Vitrectomy surgery

Edgbaston Eye Consultants has a state-of-the-art cataract suite that delivers safety and quality for our cataract patients. Our experienced surgeons use the microincision phacoemulsification technique to implant the highest quality intraocular lenses. This gives us the best results possible with minimal complications.

A vitrectomy is an operation to remove the vitreous humour, this is the transparent gel from inside your eye. The vitreous sits behind your iris (the coloured part of your eye) and lens, but in front of the retina at the back of the eye. Its function is to provide a transparent medium allowing light to get to the retina from the front of the eye.

  • A vitrectomy is necessary to treat a number of eye conditions that include:
    • Macula holes
    • Epiretinal membranes (scars distorting the retina)
    • Retinal detachment
    • Complications of cataract surgery
    • Removal of foreign bodies from inside the eye
    • Endophthalmitis (infections inside the eye)
  • Typically, when you need vitrectomy surgery you will have:
    • An appointment to assess your eye preoperatively with various scans
    • A date for the vitrectomy surgery
    • An appointment soon after surgery
    • An appointment 1 to 2 weeks after surgery
    • A final appointment 4 to 6 weeks after surgery with another scan

The vitrectomy surgery is performed under a local anaesthetic, where the anaesthetic is infiltrated around the eye using a specially designed cannula. Most patients do not require sedation for surgery, but if you and your doctor decide it is necessary, a sedative tablet can be offered to you. Before the operation, your pupil will be dilated using drops. When you get to the hospital, please let the staff know if there have been any changes to your general health or eyes since your preoperative check. You will have the paperwork for the admission checked and the operative eye will be marked. You will come into theatre and sit back on the operating chair. The eye will be cleaned, drapes will be put over you and the operation will commence. A vitrectomy normally takes about an hour to complete, it can go on for 2-3 hours if it is a complex procedure. During the procedure, fine instruments are used to remove the vitreous. The vitreous does not replace itself, instead it is replaced by a balanced saline solution that is slowly replaced by the fluid that is secreted at the front part of the eye, the aqueous humour. Sometimes it needs to be replaced by other substances including air which absorbs in around 2 to 3 days, a gas bubble that is absorbed after 2 to 6 weeks, or silicone oil that not naturally absorbed is usually surgically removed after 6 to 12 weeks.

Preoperative assessment

At the preoperative assessment our clinical team will examine your eyes and run through a routine health check. Drops will be put in both eyes to dilate the pupils before the doctor’s examination. The eye drops may blur your vision for up to 4 hours, so bring someone to drive you back after your appointment. You will have the opportunity to raise any questions or concerns with members of the team during your preoperative visit and we will listen to you. If you are on warfarin your INR reading must be checked within 7 days of your surgery to make sure it is in the therapeutic range. Please bring your record on the day of surgery so that we can confirm the level. If you are prescribed antibiotics in the time between listing for surgery and the surgery, please contact us, as we will perform the operation after you have finished the course of tablets.

Day of operation
  • Eat a light meal before coming to the clinic
  • Take your medications as normal, unless specifically advised not to. If you are diabetic, check with the nurse at the preoperative assessment.
  • Wear comfortable, loose fitting, non-white clothing. You do not need to undress for the operation.
  • Do not wear make up
  • Do not drive to the appointment
  • The time given to report to the clinic is not the time of the operation
  • On arrival, the receptionist will confirm your contact details, if needed, for your journey home
  • Do not bring any valuables
  • The total time you will be in clinic will be around 4 hours for the preoperative check, the operation and the postoperative recovery.
  • We recommend that you have someone with you to take you home after the surgery, but it is not necessary for them to stay with you overnight.
  • In the operating room

    You will be taken into the operating room and made comfortable on the operating chair that will recline. After the staff have checked your identity, the operation to be performed and the eye to be operated on, the eye is cleaned with an Iodine scrub. Your face head and chest will be covered in a sterile drape to create a sterile barrier. The sterile sheet is adhesive around the eye and it can be uncomfortable when it is carefully removed at the end of the procedure. A sterile saline solution is used to irrigate the eye during the procedure that sometimes tracks behind the surgical sheet into your ear and around your neck. We therefor recommend that you remove hearing aids on the operation side to avoid damage. Please not that the Iodine scrub can stain white clothing. The surgeon uses a bright microscope light to look into the eyes during the operation and you will be asked to look directly at it. It will not harm your eyesight to do this and it helps the operation. You need to keep still during the procedure, because small movements like talking or nodding are amplified under the microscope. We will tell you how to communicate to the surgeon if you need to cough or sneeze.

    Your experience of surgery

    We have a long experience of keeping you as comfortable as possible throughout your surgery to give you a stress-free experience. You may however feel certain sensations, like the surgeon touching your forehead or light pressure on the eye. If this becomes uncomfortable, we will give your some more anaesthetic during the surgery. You may feel mild discomfort during the procedure and you should tell us if you are, as we will try to help. In the discharge room You will be accompanied to the discharge room where you will be checked prior to going home. If you have had gas inserted into your eye, you may need to posture in a certain position after surgery. If this is the case, the nurse will explain what to do and how long for, then give you a leaflet to remind you. Your eye will be covered with an eye pad and shield for 24 hours. Sometimes a reddish fluid is seen on the eye pad, this is usually from the anaesthetic leaking out and is not blood. Eye drops are given to protect against inflammation and infection. Written postoperative care instructions on how and when to use the drops will be provided. You will be supplied with a drug chart to record your drop regime; many patients find this useful. Your postoperative appointment will be confirmed with you before your go home.

    After the operation

    If you have a pre-existing condition that requires eye drops, you should continue with the drops from a fresh bottle. Otherwise take the prescribed postoperative drops, as directed. Post-surgery symptoms and information Your eye is likely to be sensitive, swollen and red for a several days after surgery. The vision in the operated eye will be very blurred if the eye is filled with gas. This bubble will disappear between 2 and 6 weeks depending on the gas used, you will be told what to expect. Depending on how well your retina is functioning, your vision will return as the bubble resorbs. While there is a gas bubble in your eye, you must not travel by air, or drive or climb to a high altitude because gas expands more at low atmospheric pressures. This expansion can cause painful high pressure in the eye that is only relieved by expelling gas or lowering altitude. Please take the posturing seriously. Failure to maintain the correct position may result in failure of the operation. Sometimes the eye feels gritty after the procedure, but it should not be unbearably painful. If there is discomfort, please take simple analgesic tablets every 4 to 6 hours in accordance to the correct dosage OR any prescribed painkillers, as directed. Do not rub the eye which has been operated on and remember to always wash your hands before touching your face and eye or instilling your eye medication. If you run out of drops or are running low on drops please contact your GP for some more. We will write to your GP immediately after surgery so that they know what discharge medication you were given. If they cannot find the letter sent to them, please take the empty drop bottles, so they can write the correct prescription.

    Emergencies
    • Call us immediately if you experience:
      • Excessive and increasing pain in the eye after the operation
      • Increasing redness of the eye
    Time off work

    Normally, you will need 2 weeks off work after vitrectomy surgery, but this may well be longer if you have had gas in your eye, or work in a visual critical area. Minor eye complications

  • Bruising of the eye or eyelids
  • Allergy to the medication given
  • Iris trauma
  • High pressure in the eye
  • Temporary clouding of the cornea
  • Retinal swelling
  • Serious complications
  • Retinal detachment (requires a further procedure)
  • Intraocular haemorrhage (bleed in the eye)
  • Infection inside the eye (endophthalmitis)
  • Severe postoperative inflammation
  • Permanent retinal swelling
  • Progressive deterioration, or loss, of vision
  • Protecting your data
    • We will only share information about you and your health with:
      • The doctor or nurse or other healthcare professional involved in your care
      • Any healthcare organisation with the responsibility for investigating an unexpected event or result, or any complaint
      • The funding body for your care
      • Any person involved in your treatment or care
    Research

    Anonymous or aggregated data form your patient information may be used by Edgbaston Eye Consultants or disclosed to others for audit, research or statistical purposes and registered with such bodies. Your identity will not be disclosed, nor any information which might reveal your identity.

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