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At a glance
- A vitrectomy is keyhole surgery to remove the vitreous gel from inside the eye, giving the surgeon access to repair the retina.
- It treats conditions such as retinal detachment, macular hole, bleeding in the eye and advanced diabetic eye disease.
- The eye is often filled with gas or oil to help the retina heal, which affects vision temporarily.
- Recovery may involve specific head positioning and takes several weeks.
What a vitrectomy is
A vitrectomy is an operation to remove the vitreous — the clear jelly that fills the back of the eye. Taking this gel away creates space and a clear working area, so that a retinal or vitreoretinal specialist can reach the retina at the back of the eye and repair problems that would otherwise be hidden or out of reach. It is a common and well established procedure that has become the mainstay of surgery for many conditions affecting the back of the eye. In Singapore it is carried out by an eye specialist with vitreoretinal training, at centres such as the Singapore National Eye Centre and in the ophthalmology departments of public and private hospitals.
Why a vitrectomy is done
The vitreous is a clear gel filling the back of the eye. In some conditions it pulls on the retina, fills with blood, or blocks the surgeon’s access to a problem. Removing it allows repair of a detached retina, closure of a macular hole, clearing of vitreous haemorrhage, or treatment of scar tissue in diabetic eye disease.
A vitrectomy may be advised for a range of conditions at the back of the eye. Common reasons include retinal detachment, where the retina has lifted away from the wall of the eye; bleeding into the vitreous, for example from advanced diabetic eye disease; a macular hole, which is a small gap in the central retina; and a macular pucker, a fine membrane that forms over the central retina and distorts vision. It is also used to remove scar tissue that tugs on the retina, to treat infection inside the eye, and in some selected cases to clear very troublesome floaters. Your surgeon will explain why the operation is being recommended for your particular condition.
How the surgery is done
A vitrectomy is usually carried out through several tiny openings in the white of the eye. Fine instruments are passed through these openings to remove the vitreous gel and to deal with the underlying problem — for example reattaching the retina, peeling away scar tissue or a membrane, or applying laser. The operation is done under local anaesthetic, with the eye numbed and the patient awake but comfortable, or sometimes under general anaesthetic; it is often performed as day surgery, so many people go home the same day.
Once the gel is removed, the surgeon replaces it with a substitute to support the eye and the healing retina. This may be a clear saline-like fluid, a gas bubble, or silicone oil, and the choice depends on the condition being treated. The eye makes its own natural fluid to replace saline over time. A gas bubble is gradually absorbed by the body on its own, while silicone oil is usually removed later in a separate minor procedure. Any retinal repair that is needed is carried out during the same operation.
Positioning, gas bubbles and air travel
When a vitrectomy is used to repair the retina, the eye is often filled with a gas bubble or silicone oil to hold the retina in place while it heals. If a gas bubble or oil is used, you may be asked to keep a specific head position — sometimes face-down — for a period, which is known as posturing and can be important for the repair to succeed. Your surgeon and nurses will show you how to hold the position and for how long.
A key safety point applies while a gas bubble remains inside the eye. You must not travel by air, and you must not go to high altitude, until the gas has been absorbed, because the fall in surrounding pressure can cause the bubble to expand and dangerously raise the pressure inside the eye. For the same reason, certain anaesthetic agents must be avoided while gas is present, so it is important to tell any doctor, dentist or anaesthetist that you have a gas bubble in your eye. Your surgeon will tell you when the gas has gone and when it is safe to fly again.
Preparing and what to expect
Before surgery you will have an assessment of your eye and general health, and the team will explain the plan, the type of anaesthetic and the substitute that is likely to be used. You may be asked about your usual medicines, and you will be given instructions about eating and drinking beforehand if a general anaesthetic is planned. It is helpful to arrange for someone to accompany you home, as your vision will be blurred and the eye will be padded or shielded at first. On the day, drops are used to widen the pupil and numb the eye, and the surgery itself is generally not painful.
Recovery
After a vitrectomy the eye is often a little red, gritty or sore for a while, and you will be given eye drops to prevent infection and to settle inflammation; using them as directed is an important part of healing. You will be advised to avoid rubbing or pressing the eye and to avoid heavy lifting, strenuous activity and swimming for a period. Vision recovers gradually, and how much it improves depends on the underlying condition and how early it was treated. If a gas or oil bubble is present, vision stays blurred until the gas is absorbed or the oil is removed, and a gas bubble may be seen as a shifting line or dark shadow that slowly shrinks. Follow-up appointments allow the surgeon to check that the retina is healing and the eye pressure is normal.
Risks and complications
As with any eye operation, a vitrectomy carries some risks, and your team will explain the ones that are relevant to your condition. Possible complications include infection inside the eye, bleeding, raised eye pressure, and, uncommonly, a further retinal detachment that may need more treatment. A very common and expected change after vitrectomy, especially in older adults, is that a cataract develops or worsens over the following months; this clouding of the eye’s natural lens can be treated later with routine cataract surgery. Other less common problems can occur, and the surgeon will discuss the balance of risks and benefits before you agree to the operation.
Realistic expectations
Vitrectomy is highly effective for many retinal conditions, but it is important to understand that the final result depends on the underlying problem rather than on the surgery alone. When the retina has been damaged, or a condition has been present for a long time before treatment, vision may not return fully even after a technically successful operation. Where the aim is to stop vision getting worse or to preserve the vision that remains, that in itself can be a good outcome. Your surgeon will give you a realistic idea of what to expect for your own eye.
When to seek urgent help after surgery
Most people recover without serious problems, but some symptoms need prompt attention. Seek urgent eye care if you develop increasing pain in the eye, worsening or sudden loss of vision, a lot of new floaters or flashes, or a shadow or curtain spreading across your vision, as these can signal a further retinal detachment. Seek help too for signs of infection, such as increasing redness, swelling or discharge from the eye. And remember that you must not fly or go to high altitude while a gas bubble is still in the eye. If in doubt, contact your surgeon or an eye clinic without delay rather than waiting.
When to see a doctor
Retinal conditions are best treated early. Seek prompt assessment for sudden floaters, flashes, a shadow or curtain across your vision, or sudden vision loss, and consult an eye specialist experienced in retinal surgery.
Common questions
Will I need to keep my head in a certain position?
Sometimes. If a gas bubble is used — for example to close a macular hole — face-down or specific positioning may be needed for a period to help healing.
Can I fly after a vitrectomy?
Not while a gas bubble remains in the eye, as altitude changes can dangerously raise eye pressure; your surgeon will advise when it is safe.
Does vitrectomy cause cataract?
Cataract commonly develops or progresses after vitrectomy in older adults and can be treated later with cataract surgery.
Related conditions & guides
Sources
- Singapore National Eye Centre — vitreoretinal surgery.
- American Academy of Ophthalmology — vitrectomy.
- HealthHub Singapore — retinal conditions.
This article is for general information only and does not replace a consultation with a qualified eye-care professional. Please seek personalised advice for your own eyes.