After vitrectomy surgery: risks and recovery

Written by:

Ophthalmologist

Published: 02/04/2019
Edited by: Nicholas Howley

What risks should you be aware of after vitrectomy, and is there anything you should avoid doing to ensure a full recovery? We asked leading consultant ophthalmologist and director of the acute ophthalmic services at the prestigious Manchester Royal Eye Hospital, Mr Felipe Dhawahir-Scala:

Vitrectomy: overview

A vitrectomy is a procedure which involves operating on the back of the eye to remove vitreous fluid. It is performed on patients with retinal problems that need surgical correction such as:

retinal detachments macular hole epiretinal membranes ocular trauma

Once the vitreous fluid has been removed sometimes a gas bubble is left at the end of surgery to help close a macular hole or a retinal tear in the case of retinal detachment. There are also conditions and circumstances where vitrectomy is combined with cataract surgery at the same time.

Is vitrectomy safe?

A vitrectomy is safe and has little risk if performed by an experienced surgeon.

The most important risks to consider are:

postoperative infection intraocular bleeding retinal detachment or re-detachment cataracts loss of vision non-closure of the hole in the case of macular hole surgery high intraocular pressure (temporary)

In some cases you will need further surgery but this is rare. To take a macular hole operation as an example, the recurrence rate after vitrectomy surgery is approximately 4%. In contrast, another treatment for macular hole, involving injections of ocriplasmin, has a success rate of only 40%, often with significant side effects, and this practice has been abandoned by the majority of the vitreoretinal surgical community in the UK.

What does recovery look like?

This procedure is performed mainly as a day case intervention and the majority of patients do not need to stay overnight and can go home a few hours after surgery.

Immediately after vitrectomy surgery your ophthalmologist might encourage you to lie or sit face down for several hours a day, to keep the gas bubble in contact with the hole in your eye, and encourage it to close. This is known as “posturing”. However, I have recently shown that there is no need for patients to posture after macular hole surgery, demonstrating a success rate above 96%, in the article “To posture or not to posture after macular hole surgery”.

What should I avoid after surgery?

Driving – it is likely that you will need to take some weeks off driving while your symptoms settle and your vision gradually improves. Exercise: You can do light exercise but ideally not until two weeks after surgery. You should avoid swimming at least 4-6 weeks after surgery. Flying – it is very important to avoid flying while the gas bubble is still in your eye. At high altitudes, the gas bubble can expand and cause severe ocular hypertension, which can lead to permanent visual loss.

You can have showers as long as no dirty water enters the operated eye.

Finally, if you are scheduled to have any operation that involves general anaesthetic, it’s important to tell your anaesthetist that you have had a vitrectomy. They can then choose a suitable anaesthetic that avoids any complications with the gas bubble in your eye.

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