What does vitrectomy surgery involve?

RetinaRest

Surgery for macular hole consists of a vitrectomy (removal of vitreous gel) and gas injection. The vitrectomy has two basic purposes: firstly to remove the structures that originally pulled on the macula and now hold the macular hole open, and secondly to make space for gas to be injected to help seal the hole.

This surgery is commonly performed under local anaesthetic as a day case. The local anaesthetic is the same as that used for cataract surgery and involves placing some anaesthetic drops being put in your eye, followed by the injection of anaesthetic fluid around your eye. You will be lying on your back throughout the anaesthetic and surgery.

After the anaesthetic has been given, iodine solution will be used to clean around your eye. After this a plastic sheet (drape) will be used to cover your eye and face. The surgeon and anaesthetist will ensure that an oxygen and air mixture can flow freely under this sheet and that you can breathe easily. A hole will then be cut in the drape over your eye and a special clip used to hold it open. The surgeon will then sit down and position a microscope above your eye and switch the light on. You may be able to see this light but it usually fades in a little while.

During the surgery itself, you will feel the surgeons hands on your forehead and, occasionally, on the bridge of your nose. You will hear the surgeon speaking to other members of theatre staff as well as various sounds made by the vitrectomy machine and, possibly, music. You may feel a trickle of watery fluid down the side of your face but, whilst uncomfortable, this is not dangerous.

Three tiny holes (ports) will be made in the white (sclera) of your eye, through which instruments are introduced into your eye. One of these has a constant flow of fluid passing into your eye and is known as the "infusion". One of the other two ports is used to place a fibre-optic "light pipe" into your eye, illuminating it from within; the third port is used for a variety of instruments. The first of these will be a "cutter" that is used to cut and remove the vitreous. Following this, other instruments such as a pair of forceps may be used to remove a membrane on the surface of the retina.

The next step will be to use a "flute" to replace the fluid within your eye with air. You may hear a whistling sound at this stage. The air will then be replaced by a long acting gas, either C3F8 or SF6, of a specific percentage, at the end of the operation.

The surgery is not painful but you should let your surgeon know if you feel pain. This is best done without talking as speaking makes your head (and eye) move. Your surgeon or anaesthetist will let you know how to signal this before the surgery. The surgeon can easily give you more anaesthetic straight away and this takes effect almost immediately.

The time taken for this surgery varies from 30 to 60 minutes; the time taken is no indication of how well the operation has gone. At the end of the operation you will have a pad and shield over your eye. Your surgeon will arrange for an appointment for you to return to the clinic within a few weeks of your surgery.