Pars Plana Vitrectomy
The vitreous is normally a clear,
jelly-like fluid that fills the inside
of the eye. Various disease states can
cause the vitreous to cloud, fill with
blood or even harden so that light
entering the eye will be misdirected and
not reach the retina properly.
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Definition
A
vitrectomy is a surgical procedure that removes the
vitreous in the central cavity of the eye so that
vision can be corrected. It is beneficial in many
disease states including
diabetic eye disease
(diabetic retinopathy),
retinal detachments,
macular
holes,
macular pucker and vitreous hemorrhage.
Procedure
The
vitrectomy procedure is usually performed as an
outpatient procedure. Rarely, an overnight stay in
the hospital is required.
Local or general (while you are asleep) anesthesia
may be used. The eye will be held opened using
a special speculum and the eye that is not being
operated on will be covered.
The
procedure begins with Dr. Deupree making a small
(less than 2mm) slit in the side of the eye and
inserting an infusion line to maintain constant eye
pressure. Next, a microscopic cutting device is
inserted which will aspirate (suck out) the vitreous
fluid.
A
microscopic light source is also inserted to
illuminate the inside of the eye through the
procedure. Additional instruments may also be used
to perform additional maneuvers such as cauterizing
blood vessel leaks or removing scar tissue.
Dr. Deupree will look through a microscope while
performing the procedure. The surgeon may also use
special lenses to help see the anatomy of the eye.
After the vitreous is removed, the surgeon will
refill the eye with a special saline solution that
closely resembles the natural vitreous fluid in your
eye. Tiny absorbable stitches are used to close the
three small openings and antibiotic injections to
prevent infection will be instilled at the end of
the procedure.
Vitrectomy Risks
Vitrectomies have been commonly performed and
perfected for over 30 years. However, certain risks
do exist. They include:
•
retinal detachment
•
development of
glaucoma (increased
pressure in eye)
•
cataract formation or progression
•
bleeding and/or infection inside or outside of eye
• red
or painful eye
• loss
of depth perception, blurring of vision, double
vision, or blindness
•
swelling of layer under the
retina (choroidal
effusion)
•
change in focus, requiring new spectacle lenses
(refractive changes)
•
wrinkling of retina (macular pucker)
•
swelling of the center of retina (cystoid macular
edema)
• loss
of night vision or distortion of vision
• loss
of eye (extremely rare)
• need
for additional treatment and/or surgery
Retinal
detachment during or after the procedure is the most
common risk. Dr. Deupree is prepared for this to
happen and can repair the detachment by inserting
gas that applies pressure on the retina before
completing the case.
The
retinal detachment will heal during the normal
vitrectomy healing time, which is between 4 to 6
weeks. Normal restoration of vision can take
several weeks. Physical activity will be restricted
during this time to prevent complications.
Postoperative
Instructions
Since vitrectomy is
often performed along with other procedures,
postoperative instructions may vary. Some general
guidelines are provided; however, please consult
with your surgeon for specific instructions.
1. Begin using any
anti-inflammatory and antibiotic drops prescribed by
your physician immediately after your eye patch has
been removed.
2. Wear the
plastic eye shield when sleeping for the first 7
days following surgery. The shield should be worn
for the first 3 days following surgery when
showering.
3. Avoid bending,
stooping, lifting objects over 5 pounds, or any
strenuous activity for one week (unless directed
otherwise by your physician).
4. Take Tylenol
E.S. or gently apply ice compresses to the eye to
relieve mild discomfort.
5. Follow any
special instructions given by your physician for
head positioning (this is not necessary in all
cases).
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