VITREOUS SURGERY

There are many patients who lose vision due to clouding of the normally transparent vitreous gel or the development of scar tissue in the eye. Techniques have been developed to permit surgical treatment of these conditions. This page will provide a basic understanding of vitreous surgery.

What is vitreous?
Vitreous gel is a clear, jelly-like substance that fills the inside of the eye. The retina is the nerve tissue that lines the back of the eye. The retina is lik the film in a camera that “sends a picture” to the brain. Because the vitreous gel is normally clear, light rays are able to through it to reach the retina. However, any change in the consistency, color or structure of the vitreous can interfere with the transmission of light to the retina, causing visual symptoms.

When would vitreous surgery be recommended?
Vitrectomy, or removal of the vitreous gel, is most commonly recommended for two conditions:
• Clouding of the vitreous gel
• Scar formation on the retina

Clouding of the vitreous gel is typically caused by bleeding due to diabetes, trauma, or blockage of a blood vessel. Scar tissue can develop in association with the bleeding, but can form in other conditions, such as inflammation or infection and even after minor injuries to the eye. Scar tissue may also occur in an otherwise healthy eye, as a result of posterior vitreous detachment (PVD), a normal aging change in the eye.

What is involved in Vitrectomy surgery?
During Vitrectomy surgery, the surgeon uses a fiber optic light, inserted through a tiny incision, to illuminate the inside of the eye. A special instrument is used to cut and vacuum the vitreous and remove blood or scar tissue with the vitreous. The surgeon also will utilize other instruments, such as forceps and scissors, when required for the surgery. The surgery takes from one to four hours to complete, depending upon the complexity of the individual case. The surgery is usually performed under local anesthesia An anesthesiologist is always present in the operation room to monitor EKG, blood pressure, and breathing, and to administer sedatives to ensure the comfort and relaxation of the patient during the surgery. An assistant surgeon may also be present during surgery. You may receive a separate bill from this physician’s office.

Will any special medial exam or tests be needed before surgery?
It may be necessary to consult with an internist before your surgery to make sure you are in satisfactory condition for the operation. Blood tests, an electrocardiogram and chest X-ray may be ordered. Our office staff will make the arrangements for these tests with the hospital. A separate bill will be sent by the doctor, lab or hospital where these services are performed.

Are there any special instructions for the day of surgery?
On the day of surgery, do not eat or drink anything unless specific instructions are given to the contrary. Do take your regular medications the day of surgery with a sip of water. If you take Insulin, ask about instructions for the day of surgery.

What should I expect after surgery?
The eye that has been operated on will be covered with an eye patch. Some degree of discomfort is to be expected, but Tylenol or Advil is usually sufficient to relieve it. Call the office if the pain is more severe. Most patients are discharged within a few hours following the surgery. An office appointment will be scheduled for the day following the surgery.

How much vision will I get back?
Following successful vitreous surgery, vision will be quite blurred at first and improve very gradually over a period of many months. Just how well you will be able to see depends upon the complexity of the problem before surgery. Be patient with your eyes and do not expect too much too soon!

DISCHARGE INSTRUCTIONS:

Appointment
An office appointment will be scheduled for the day following surgery.

Medications
Eye drops will be prescribed the day after surgery. The typical drops are:
ATROPINE - Used to keep the pupil dilated—helpful while the eye is healing.
ZYMAR - An antibiotic used to protect against infection.
PRED FORTE - A steroid used to decrease inflammation.
You may need additional drops or ointments depending on you individual case.

Head Positioning
If a gas bubble was placed in the eye during surgery, it may be necessary to keep your head in a given position for several days. Your physician will give you specific instructions if this was part of your surgery.

Infection
Your eye will be red, watery and uncomfortable when you leave the hospital. This will clear up over 2-3 weeks. If the redness worsens, the discharge becomes yellow or green, and/or the eye becomes very painful, contact our office so you can be checked immediately for infection.

Loss of Vision
Vision will be poor immediately following surgery and should then show gradual improvement. Any sudden and severe drop in vision form its level immediately following surgery should be promptly reported and evaluated in the office.

Patch
In most cases, the patch is necessary for only one day after surgery. However, if the patient feels more comfortable wearing a patch, it is not harmful to wear the patch for more than one day..

We hope this information is helpful in understanding Vitrectomy surgery. Please do not hesitate to call with any additional questions or concerns.

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