vitrectomy


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Vitrectomy

 

Definition

Vitrectomy is the surgical removal of the vitreous (transparent gel that fills the eye from the iris to the retina).

Purpose

The bulk of the contents of the eyeball is a clear jelly-like substance that is susceptible to several afflictions that impair vision by damaging its transparency.
  • Infections
  • Injuries
  • Bleeding, particularly from diabetic retinopathy
  • Blood vessels growing into the vitreous, again due to diabetes.
The retina is the light-sensitive membrane that receives images and transmits them to the brain. It covers the inside of the back of the eye. On occasion the retina will fall into the vitreous, a condition called retinal detachment. This may be due to disease in the vitreous that pulls the retina inward, small tears in the retina that allow liquid to seep behind it and push it forward, or injury to the eye that simply breaks the retina loose. It may be necessary to remove the vitreous in order to replace the retina and restore vision.

Description

Using instruments suited for microscopic surgery, the ophthalmologist (eye surgeon) penetrates the eyeball, aspirates the vitreous, and replaces it with saline. The saline replaces the vitreous at a constant pressure in order to keep the eye from collapsing. Once the saline is in place, both eyes are patched. The procedure takes two to three hours to complete.

Preparation

Because this is a major operation on the eye, the surgeon will perform a very extensive evaluation of both eyes. After looking inside with a variety of lenses, a CT, MRI, or ultrasound study may be needed. Immediately prior to the vitrectomy, the pupils will be dilated.

Aftercare

Eye drops and antibiotics are administered, and eye rest is advised until healing is completed.

Risks

Risks associated with vitrectomy are retinal detachment, bleeding, iatrogenic (medically caused) cataracts, and endophthalmitis (inflammation of the eyeball).

Normal results

Vision is restored to useful levels in two-thirds of patients.

Resources

Books

O'Malley, Conor. "Vitreous." In General Ophthalmology, edited by Daniel Vaughan, 13th ed. Stamford: Appleton & Lange, 1993.

Key terms

Computed tomography (CT scan) — Computerized method of creating images of internal organs using x rays.
Diabetic retinopathy — Disease that damages the blood vessels in the back of the eye caused by diabetes mellitus.
Endophthalmitis — Inflammation of the eyeball.
Iatrogenic — Inadvertently caused by medical treatment.
Magnetic resonance imaging (MRI) — Computer ized method of creating images of internal organs using magnetic fields.
Saline — A salt solution equivalent to that in the body—0.9% salt in water.

vitrectomy

 [vĭ-trek´tah-me]
surgical removal of a diseased vitreous of the eye. Vitreous strands are cut with a specially designed infusion cutter that delivers a physiologic solution (e.g., Ringer's solution) to maintain intraocular pressure, and withdraws the diseased vitreous by suction. Almost half of all vitrectomies are done for the treatment of diabetic retinopathy in order to prevent blindness. It also may be done for treatment of vitreous hemorrhage due to other causes, such as penetrating injuries to the eye, hemolytic glaucoma, central vein occlusion, and some forms of retinal detachment.

vi·trec·to·my

(vi-trek'tŏ-mē),
Removal of the vitreous by means of an instrument that simultaneously removes vitreous by suction and cutting, and replaces it with saline or some other fluid.
[vitreous + G. ektomē, excision]

vitrectomy

(vĭ-trĕk′tə-mē)
n. pl. vitrecto·mies
Surgical removal of the vitreous humor from the eyeball.

vitrectomy

Ophthalmology A procedure in which the vitreous is removed to operate on the retina. See Diabetic retinopathy.

vi·trec·to·my

(vi-trek'tŏ-mē)
Removal of the vitreous by means of an instrument that simultaneously removes vitreous by suction and cutting and replaces it with saline or some other fluid.
[vitreous + G. ektomē, excision]

vitrectomy

An ophthalmic operation to remove part or all of the VITREOUS BODY of the eye.

vitrectomy 

Removal of the whole or a portion of the vitreous humour and replacement by saline or, more commonly, silicone oil. Indications for this surgical intervention include persistent vitreous opacities (usually as a result of unabsorbed haemorrhage), severe penetrating trauma, luxation of the lens, retention of some foreign bodies which cannot be removed with a magnet, endophthalmitis, and especially advanced diabetic eye disease such as proliferative retinopathy to prevent retinal detachment because the fibrovascular network of the retina tends otherwise to adhere to the vitreous body. See intravitreal injection.
References in periodicals archive ?
In one study, 3.3% of eyes undergoing 23-gauge vitrectomy experienced transient hypotony on first post-operative day.6 In another study, 66 eyes were operated with 23-gauge vitrectomy, out of which post-operative hypotony occurred in 2 eyes.7 Frequency of post-operative hypotony is 3.3%.6 Unlike internationally made sophisticated instruments, we use locally made re-usable and cost-effective instruments in our setup, therefore we assume that there may be higher frequency of hypotony in our clinical practice.
It can be caused by many factors amongst which intraocular surgery and pars plana vitrectomy accounts for a significant proportion of cases.
Cataract development is one of the most common complications after vitrectomy.1,7 In the adult population, the reported incidence of new or progressive lens opacities after vitrectomy ranges from 12.5% to 80% for nuclear sclerotic cataracts and 4% to 34% for posterior subcapsular cataract.8,9 The risk factors for the development and progression of cataract include intraoperative lens touch, silicone oil or gas injection, intraoperative perfusion and postoperative inflammatory response, etc.10,11 In order to correct post-vitrectomy cataracts, phacoemulsification combined with intraocular lens implantation is usually performed.
However, due to small study group and short follow up further studies with longer follow-ups are required to establish the long-term changes in corneal dioptric power after 23G suture less vitrectomy.
In group 1 patients, triamcinolone-assisted anterior vitrectomy was performed after this procedure and the foldable IOL was placed in the bag between the cohesive viscoelasticfilled anterior and posterior capsule.
Patients were included who consulted the Chinese PLA General Hospital between January 2013 and May 2017, underwent transconjunctival 25-gauge pars plana vitrectomy for the treatment of an idiopathic macular hole, and were followed up for 6 months or longer.
Typically, a vitreous sample is acquired for cultures and PCR, IVABs are administered, and, in severe cases, pars plana therapeutic vitrectomy is performed [4, 9, 11].
To the best of our knowledge, no well-designed controlled studies evaluating the long-term changes in RNFL thickness after vitrectomy in patients with OAG have been reported thus far.
In this study we aimed to evaluate PCO status and treatment required due to PCO obscuring the optical axis in patients 4-12 years of age who underwent pediatric cataract surgery without posterior capsulotomy or anterior vitrectomy.
The quest to find new ways to shorten surgical time and minimize trauma to the eye led to the development of 20G sutureless technique by Chen et al in 1996, (4) where a tunnel incision is used instead of a stab incision used in Conventional 20G vitrectomy and there by incision is made self-sealing and left without sutures.
Vitrectomy may also be combined with this procedure to relieve any fraction, which threatens the macula, and to remove blood from any previous vitreous haemorrhage