Diseases of the center of the retina (macula), and their treatment by removal of the vitreous (vitrectomy).
A mechanical impairment of the retinal center can cause a loss of visual acuity, and a disturbance of binocular vision in the eye. The main problem is
- a scar tissue layer (membrane) on the retinal center with distortion of the retinal sensory cells
- a hole in the center of the retina (macular hole)
- disturbing vitreous opacities, which impair vision
- inflammation with swelling of the center of the retina (macular edema)
The goal of surgery is to remove bothersome opacities and mechanical interference with vision.
By removing the vitreous, we can eliminate all mechanical factors, and optically disturbing opacities from the retina. However, an improvement in visual function can only be achieved if the structure of the retina is not yet irreversibly damaged, and can recover in the long term. This can take more than a year. Without treatment, visual improvement cannot be expected in the foreseeable future, and there will probably even be further deterioration of visual function, if the eye is not operated on.
The vitreous humor, which has lost its supporting function over the course of life, but is partly responsible for the visual disturbances, is removed from the eye and replaced. The replacement is usually an air, or gas filling that is absorbed by the body within fourteen days after surgery, and replaced with a newly formed fluid.
It is impossible to predict how good visual acuity may become after surgery. Visual acuity is reduced to the perception of light glare and motion within the first fourteen days after surgery, and then usually recovers rapidly to pre-surgery visual acuity. However, the best possible visual acuity for the eye may not be achieved until a year after surgery. Although we hope for an improvement in visual acuity, the surgery is essentially performed to stabilize the retinal situation, and prevent further visual deterioration.
If the patient does not already have an artificial lens, removal of the vitreous will likely result in the development, or progression of a lens opacity (cataract) within 6 months of surgery. If this becomes visually bothersome, it can be operated on.
Fluctuations in eye pressure may occur in the first few days after surgery, which must then be treated. If postoperative bleeding occurs, this means delayed recovery of visual acuity.
Almost always, the removal of the vitreous is possible without major, or unpredictable problems. Stability of the retina is not endangered; nevertheless, at the end of the operation, tears are occasionally discovered in the retina. These are treated with cold or laser, as they could otherwise cause retinal detachment later. However, secondary retinal tearing, and retinal detachment also occurs in about 3-5% of cases, usually within 4 weeks postoperatively, and surgery must be performed quickly. If the retina is not stable enough, replacement of the vitreous with silicone oil is necessary in rare cases, to ensure retinal stability after surgery. In this case, a later, second surgery is required to remove the silicone oil.
Postoperatively, the eye is very sensitive for the first few days, but the procedure is not very painful., The eye needs rest though, and physical exertion should be avoided for a few days. That is why we do not perform the procedure on an outpatient basis, but advise a one-day inpatient treatment. With an air or gas filling, it is not allowed to go to altitudes above 700 m above sea level, for about 8 days, which should be taken into account when planning the trip home.
Postoperative retinal detachment (occurring in about one in 30 patients) is the most common and important complication. Minor hemorrhage may result in delayed recovery of vision, but usually does not cause problems otherwise. Severe hemorrhage, infection, visual deterioration, or even further loss of vision, or eye are extremely rare (less than 1 in 1000), but are generally possible. If any of the above complications occur, a repeat surgery is usually required to achieve the best possible outcome. However, we estimate the risk of deterioration, or loss of visual function without surgery, to be greater than the risk of surgery.