What is vitreoretinal surgery?
Vitreoretinal surgery is a highly specialised type of eye surgery used to treat disorders of the vitreous (the clear gel inside the eye) and the retina (the light-sensitive tissue at the back of the eye). The most common procedure is a vitrectomy, in which the vitreous gel is partially or completely removed to allow access to the retina.
The procedure is usually performed under local anaesthesia with sedation, meaning the eye is numbed and the patient remains comfortable and relaxed. General anaesthesia may be used in more complex cases or for children.
Why is it done?
Vitreoretinal surgery is performed to treat conditions that may otherwise lead to permanent vision loss. These include:
- Retinal detachment.
- Macular hole.
- Epiretinal membrane (macular pucker).
- Diabetic retinopathy with bleeding or scar tissue formation.
- Vitreous haemorrhage.
- Retinal vein occlusion complications.
- Severe eye trauma or intraocular infection (endophthalmitis).
The aim is to preserve vision, improve visual function where possible, and prevent further retinal damage.
What does it involve?
The surgery involves making tiny incisions (usually less than 1 mm) in the sclera (white of the eye). Fine microsurgical instruments are used to remove the vitreous gel and treat the underlying retinal condition.
Depending on the diagnosis, the surgeon may:
- Reattach the retina using laser (photocoagulation) or cryotherapy.
- Remove scar tissue or membranes from the retinal surface.
- Treat bleeding within the eye.
- Insert a gas bubble or silicone oil to support retinal healing.
- Perform delicate macular surgery, such as internal limiting membrane peeling.
The procedure typically lasts between one and two hours and is commonly carried out as a day-case.
Preparation for vitreoretinal surgery
Prior to surgery, a detailed eye assessment is performed, often including imaging such as optical coherence tomography (OCT) and ocular ultrasound.
Patients may be advised to:
- Temporarily stop certain medications, such as anticoagulants, if appropriate.
- Fast for several hours before surgery if sedation or general anaesthesia is planned.
- Arrange for someone to accompany them home after the procedure.
Pre-operative instructions will be provided clearly by the surgical team.
Recovery after the procedure
After surgery, patients may experience mild discomfort, redness and blurred vision. Eye drops are prescribed to reduce inflammation and prevent infection.
If a gas bubble is inserted, strict head positioning may be required for several days to optimise healing. Patients must avoid flying and high altitudes until the gas has fully absorbed, as this can dangerously increase eye pressure.
Visual recovery can take several weeks to months and depends on the underlying condition. In some cases, further procedures may be required, particularly if silicone oil is used and later needs removal.
Alternative treatments
In selected cases, less invasive treatments may be appropriate, depending on the severity and type of condition. These include:
- Intravitreal injections (e.g. anti-VEGF therapy or steroids).
- Laser photocoagulation for early retinal disease.
- Pneumatic retinopexy for certain types of retinal detachment.
Recent advances in vitreoretinal surgery include small-gauge, sutureless techniques and enhanced intraoperative imaging, improving surgical precision, safety and recovery times.
