Vitrectomy is an ophthalmic surgery in which the doctor removes the vitreous. Partial removal of this element of the visual system is possible, in some cases complete removal is indicated. The essence of the operation is reflected in the name of the procedure: “vitreum” in Latin means vitreous, the second root is translated as “removal”.
general information
Vitrectomy of the eye is an operation usually performed if the eye retina exfoliates. Through a surgical event, the doctor gets the opportunity to work with the posterior ocular wall. Typically, specific components are implanted in place of seized organic tissues to minimize loss to the visual system. When choosing an implant, only extremely transparent substances are used that do not interfere with the functioning of other elements of the ophthalmic system. To replace the vitreous body, long-term, reliable materials are chosen. The substances used during the operation must have an adequate degree of viscosity. It is unacceptable to operate hazardous, poisonous components or compounds that can provoke an allergic reaction.
Retinal vitrectomy is usually done using synthetic polymeric compounds, gas or oil bubbles. Sometimes doctors use specific saline solutions, the composition of which is selected taking into account the requirements of the human eye. In the future solution, the gas gradually gives way to intraocular fluid. Such implants do not have to be changed. Artificial polymers are allowed to operate up to ten days in a row. Silicone oils in the vesicles are used by persons who have undergone vitrectomy for several years.
Options and types
Currently, microinvasive vitrectomy is practiced in medicine. The operation received this name due to the nuances of carrying out: during the event, the skin integuments are damaged to a minimum extent. A total vitrectomy may be prescribed to the patient if it is necessary to completely or partially remove the natural vitreous body. During such an operation, only certain sections are seized. Based on the need to remove tissues, they decide in favor of the posterior, anterior vitrectomy.
When is it needed?
Of course, it is impossible to prescribe an intervention on your own, and the doctor who prescribed vitrectomy will explain the need for it in a particular case. An operation is usually advised to be done if tears in the retina are detected - during the intervention, doctors will restore this element of the visual system. If there is a detachment, the doctor will work on the restoration of the retina, with a high probability of such a pathological condition, the intervention is done as a preventive. Especially effective and necessary vitrectomy is considered if the detachment can cover the macula.
Vitrectomy of the eye is indicated for severe cases that develop to the late stage of retinopathy with tissue proliferation, which is usually accompanied by scar formation. If vision loss is due to vitreous hemorrhage, vitrectomy helps restore the patient’s vision. This is especially true if a lot of blood is released, the hematoma does not resolve within a few months.
When else will it help?
Microinvasive vitrectomy is a modern method of treating pathological vascular ocular growths localized in the retina. Surgery is resorted to if the use of a laser has not produced any result, even following the results of numerous procedures.
Is it possible or not?
Vitrectomy of the eye is prohibited if, during examination, severe opacities in the cornea are noticeable. You can not resort to this operation if the retina is transformed, the nervous system of the eye has undergone gross changes.
How is everything going?
Vitrectomy is an operation that generally requires hospitalization of the patient, but outpatient surgery is sometimes permitted. This option is exceptional and allowed only if there is an important indication for this. Immediately before the intervention, the patient receives analgesics.
Performing an anterior, posterior vitrectomy, the doctor creates thin punctures through which the vitreous tissue is removed from the patient's eye. The next stage is therapeutic. The retinal elements in need of this are treated with a laser, the exfoliating areas are densified. One of the main tasks of the doctor responsible for the intervention is to normalize the condition and restore the integrity of the retina. The duration of surgery in most cases is from two to three hours.
What to count on?
Officially, it is believed that posterior, anterior vitrectomy is a reliable and effective surgical measure that normalizes the patient’s ability to see if it is lost due to hemorrhage that does not disappear on its own over a long period of time. With good tolerance and a minimal likelihood of complications, the procedure reduces the risk of severe vascular bleeding if hemorrhage has already begun.
As can be seen from the reviews, vitrectomy is an operation on which patients have high hopes. Since vision is one of the most important ways a person can obtain information about the world around him, it is important to choose the most effective and reliable measure of intervention. According to reviews, vitrectomy of the eye refers to just such - people who underwent surgery indicate its reliability, rarely complications, good results, and restoration of vision. Many people agree: the price of the intervention is fully justified, the event is worth the money. Reviews about vitrectomy, however, are different. In rare cases, those who underwent surgery were dissatisfied. More often this is due to the unsuccessful choice of the clinic, the unprofessionalism of an inexperienced doctor or an incorrect diagnosis.
Recovery period
Vitrectomy is an operation, recovery after which in some cases lasts only a few days, but can last for weeks. The specific duration is determined by the general condition of the patient, tolerance of the event, the state of the ocular retina. The size of the affected area, the choice of an implant to replace the vitreous body, plays a role.
In the case when the changes are severe, it is likely that the event will not allow to fully restore vision. As a rule, the doctor warns about this in advance. This outcome is due to the fact that some changes in the nervous system and retina are irreversible.
Vitrectomy is an operation using implants, the service life of which varies. In order to avoid complications in the future, you will have to regularly replace. To do this, you need to contact the ophthalmic clinic.
Negative consequences: what are the dangers?
Despite the high accuracy and relative safety, the operation in question, like any other surgical intervention, is a source of risk. The probability of negative consequences is relatively small, but not zero. It is known that a complication of vitrectomy may be an increase in pressure inside the eye. This is more threatening for patients with glaucoma. There is also a risk of retinal detachment and hemorrhage. Vitrectomy can cause edema, in which fluid accumulates under the ophthalmic sheath.
Infectious complications are known. With a low degree of probability, vitrectomy can provoke the formation of a new system of blood vessels on the iris surface. Against the background of such changes, neovascular glaucoma, a severe state, is progressing. The consequences can be severe pain, loss of ability to see.
Technical points: what to use at operation?
Each composition used for implantation has its own rules and features. In addition, the choice of a specific component determines the nuances of the rehabilitation period. The main task of all implants is to fix the retina, ensure close interaction with the choroid, and prevent the negative effects of the intervention.
Quite often resort to silicone oils. Such substances have a specific structure - they are chemically inert, do not show biological activity, and therefore do not harm the human body. There are no problems with the survival rate of the fibers. If a total, subtotal vitrectomy is performed using such a composition, the elements of the eye occupy anatomically correct positions, and the functionality of the organ normalizes as soon as possible. The risk of an allergic response is minimized. The light refractive index of the implant is 90% identical to the natural one. Relative to other alternatives, silicone oil benefits due to its long service life - usually about a year.
Organofluorine liquids and gas mixtures
Sometimes a total, subtotal vitrectomy is performed using organofluorine liquid substances - the so-called heavy water. A distinctive feature is a significant molecular mass, twice the rate of ordinary water. During the operation, a cavity is formed, filled with such a composition, and the patient will not have to adhere to a specific regime during the rehabilitation period. About a third of the year, the filler fixes the ocular retina in the anatomically correct position, after which the compounds are removed in a hospital setting.
Sometimes a gas bubble is used as an implant. Its main positive effect is the ability to resolve independently a few weeks after the intervention. The composition of the bladder is gradually replaced by intraocular fluid produced in the visual system. However, along with the pluses, there were some disadvantages: after the operation, you will have to adhere to a strict regime. For a long time, it is necessary to observe the stationary position of the head. If it was decided to use gas, it is forbidden to fly in an airplane for a long time after the operation - atmospheric pressure drops provoke eye expansions, which increases the internal pressure in the system. It is currently impossible to control the process with medications.
The nuances of the rehabilitation period
When conducting a vitrectomy (closed, total, or any other), one can expect a speedy return to the usual conditions: usually on the day of the event, the patient can leave the clinic. An exception is a very serious condition. Before discharge, the patient receives a series of instructions, following which will help simplify the rehabilitation period and shorten it. The basic rule of recovery is minimal strain on the visual system. You can’t read, look at monitors and screens for more than 30 minutes in a row, write and strain your eyes in other ways. Within two weeks, a strict ban is imposed on lifting weights: no more than three kilogram loads.
If vitrectomy was performed, after the operation, the patient should abandon the sharp bends forward, backward, as well as similar activity. The entire recovery period will need to use eye drops selected by the doctor, which stimulate regenerative processes and control the internal pressure in the eye. It is forbidden to bend to the fire, a hot object - an oven, a gas stove. Within a month, you will have to abandon the bath, sauna.
Special occasion
If the patient's condition is serious, the doctor may prescribe bed rest for several weeks. If a gas bubble is used as an implant, you will have to constantly maintain an unnatural position of the head. This applies to the first three weeks after the intervention. It will be possible to sleep strictly face down or on one side (on which side it depends on the location of the operation). Sometimes the only option is to use a specific head support system in a downward facing position. The duration of use of the device is from five days to a three-week period.
Neglect of these rules with a high degree of probability can provoke bleeding and a rollback of the state of health of the visual system to the initial level. The risk of infection and other undesirable consequences increases, the correction of which will require a long, complex and expensive treatment. It must be remembered that neglect of the rules of the recovery period sometimes leads to irreversible negative consequences. Compliance with recommendations is the key to quick and effective rehabilitation.
About dates and dates
The duration of the rehabilitation period, the timing of the restoration of the functionality of the visual system are determined by a number of factors. Predicting the development of the patient’s condition, the doctor takes into account the nuances of the implant used, the amount of intervention and the number of additional measures to stabilize the condition. In many ways, the timing is determined by the transparency of the biological tissues that form the eye, the initial state of the nervous system, retina, and its changes after the intervention.
If an anterior vitrectomy is indicated, small areas of tissue are removed, a positive result can be seen already after seven days after the event. With the advanced stage, the probability of irreversible changes in organic tissues is high, and vitrectomy is aimed at preventing complications. It is quite possible that visual acuity will not get better at all according to the results of work.
The subtleties of intervention
There are certain nuances associated with the use of saline solutions as implants. Such liquids have a fairly low level of viscosity. The eye cavity contains blood, cellular elements, the resorption of which takes several weeks. Therefore, one does not have to rely on the instant normalization of the ability to see.
If silicone oils were used as an implant, glasses will probably be needed in the future. For correction, lenses with plus diopters are used. Gas mixtures can cause a black curtain to appear in front of your eyes. As a rule, this worries only occasionally during the first week after the intervention, after which the unpleasant manifestation is independently exhausted.
What to count on?
Vitrectomy is indicated for retinal detachment. The process is accompanied by a violation of the biological functions of the body. The best results will be if you go to the clinic on time, use the services of a qualified doctor who has modern equipment. Such an approach will soon restore the functionality of the visual system. If you delay the trip to the clinic or postpone the prescribed operation, the changes are likely to progress to an irreversible state. The nervous visual system is disturbed, the retina completely loses its functions. In this case, the recovery period lasts a long time, even if the intervention allowed to achieve the best real for the outcome.
The patient who underwent surgery is registered. It is necessary to regularly check the performance of the visual apparatus to prevent and timely detect regression or complications.
Operation: additions
Sometimes vitrectomy is accompanied by additional measures, the set of which depends on the nuances of the patient's condition. In particular, a small portion of the atmospheric air can be injected into a specific segment behind the apple to inject fluid from the eye. Such a measure helps to normalize internal pressure indicators, to ensure the integrity of all elements of the retina, to keep this structure in an anatomically correct position. The pressure due to the injected air soon decreases, and the liquid occupies the free space.
With vitrectomy, scleral screed may be performed. Such an event involves the installation of a support system around the eye apple. The system is designed to fix biological structures after fixing retinal tissues in the correct position.
Sometimes with a vitrectomy, the lens is removed. As a rule, the indication is cataract, the fastening of the lens elements with a scar formed inside the eye. If laser treatment is necessary, the patient is prescribed photocoagulation. This is necessary if the integrity of the circulatory system is violated - the laser closes the affected areas. Damages of this kind in diabetics are frequent. Laser operation is effective if necessary, tightly block the holes in the retina.
If the patient, in addition to the main intervention, is shown any additional procedure, the duration of the recovery period increases.
Pay attention: safety nuances
If vitrectomy is performed against a cataract, there is a high probability of accelerating the progress of the pathological condition in the first year after the intervention. A risk group for an undesirable consequence is people who choose silicone oils as implants.
The operation does not guarantee the absence of relapse in the future.
. , .
, , , .