Vitrectomy surgery is commonly performed by vitreoretinal specialists and involves the removal of the vitreous gel from the back of the inner eye. Removal of this gel treats a source of pathology in many retinal diseases and allows access to the retina for surgical treatment.
The vitreous gel occupies the posterior 80% of the inside of the eye which is known as the vitreous cavity. This space is in front of the retina and behind the lens.
Vitrectomy surgery has many indications. The most common reasons for surgery include the following diseases:
- Diabetic retinopathy
- Vitreous hemorrhage (bleeding in the vitreous cavity)
- Macular hole
- Macular pucker
- Retinal detachment
- Retained lens material (retained lens particles following cataract surgery)
The surgery is performed through three tiny openings made in the eye. The standard surgical incisions are made with a microscopic blade and measure approximately one millimeter.
Each incision serves as a port for entry into the back of the eye. The first port is used to infuse fluid (saline solution) into the eye as the vitreous gel is being removed. As the gel is removed during surgery, a computer on the vitrectomy unit senses a decrease in eye pressure and infuses fluid through this port to keep the eyeball pressurized and formed. The second port is typically used to place a fiberoptic light to illuminate the inside of the eyeball and allow the surgeon to see where he/she is operating. The third port is typically used to insert and remove specialized instruments to operate on the vitreous and retina. These include the vitrectomy probe that is used to remove the vitreous gel.
Standard vitrectomy surgery uses openings in the eye of approximately one millimeter (20-gauge). Despite the small size of these incisions, sutures are still required in most cases to prevent leaks while the eyeball is healing following surgery.
A newer technique allows for the use of 0.5 mm incisions. This technique is called 25-gauge surgery. The greatest advantage of this technique is that the incisions generally seal by themselves and do not require sutures. Almost all of the instruments used in standard surgery have been miniaturized to fit through the smaller openings and allow for the application of this technique in most surgical indications. The main advantages of 25-gauge surgery derive from the lack of sutures and tiny incisions. Sutures can be irritating on the surface of the eye until they dissolve after several weeks. Sutures can also temporarily change the shape of the eye and alter the focus. Patients who undergo 25-gauge surgery generally report no postoperative discomfort and enjoy a more rapid surgical recovery (often within days).