Vitrectomy

Microsurgery inside the eye

Overview

Vitrectomy is a surgical procedure in which the vitreous gel filling the back of the eye is removed, giving the surgeon access to the retina. Modern pars plana vitrectomy uses small gauge instruments inserted through the sclera, with a light pipe, an infusion line, and a cutter, and the technique was pioneered by Robert Machemer in the early 1970s. Indications include retinal detachment, macular holes, epiretinal membranes, nonclearing vitreous hemorrhage, complications of proliferative diabetic retinopathy, dislocated lens material, intraocular foreign bodies, endophthalmitis, and severe floaters. Membranes can be peeled from the retinal surface, sometimes made visible with dyes. At the end of surgery the eye may be filled with saline, a gas bubble, or silicone oil to hold the retina in place while it heals. Gas bubbles expand at low pressure, which is why they are incompatible with air travel and nitrous oxide anesthesia until absorbed. Cataract formation is a common later consequence in eyes that still have their natural lens.