Vitreo-Retinal Surgeries

Vitreoretinal eye surgery plays an important role in restoring vision in cases of critical eye conditions

Vitreoretinal eye surgery includes a group of procedures performed deep inside the eye’s interior with lasers or conventional surgical instruments. Various vitreoretinal surgical and laser approaches can restore, preserve and enhance vision for eye conditions such as certain types of age-related degeneration, diabetic retinopathy, diabetic vitreous haemorrhage, macular hole, a detached retina, epiretinal membrane and CMV retinitis.

For most patients who undergo a vitreoretinal surgery, sight is restored or significantly improved. The procedure is a marvel of modern medicine for people with conditions that might be otherwise blinding.

Poona Eye Care has specialised expertise and set-up to handle vitreoretinal surgeries across a spectrum of eye-conditions

Patients presenting for vitreoretinal surgery tend to be very young or the old. Their problem may arise due to several different health and eye conditions. They often require tests and monitoring for other conditions such as diabetes, cardiovascular or renal diseases etc. At Poona Eye Care we take a holistic health view to ensure general safety of the patient during surgery and to optimize surgical outcome.

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Normal Vision

Affected Vision

Frequently Asked Questions

Which eye conditions are treated by vitreoretinal surgery?

The vitreoretinal surgery treats problems related to extremely sensitive parts of the eye. It refers to any operation to treat eye problems involving the retina, macula, and vitreous fluid.

(This diagram is taken from the Internet)

A large variety of conditions can affect the vitreous and retina and macula that lie on the back part of the eye that is not readily visible. These include diabetic retinopathy, macular degeneration, retinal detachments or tears, macular holes, retinopathy of prematurity, retinoblastoma, uveitis and eye cancer.

Conditions commonly treated by vitreoretinal surgery

Retinal detachment

Retinal detachment is a disorder of the eye in which the retina separates from the layer underneath. Without vitreoretinal surgery, the retina will not reattach and will invariably result in blindness. Surgery is the only treatment for retinal detachment.

Epiretinal membrane

An epiretinal membrane is a thin sheet of fibrous tissue that can develop on the surface of the macular area of the retina and cause a disturbance in vision. Epiretinal membranes are treated by peeling the offending membrane from the surface of the macula, using a vitreoretinal surgical technique.

Macular hole

A macular hole is a small break in the macula, located in the center of the retina and can be treated in a small proportion of cases with an injection, but in most cases the macular hole requires vitreo retinal surgery to repair the defect.

Vitreous haemorrhage

The most common cause of vitreous haemorrhage, which refers to bleeding into the back of the eye, is diabetic eye disease, and if the blood does not clear in a reasonable time, vitreoretinal surgery will be required so that the retina can be fully assessed and vision restored.

What are the tests and precautions needed before such a surgery?

Patients with retinal disease frequently have a history of diabetes with concomitant cardiovascular and renal disease. Fasting blood sugar is therefore advised before surgery. A preoperative ECG is indicated for patients with diabetes or signs and symptoms of cardiac disease.

Potassium, BUN, and creatinine tests are indicated for patients who take diuretics and/or have renal disease. Coagulation studies are indicated for patients with history of coagulopathy or anticoagulation as a medical treatment. Warfarin and antiplatelet drugs (e.g., aspirin ) may be held for 5 days before surgery.

Why is this surgery difficult to perform?

Unexpected patient movement during delicate microscopic intraocular surgery can lead to increased intraocular pressure (IOP), choroidal haemorrhage, extrusion of intraocular contents, and loss of vision. Therefore, the avoidance of movement, coughing, and straining is essential during vitreoretinal procedures.Anaesthesia management plays a pivotal role in vitreoretinal surgery.

What are the types of vitreoretinal surgery?

There are several types of vitreoretinal surgeries depending on the part of the eye one is dealing with, the problem to be rectified and the method used.

Types of vitreoretinal surgeries:

Vitrectomy

Anterior vitrectomy is the removal of the front portion of vitreous tissue. It is used for preventing or treating vitreous loss during cataract or corneal surgery, or to remove misplaced vitreous in conditions such as aphakia pupillary block glaucoma.

Pars plana vitrectomy (PPV), or trans pars plana vitrectomy (TPPV), is a procedure to remove vitreous opacities and membranes through a pars plana incision. It is frequently combined with other intraocular procedures for the treatment of giant retinal tears, tractional retinal detachments, and posterior vitreous detachments.

Retinal detachment repair
A scleral buckle is used to repair a retinal detachment (to indent or “buckle” the sclera inward) usually by sewing a piece of preserved sclera or silicone rubber to its surface.
Laser photocoagulation, or photocoagulation therapy, is the use of a laser to seal a retinal tear.
Pneumatic retinopexy
Retinal cryopexy, or retinal cryotherapy, is a procedure that uses intense cold to induce a chorioretinal scar and to destroy retinal or choroidal tissue.
Macular hole repair
Posterior sclerotomy is an opening made into the vitreous through the sclera, as for detached retina or the removal of a foreign body.
Partial lamellar sclerouvectomy
Partial lamellar sclerocyclochoroidectomy
Partial lamellar sclerochoroidectomy
Radial optic neurotomy
Macular translocation surgery through 360 degree retinotomy/scleral imbrication technique.