Vitrectomy is often said to be a "last-ditch operation", and there is a lot of truth to it. Thanks to this procedure, many people have good eyesight, although they had little chance of keeping it before. When is vitrectomy performed and how is the operation performed?

Vitrectomyis a modern surgical technique that treats mainlyretinal diseases , which several decades ago inevitably led to blindness.

The retina (the membrane that lines the back of the eye) plays a very important role in the process of seeing. It transmits light impulses to the brain cells (previously transforming them into electrical impulses), where they are transformed into images of the objects we see. Therefore, if something in the retina fails, your eyesight deteriorates.

The accuracy of vision depends on the condition of the so-called the macula, the central part of the retina that allows you to see precisely what is in front of you. This is where the most photosensitive receptors are located and each of them is connected to one neuron located in the visual field of the brain (1: 1), while in other regions of the retina 200 receptors "supply" one nerve cell.

Vitrectomy: indications

The indication for vitrectomy are all diseases related to mechanical damage to the retina. It can save and improve eyesight in cases of retinal detachment, macular hole or subretinal haemorrhage. Operations are most often performed when there is no other way to cure the condition.

Vitrectomy is the only remedy for damage to the retina due to adhesions with the vitreous (a gelatinous substance, 98 percent water, that fills the posterior chamber of the eye between the lens and the retina, gives the eyeball shape and protects the retina). The procedure is performed mainly to put the retina in, when a special seal that closes the "hole" from the outside cannot be used. It then releases the retina from abnormal adhesions with the vitreous, which causes the retina to tear.

Vitrectomy is also used to remove membranes on the retina or to close the macular opening. The holes are created by the action of forces that pull the retina to the sides. However, it is not known what triggers such tension or why the vitreous body sticks to the macula.

Vitrectomy is also used to clear the path of light fromresidual blood or plaque obscuring vision. Bleeding in the eye most often accompanies changes related to diabetes (diabetic retinopathy). Initially, the disease causes damage to the small vessels of the retina - the more damaged vessels, the larger the ischemic area. This results in the formation of new, abnormal blood vessels and recurrent bleeding, leading to repeated haemorrhages into the vitreous and retinal detachment. People with degeneration of blood vessels are also exposed to strokes. Vitreous floaters form in the vitreous with age, which shrink over time and separate from the retina. During this process (which begins around the age of 50), a blood vessel may be damaged, tearing and detaching the retina. These types of changes usually occur in the weakened part of the retina, most often in the so-called checkered degeneration.

In some, poor metabolism accumulates in the vitreous body, which obstruct the flow of light to the retina. As a rule, these are calcium soaps or cholesterol deposits - this is what we call sparkling. White or whitening sparkles refer to calcium soap, while sparkling (the test shows golden dust) accompanies cholesterol deposits.

Worth knowing

Better not to delayThe smaller the degenerative changes leading to the edema or distortion of the retina, the better the effect of the operation. If the retina is operated within three days of its detachment, vision can be regained almost 100% after it is applied. The longer we delay the operation, the worse the effect will be. Tears and holes should not be underestimated, especially around the periphery of the retina, as this usually leads to its detachment. A hole in the macula causes a detachment of the retina in 1%, and in 99% it simply impairs vision.

Pre-vitrectomy examinations

Before the doctor makes a decision about surgery, a series of tests must be performed:

  • OCT (ophthalmic coherence tomography) gives a cross-section of the retina with an accuracy of 3 micrometers, thanks to which the doctor can see in which layers of the retina is damaged or what the relationship between the vitreous and the retina is;
  • The eye ultrasound shows the topography of the eye, which allows you to accurately locate the place where the retina is detached;
  • ophthalmological examinations (focus and field of vision, pressure in the eyeball).

Based on the results, a map of the retina is made, marking the place of tearing and / or holes and the extent of the detachment, and a treatment plan is prepared.

How is the operation going?

PurposeVitrectomy is the removal of pathological changes from the retina and the vitreous. The surgeon performs this operation using a specialized microscope and special lighting, usually xenon or diode, which gives bright white light, does not heat and is delivered to the eye by means of an optical fiber. To get into the retina, incisions are made in three places: for the optical fiber, for the vitrectome (it is a kind of high-speed guillotine that cuts and sucks), and for the infusion to give the necessary fluid or air. The mornings are small, about 0.65 millimeters long.

With the help of the vitrectom, the vitreous body is removed and another substance is injected into the eye: gas (sterile air or a mixture of air and a special expansion gas), an infusion fluid or silicone oil, which are used to hold the retina and keep the shape of the eye. The type of filling depends on the type of retinal disease and the surgeon's decision. Often only during the operation it is possible to fully assess the condition of the eye. Silicone oil is administered in severe conditions, when it is necessary to press the retina to the ground for a long time to regain vision. Fluids and gases are spontaneously absorbed within 1-6 weeks. The disadvantage of the oil is that it has to be surgically removed. Due to the condition of the eye, sometimes the oil is only changed after a few or a dozen or so months.

The procedure may be different depending on the eye condition. It is not necessary to excise the entire vitreous to close the macular opening. It is only a tunnel through which, with the help of tools, under high magnification, the inner boundary membrane of the retina, previously colored with a special substance, is removed in order to relax the tensions around the opening. Then a gas or other substance is administered inside to massage the swelling of the macula and allow the edges of the opening to come together.

In the case of retinal detachment, you need to find all holes and tears, separate the vitreous from them, apply the retina (pump out the fluid from under the retina so that it adheres to the substrate), irradiate the places around the holes with a laser and for it to heal - give gas or silicone oil. Sometimes the procedure is performed together with cataract extraction.

Worth knowing

Vitrectomy privately or under the National He alth FundVitrectomy is performed by some centers under the National He alth Fund. In a private clinic you have to pay 6-8 thousand. depending on the type of disease. The procedure is performed under local anesthesia (injection in the vicinity of the eyeball), on an outpatient basis - you can go home immediately. It takes about an hour, and for a macular hole - 20 minutes. In private clinics, at the patient's request (atno contraindications), general anesthesia is also possible. The patient remains under the care of an anaesthesiologist all the time.

What after surgery?

Eye pain may persist for a few days - usually over-the-counter painkillers help. Your vision may be worse initially, but your eyesight will gradually return to normal. When filled with silicone oil, the deterioration of eyesight sometimes lasts longer and is so inconvenient that you have to replace the lenses until the oil is drained out.

In convalescence, it is very helpful to stay 4-5 hours a day in a forced position: sitting with a tilted forward, supported head, walking in a slight bend, lying on the stomach. You must not sleep on your back. The operated eye can be covered at night to avoid accidental irritation. Until the gas is absorbed (1-5 weeks depending on its type), air travel and mountain tours should be avoided; you can fly with silicone oil.

You must not swim or bathe for 3 weeks to prevent infection of the wound. You should also avoid the sauna - prolonged contact with very hot air is not good for the operated eye.

You should report for control visits by the appointed date. This is very important because the surgery is associated with the risk of complications (estimated at 10%). Most often it is cataract or eye haemorrhage, the most serious complication is detachment, and in the case of detachment - retinal failure.

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