Vitrectomy

A significant part of the eyeball is occupied by the vitreous body, the functions of which are quite important for vision. Thanks to him, the eyeballs acquire a certain shape. Also, the body cavity, consisting of a gel-like substance, protects the nutrient channels leading to the retina. In certain diseases, despite the importance of this organ, it becomes necessary to remove part of the vitreous body or the entire body.

Operations on the back of the eyeballs (vitreoretinal intervention) are called “vitrectomy” and are quite complex and require high qualifications from an ophthalmologist. This is due to both the severe course of the disease itself and the many causes of its occurrence, as well as the complexity of treatment.

Historical information

Modern plastic surgery of the eye – vitrectomy – appeared about half a century ago. Its ancestor was Robert Machemer, who created a device in 1970 that allows you to control access to the posterior part of the eyeball. The suction apparatus invented by the scientist became the first device for vitrectomy, which also allows you to control intraocular pressure during the operation.

Initially, vitrectomy was used exclusively to clear the vitreous in cases of opacity, including blood. In the years that have passed since the invention, Robert Machemer’s apparatus has been repeatedly improved. In its modern form, it is represented by a device of a new formation, which has a number of calibration systems with an improved work cycle and cutting speeds, due to which the possibilities of vitreoretinal eye surgery have significantly expanded.

In modern vitrectomy, complete or partial removal of the vitreous body is accompanied by the replacement of this component of the eye with a special gel or gas with the possibility of further correction of the position of not only the retina, but also its epithelium.

Structural features of the vitreous body

The vitreous body is designed to conduct light rays to the retina. It consists of water (99%), collagen fibers, proteins and hyaluronic acid. A mixture of the substances listed above is an absolutely transparent substance of a gel-like consistency, with which the inner center of the visual organ is filled by two-thirds. Its function is to protect the vessels that feed the retina of the eye, give our organs of vision a shape and contribute to their preservation.

The specific consistency of the body in some cases becomes the cause of certain pathological processes. Diseases of the internal cavity of the eye can be accompanied by a drop in transparency, clouding of the substance of the body, and even filling it with blood. Such changes become an obstacle to the correct hit of light rays on the retina and can lead to reduced vision or its complete loss.

Indications for surgery

The need for vitrectomy is due to a number of indications and in each case is decided individually. The cost of such operations directly depends on the severity of the disease and how advanced it is.

In particular, changes in the vitreous body (clouding, hemorrhages, contraction) can occur due to injuries of the eyeball, which are accompanied by the ingress of foreign bodies, as a result of retinal detachment or disease of its vessels. The operation is performed due to a macular hole in the central region of the retina, caused by wrinkling or detachment of the vitreous body. The resulting voids can be filled with liquid, which causes distortion of vision. Vitrectomy is indicated due to inflammatory diseases of the eye (posterior uveitis caused by inflammation of the vessels and retina), due to cataracts – clouding of the lens, causing loss of visual acuity.

Diabetes mellitus can also cause a trip to the doctor – diabetic retinopathy, in which neovessels form on the retina, leading to its detachment and blindness. Because of hemophthalmos – a hemorrhage in the eye cavity caused by hypertension, blood cancer, vascular inflammation, sickle cell anemia and other causes.

With epiretinal fibrosis (an age-related disease that causes a sharp deterioration in vision). Because of an infection in the eye (endophthalmitis, leading to the accumulation of pus in the vitreous body), they also go for the procedure.

Противопоказания

Physicians do not mention any significant contraindications to vitrectomy.

However, such operations should be abandoned:

1. If you suspect any form of retinoblastoma.
2. In cases of disease with an active form of melanoma, since the operation can give impetus to the spread of cancer cells through the circulatory system.
3. Relative contraindications include the patient taking drugs that thin the blood. In this case, the conclusion about the advisability of such an operation is given by the attending physician. In case of urgent need, he also gives advice to the patient on how to prepare for a vitrectomy.

Order of conduct

Depending on the severity of the disease, vitrectomy is performed under general or local anesthesia. During the operation, a special cylindrical knife is used – a vitreotome, a lighting device and an infusion cannula, which is used to replace the fluid in the eyes with saline and maintain the desired eye pressure. The duration of vitrectomy reaches one and a half to two hours.

Surgical intervention takes place in several stages. After incisions, the vitreous body is sucked out of the capsule. The affected tissues are removed, the retina is corrected. A new vitreous body is “installed”, which can be a special gas, an organofluorine liquid (water, fluorine, silicone oil). The incisions are sutured.

Types of vitrectomy

Depending on the volume of removal, vitrectomy can be total, in the case when it comes to complete removal of the vitreous body, or subtotal. The latter implies a partial resection and is divided into anterior and posterior.

Anterior vitrectomy

In the first case, surgery is necessary due to leakage of the gel substance of the body into the anterior chamber of the eye. It may be preceded by eye trauma and problems with the lens. Such penetration sometimes occurs during operations to remove glaucoma or cataracts.

This fact can cause serious problems, therefore, in order to minimize the risks of complications and inflammation, surgeons decide to perform an anterior vitrectomy. Very often, such operations are unplanned.

Posterior vitrectomy

Due to the fact that the collagen and hyaluronate components make the gel-like consistency of the body highly elastic, and the vitreous grains are able to absorb only a small part of the adhesion, it may flow into the posterior segment of the eye. This can lead to retinal tears (retinal tears) and macular edema (a yellow spot in the center of the retina).

In such cases, and also in cases where access to the posterior segment of the eye is necessary, a Pars posterior or plastic vitrectomy is performed by retinal specialists.

Microinvasive Vitrectomy

In modern realities, it is possible to perform an operation to remove part or all of the vitreous body that does not require hospitalization. Such a surgical intervention is carried out through 3 main punctures of microscopic size (0,3-0,5 mm).

Surgeons use a microscope and miniature instruments: special self-locking multi-point lights and a pneumatic or electric vitreotome operating at twice the frequency of conventional surgery.

The operation is carried out as follows. After the vitreous has been removed, a bubble of gas or air is placed in the patient’s eye to return the retina to normal. Helping the retina stay in the correct position, it disappears on its own over time.

After that, a special fluid is injected into the eye. This may be silicone oil, which is removed later, after the cornea has healed.

Benefits of microinvasive surgery:

1. Improving the accuracy and quality of the operation.
2. Minimizing injury.
3. Carrying out on an outpatient basis.
4. Local anesthesia for complete painlessness.
5. Removing the patch on the eye the day after surgery.
6. Significant reduction in the rehabilitation period.
7. Ability to execute another operation in parallel.
8. Rapid retinal repair as no sutures are required.

Postoperative period

Specialists warn of possible discomfort for some time after the operation. In general, recovery comes in 3-6 months, but sometimes the recovery process can take from a year to a year and a half. Vision after surgery is restored depending on the condition of the retina and optic nerve, as well as the composition of the substance, which replaced the vitreous body.

When replacing a gel-like substance with a low-viscosity saline solution, it may take several weeks to restore visual function. This is due to the presence of remnants of cells and blood in the eye cavity.

In the case of using a special gas, a black film “hangs” in front of the patient’s eyes for some time, and one week is enough for the disappearance of it.

In cases where silicone oil is poured into the eye cavity, some patients need vision correction (“plus” glasses).

In addition, most operated patients have retinal dysfunction, which requires a certain amount of time to recover.

Operated patients have been registered with an ophthalmologist for some time. They are also not recommended physical and visual overload. In the case of filling the eye cavity with gas, patients are not recommended to use underground transport.

Postoperative complications

Infection during vitrectomy is extremely rare (up to 0,07% of cases). Retinal detachment is described in 5,5-10% of cases. It is mainly associated with breaks in the retina when touched.

In some cases, irreversible changes occur in the retina, which complicate the rehabilitation process. Under such circumstances, the positive anatomical effect of the operation (adherence of the retina, transparency of the vitreous cavity) does not guarantee visual acuity.

There are also cases of increased intraocular pressure, re-clouding of the vitreous body, defects of the lens, swelling of the corneal tissues and the development of cataracts. With such pathologies, a second operation is recommended.

To minimize the risks, it is important to follow the recommendations of the doctor and operate only in trusted clinics.

In general, reviews of vitrectomy cannot be called unambiguous.

There is evidence that up to 80% of operated patients are satisfied with its results, and the rest are not completely dissatisfied, but mention the complications that have arisen.