What is a vitrectomy?

A vitrectomy operation is microscopic keyhole surgery on the eye. Usually 3 tiny keyhole
sites are made on the white of the eye. Through these keyholes microscopic instruments enter the back part of the eye, called the vitreous cavity. This enables the surgeon to perform surgery to the parts of the eye such as the retina, vitreous gel, and in special situations the lens, cataract or
intraocular lens implant.

What is it like to have a vitrectomy?

Surgery is usually performed as a daycase - this means you come and go the same day without
an overnight stay. Surgery usually lasts around one hour, but this varies depending on the reason for surgery. It can be as quick as 30 minutes or over 2 hours. On the day of surgery, you arrive at the admission ward and have eye drops to enlarge your pupils. A series of health and safety checks are performed. You will have a mark placed above your eye confirming the operation side and you will sign a consent form as final agreement to proceed with surgery.

After these checks you are taken to the treatment room for the anaesthetic (making the
eye comfortable) and then the operation takes place. During the operation you are lying on a bed with a sterile tent covering your face. The tent is air conditioned and sticks to the eyelids of the eye having surgery. You cannot really see or feel much during surgery. Some people describe seeing coloured lights, rainbows or even fireworks. Afterwards you return to the ward to prepare to go home. You will be given eye drops to take home and any extra care advice for your first week at home. Usually you will have a pad covering the eye, which you can remove at home the following morning.

What anaesthetic will I have?

This is discussed in clinic before surgery. Surgery is frequently performed ‘under local anaesthetic’. This involves having the eyeball numbed with an anaesthetic given around the eyelid, this is an injection through the skin. Sometimes, in addition to local anaesthetic a sedative can be given to help relax you. In this situation, you are still awake and can talk and hear voices but you might
not have a clear memory of the operation. Surgery can be performed whilst asleep, known as ‘general anaesthetic’- this is subject to additional health checks. With general anaesthetic you must not eat 6 hours before surgery and you can only drink clear fluids (no milky drinks) after this
time. You cannot eat or drink 2 hours before surgery when having general
anaesthetic.

Will I have stitches after my operation?

The keyhole sites can close up without a stitch, however about half the operations
performed will have a ‘dissolving stitch’ placed to securely close the keyholes.
Stitches dissolve in the first 2 months after surgery, they can be seen under
the eyelid as red spots which is the evidence the body’s immune system is
‘dissolving’ the stitch. Stitches can give a gritty feeling in the eye. Eye drops are used after surgery for one month which should help this discomfort.

Using temporary intraocular gas

Depending on the reason for undergoing vitrectomy, a gas may be put inside the eye during
the operation. Gases are temporary and may last for a couple of weeks or up to 3 months. Gases are used to support the retina in the recovery period after surgery. The retina is the nerve tissue inside the eye that detects light and sends the image to the brain- similar to a camera film (or digital chip) inside a camera. It is difficult to see through gas. The bubble slowly shrinks downwards during the
weeks of recovery. This often affects work and the ability to drive. You cannot fly in aircraft whilst gas is in the eye due to pressure changes in the gas bubble that could blind your eye. Additionally you cannot have any anaesthetic involving nitrous gases whilst gas is in your eye. These anaesthetic gases dissolve into the gas bubble in your eye and change the pressure which could blind the eye.

If you have gas in the eye you will have a medical alert bracelet on your wrist after surgery. This is in case of a medical emergency attending doctors will be alerted to the presence of gas in your eye and avoid the use of nitrous gases in any anaesthetic required. This bracelet can be removed once the gas has disappeared.