Vitrectomy Surgery

Information to help you understand your condition and discuss your care with your eye specialist.

What is vitrectomy?

A vitrectomy is a surgical procedure to remove the vitreous gel (the clear, jelly-like substance) from the back part of the eye. It may be recommended for several conditions, including:

• Retinal detachment
• Macular holes
• Epiretinal membrane (scar tissue on the retina)
• Vitreous haemorrhage (bleeding into the gel, often from diabetes)
• Vitreous opacity
• Complex intraocular lens surgery
• Infection or injury

During surgery, small instruments are inserted into the eye to cut and remove the vitreous gel. Once removed, your surgeon may:

• Treat the retina with laser (photocoagulation) or freezing (cryotherapy)
• Remove scar or fibrous tissue
• Repair holes or tears
• Reattach areas of detached retina

At the end of the procedure, the gel is replaced with saline, air, gas, or silicone oil to help maintain eye shape and pressure.

Alternatives to the surgery

For certain conditions like retinal detachment, alternative procedures may include:

• Pneumatic retinopexy (gas injection)
• Scleral buckle (placing a band around the eye)

Your surgeon will discuss the benefits, risks, and whether vitrectomy is the best option in your case.

How will the vitrectomy procedure affect my vision and/or condition?

The outcome depends on the reason for surgery:

• Diabetic eye disease: Vision often improves, especially if there was bleeding in the eye.
• Retinal detachment: Visual recovery depends on how much of the retina was affected and how long it was detached.
• Macular hole or epiretinal membrane: Many patients notice improved vision, though not all.

If a gas bubble is used, your vision will be blurred until it is absorbed. Do not fly or travel to high altitudes while gas remains in the eye. Do not drive until your surgeon confirms it is safe. If silicone oil is used, vision may remain blurred and another procedure may be needed to remove the oil.

Tell every healthcare professional treating you that you have gas in your eye. Nitrous oxide, including Entonox or “gas and air”, must not be used while the gas remains. Ask your surgeon when it is safe to resume travel and driving.

Anaesthesia: What to Expect

Vitrectomy is usually done with local anaesthetic and light sedation. A small injection is given around the eye. In some cases, general anaesthetic may be used. The procedure is typically day surgery, though an overnight stay may occasionally be needed.

Risks of anaesthesia (especially local injections) include:

• Eyeball perforation
• Optic nerve injury (vision loss)
• Bleeding
• Retinal detachment
• Temporary droopy eyelid
• Changes in blood pressure or breathing
• Rare complications with general anaesthetic (e.g., heart/lung issues, extremely rare death or brain dysfunction)

What are the risks of vitrectomy surgery?

While most patients do well, all surgeries carry risks. Complications may occur immediately or later and could require further treatment or surgery. Risks include:

• Vision loss
• Double vision or blindness
• Retinal detachment or re-detachment
• High eye pressure (glaucoma)
• Infection or bleeding
• Cataract formation (may require surgery)
• Corneal problems (clouding, scarring, poor healing)
• Eyelid droop
• Loss of eye in very rare cases
• Shrinkage of the eye (phthisis)

Your surgeon will explain your specific risks, especially as they relate to your condition.

Please take time to ask any questions you have. Understanding the procedure, its potential benefits, and risks is an important part of making the right decision for your eye health.

Positioning after surgery

If a particular head position is needed after surgery, your surgeon will explain the position and how long to maintain it. Follow your own instructions rather than a general timetable.

Further information

• Gas in the eye and nitrous oxide — Royal College of Ophthalmologists