• Reference Number: HEY180-2024
• Departments: Ophthalmology Department
• Last Updated: 3 June 2024

Introduction

This leaflet has been produced to give you general information about having vitrectomy surgery.  Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is a vitrectomy operation?

A vitrectomy is an operation which involves making three small incisions, in the white of the eye, to enable fine instruments to enter the eye.  Some or all of the vitreous gel (clear, jelly-like material) inside the eye is then removed and replaced with a salty fluid (saline).  Depending on the reason for your surgery additional procedures may be required; these will be discussed with you prior to going on the waiting list for surgery.

Once the main part of the operation is completed, the retinal lining (a light-sensitive tissue on the inner surface of the eye) is examined for any weak areas.  As such, you may need additional treatment such as a freezing treatment (cryotherapy) or laser treatment to those weak areas. This would be in order to reduce the risk of a post-operative complication called retinal detachment.

During the operation, you may be aware of some shadows and lights inside your eye; this is quite normal as your retina is still working.  The amount of light and shadow you may experience can vary due to the intensity of the local anaesthetic.

Gas Bubble

We may use a gas bubble to help the eye to heal.  The gas will be inserted into your eye during the operation.  This gas bubble will act as an internal splint to support the retina during the healing process.  You will leave hospital with a wrist band stating that there is a gas bubble in the eye.  The wrist band should not be taken off until after the gas bubble has gone from your eye. This is so other healthcare professionals are aware that you have gas in your eye.

Following the operation, it is very important that you do not fly in an aeroplane, until the gas has been absorbed (this can be up to eight weeks).  In some cases, you may also be asked to keep your head in a specific position in order to help the gas bubble do its job.  You will be given a diagram and specific instructions on how to do this.

For the first week you will only be able to see light and dark with your eye. This is because the gas makes everything badly out of focus. Some people are able to see objects held very close to the eye.

Later on, your sight will begin to return.  The timing depends on the type of gas used.  When the gas bubble is down to half size, you will see a horizontal line across your vision, bobbing up and down with head movement.  This is where the gas meets the fluid which is gradually replacing it.  It is just like a spirit level.  You will have sight above this line, and blackness below it.  Day by day the line will move lower down; the seeing area will get bigger, and the black area will get smaller until it is just a circle at the bottom of your vision, and then it disappears.

If you require a general anaesthetic for another operation, during the 8 week period following your vitrectomy operation, it is essential that you inform the anaesthetist that you have gas inside the eye.  This will be discussed with you before the operation and specific instructions will be given to you after the operation and before you go home.

Silicone oil

On occasions a special type of medical oil (silicone oil) is used instead of gas.  This is usually removed several months later at a second operation.  Your doctor will give you further details on do’s and don’ts should it be necessary to use silicone oil.

Why do I need the operation?

Your individual circumstances will be discussed with you by the surgeon. Successful surgery will usually bring back some of your sight however, it may not completely restore your vision.

Vitrectomy operations are carried out for a number of severe eye conditions such as those listed below:

• To remove haemorrhages (blood) caused by bleeding from the retinal blood vessels from the vitreous gel inside the eye;

• To control scar tissue formation which can affect vision in conditions such as diabetes or following retinal vein occlusion (a blockage in the blood supply to the eye);

• To remove foreign bodies from inside the eye following an injury;

• To clear away cloudy gel following a severe internal infection called Endophthalmitis.

Can there be any complications or risks?

This type of surgery has similar risks to other types of eye surgery such as:

• You may develop an infection in the eye. This is called Endophthalmitis and is very rare but can give rise to serious loss of sight.

• Bleeding inside the eye.

• Retinal detachment which can happen at anytime following the surgery and will require further surgery in order to repair it.

• Almost all patients develop a cataract (a cloudy lens which impairs vision) more rapidly than normal, following this type of surgery. This is because the internal fluid has been disturbed and also due to the presence of gas in the eye.  In some cases, the cataract may be removed during the operation, to enable a clearer view for the vitrectomy surgery to be performed.  Cataracts can also be removed in a separate operation.  Your surgeon will discuss the best option for your eye condition.

• High pressure inside the eye. You may require additional eye drops to control the pressure, for a period of time, following the operation.

• Inflammation inside the eye.

• Bruising to the eyelids and eye – this will settle after a few weeks.

• Allergy to the medication used.

If you experience any of the following problems following your return home:

• Excessive pain
• Loss of vision
• Increasing redness of the eye
• Discharge from the eye

You should contact us immediately.

How do I prepare for the operation?

Please read this information leaflet carefully.  Share the information it contains with your partner and family (if you wish), so that they can help and support you.  There may be information they need to know, especially if they are taking care of you following this operation.

This is major eye surgery which is normally carried out under local anaesthetic.  However, in exceptional circumstances a general anaesthetic is offered.

Pre-operative Assessment

Before the surgery you will need to attend for a pre-operative assessment.  At this visit you will be asked questions about your general health and blood tests and a recording of your heart beat (sometimes referred to as an Electrocardiogram or ECG) are sometimes performed.  These tests are to ensure that you are in good general health and well enough to undergo the surgery.  Measurements will also be taken of your eyes.  We will need to know what tablets and medicines you are currently taking and also if you are sensitive/allergic to any substances.  It may be useful to write these down to bring to your assessment.  At this visit, you will be advised on what pre-operative preparations you need to make, such as altering medications. 

At this visit you will be given a suitable date for your operation.

What will happen?

The operation is carried out as a day case and you will be instructed in your appointment as to when to attend the Eye Hospital on the day of surgery.  You can expect to be in the hospital for most of the day.

The following morning you may need to attend the ward, for a quick eye check.  Due to space restrictions, if you want to bring anyone with you, we request only one person accompanies you.  We will request that they come back to collect you later in the day.

• Please bring a clean dressing gown and pair of slippers with you, with overnight clothing and toiletries. 

• If you use a hearing aid please also bring this with you. 

• On the day of surgery take your usual medications as normal unless you have been advised to stop them prior to surgery. 

• Please bring with you any medications that you may need to take whilst you are in hospital, including inhalers and sprays. 

• Please do not wear any make up, nail varnish or jewellery, other than a wedding ring, as you will need to remove them before your operation. 

• It is advisable not to bring valuables or money to the hospital, the Trust will not accept responsibility for loss or theft. 

• Please eat and drink normally before coming in to hospital, unless you have been instructed not to do so. 

• On arrival in the ward a nurse will meet you and confirm the information that you gave at your pre-assessment appointment. 

• We will give you eye drops before the operation. This is in order to dilate (widen) the pupil of the eye to enable us to perform the operation. 

• Patients are offered drinks and light snacks free of charge. 

• Visitors are asked to use the dining facilities in the Eye Hospital café, main hospital or at the Women and Children’s Hospital. A drinks machine is also available on the ground floor of the Eye Hospital. 

• During your stay several checks are made these are to ensure that you will be receiving the correct treatment.

What happens afterwards?

Blurred vision after surgery: It is perfectly normal for your vision to be significantly blurred or poor after the operation especially if gas was used as a tamponade agent. The gas will gradually absorb and you will notice a line in your vision that moves similar to a spirit level.  You will start to see above the line, but under the line your vision will remain fuzzy or blurred. The gas will eventually disperse until it is only a small bubble in the bottom of your eye; the bubble will eventually disperse too.

If silicone oil was used as part of the surgery, the vision will also remain blurred until the silicone oil has been removed.

Following your surgery you will need to use eye drops for up to four to six weeks whilst the eye heals.  The drops are to prevent infection and to reduce inflammation around the eye.  You will be advised on how and when to use the eye drops before you leave hospital.

Following your operation, it can take several months to determine the full effect of the procedure.

Do I need to wear an eye patch?

You should wear the eye patch for the first 8 hours after surgery.  You do not need to wear an eye patch after the patch is removed.  However, we do recommend wearing sunglasses or prescription glasses during the day and a shield over the operated eye at night when sleeping for the first week after surgery.

Will I have pain after surgery?

Some discomfort is normal and expected following surgery.  The first few days after surgery you may need to use over the counter pain relief tablets. Discomfort should gradually decrease and over  the counter pain relief should be sufficient to relieve pain.  If the pain is not relieved, call the Eye Hospital.

How much discharge should I expect from the eye?

A moderate amount of discharge during the first week is expected. Gradually, this should decrease. The lids can be cleaned with a clean washcloth, tissue or cotton ball.  Wipe the eyelids gently from the nose outward.  You should avoid getting shampoo and soap into your eye for 2 weeks.

Will there be swelling and will my eye be red?

Some swelling is normal for about a week after which it will gradually decrease.  Swelling may worsen or last longer if you are maintaining face down positioning after surgery as instructed by your doctor.  The eye will be red after surgery.  You should see a gradual decrease of redness over the first 3 to 4 weeks.

How long will it take for my vision to improve?

The first day after surgery often the vision is worse because of eye medication or/and inflammation from surgery.  Double vision can occur and will usually resolve over the first few days.  Your vision should gradually improve, but it may take up to six months or longer to regain your best vision.  Frequently, air or gas bubbles are injected into the eye at the time of surgery.  This will blur your vision significantly at first but your vision will gradually improve as the bubble dissipates.  You may notice floaters or double vision soon after your surgery.  These symptoms usually will decrease with time.  If the double vision is bothersome, patching the eye may help.  If you notice a sudden worsening in your vision, call the Eye Hospital straight away.

Are there any physical restrictions after surgery?

If oil or a gas bubble was placed in the eye during surgery, you will be asked to spend most of your time (both awake and during the night) with your head in a specific position, frequently face down.  As the eye heals and the bubble dissipates, there will be less of a need for you to stay in that specific position.  You should avoid sleeping on your back until the bubble has totally dissolved or the oil is removed surgically.  In addition, you are restricted from air travelling, mountaineering and diving until the bubble completely dissipates.  This last restriction does not apply if you have oil injected.

When may I resume normal activities and return to work?

• You may return to work in about 1 to 2 weeks.
• If your work involves physical activity or driving, you will need to restrict your activities and remain home longer.
• You may watch TV, look at magazines, or do puzzles.  Reading may be uncomfortable for several days, but using the eyes will not cause any damage.
• You may go outside as usual. If conditions are windy or dusty, wear prescription glasses or sunglasses to avoid getting dust or dirt in the eye.
• You may resume most of your activities around the house including most routine chores.  However, avoid excessive bending, straining or heavy lifting for the first 2 weeks after surgery.
• You should avoid swimming for 8 weeks.

Are there any driving restrictions?

Someone will need to drive you home from the hospital.  Generally, driving can be resumed in several days if you have good vision in your other eye.  If you do not feel comfortable driving, do not drive.  Your depth perception may be decreased, so you will want to try driving during the day in light traffic until you feel comfortable driving.  You should restrict your driving while you are taking prescription pain relief tablets as they can affect your judgment.  You should not drive with the gas bubble still in position.

Can I travel?

You cannot fly in an aeroplane if you have an air or gas bubble in your eye. Talk to your doctor about the duration of this restriction.

Follow up appointments

You will be normally be reviewed in the Eye Clinic after two weeks, then again at approximately eight weeks, following your surgery. 

If for any reason you are unable to attend for your appointments or need further advice, please do not hesitate to contact the Eye Clinic, Ophthalmology Department.

 

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Ophthalmology Department on tel: 01482 816658 or tel: 01482 608788 between 08:30 am to 17:00 pm, Monday to Friday.