What is retinal Surgery (vitrectomy)?
Vitrectomy (retinal Surgery) is a surgical procedure in which the vitreous gel that fills the eye cavity is removed by specialists to provide better access to the retina. In this way, various repairs can be made on the eye. For example, removing scar tissue, such as laser retinal detachment repair and macular holes treatment. After the surgery is completed, to keep the retina in place, the vitreous gel can be injected with saline, gas bubbles or silicone oil.
When explaining eye-related diseases, the eye is divided into two parts, the anterior segment and the posterior segment. In the front of the eye are the cornea and lens, while in the back are the vitreous body and the retina. The part that performs the main visual function of the eye and transmits nerve messages to the brain is the back to the eye. Vitrectomy is the name of the surgery that is performed on the back of the “vitreous fluid” on the retina with the help of special tools by making incisions smaller than 1 mm.
How is vitrectomy surgery performed?
vitrectomy surgery Performed using local or general anesthesia? The pupil is entered and then into the white part of the eye by 3 trocars, approximately 0.5-1 mm in size, to clean the vitreous body, where this entire process is done under a microscope.
In what cases is a vitrectomy preformed?
In cases, a vitrectomy is preformed:
- Diabetic retinopathy (associate with diabetes)
- Vitreous hemorrhage (bleeding inside the eye).
- Macular creases (the fold in the visual center).
- Retinal detachment and fissures (tears or break in the layer of the nerve of the eye).
- Macular hole (hole in the visual center)
- Removal of foreign bodies from inside the eye (as a result of eye injuries).
- After cataract surgery (or what is called white water).
Purpose of vitrectomy surgery?
if the vitreous is infected, inflamed, floated with blood, or filled with pieces of tissue, a vitrectomy can be performed. Vitrectomy can also help your doctor treat conditions that can affect the retina or inside the eyeball, for example: bleeding inside the eye, eye infections (endophthalmitis) cataracts (or what called white water) wrinkles, tears or injuries in the retina: a tear in the retina that occurs when the retina detaches from its normal place and moves inside your eye: a serious accident or injury to the eye, complications of diabetes cause damage to the retina. This happens when the tissues of the retina are damaged, resulting in a macular hole. Even if you are over 60 years old, the success rate of vitrectomy is about 90 percent.
Retinal Surgery (Vitrectomy) in which cases is it recommended?
five main reasons for performing a vitrectomy, in addition to other causes are:
- Vitreous opacity that obscures vision (blurring).
- Diseases resulting from the abnormal shrinkage of the retina
- Cases requiring retinal surgery or other eye surgeries
- Diagnosing a disorder of the retina and the vitreous body (diagnostic vitrectomy)
- Putting a device for the purpose of treatment or giving medicine.
In what cases should a vitrectomy be performed?
Vitrectomy is generally preformed in diseases, in which the pupil and the part behind the lens are affected. This means in some cases of retinal diseases, which are:
- Retinal Detachment
- Macular hole
- Bleeding associated with diabetes and retinal diseases (Diabetic Retinopathy)
- Formation of a membrane on the surface of the retina (ERM)
- Complication of cataract Surgery (Complications of white-water surgery)
- Uveitis related to the blurring of the vitreous is done in such diseases.
The gel was cleaned and the surgery was completed, dose the gel form again or is it replaced with a second substance?
The gel was cleaned and the surgery was completed. Is the gel material formed again, or is it replaced with a second substance after cleaning the gel? It is not possible to form again. At the end of the operation, a liquid /air/ gas or silicone is left inside the eye. Over time, the fluid produced by the eye replaces the remaining substance in the eye, 1 week for air and 2-8 weeks for gas, as for the silicone, it does not disappear in the eye and a second surgery is required to remove it.
The patient who will undergo a vitrectomy and also has a cataract, can this be done in the same session?
If the patient suffers from cataracts in the eye and prevents seeing the back of the eye, it is very necessary to perform cataract surgery in the same session. If the cataract disease is mild and dose not prevent vision cataract surgery can be preformed in a second session. However, since the progression of cataract disease will accelerate after vitrectomy surgery, some surgeons may prefer to perform the operation in the same session even if the cataract disease is mild.
We talked about putting gas and silicone inside the eye, so what are their advantages and disadvantages?
The gas that is placed in the eye will be absorbed over time, and no second surgery is required. But, as long as there is gas in the eye, the vision will be blurry. In addition, when gas is introduced to the site of the disease, a suitable head position will be required for the operation site. If the position is not applied to the head properly, the disease may recur. In addition, the person who has gas in his eyes should not lied on his back, or climb to a great Hight and cannot board the plan because it could cause the anterior part of the eye to be infected (eye cataracts).
Silicone, since it is transparent, dose not impair vision. When a person boards the plane, it dose not require a specific head position and can be left in the eye for long periods. Silicone in some serious diseases or people who cannot maintain a certain position of the head must be removed and a second surgery is required. This is an additional burden. Over time, silicone structure weakens and can cause pressure on the eye that can cause damage to the lens and cornea, usually causing cataracts. Cataract surgery can be performed while treating the eye with silicone.
It is preferable, if possible, to use gas.
What are the risks of a vitrectomy surgery?
It is a successful surgery with a high success rate and a few complications. However, it dose carry some risks. The most common complications are developments in cataract disease. Apart from that, complications such as bleeding appear. Infection, increased intraocular pressure, disease recurrence, retinal tearing, and retinal light damage. However, these problems are rare and less harmful than the disease for which the patient underwent surgery.
When dose vision improves after surgery?
The most difficult surgery for Ophthalmologists to predict vision after surgery is a vitrectomy. The anatomical success of the surgery is to return the eye tissue to the shape it should have, and this is usually provided. However, career success can almost be considered as an increase in the level of vision, which can only be understood after a certain period of time in the process. Of course, it also relates to how sensitive structure that provide preoperative functional success are affected. If the damage to the retinal tissues before the operation is small, the increase in vision after surgery can be achieved at a very high rate.
What are the things that should be taken care of after vitrectomy surgery?
- After the operation, the eye must remain closed for the next day until consulting the doctor, and it must remain closed unless the doctor said otherwise.
- The water should not touch the eyes for a week, and when taking a shower, the body should be washed only from the neck down.
- The eye should never be touched or wiped.
- Medicines prescribed after the operation should be used in an organized manner as per the prescription.
After the operation, tingling and burning is normal for one to two weeks (if you feel severe pain, consult your doctor).
- After the operation, the position of the head is important and must be learned from the doctor by asking how to lie down and how long he must lie down for and to stay in the specified position.
- If gas is injected into the eye, normally for vision will be weak.
There may be a noticeable black shadow in front of the eye. Depending on the type of gas injected, it remains in eye for 2-6 weeks and it is normal for it to block vision during this period. Patients who carry gas in their eyes are not allowed to travel by plane, other means of travel should be preferred until the gas is completely gone: this period may last between two weeks to two months after the operation, depending on the nature of the gas given for any reason, if you need general anesthesia (in emergency situation), the anesthesiologist must be informed of the presence of gas in the eye to choose the appropriate anesthesia. After gas removal there is a slight risk of retinal detachment of re-bleeding. If silicone oil is injected into the eye, it is usually left in the eye for 3-6 months and then a new surgery is performed to remove it. The silicone structure after a while is likely to weaken and damage the eye (eye redness, increased intraocular pressure, etc.). it is absolutely necessary to check it at regular intervals. It must be taken into account that the risk of retinal detachment after silicone removal may recur.
After vitrectomy surgery?
After vitrectomy surgery in the first days, eye discomfort, pain, redness, and tingling are the usual and expected situation. If the retina is not affected by intraocular hemorrhage, the results are very positive. Especially in cases where the central retina is not affected, vision can reach better levels after the operation. Depending on the type or severity of the disease in your eye, serum, gas, or silicone oil is placed in the eye during the surgical intervention. Sometimes patients are asked to lie in certain position for a period of time after surgery.
In vitrectomy, it is not appropriate for patients who have had gas put into their eyes to travel by plane until the gas has been absorbed. Usually after placing silicone oil in the eye, it can be removed 3-6 months after placing the silicone in the eye. With Non-surgical vitrectomy, the recovery period and the operation time are shortened. The irritation of the ocular surface is reduced and the patient’s comfort is increased. After vitrectomy, you can go home in a very short time.
After vitrectomy, what are the things that the patient should pay attention to?
- The eyes should not be wiped with unclean tissues, paper towels, etc.
- Eyes should not be pressed
When leaving the hospital, the patient should pay attention to the use of medicines for a period of time, and for how long they should be used, and must be taken into account not to neglect it after leaving the hospital. Some pain and a feeling of tingling in the eye can be considered normal. When you feel pain, the pain relievers recommended by your doctor will help you. They will help you about the type of substance that is injected into the eye (eg. Air,gas,silicone). Information must be obtained from the doctor. Depending on the type of substance given, healing times may be different. If gas is injected into the eye, it is normal to feel black in front of the eye. The injected gas remains in the eye for 2-6 weeks, depending on the type, and it is normal to block vision during this period. Within the specified time, gas absorption will be complete and vision will improve, as the position of the head is important after the operation. You should learn from your doctor how and for how long to lie down and be careful to stay in the recommended position.
In emergency cases for any reason, if general anesthesia is required for the person, the anesthesiologist must be informed of the presence of gas in the eye and the appropriate anesthetic substance must be selected accordingly.
A vitrectomy is able to treat many eye diseases, it is a low-risk procedure and has a high chance of success. Even if you are over 60 years old, the success rate of vitrectomy is about 90 percent. In some cases, if substances or blood in the vitreous cause blurred or blurred vision, this may improve your vision. Before having this procedure talk to your doctor about what to expect from your ability to see.
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