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A vitrectomy is a surgery to remove vitreous humor, the clear gel filling the eyeball. In an anterior vitrectomy, small amounts of vitreous humor are removed from the front structures of the eye, while a pars plana vitrectomy is performed in the deeper part of the eye. There are a number of medical reasons for removing vitreous humor from the eye, including bleeding in the eye and vitreous floaters, deposits in the vitreous humor that affect vision. Vitrectomy is also sometimes performed as a preliminary step in more extensive eye surgeries.
Vitrectomy arose as a medical procedure in late 1969, when it was used to treat clouded vitreous humor, usually due to vitreous hemorrhage, or bleeding in the eye. The surgery became more sophisticated over the 1970s and 1980s, with the invention of smaller, more precise instruments and techniques. It also gained a wider array of applications, and became useful in the treatment of medial problems affecting the retina and lens.
The retina is the light-sensitive tissue covering the inner surface of the eye. Some disorders of the retina that can be addressed through surgery include retinal detachment, diabetic retinopathy, macular holes, and maular pucker. In retinal detachment, the retina becomes loose from the surface of the eye.
In both diabetic retinopathy and macular pucker, unhealthy tissues form on the retina. Diabetic retinopathy may lead to retinal detachment. Macular holes are caused by the natural shrinking of the vitreous humor as a person ages, which can cause pieces of the retina to tear away. All of these disorders cause problems with the vision, and all can be addressed with vitrectomy.
At its simplest, vitrectomy involves inserting small tools into the eye to suction vitreous humor out. It may be performed under local or general anesthesia. The surgery lasts about two or three hours. Typically, the surgery requires an overnight hospital stay, but the patient is sometimes able to return home right after the procedure.
Discomfort is common for up to a few days after the procedure, mainly due to swelling of the eye and eyelid. Ice compresses and acetaminophen can help address most pain associated with the surgery. If discomfort persists or is intense, contact a physician for advice.
In addition to removing vitreous humor from the eye, the surgery may include the injection of air, gas, or liquid silicone into the eye to help hold the retina in place. The surgery may also include scleral bucking, the placement of a band inside the eye to hold the retina in position. Removal of damaged or unhealthy tissues from the inner eye may also be performed, and laser treatment may be used to real macular holes or to shrink unhealthy blood vessels in the eye. Lensectomy, removal of the lens, may also be a part of surgery if the lens has cataracts or is attached to scar tissue.
Complications of vitrectomy include the formation of cataracts, pressure or bleeding in the eye, and less commonly, retinal detachment. Recovery typically requires the use of eye drops for several weeks, and the patient may have to maintain a certain head position during healing if a gas bubble is used to hold the retina in place. Flying and heavy lifting are not recommended during the recovery period. The likelihood of full recovery depends upon the reason for surgery, but a simple procedure to clear up blood or vitreous floaters usually results in a return of 20/20 vision.
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