Vitrectomy

Keyhole surgery to remove the vitreous gel that fills the eye — opening a clear path to repair the retina from within. It is the core vitreoretinal operation, and the foundation of most of the surgery on this site.

The centre of the eye is filled with a clear jelly called the vitreous. In a vitrectomy, the surgeon makes three tiny openings in the white of the eye — each less than a millimetre — and, working under a microscope, removes that jelly with a fine cutting instrument. With the vitreous out of the way, the retina at the back of the eye can be reached and repaired directly.

It is not one operation but a platform for many: the same access is used to reattach a detached retina, to peel a membrane off the macula, to close a macular hole, to clear blood or scar tissue in diabetic eye disease, and to remove a dislocated lens. At the end, the eye is usually filled with a gas bubble, air, or occasionally silicone oil to support the retina while it heals.

Who it is for

Vitrectomy is considered when a problem sits at the back of the eye and cannot be treated with drops, injections or laser alone. Common reasons include retinal detachment, macular hole, epiretinal membrane, advanced diabetic retinopathy, vitreous haemorrhage, and floaters severe enough to disable vision. Whether it is the right step for you is decided at consultation, on the basis of your scans and your symptoms.

A surgeon operating under an ophthalmic microscope in a sterile theatre. — **Fig. 1** · Vitreoretinal theatre — sterile field

What to expect

Before, during, and after.

Before

Imaging and a plan

Your eye is scanned and examined, the options are explained in plain terms, and consent is taken with time to ask questions. You may be asked to pause certain medicines; most people can eat normally for local anaesthetic.

During

Keyhole surgery, awake or asleep

Under local anaesthetic the eye is numb and you feel no pain, though you may sense light and movement; general anaesthetic is available. The surgery is carried out through the sub-millimetre openings under the microscope, and the eye is filled to support the retina.

After

Healing over weeks

Vision is blurred at first and clears gradually. If a gas bubble is used you may need to hold a particular head position for a time, and you must not fly until it has absorbed. Drops prevent infection and inflammation; most people return to light activity within a week or two.

Risks, stated plainly

Vitrectomy is a well-established operation, but no eye surgery is without risk. The ones worth understanding are:

Cataract. The eye’s natural lens often clouds in the months or years after vitrectomy; many people go on to have cataract surgery, or it is combined with the vitrectomy.
Raised eye pressure that usually settles with drops, and, less often, lowered pressure.
Infection or bleeding inside the eye — uncommon, and treated promptly if it occurs.
A new retinal tear or detachment, which may need further treatment.
The problem being treated may not fully resolve, and a second operation is sometimes needed.

Your individual risks depend on your eye and the reason for surgery, and are discussed honestly before you decide.

Conditions treated this way

Consultation

Talk it through with Dr. Diafas.

Whether vitrectomy is right for you is a decision made together, after your scans and symptoms are reviewed.

Refer a patient

This page provides general information only and is not a substitute for an individual consultation. If you are worried about your vision, seek medical advice.