What is Vitrectomy? Pars Plana Vitrectomy
Eye related diseases can be split in two subjects. The front part of the eye and the back. At the front, there is the cornea and the lens, and the Vitreous and Retina at the posterior part. The front part of the eye transmits the image to the posterior part. However, the posterior part completes the “seeing” by transmitting everything to the brain.
Vitrectomy, also known as Pars Plana Vitrectomy surgery, is the name of the surgery which performs holes smaller than 1mm on the retina and the gel at the posterior part.
On Which Diseases Can Vitrectomy be Applied?
Vitrectomy application has many causes. This procedure is performed almost in every vitreous - related conditions. Most significant reasons for Vitrectomy are: Diabetic Retinopathy (Advanced pathologies in diabetes patients), Vitreous Bleeding (Intra ocular bleeding), Macular Pucker, Retinal detachment and tears (ruptures of nerval system of the eye), macular holes, removal of a foreign object (post traumatic), post cataract operations (lens complications in), intra ocular infections after cataract or other eye surgeries.
How is Vitrectomy Performed?
It might be performed both under general anaesthesia or local. Vitreous chamber and retina are reached via 3 holes of 0.5 mm created on the eye wall.
After the intra ocular gel (vitreous) is cleaned via a probe which performs 1500 – 6000 incisions per minute, interventions are performed in order to correct the problems on the retina.
After the Operation
Depending on the type of the condition or the surgical intervention, gas or silicone oil might be injected into the eye, so you might be recommended to lie or sleep in a certain position.
If gas is injected into the eye, it is not recommended to fly for a while.
It is necessary to remove the silicone oil after 2-6 months if it is used.
You get discharged shortly after the vitrectomy procedure.
You might have discomfort, burning or stinging feelings or feel itchy. Those are normal and expected.
In order to protect your eye from traumas or environmental affects, it is recommended to wear a protective bandage for a few days or a week.
Vitrectomy without stiches provides a shorter healing period, decreases the irritation on the eye surface and increases the patient comfort.
Anatomical healing and improvement on the eyesight is directly related to the damaged on the sensitive structures of the eye before the operation.
The results are very positive if the retina is not affected in the presence of intra ocular bleedings.
The results are expected very positive if the central retina is not affected.
Posterior Vitreous Detachment
The eyeball is filled with a transparent gel-liquid called vitreous. Mostly, the vitreous loses its form and consistence age relatedly. This loss of consistence causes the vitreous to detach from the posterior wall. This is called Posterior Vitreous Detachment. It is mostly caused by age, traumas, myopia, inherited conditions or former eye surgeries.
What Are the Symptoms of Posterior Vitreous Detachment?
Flying dots, objects, spiderwebs when looking at bright white surfaces
Flashing lights (both when eyes closed and open)
Posterior vitreous detachment and retinal detachments are not the same. The risk of retinal detachment increases during the appearance of posterior vitreous detachment, especially in first 12 months. Because of that, a patient with the symptoms of posterior detachment should definitely have a retinal examination.
Intraocular fluid leaks through the retinal tear, between the eyewall and the retina. As a result of vitreous fluid shrinking, this liquid leaves the posterior eye wall. This is called the posterior vitreous detachment.
During the formation of the posterior vitreous detachment, tears might occur on retinal nerve layers. Symptom of the retinal detachment and posterior vitreous detachment are nearly the same. After the retinal tear, the intraocular fluid leaks between the retinal and the eye wall and causes to retinal detachment.
What Are the Symptoms of Retinal Detachment?
These symptoms are:
Flashing lights when the eyes are closed and open (just like the vitreous detachment).
Appearance of dots in the vision.
Gray and black tint in the visual area.
Blurred vision or visual impairment which also stays after blinking.
Treatment of Retinal Detachment
A surgical intervention is needed if the retinal detachment is developed. The surgical method depends on the number of the retinal tears, the width, the shape and the timing.
Scleral Buckling Method
It is the oldest method used in detachment surgeries. A hard silicone material is placed on the outer wall of the eyeball, the buckling is applied so the retinal tear is closed. After that, the retinal detachment fluid is suctioned by the eye and the healing is completed.
Vitrectomy might be needed if the tears are multiple, big, dispersed or if there are other conditions of the eye (internal bleeding etc.), or if it’s been a long while after the tears occurred. Retinal detachment is intervened from the inside of the eye in this procedure. Small holes are opened on the eyeball, vitreous fluid is suctioned by the probes and aspiration equipment. The tears are closed, and laser treatment is applied. A tampon material is needed for the torn area to stick back together after the laser treatment. This tampon material can be air-like gases or silicone oil. The patient will need to use a protective eye drop after the operation and lie down with a certain head position.
Who Should Have the Examinations for Retinal Tears and Retinal Detachments?
If there are sudden appearances of flying objects in the vision or flashing lights, an examination of retinal tear is definitely a must. Or if the following symptoms are present:
• High degree myopia
• After heavy traumas
• Cataract or eye surgeries before
• Retinal tears in the family
• Retinal operations in the family