A vitrectomy is an operation to remove the vitreous humor, a clear, transparent jelly from inside the eye.  The vitreous humor is situated behind the iris, the coloured part of the eye and in front of the retina, at the back of the eye. It has no real function in the adult eye other than providing packaging inside the eye. 

What is a floater?

Floater results from aging changes in the vitreous gel. Such changes occur prematurely if you are short-sighted or have had inflammation or bleeding in the eye. Most adults notice some mild floaters in certain lighting conditions. At some point in everyone's life the outer, thicker part of the vitreous gel separates from the retina (vitreous detachment). When this occurs there is usually a dramatic increase in the number of floaters. It is wise to have your eye examined by an ophthalmic surgeon, to ensure that the gel has separated cleanly, without tearing the retina.

What are the treatment options?

Do nothing

Undergo YAG laser

Have vitrectomy operation

Do Nothing

This is the normal recommendation for most patients who are able to learn to live with the symptoms. Floaters clear on their own almost all of the time.  Even patients with persistent floaters usually adjust to them.  Their is a small group of patients with sheet like floaters and veils that affect their visual function and do not clear even after waiting over a year.  In this situation, it is acceptable to consider vitrectomy surgery.  Vitrectomy does carry a risk of retinal detachment, infection and bleeding.  So the risk of surgery has to be balanced with the potential benefit.

Undergo YAG laser

If a large floater bothers you it can be broken into smaller ones that often move to parts of the eye where they are not so much trouble. The procedure is not always effective. The risks are minimal and include cataract or retinal injury.

Undergo a Vitrectomy operation

This procedure removes the floater surgically and may be appropriate if life is intolerable or if your job makes floaters dangerous e.g. You are a Bus driver.

What is involved in a vitrectomy operation?

A vitrectomy operation for floaters can be performed under a local or a general anaesthetic. The eye is held open with a clip and 1-3 small keyhole incisions are made into the eye. One incision is used to pass a light probe into the eye that shows me the inside of the eye, the second incision is used for dripping fluid into the eye to keep the eye inflated and the third incision is used for cut and suction clearance of the jell. If the retina tears at the entry site for instruments, the eye is temporarily filled with a gas bubble to allow the retinal tears to heal better. It is only if gas or oil is used that you may be asked to position your head in various directions. Dissolvable stitches are used to close the surface lining of the white of the eye (Conjunctiva). Newer vitrectomy techniques have the benefit that stitches may not be required. Modern 25gauge technology allows a sutureless (no stitch) approach to the problem, improving immediate post operative comfort.  

What are the benefits of surgery?

To reduce symptoms of floaters.

What are the risks of surgery?

• Those of the anaesthesia

Rare but serious complications

• Infection & bleeding into the eye (1:1000). Many of these problems are treatable but blindness is possible in the worst-case scenario.

• Sympathetic Ophthalmia (1:1500-1:800). This is an extremely rare inflammation of the un-operated eye that can result from any operation that involves opening the eye but is said to be a little more frequent with repeat vitreous surgery. It can usually be successfully treated with steroid tablets or injections into and around the eye.

• Retinal detachment (0.5-2%). This is a condition where the retina can peel off from the back wall of the eye resulting in loss of side vision. It can usually be fixed with further surgery but can occasionally be beyond repair.

• Macula hole formation. This is rare and may be managed with further vitreous surgery.

• Epiretinal membrane. This causes blurred vision many months after successful surgery and is due to scar tissue that forms at the centre spot. It can usually be fixed with further retinal surgery.

• Glaucoma. Usually temporary and treatable medically but occasionally requiring operative intervention. In some patients the optic nerve may be very sensitive to glaucoma and can result in permanent loss of sight.

More common but less serious complications are:

• Cataract. This is where the natural variable focus lens inside the eye becomes cloudy. It is a treatable complication.

• Macular oedema. A soggyness of the centre spot due to post-operative inflammation, usually treatable in this setting.

• Post-Vitrectomy Haemorrhage. Blood can sometimes ooze into the eye from the incisions. This may temporarily lead to hazy vision with MORE FLOATERS. Occasionally this haemorrhage may need washing out surgically.

• Eye redness and grittiness due to tissues healing and stitches dissolving.

Before vitrectomy surgery

You will have a pre-assessment visit with our nursing staff. They will take baseline information. The decision about anaesthesia is discussed with your surgeon.

After vitrectomy surgery

There will be no need to posture if gas has not been used. You will be asked to use eye drops and wear an eye shield at night

With a gas, the vision is usually much worse post-operatively for between 2 weeks to 3 months. Patients often find it helpful to block off the vision in that eye using a pirate’s patch or masking tape over a spectacle lens. There is often a pricking gritty sensation around the eye. With the posturing there can be significant  eyelid swelling.

It is crucial that if you have a gas filled eye that you do NOT fly in an aircraft until all gas has disappeared. Depending on the gas type used you should NOT fly for between 2 weeks to 3 months following surgery. It is also crucial that if you are to have a general anaesthetic shortly after this surgery for other elective or emergency operations that you discuss you previous eye surgery explicitly with an anaesthetist who will modify his/her methods to avoid blinding complications during such anaesthesia.

Once the posturing is completed it is possible to resume everyday activities. You are allowed to drive if the unoperated eye has appropriate vision, the operated eye is occluded and you have become accustomed to being one-eyed. You will be seen routinely 1-2 weeks, 6 weeks, and 3 months postoperatively. It is NOT usually possible to assess the success of the surgery until the gas has disappeared. As the gas bubble reduces in size there can be many benign symptoms such a wobbly object in the lower part of the vision, variable vision for reading depending on head position and sometimes seeing more than one bubble as it breaks up. These symptoms all disappear once the bubble has disappeared.