home Audience 5 Performing eye vitrectomy, indications and rehabilitation. A high-tech method of vision preservation - vitrectomy, its consequences and life after Vitrectomy with silicone

Performing eye vitrectomy, indications and rehabilitation. A high-tech method of vision preservation - vitrectomy, its consequences and life after Vitrectomy with silicone

Vitrectomy(from the Latin “vitrium” - vitreous body, “ectomy” - remove) - an ophthalmic surgery procedure with partial or complete removal of the vitreous body of the eye.

Mainly, vitrectomy surgery is performed in cases of retinal detachment, since such an intervention allows the surgeon to gain access to the posterior parts of the eye. The removed vitreous is usually replaced with a special substance with certain properties. Among the main requirements for vitreous substitutes, experts highlight: high transparency, so as not to impede the operation of the optical system; stability and durability; a certain degree of viscosity of a substance; lack of toxicity and allergenic effects.

Most often, saline solutions, perfluoroorganic compounds, silicone oil, and artificial polymers are used as a substance replacing the vitreous body. At the same time, after a certain time, saline solutions and gases are replaced by their own intraocular fluid, so their replacement is not required. The shelf life of silicone oil is limited to a certain number of years. As for the use of artificial polymers, their presence in the eye should not exceed 10 days.

Vitrectomy is a microinvasive method of surgical intervention, since penetration into the internal structures of the eye and their perforation is minimal. Depending on the volume of the vitreous body to be removed, the operation can be total or partial. In a total vitrectomy, the vitreous body is completely removed. In partial vitrectomy, a certain area of vitrectomy is removed - this is a subtotal vitrectomy, divided into anterior and posterior vitrectomy procedures.

Indications for vitrectomy

The purpose of a total or partial vitrectomy is usually the following:

Restoring the integrity of the retina when it is torn.
Restoration of vision after total or subtotal hemophthalmos that is not amenable to conservative therapy.
Prevention of traction leading to retinal detachment, proliferation with the formation of pathological vessels.
Treatment of diabetic retinopathy leading to the formation of scar tissue.
Restoration of vision in case of traumatic damage to the vitreous body and the introduction of a foreign body into the body.

Among the contraindications to vitrectomy, experts name: serious damage to the optic nerve or retina, severe clouding of the cornea.

Operation stages

Vitrectomy usually requires hospitalization of the patient, although in certain cases the operation can be performed on an outpatient basis. Immediately before the intervention, the patient is placed on a surgical table in a specialized operating room. Local or combined anesthesia is performed, and an eyelid dilator is inserted into the eye.

The surgeon then makes tiny punctures and removes the vitreous tissue from the eyeball. After gaining access to the retina, the main treatment is carried out: cauterization of areas of the retina with a laser, restoring the integrity of the retina and sealing the detachment. The entire procedure, depending on the extent of the intervention, usually takes up to 2-3 hours.

Video of real operation

Rehabilitation period

The duration of the rehabilitation period after vitrectomy can range from several days to several weeks, which depends on the extent of the intervention performed, the condition of the patient’s retina and the type of vitreous replacement substance. In case of serious damage to the retina, complete restoration of vision is unlikely, even after a successful operation, since the changes in the retina and optic nerve have become irreversible.

The effectiveness of vitrectomy and possible risks

Operation vitrectomy is an effective method of improving visual functions in the case of long-term non-absorbing hemorrhages in the vitreous, during intensive drug therapy. Microinvasive vitrectomy is a real chance to reduce the risk of total bleeding even in the case of hemorrhage that has already begun, as well as in the case of the growth of newly formed pathological vessels in the iris.

However, like any surgical intervention, vitrectomy is accompanied by certain risks and can result in certain complications. Among the complications of the operation, experts identify the following:

Infectious inflammation (rarely endophalmitis).
Increased IOP, especially in people with glaucoma.
Corneal edema, with the accumulation of excess fluid under the transparent membrane.
Hemorrhages in the vitreous area.
Retinal detachment.
Proliferation of newly formed vessels on the surface of the iris. A condition threatening the development of neovascular glaucoma or leading to an acute attack of glaucoma, with serious pain and the risk of loss of visual function.

Cost of vitrectomy surgery

The cost of vitrectomy surgery is determined by many factors. The main ones are: the condition of the patient’s organ of vision, indications for surgery, the volume and nature of the surgical intervention, and the qualifications of the ophthalmic surgeon.

Vitrectomy is an operation to remove the vitreous humor from the inside of the eye to allow access to the retina.

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About the vitreous body

The vitreous body is approximately 99% water and contains collagen fibers, proteins and hyaluronic acid. This clear, gel-like substance that makes up the center of the eye takes up about two-thirds of its volume and helps maintain its shape.

Due to its consistency, the vitreous body can be affected by various pathological processes, which lead to its clouding and filling with blood. This, in turn, makes it difficult for light to reach the retina correctly, causing decreased vision, clouded tears, detachment and other serious pathologies.

What is vitrectomy?

Modern plastic vitrectomy was developed by Robert McHamer in 1970. Machemer created a suction device that was the first closed-system vitrectomy device, which was necessary to control intraocular pressure levels during surgery. This achievement was monumental in ophthalmology as it allowed controlled access to the posterior segment of the eye for the first time.

Initially, vitrectomy was used primarily to clear opacity such as blood from the vitreous. In modern ophthalmology, technological development and improved equipment allow this procedure to be used much more widely. This intervention is now a fairly routine procedure for the vitreoretinal surgeon and can be performed as an outpatient procedure. Long gone are the days when 20 gauge vitrectomy was first introduced. Ophthalmologists now have 23, 25 and 27 gauge systems with improved duty cycles and cutting speeds.

Kinds

Vitrectomy of the eye can be of two types, depending on how the vitreous body is removed, completely or partially:

Total (the entire vitreous body);
Subtotal or partial (part of the vitreous).

Subtotal vitrectomy, in turn, is divided into anterior and posterior.

Front

In rare cases, the vitreous penetrates through the pupil into the anterior chamber of the eye.

This may happen:

after ;
during surgery with or;
as a result of problems with the lens of the eye.

Because vitreous gel leakage can cause serious problems, anterior vitrectomy is necessary to minimize the risk of complications and promote vision restoration.

This operation is a critical tool in the skill set of the surgeon who operates on the anterior segment of the eye. Although planned anterior vitrectomy can be performed to remove traumatic cataracts or for glaucoma, this procedure is most often an unplanned and unwanted adjunct to cataract surgery.

Posterior Pars Plana vitrectomy

Vitrectomy performed for diseases of the posterior segment is called posterior or pars plana. This view is performed by a retina specialist.

Indications

Vitrectomy is sometimes necessary in the treatment of such diseases:

Retinopathy

Parsa plastic vitrectomy is suitable when treatment requires access to the posterior segment of the eye.

General indications are:

Rhegmatogenous or traction retinal detachment;
Hemorrhage into the vitreous body (hemophthalmos);
Remaining lens fragments after cataract surgery;
Endophthalmitis;
Epiretinal membrane;
Macular fossa;
Vitreomacular traction;
Intraocular.

Contraindications

Vitrectomy is contraindicated:

in the presence of suspicious or active retinoblastoma;
in some cases of active choroidal melanoma, since the incision of the eye may be associated with the spread of tumor cells through the circulatory system.

In some cases, such as removal of epiretinal membranes or treatment of a macular hole, the use of blood thinners (eg, aspirin or warfarin) is a relative contraindication.

Sometimes patients receiving an indirect anticoagulant (warfarin) cannot stop using it for health reasons. In such cases, the doctor prescribes heparin or enoxaparin before surgery, and warfarin can be resumed after the procedure. On the day of the procedure, such a patient must donate blood for a coagulogram. The prothrombin time should be determined, even if the drug has been discontinued, to ensure that the blood level is low enough for surgery to proceed.

Parsa plasma vitrectomy is often performed in emergency cases when:

treatment of rhegmatogenous retinal detachment;
management of endophthalmitis;
removal of intraocular foreign body.

Under these conditions, the procedure can only be contraindicated if the eye does not have light perception and restoration of vision is impossible.

Anesthesia

In most cases, local anesthesia with intravenous sedation is appropriate. A retrobulbar block consisting of an equal mixture of short-acting lidocaine 2% and 0.75% can be used; longer acting bupivacaine.

Before performing a retrobulbar block, propofol may be prescribed by the anesthesiologist for short-term sedation (5-6 ml is usually sufficient).

In some cases, general anesthesia may be required. This should be considered by the anesthesiologist for pediatric patients and overly anxious patients. General anesthesia should also be given when the operating time is expected to be longer than usual or when the patient requests it.

In the operating room

Patients are taken to the operating room in a bed with an appropriate headrest. The bed is located next to the operating microscope. The patient is secured so that the head rests comfortably on the headrest.

The patient's arms should be properly secured so that they do not hang over the sides of the bed. The drape may be wrapped around the torso and secured to prevent unintentional movement during surgery.

Intervention Overview

This procedure involves removing all or part of the vitreous by cutting and sucking it out using tiny ophthalmic instruments that are inserted into the eye. Surgical removal of the vitreous is necessary for unobstructed access to the retina.

During the operation, the ophthalmologist acts on the retina with a laser, cuts out or removes scarred and pathologically altered tissue, gradually aligns its individual areas or restores holes in it.

Tools:

Pneumatic high-speed vitreotome (disposable or reusable) – is a special cylinder with a knife (removes the vitreous slowly and in a controlled manner);
Fiber optic luminaires;
Infusion cannula (infusion port used to replace fluid in the eye with saline and maintain proper eye pressure);
A 25 cm long flexible tube is attached to the infusion source.

Patients may experience mild discomfort for a few days after the procedure.
The removed vitreous does not grow back, but is replaced by fluid that is normally produced by the eye. This gel is very important during eye development, but is not essential for eye health or focus after birth.

Although the results of vitrectomy vary depending on the individual condition, most patients experience improvement in visual acuity after this procedure.

The surgery is considered safe, but there are certain risks associated with any surgical procedure. Some of these include retinal detachment, fluid build-up, new blood vessel growth, infection, and further bleeding (hemophthalmos). Education is often accelerated in those patients who have not previously undergone surgery.

Complications and consequences

The most common postoperative complications:

Infection (about 0.039-0.07% of cases);
Retinal detachment (5.5-10% of cases) can occur during vitrectomy if an iatrogenic retinal tear occurs during the procedure (eg, accidental touching).

Requirements

The patient should stop taking indirect anticoagulants.
During surgery, it is necessary to maintain adequate homeostasis and control intraocular pressure so as not to cause choroidal hemorrhage.
Before the procedure, you should rinse thoroughly with a diluted povidone-iodine solution.
A subconjunctival or topical antibiotic should be administered before surgery is completed. The doctor prescribes antibiotic eye drops to the patient, which must be used for at least 1 week.

Microinvasive vitrectomy

This ophthalmic operation involves the extraction (removal) of a small part or the entire vitreous. It is carried out through 3 main punctures measuring 0.3-0.5 mm. The peculiarity of this intervention is that the surgeon inserts much smaller instruments into the eye, while the frequency of operation of a pneumatic or electric vitreotome during this procedure is much higher by 2 times - not 2500 per minute (as usual).

Microinvasive vitrectomy is performed using special self-fixing multipoint lamps.

Advantages:

less traumatic;
significantly reduces the risk of intra- and postoperative bleeding;
can be carried out on an outpatient basis, this does not require hospitalization of the patient in a hospital;
usually performed under local anesthesia with sedation (the patient is awake during the procedure, but does not feel pain or see the procedure being performed);
patients go home with a patch on the eye, which is removed in the doctor's office the day after surgery;
The duration of the rehabilitation period has been significantly reduced.

The duration of the operation varies from one to several hours, depending on the patient's condition. In certain situations, your doctor may perform other surgery, such as cataract removal.

Progress of the operation

The vitreous body is removed.
All existing scar tissue is eliminated (it is necessary to return the retina to its normal physiological position).
A bubble of air or gas is placed in the patient's eye to help the retina stay in the correct position. The bubble is not removed, it will gradually disappear on its own.
A special fluid (such as silicone oil) is then injected, which is later removed from the eye through another surgery.
The silicone is removed as soon as the cornea heals.

Operation scheme

Postoperative period

The patient may experience slight discomfort during rehabilitation. Doctors recommend wearing a special bandage and avoiding any strain. For some, the doctor prescribes painkillers after surgery.

If a gas bubble has been placed in the eye, the specialist may recommend that the patient keep his head in a special position for some time. With a gas bubble or other substance in the eye, vision will be blurred. There are certain limitations after microinvasive vitrectomy. The patient is advised not to fly in an airplane or travel at high altitudes until the gas bubble disappears.

After the operation, it is prohibited for 6 months:

lift weights more than 2 kilograms;
visit the solarium;
throw back your head and look up for a long time;
read books and write for more than 30 minutes;
stand near an open fire or lean over a fire (this includes a gas stove);
rub your eyes and press on the eyeball;
engage in professional sports;
watch TV or work at the computer for a long time;
bend over;
exercise intensively;
visit the bathhouse and sauna;
You can wash your hair, but very carefully and avoid getting shampoo and soap into your eyes;
In summer you need to wear sunglasses, you can’t look at the sun.

The technique was developed and first applied in the second half of the twentieth century. Today it is a common surgical procedure. Its main advantages are high efficiency, a wide range of indications and low trauma to the visual organs.

The essence of the operation

Vitreous humor is a gel with high light transmittance. It fills the space between the lens and the back wall of the eye and is 99% water. The remaining 1% consists of collagen fibers and hyaluronic acid. The transparency of the body ensures that light rays reach the retina of the eye.

During a vitrectomy, the ophthalmic surgeon makes small incisions on the eyeball, through which he destroys and removes the damaged vitreous body. It is immediately replaced with special inert substances.

Depending on the volume of removed contents, the operation can be subtotal (with partial destruction of the vitreous body) or total (the vitreous substance is completely removed).

Indications and contraindications

Surgery on the vitreous body is indicated for the following pathologies:

caused by various reasons (high myopia, trauma, diabetes mellitus);
hemorrhage into the vitreous body (hemophthalmos);
injuries, including penetration of foreign bodies and lens dislocation;
the need to remove retinal scars formed after hemorrhage or detachment;
opacity and fibrosis of the vitreous body;
infections of the membranes of the eye.

Surgical procedures are always associated with vascular damage and subsequent bleeding. Therefore, surgery is not performed in severe forms of coagulopathy (blood clotting disorder).

Contraindications for surgical intervention are:

high intraocular pressure - vitrectomy is possible only after its normalization;
decreased transparency of the cornea and lens;
malignant retinal tumors;
optic nerve atrophy.

Preparation

Before a planned operation, the patient is prescribed a series of examinations to assess the condition of the affected eye and choose the optimal treatment tactics:

Visiometry – testing visual acuity.
– detailed examination of the fundus and assessment of the transparency of the internal media of the eye.
Ultrasound examination - it is used to detect decreased transparency of the vitreous body and hemorrhage.
Computed tomography is an additional method used in complex diagnostic cases.
Tonometry is the measurement of intraocular pressure.

If the patient has chronic diseases, such as diabetes mellitus or arterial hypertension, it is important to achieve their compensation before surgery on the vitreous body. Blood pressure and blood glucose concentrations should be stabilized.

Carrying out the operation

Vitrectomy on the eyes is performed only in a specialized hospital. The duration of the operation ranges from 30 minutes to 2 hours. Depending on the clinical situation, both general anesthesia and local anesthesia can be used.

After performing anesthesia and fixing the eyelids using a speculum, the surgeon makes 3 incisions. Through them, trocars are inserted into the eye - hollow tubes that serve as conductors for surgical instruments.

The operation requires: a vitrotome, a light source with a video camera and an irrigation system that ensures the maintenance of the eyeball in good shape. A vitrotome is an instrument that destroys the glassy substance and removes the resulting mass by aspiration.

All manipulations are performed using a powerful microscope, which allows the surgeon to clearly see the structures of the eye. The signal from the video camera is transmitted to the monitor, which gives the doctor additional opportunities to control his actions.

After removing the vitreous, it is necessary to fill the vacated space, straighten the folds of the retina and press it to the back wall of the eye.

For this use:

Special salt solutions . They dissolve on their own after a few days.
Silicone oil . Remains in the eye for 2 to 6 months.
Gas mixtures. They represent sterile air with the addition of special gases. After 2–4 weeks, the gas is completely absorbed into the blood. Its place is taken by the resulting intraocular fluid.
Synthetic polymers . Perfluorates are used - inert compounds of carbon and fluorine. Their properties are similar to water, but they have more weight, which is used to put pressure on the retina of the eye. Residence time in the eye is 14–21 days.

Microinvasive vitrectomy

This is a modern technique in which all manipulations are carried out through micro-incisions of no more than 1 mm, in contrast to 4 mm with the standard method. The advantage of the operation is that holes of this size do not require sutures, which significantly speeds up the regeneration process and facilitates an easy postoperative period.

Microinvasive vitrectomy requires high-tech equipment and a trained team of surgeons, and is therefore performed only in specialized ophthalmological centers.

Rehabilitation

To successfully restore visual functions and prevent negative consequences of the operation, the recovery period should be properly managed.

Follow the regimen prescribed by your doctor, especially on the first day after surgery.
Wear bandages on the operated eye in the first days after the procedure. They will protect it from excessive lighting and dust particles.
Make sure that water and soap do not get into your eyes when washing. If this happens, rinse it with pharmaceutical solutions of furatsilin (0.02%) or chloramphenicol (0.25%). Washing your hair should be done by tilting your head back, not forward.
If a gas mixture was used for retinal tamponade, then spend most of the first days (45 minutes of every hour) lying on your stomach, with your face on a special pillow. This position helps to move the gas bubble to the fundus and better compression of the retina.
Always use eye drops prescribed by your doctor.

Remember that visual acuity is restored gradually - at least 2 months. Arterial hypertension, diabetes mellitus, and a high degree of myopia extend rehabilitation to six months. New glasses should be selected no earlier than 2–3 months after surgery.

Possible complications

Despite modern technologies that minimally injure the eyeball, eye vitrectomy can cause the following complications:

infections;
increased eye pressure;
retinal disinsertion;
intraocular bleeding;
development .

Frequent consequences of vitreous surgery are clouding of the lens and increased intraocular pressure. Pathologies develop in the first months after surgery, especially when silicone is used to compress the retina.

The vitrectomy operation is used in cases where it is necessary to gain free access to the retina and the back wall of the eye. This is a high-tech surgical intervention that allows treatment and preservation of vision in severe ophthalmological pathologies.

Useful video about vitrectomy

10.10.2017

Vitrectomy is a surgical procedure aimed at removing the vitreous humor. It looks like a transparent gel-like substance that is located in the cavity of the eyeball. Consists of 99% water, also contains collagen fibers, proteins and hyaluronic acid.

Such an operation is usually not associated with its changes. It is often necessary to gain access to the posterior segment of the eye in various pathological conditions of the retina. This microsurgical intervention was first performed in 1970. Vitrectomy has undergone many changes since then, but has not lost its relevance in modern ophthalmic surgery.

There are 2 types of vitrectomy based on the surgical approach used to remove the vitreous, namely anterior and posterior.

The most common method of intervention is the posterior or pars plana. This operation is sometimes the only method to restore a person’s vision.

When is eye vitrectomy indicated?

Microsurgical removal of the vitreous body of the eye is performed in the following pathological conditions:

Proliferative diabetic retinopathy (including vitreous hemorrhage).

Macular holes.

Epiretinal fibrosis.

Complicated, traction or recurrent retinal detachment.

Intraocular foreign body.

Displacement of the artificial lens after its implantation for cataracts.

Giant retinal tears.

Age-related macular degeneration.

Traumatic injuries.

Vitrectomy is often performed in emergency clinical situations. It may be contraindicated for a certain category of patients, for example, with a reliably known lack of light perception or the inability to restore vision. The presence or suspicion of active retinoblastoma or choroidal melanoma of the eye casts doubt on the operation due to the high risk of dissemination of the malignant tumor.

When removing the epiretinal membrane or treating macular holes, the use of drugs from the group of systemic anticoagulants and antiplatelet agents (for example, aspirin or warfarin) is a relative contraindication for vitrectomy. Severe systemic coagulopathies also require close attention from the doctor, therefore, during the vitrectomy operation, it is necessary to monitor the condition of the coagulation and anticoagulation systems, and, if necessary, make corrections.

Technical features of the operation

Vitrectomy is an outpatient procedure, that is, after its completion, short observation and receipt of recommendations, the patient can leave the clinic. Anesthesia is usually local using eye drops, supplemented by intravenous sedation. During the intervention, the patient is conscious, but does not feel pain; there may be slight discomfort. Sometimes during vitrectomy surgery, retrobulbar blockade is used as an anesthetic aid.

During surgery, vital signs such as pulse, blood pressure and ECG are carefully monitored.

In the area of the eyeball, called the pars plana in Latin, microscopic incisions are made and three trocars with a diameter of 27G are installed. These devices are conductors through which special surgical instruments are delivered into the eye.

One of the ports is used for the infusion line necessary to introduce a special solution into the eye cavity during surgery. The second port during vitrectomy is necessary for a video camera with a light, thanks to which the ophthalmic surgeon can monitor the progress of the work on a special monitor. The third trocar is used for a vitreotome, an instrument that performs basic operations with the vitreous body. All manipulations on the eye during vitrectomy are performed by a microsurgeon using a high-precision microscope.

A surgical microscope equipped with a special high-power lens provides a clear and magnified image of the inside of the eye.

During the vitrectomy operation, the vitreous body of the eye is aspirated, and the empty cavity is filled with sterile silicone oil or a special gas-air mixture. The vitreous does not return, and the eye can function normally without it.

If there is no retinal detachment, air or saline (which is absorbed after a couple of days) can be used. However, if the patient has a retinal detachment, then either sulfur hexafluoride (which stays in the eye for 10-14 days) is used to tamponade it, or in more complex cases, another gas is used, for example, fluorohexane or fluoropropane.

Recovery period

The duration of the vitrectomy operation depends on the underlying eye disease and the presence of concomitant ophthalmological pathology and averages from 1 to 3 hours. After the vitrectomy has been performed, the patient goes home with a bandage, which the ophthalmologist removes from the eyes at the first postoperative visit. Sometimes eye drops with glucocorticosteroids are prescribed to minimize inflammatory changes, as well as local antibiotics to reduce the risk of developing bacterial complications.

Doctors sometimes recommend postoperative positioning to patients. This means that after the operation has been completed, the patient will have to spend some time “head down” or lying on his stomach. This position helps to press the gas bubble to the back wall of the eye, which prevents retinal detachment. A certain head position must be maintained for at least 45 minutes every 60 minutes. These 15 minutes are intended for eating and visiting the rest room.

If during vitrectomy the eye cavity was filled with a gas-air mixture, vision in the early postoperative period will be sharply reduced. The doctor must warn the patient about this in advance. Restoration of visual function is observed as the gas dissolves. Double vision and glare after surgery are also acceptable.

In the postoperative period, you should not lift heavy objects and, if possible, avoid psycho-emotional stress, as this can lead to an increase in intraocular pressure and the development of various complications.

Complications

Although vitrectomy has revolutionized the treatment of posterior segment disorders and significantly improves vision in patients with retinal diseases requiring surgical intervention, it is also associated with comorbidities and complications.

Complications after vitrectomy:

Bleeding.

Infection.

Retinal disinsertion.

Formation of scar tissue.

Loss of vision.

Increased eye pressure or glaucoma.

Progression of cataracts requiring cataract surgery at a later stage.

Cataract formation or progression is believed to be the most common complication associated with vitrectomy.

Often, nuclear sclerotic cataracts that develop after vitrectomy reduce visual acuity and reach such an extent that it will lead to its surgical removal. The exact pathogenesis of cataract formation or acceleration of the pathological process in the lens after vitrectomy is still unknown.

If the surgical intervention was performed by a professional ophthalmic surgeon and the patient strictly followed all the doctor’s recommendations, then the risk of complications is minimized.

Vitrectomy is an integral part of many procedures aimed at treating retinal diseases and restoring vision. Modern technologies and equipment make vitrectomy surgery less traumatic for the eyes and comfortable for patients.

Prices for eye vitrectomy surgery

№	Service name	Price in rubles
2011039	Vitrectomy for uncomplicated hemophthalmos or vitreous opacities of the second category	53 750

Contents of the article: classList.toggle()">toggle

Vitrectomy is a surgical procedure during which the vitreous body is completely or partially removed. It was first carried out by R. Machemer in 1971.

This is a rather complex operation that requires high-tech equipment and a highly qualified surgeon. But at the same time, it is the only solution to some eye diseases.

Indications and contraindications for surgery

Vitrectomy is advisable in the following cases:

Vitrectomy is not done in the presence of blood diseases (especially if there is a violation of the coagulation system), severe clouding of the cornea and the patient’s serious condition.

Stages of vitrectomy surgery

Today, vitrectomy is performed on an outpatient basis under local anesthesia. The patient is in a supine position, his head is fixed with a special device.

The sequence of actions of the surgeon is as follows:

The duration of vitrectomy varies from 2 to 3 hours, depending on the qualifications of the surgeon and the severity of the patient's condition.

Vitreous substitutes

Currently There are several vitreous substitutes available: Silicone oil, complex saline solution, liquid perfluoroorganic compound or sterile gas bubble. The use of these substances ensures close contact between the choroid and the retina and prevents the development of complications.

Using silicone oil

The light refractive index of silicone oil is almost the same as the natural refractive media of the eye

Silicone oil is a substance unique in its nature, which is characterized by biological and chemical inertness. Thanks to this property, the oil is easily tolerated by patients and does not cause allergic reactions. Its refractive index of light is almost the same as the natural refractive media of the eye.

These features allow you to leave silicone oil in the eye cavity for a long time (up to 1 year).

Silicone oil ensures the correct anatomical position of the retina and rapid restoration of its function.

Using a gas mixture

The introduction of an air bubble into the eye cavity requires the patient to strictly adhere to certain rules. This mainly concerns long-term holding of the head in a certain position, which is discussed with the doctor and depends on the scope of the operation.

The advantage of the gas bubble is that over time (12-20 days) it completely resolves and is replaced by natural intraocular fluid.

During this period, air travel is strictly contraindicated for a person. This is because changes in atmospheric pressure expand the gas and can cause an uncontrolled increase in intraocular pressure.

Use of liquid perfluoroorganic compounds

They are also known as “heavy water” because their molecular weight is almost twice as heavy as that of ordinary water.

After the introduction of such a substance into the vitreous cavity, the patient is not required to comply with any special regimen.

The only downside to liquid perfluoroorganic compounds is that they need to be changed every two weeks.

Postoperative period after vitrectomy

After the intervention, the patient can go home the same day. For a speedy recovery, you must follow the following recommendations:

The timing of restoration of visual functions directly depends on the extent of the operation and what kind of vitreous substitute was used.

For example, if only part of the vitreous was removed during vitrectomy, vision improvement may occur within the first week. If the operation was performed at an advanced stage of the disease, when tissue changes have become irreversible, a noticeable improvement in vision may not occur.

Complications that may develop after vitrectomy

Like any surgical intervention, vitrectomy carries a certain risk of developing postoperative complications.

Possible postoperative complications:

Progression. If the patient already had cataracts at the time of the intervention, then there is a possibility of its progression in the first six months or a year after the intervention. This happens more often when silicone oil is used as a vitreous substitute.
Secondary development.
Relapse (repetition) of retinal detachment.
Ocular hypertension, or increased intraocular pressure. This complication occurs when an excess amount of substitute is introduced into the eye cavity. To eliminate this complication, the patient must use anti-glaucoma drops for some time.
Infectious and inflammatory complications (for example, endophthalmitis).
Cloudiness of the cornea. It is rare and is caused by the toxic effects of the vitreous substitute.