures the issue, but sometimes, it's just part of a longer surgery needed to solve an eye problem.
Your surgery could be over in about an hour, but your recovery can take a month or longer. During that time, your body is creating new fluid to fill your eye, and it's pushing out the substances your surgeon used as placeholders. (Learn more)
After surgery, your doctor may ask you to keep your head parallel with the floor. Pressure from the new fluids in your eye push on openings in the back of your eye, and in some cases, that's critical to protecting your vision. This can be awkward, but there are chairs that can help you hold this position without wrenching your neck. (Learn more)
What Happens During Vitrectomy?
Your eyes have a bit of give to them. If you push gently on your closed eyelids, you'll feel the globes compress and release. Gel in the center of each eyeball is responsible for that movement. Surgery to remove and replace some or all of that fluid is a vitrectomy.
Doctors have used this surgery since the 1970s, according to the American Society of Retina Specialists, but it's changed quite a bit over time. The tools your doctor uses are tiny compared to old surgical kits. Stitches and glues have also improved, and that can lead to a quicker recovery.
Experts say the surgery is done in as little as an hour, but if it's combined with another surgical procedure, it can take a little longer to finish.
During the surgery, your team will:
- Anesthetize. Drugs can numb your eye and face, or doctors can use medications to help you drop into a form of sleep.
- Prepare. Drops will dilate your eyes, and they'll be cleaned and draped with sterile material. Tools keep your eyes open.
- Cut. A tiny incision on the outer membrane of the eye allows surgeons to push devices into the center.
- Suction. Small tools remove the gel inside your eye.
- Repair. With the gel out of the way, doctors can seal bleeding blood vessels, remove scar tissue, or address other issues in the back of the eye.
- Fill. Saline solution, oil, or gas fills the space left behind.
- Stitch. Your doctor might use glue or small stitches to seal up the incision, but not all surgeons do this.
A local anesthetic can keep you from feeling the cuts, suction, and filling that's happening to your eye. But it's not uncommon for patients to see the surgery's various steps. In a study from 2006, researchers found that 94.6 percent of patients saw lights and 82 percent saw colors. Sometimes, these visions frightened patients, as they thought the images were signs that the procedure was going wrong.
It's natural, surgeons say, for patients to see things as the work progresses. If you're sure this will frighten you, general anesthesia might be a better choice for you. Your doctor can help you make the right choice.
The risk of serious complications is low, says the American Society of Retina Specialists, and the success rate for the surgery stands at 90 percent or better.
Do You Need Vitrectomy?
A vitrectomy could be key to preserving your sight in the aftermath of an injury or sudden damage to the back of your eye. Removing the fluid allows your doctor to see and repair critical parts of your eye.
The American Academy of Ophthalmology says you might need a vitrectomy if you have:
- A hole, tear, or pucker in the macula.
- Retinal detachment.
- Eye infections.
- Severe eye injuries that cause bleeding.
- Diabetic retinopathy.
You might also consider vitrectomy a solution for floaters. As the American Society of Retina Specialists points out, eye gel can clump with age. We see specks of what looks like debris floating across our vision. Often, these are so tiny that we can learn to ignore them. But sometimes, they're large enough to keep you from driving safely. When that happens, surgery might be the right solution for you.
Recovery Can Take a Month or Longer
On the day of your surgery, your doctor will give you painkillers and eye drops. You'll use those tools to keep your eyes lubricated and your pain under control. Your doctor will tell you how often to use each solution, and you'll also have instructions about when you can go back to work.
It's normal to feel discomfort after surgery. Your eyes have been poked and prodded, and they're likely to be uncomfortable. But if your pain seems severe or you're just not getting better as time passes, call your doctor.
During recovery, you'll also need to keep your head in a specific position, and for some people, this is the hardest part of the healing process.
How to Make Recovery Easier
Vitrectomy is often part of a surgery to heal retina tears or buckles. Your surgeon starts the healing process, but the way you hold your head after surgery can help or hinder complete resolution of your eye health issue.
For example, tiny tears on the back of your eye may have prompted vitrectomy. The gas bubble your doctor blew into your eye at the end of the procedure can push against those holes, and with this pressure, they'll knit back together.
For that to work, the bubble must be pressed toward the back of your head‚ and that means your nose must be pointed at the floor.
Doctors typically suggest that patients take 10 minutes out of every hour to stretch, use eye drops, or go to the bathroom. But at all other times, you must point your nose at the floor and the back of your head at the ceiling. You'll need to do that for a week or longer.
To get through it, you could:
- Listen to podcasts. Reading will be difficult or impossible as your eye heals, but your ears will be untouched.
- Move around. A massage chair keeps your head perfectly positioned, but the view from your seat can be boring. Try lying your head on your desk or the dining room table.
- Ask for help. Cooking, cleaning, walking the dog, and other household chores are tough to complete while you heal. Let others tackle tasks for you.
- Use mirrors. Well-positioned glass can help you watch television, or prop a tablet under your nose and stream your favorite shows.
These days aren't likely to be your favorite. But the work you do here helps your eye to heal, and that might help you avoid a second surgery.
Your doctor might have other tips too. Be sure to discuss your recovery process in detail before your surgery, so you'll know what to expect. And if you're worried at any point in the healing, call and ask your doctor for advice.
Vitrectomy. (2016). American Society of Retina Specialists.
Vitrectomy: Procedure, Complications, and Recovery. (October 2017). Medical News Today.
Visual Sensations During Vitrectomy. (October 2006). Ophthalmology.
What Is Vitrectomy? (February 2018). American Academy of Ophthalmology.
Vitrectomy for Floaters. (2016). American Society of Retina Specialists.
What Happens During a Vitrectomy? (April 2018). American Academy of Ophthalmology.
Retinal Detachment. (March 2019). Mayo Clinic.
Post-Operative Positioning Following Vitrectomy Surgery. (January 2016). University of Wisconsin Hospital.
Recovering After Vitrectomy: Some Thoughts From Our Past Patients. (November 2012). Oxford Radcliffe Hospitals NHS Trust.