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Vitreoretinal Surgery Guide - Vitrectomy, Membrane Peeling

Vitreoretinal Surgery Vitreoretinal surgery is a general term covering several procedures which are performed deep within the eye. These surgeries, which can be performed with lasers or with more conventional tools, treat disorders which involve the gel-like vitreous humor that fills the eye and retina, which lines the back of the eye. Vitreoretinal surgery may be used to preserve, restore or enhance existing vision for those suffering with serious eye problems including:

Because this type of procedure is very delicate and highly specialized, your eye doctor will likely refer you to a specialist if vitreoretinal surgery is needed. In some cases, laser surgery may be performed by a general ophthalmologist, but most procedures requiring traditional surgical methods will be carried out by a vitreoretinal surgeon.

Vitrectomy
A vitrectomy is the term used when the gel-like substance in the eye, called the vitreous humor, is removed. A general anesthetic is generally required although occasionally the surgery is performed under only local anesthetic. Tiny slits are made behind the iris in front of the retina to accommodate the surgical instruments. During surgery, the vitreous humor is removed, the area cleaned and then a saline liquid is injected as a replacement.

A vitrectomy may be used to remove a foreign body in the eye, or to retrieve a lens nucleus after cataract surgery. It can also be used to treat:

  • Retinal detachment
  • A macular hole
  • Diabetic vitreous hemorrhage
  • Endophthalmitis

A vitrectomy is not usually used to treat floaters, even though they do occur in the vitreous humor. Most people develop these deposits as they age, and they are a fairly benign problem.

After vitreoretinal surgery antibiotic eyedrops will be prescribed to avoid infection, and anti-inflammatory eyedrops should be used for several weeks to ensure the best possible recovery and healing. Each case is very individual, so follow your surgeon’s advice carefully. Healing time depends upon the type, range, underlying reason and simplicity of the procedure. Vision may be affected for several weeks after surgery, but follow-up checks with your surgeon will be the most informative way to discover what progress is being made and what the likely outcome will be.

Vitrectomies have a very high rate of success; possible complications include bleeding, infection, retinal detachment or cataract progression. Most patients have their sight considerably improved or restored in the case of disorders that otherwise would have led to blindness.

Epiretinal membrane peeling
Epiretinal membrane, also known as ‘macular pucker,’ is a condition where a fibrous membrane grows across the macula, similar to scar tissue. (The macula is the central part of the retina, responsible for our finely detailed central field of vision.) In some cases, the growth is mild and produces little or no noticable symptoms, but in others, it distorts the retina and consequently vision, causing straight lines to appear wavy and crooked. It can also cause other vision problems, such as blurring. Symptoms may get worse over time as the membrane continues to grow.

Possible causes of an epiretinal membrane include:

  • Retinal tears
  • Retinal detachment
  • Uveitis (inflammation)
  • Blood vessel abnormalities
  • Previous eye surgery
  • Tramua

In some cases, an epiretinal membrane simply develops on its own, as a result of the natural process in the eye.

If the epiretinal membrane is causing poor vision, surgical intervention may be required. A membranectomy, also called an epiretinal membrane peeling, can be performed. The first stage of this surgery is a vitrectomy as described above. After the vitreous humor has been removed and replaced with saline, the surgeon will use fine ‘diamond dusted’ instruments to peel away the membrane. Very thin, absorbable sutures may be used to close the incision.

After surgery, you may need to wear an eye patch until the following day, and eye drops or ointment will likely be prescribed to prevent infection and inflammation. Vision will improve gradually; it may take as much as 3-6 months for the full benefit to be seen. The risk of permanent retinal damage is possible with this procedure, and a recurrence of the problem is experienced in about 10% of patients.

Proliferative vitreoretinopathy
Proliferative vitreoretinopathy is the most common complication following a retinal tear or detachment and occurs when special cells, called RPE cells, which are usually under the retina, migrate into the vitreous cavity. These cells can then grow on the retina, forming a membrane which can contract, pulling on the retina, causing further retinal detachment and serious vision loss. Surgery treatment involves a vitrectomy to remove the vitreous humor, as described above, followed by a membrane peeling process to remove the contracting membranes. A gas bubble or silicone oil will then be injected into the eye to flatten the retina, allowing it to heal and reattach itself. The head may need to be stabilized for some weeks after surgery if gas is used. If silicone fluid is used, the patient may be able to return to normal activities within a few days with no special positioning, but a second surgery will be required months later to remove the silicone.

Recovery may be slow after proliferative vitreoretinopathy and often the patient only regains enough vision to clearly see large objects. This may be enough to navigate a room, but tasks like reading and close work will likely require additional aids such as assistance devices and special lighting.

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