Overview

A vitrectomy is a type of surgery used to repair retinal detachment. 

Problems of retinal detachment

Retinal detachment can cause your vision to become blurred and dim. Being treated quickly can often reduce the damage to your eye. If the detachment is not treated, your vision will probably get worse and you will lose all useful vision in the affected eye.

Success of a vitrectomy

This depends on how much of the retina is detached and for how long. The retina is permanently re-attached after 1 operation in 8 or 9 out of 10 of cases.

Sometimes 2 or more operations are needed. This happens in about 1 out of every 5 to 10 cases.

Your doctor will speak with you in more detail about what results you can expect from the surgery.

Risks associated with a vitrectomy

Like any surgery, there are some risks associated with a vitrectomy. 

We will explain these risks to you in more detail before you sign the consent form.

It is normal to be anxious. If you have any questions or concerns about the procedure you will have time at your pre-assessment appointment to discuss these with your surgeon.

The most common problems from this surgery are:

Failure to repair the retina

Another operation might be needed. Between 1 and 2 operations in 10 fail. Almost all retinal detachments can be repaired with more surgery, but sometimes this will not be possible and all sight can be lost in that eye. We can advise you more specifically when you sign the consent form.

Infection

Infection occurs in about 1 out of every 1,000 vitrectomies, and can be very serious. This is treated with antibiotic injections. 

High pressure in the eye

This occurs in about 1 out of every 5 to 10 vitrectomies and can cause pain and double vision. It is treated with extra eye drops.

Cataract

You have a slightly increased risk of developing cataracts in the long term. You might need surgery to treat this.

Risks during the surgery

If there are any complications during your surgery, the following problems can happen. Your doctor will discuss these with you in more detail.

• Bleeding in the eye
• Glaucoma (increased pressure in the eye)
• Inflammation
• Retinal re-detachment
• Wound problems (infection)
• Drooping eyelid
• Distorted vision
• Blurred vision

Other treatment options

Laser or freezing treatment is sometimes used if the problem is identified early. Your surgeon can speak with you about this in more detail.

Asking for your consent (permission)

We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This states that you understand what the treatment involves and you agree to have it. 

Read more about our consent process. 

Preparing for surgery

A vitrectomy is sometimes done under a general anaesthetic (medicine that causes you to be asleep). Other times it is done under a local anaesthetic which ‘freezes’ the area around your eye so that it is pain-free but you are awake.

Your surgeon and anaesthetist will speak with you about the risks and benefits of the different types of anaesthetic. 

You can also read our information about having an anaesthetic.

The doctor or nurse at the pre-assessment clinic will speak with you about any medicines you are taking and if and when you should take them before your operation.

If you are having a general anaesthetic

During a vitrectomy

Using delicate instruments, the surgeon will remove the jelly in your eye. They take particular care peeling the jelly away from your retina at the back of your eye. This leaves a space inside the eye which we put gas in.

The gas is inserted to help the retinal detachment heal in the correct place. The bubble floats upwards because the gas is lighter than the fluid which normally fills the back of the eye. The gas acts like a splint, keeping the retina in place while the hole or tear in the retina seals. This sealing of the hole occurs in response to either freezing or laser treatment, which is done as part of the operation.

The gas bubble is slowly absorbed by your body. Depending on the gas used, this takes either 10 to 12 days, or 6 to 8 weeks, after the operation. The gas bubble slowly gets smaller so that eventually it is no longer in the eye. As this happens, the space that was taken up by the gas is filled with aqueous fluid (the natural fluid made by the eye).

With the gas in place, the vision in your eye will be very poor, a bit like having your eye open under water. When the gas has been absorbed, your vision should improve.

If you have other problems with your eyes, such as cataracts, it is possible, and quite common, for these to be treated during the same operation. Your surgeon will give you more information on this. You can also ask for our information on the other conditions that are being treated.

After surgery

Your eye might be sore after the operation. When you wake up, your eye will be padded with a plastic protective shield taped over it. The pad and shield can be removed the day after the operation. 

You will have some vision in the eye which was operated on. It is very hard to predict how much because it depends on a lot of different things. Your surgeon will talk with you before the operation about what you should expect.

Leaving hospital

You can usually leave hospital the same day as the operation.

If you had a local anaesthetic for your surgery, you can expect to leave hospital about 1 hour after surgery.

If you had a general anaesthetic or sedation for your surgery, you can expect to stay in hospital for at least 2 hours after your surgery, until you are fully alert.

If you have had general anaesthetic you cannot leave the hospital unless a responsible adult is there to help you get home.

We sometimes suggest that you stay in hospital overnight after the operation.

This might be due to :

• other medical conditions that you have
• the type of anaesthetic you were given
• the amount of help you have at home 
• the long distance you have to travel home

You will also be given information about going home after your surgery, which has more detail about looking after yourself until you have fully recovered from the anaesthetic. It is very important for your safety that you follow these instructions.

Resuming your normal activities

The gas bubble will still be in your eye for 6 to 8 weeks after your surgery.

If you have a general anaesthetic for any reason during this time, you must tell your doctor and anaesthetist that you have recently had a vitrectomy and might still have a gas bubble in your eye.

Most people are aware of when the gas bubble has gone. You will be able to see it getting gradually smaller. It usually takes 2 to 8 weeks, depending on the type of gas used. 

For 6 to 8 weeks after your surgery: 

You should be able to continue most of your usual activities, including exercise and work, without damaging your eye. You will need to be very careful because your vision in the eye that was operated on will be poor. For example, stairs and kerbs might be difficult until your vision returns to normal

Caring for your eye after surgery

Eye drops

We will give you eye drops to take home. It is important that you use these as directed. One is usually a steroid to control the inflammation, and the other is an antibiotic to prevent infection. You might also be given drops or tablets to control the pressure in your eye.

Sleeping positions

You will need to sleep in a position where your head is to the side, so that you are resting your head on 1 of your ears. This is to make sure that the gas bubble is in contact with the retinal detachment as much as possible.

If you cannot lie on your side, you should sleep propped up with pillows so that you are at a 45 degree angle. If you move around a lot at night, some people have found it useful to sew a clothes peg onto the back of their nightclothes. This can stop you from moving onto your back while you are asleep. We can give you more information about this.

If you have concerns about sleeping positions, please talk to your doctor or nurse.

Day time posturing

As well as keeping your head in a certain position overnight, it might be necessary for you to spend several hours during the day with your head held still and in a specific position. This is called posturing. It will depend on your specific condition and the professional opinion of your surgeon. Some people will not need to do posturing at all.

If you need to posture after your operation, your surgeon and nurse will explain this to you. We will also give you instructions to take home.

Follow up appointments

You will need to return to the hospital the day after your surgery. This is so we can remove your dressing and examine your eye.

You will also be given an appointment to return to the hospital 1 to 3 days after the operation. This is to check that the retinal detachment is healing. We will often change the eye drops that you are using as well.

If you do not receive an appointment, or need to change it for any reason, please contact the eye department’s reception, phone: 020 7188 4311. 

When to get help

Your eye will feel sensitive and might be uncomfortable after the operation.