Repairing a retinal detachment with vitrectomy has become more popular. Vitrectomy can be viewed as fixing a retinal detachment from the inside of the eye whereas a scleral buckle fixes the retinal detachment from the outside.
Modern vitrectomy is comparable to cataract surgery in terms of safety. For many retina surgeons, this eye operation is faster and more efficient compared to other operation which may involve a scleral buckle (you can repair a retinal detachment with only a scleral buckle or combine vitrectomy with a scleral buckle).
For patients, vitrectomy can mean a faster healing period with fewer side effects.
All (rhegmatogenous) retinal detachments start with a tear or hole in the retina. The vitreous can pull on the retina and cause a tear. Sometimes pre-existing retinal holes can also cause a retinal detachment.
By removing the vitreous, the retina is allowed to more easily fall back into place. Usually this is done with the aid of a gas injected at the end of the case.
This gas replaces the fluid, called a fluid-gas exchange, both in the center of the eye and underneath the detached retina. Similar to pneumatic retinopexy, the gas must be positioned against the retinal tears/ holes, thus requiring certain head positioning after the surgery (e.g. face down, head tilted to the right, etc.).
While the retina is almost always attached at the end of the operation, the gas keeps the retina attached until adequate scarring takes place to seal the retinal hole or tear.
The key to fixing most retinal detachments is finding the retinal tear(s) and treating them with laser or freezing. This “seals” the tears and prevents redetachment from the same retinal tear.
Highly Effective – Vitrectomy is highly effective at repairing the retinal detachment. By removing most of the vitreous, traction on the original tears is decreased and additional tears are less likely.
Most Retinal Detachments – Vitrectomy can treat almost any retinal detachment (perhaps not a giant retinal tear), whereas pneumatic retinopexy can not treat detachments associated with “inferior” tears, that is, tears located between the 4 and 8 o’clock position of the eye (impossible to hold your head in such a way so that the gas abuts these tears).
Rapid Healing due to minimal surgical trauma. Very little cutting is required. In fact, with 25 gauge systems, there are no stitches. Compared to scleral buckle, vitrectomy is very, very gentle.
No Change in Refraction – the shape of the eye is not altered, therefore, there should be no change in your refraction. With a scleral buckle, the eye becomes elongated causing induced myopia and/or significant astigmatism.
Short Surgery – This is can be a very quick procedure for selected cases, requiring less than 30 minutes to perform.
There really are no disadvantages of vitrectomy. It can be used for almost any retinal detachment except with the possibility of giant retinal tears.
Head Positioning – Intraocular gas must be used with vitrectomy, thus, head positioning after surgery is mandatory.
Multiple Tears – vitrectomy alone may not be as good as vitrectomy combined with scleral buckle for multiple retinal tears, but I wouldn’t count this as a disadvantage.
When I use Vitrectomy to Repair Retinal Detachments.
I use vitrectomy for most retinal detachments. I especially like to use vitrectomy for small localized retinal detachments where additional holes or tears are unlikely.
Surgery is very “easy” on the patient with 25 gauge vitrectomy as the surgery is sutureless, thus, there is minimal or no discomfort. There is rapid healing and potentially fewer trips to the office.