Vitrectomy is the surgical removal of the vitreous gel from the middle of the eye. It may be done when there is a retinal detachment, because removing the vitreous gel gives your eye doctor better access to the back of the eye. The vitreous gel may also be removed if blood in the vitreous gel (vitreous hemorrhage) does not clear on its own.
During a vitrectomy, the surgeon inserts small instruments into the eye, cuts the vitreous gel, and suctions it out. After removing the vitreous gel, the surgeon may treat the retina with a laser, cut or remove fibrous or scar tissue from the retina, flatten areas where the retina has become detached, or repair tears or holes in the retina or macula.
At the end of the surgery, silicone oil or a gas is injected into the eye to replace the vitreous gel and restore normal pressure in the eye. Vitrectomy is always done by an eye doctor who has special training in treating problems of the retina.
Epiretinal membrane, also known as ‘macular pucker,’ is a condition where a fibrous membrane grows across the macula, similar to scar tissue. In some cases, the growth is mild and produces little or no noticeable symptoms, but in others, it distorts the retina and consequently vision, causing straight lines to appear wavy and crooked. It can also cause other vision problems, such as blurring. Symptoms may get worse over time as the membrane continues to grow.
Possible causes of an epiretinal membrane include:
Blood vessel abnormalities
Previous eye surgery
During this procedure, the surgeon injects a bubble of special gas into the vitreous cavity of the eye. This bubble then expands, putting pressure on the retina and pressing it against the back of the eye, allowing it to reattach. In some cases, the surgeon will first need to remove some fluid from between the cornea and iris in order to soften the eye. The injected gas will disappear on its own, generally over a period of several weeks.
Silicone oil is used for recurrent retinal detachments or complicated retinal detachments including PVR (proliferative vitreoretinopathy). It can be a valuable tool to prevent blindness.
Laser surgery is used to treat many retinal conditions. Retinal laser surgery is performed in our office. Eye drops will be given to dilate the pupil and numb the eye. The treatment is performed while you are seated in a chair, similar to the one used for regular eye examinations. You will remain awake and comfortable. Treatment is usually painless, although some patients may require a numbing injection for discomfort or sensitivity to the laser light.
Photodynamic therapy (PDT) is an in-office treatment proven to be beneficial for wet macular degeneration and it has been used successfully to treat other retinal conditions as well. It involves injecting a light-activated drug called Visudyne into the bloodstream that travels to the abnormal vessels causing damage to the vision. The drug is then activated by a painless low-energy laser to close the abnormal vessels while at the same time minimizing damage to healthy retina tissue. After treatment in the office is complete, patients must avoid direct sunlight or bright indoor light for five days to avoid photosensitivity reactions that can occur with Visudyne. Patients who must go outdoors must protect all parts of their skin and eyes by wearing protective clothing, hats, and dark sunglasses. Ultraviolet sunscreens are not effective in protecting against photosensitivity reactions.
Injections into the eye or surrounding tissues can be made for various reasons. Injections can be made into the vitreous of the eye, behind the eye, below the conjuctiva, or under tenon’s capsule.