Vitrectomy surgery
What a vitrectomy involves, the different types of tamponade (gas and oil), posturing, and what to expect after surgery.
What is a vitrectomy?
A vitrectomy is an operation inside the eye, performed through three small keyhole incisions in the white of the eye. The vitreous gel is removed as part of the surgical treatment of conditions such as retinal detachment, macular hole, epiretinal membrane, vitreous haemorrhage, and advanced diabetic eye disease.
Your eye does not need the vitreous gel and does not replace or regrow it. At the end of the operation, it is replaced with balanced salt solution, a gas bubble, or a silicone oil bubble.
Gas bubbles
Some vitrectomy operations require a gas bubble to hold the retinal layers together while sealing takes place. Because the gas always floats upwards, you may be asked to posture — positioning your head so the bubble presses against the right part of the retina.
There are different types of gas: shorter-acting SF6 (2–4 weeks) and longer-acting C3F8 (4–8 weeks). Vision will be very poor while the bubble is present, recovering gradually as it shrinks.
You must not fly or travel to high altitude while gas is in your eye. If you later need a general anaesthetic, you must inform the anaesthetist.
Silicone oil
For some cases — particularly complex retinal detachments, or when air travel is necessary soon after surgery — silicone oil is used instead of gas. Oil does not absorb on its own and requires a second small operation to remove it, usually after several months.
Anaesthesia
Most vitrectomy surgery can be done with local anaesthetic — an injection to numb the eye while you are awake. For patients who are unable to lie still or who prefer it, general anaesthesia or light sedation can be arranged.
Vitrectomy is usually a day-case procedure. You will be in hospital for a few hours and go home the same day.
After surgery
You will be given antibiotic and steroid drops for a few weeks. Follow any posturing instructions given. You can bathe or shower but avoid splashing water near the eye. Do not drive in the first few days. Contact the team promptly if you notice increasing pain, redness, or worsening vision.
Most people need at least two weeks off work, sometimes longer depending on the type of surgery.