Treatment

Vitrectomy Surgery

Most, but not all vitreoretinal surgery is performed with a procedure known as vitrectomy surgery.  Vitrectomy surgery as a procedure for removing the vitreous gel from the central cavity of the eye and replacing it with clear saline solution, which is very similar to the solution that the eye normally creates throughout life.  The vitreous gel is an embryological structure and can be removed without damage to the eye if it is involved with pathological conditions that can harm the eye.  There are a number of these conditions which are discussed separately.  However, the procedures have some things in common.

  • Almost all vitrectomy surgeries performed in adults are performed under local anesthetic, and usually in an outpatient operating room.  When the patient arrives an intravenous line is started and the patient is given a sedative prior to the local anesthetic.  Usually a retrobulbar block is performed.  This involves injecting local anesthetic into the orbit, or eye socket, which deadens the sensory nerves and usually the visual nerve as well.  Most patients are not aware of the injection because of the sedative used.  Although patient’s are awake for the procedure, they are not able to see or feel anything and frequently doze off.  However, this is not general anesthesia where a tube is placed in the airway and general anesthetic gasses used to keep the patient asleep.

  • Most procedures are less than two hours long, and oftentimes much less than one hour long, so prolonged anesthesia and sedation is rarely necessary in adults.

  • The procedure involves placing three, or sometimes four, cannulas through the sclera, which is the white part of the eye.  These cannulas are small tubes with a very small diameter, the size of a small gauge needle.  The cannulas are so small that stitching the wound is rarely needed when they are removed.  Through these cannulas are placed various instruments including a fiberoptic light pipe to illuminate the inside of the eye, infusion cannulas to keep the eye inflated with solution during the procedure, and other micro instruments to manipulate the retinal tissues.  These can include scissors, suction devices, cauterizing instruments, and grasping instruments.

  • The surgeon views the inside of the eye through a dilated pupil with a microscope during the surgery.

  • After the surgical procedure the cannulas are removed from thse eye and the eye is usually patched with antibiotic and anti-inflammatory ointment.

  • There is rarely any significant pain following the procedure since very small incisions are made.  Most patients have only very mild aching when the anesthetic wears off which is usually controlled well with Tylenol.

  • The postoperative patch is worn overnight and removed the following day for a postoperative examination.

  • Following this, anti-inflammatory and antibiotic eyedrops are used in the eye for several weeks.

Please see the video links which describe the various surgical procedures for specific disease conditions.

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