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), intermediate-acting C2F6 (4–6 weeks), and longer-acting C3F8 (6–8 weeks). The gas always floats upwards, so the type of gas chosen and the posturing position depends on where the retinal problem is. The principle is similar to pressing two wet sheets of paper between books until the glue dries — the bubble holds the retinal layers together until sealing takes place, usually over about 5–7 days. Vision will be very poor while the bubble is present, recovering gradually as it shrinks from the bottom of your vision upwards.
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.
Balanced salt solution
If neither gas nor oil is needed, the vitreous is replaced with balanced salt solution, which is gradually replaced by fluid produced naturally inside the eye. There are no posturing requirements and no restrictions on air travel or altitude.
Posturing after surgery
If a gas or oil bubble has been used, you will need to posture — keeping your head in a specific position so the bubble is in contact with the relevant part of the retina. You will be given clear instructions before discharge. Posturing is usually required for 45 minutes in every hour, with 15-minute breaks to move around, and must be maintained overnight as well.
The most common positions are face-down — I recommend an "eyes down" position, as if reading a book in your lap, rather than lying flat on your stomach — or cheek to the pillow on one side. Posturing aids such as horseshoe pillows can be borrowed or hired and make this considerably more comfortable.
Anaesthesia
Most vitrectomy surgery can be done with local anaesthetic — an injection using a blunt cannula or fine needle to numb the eye while you are awake. For patients who are anxious or unable to lie still, light sedation alongside local anaesthetic is a good middle option. General anaesthesia is also available where needed; this is decided with the anaesthetist looking after you.
How long does surgery take?
Vitrectomy is usually a day-case procedure taking 1–2 hours depending on complexity. You will be in hospital for several hours in total and can usually 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.
Eye pressure is checked in the days after surgery. Sometimes pressure is normal in the first 24–48 hours but rises in the following days — this may cause pain in and around the eye and will need a repeat check. High pressure usually responds well to additional eye drops prescribed for a few weeks.
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.