• Reference Number: HEY-180/2021
• Departments: Ophthalmology Department
• Last Updated: 16 September 2021

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. However, it is not intended to replace the discussion between you and the healthcare team.  If after reading this leaflet, you have any concerns or questions, please do not hesitate to discuss them with a member of the healthcare team.

What is a vitrectomy operation?

A Vitrectomy is an operation which involves making three small incisions, about 1mm in length 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.  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.

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 fuller details on do’s and don’ts should it have been 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 in 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 the ward 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 or 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.  In some cases, an overnight stay may be required, but this is uncommon.

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 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.

Important points to follow:

• You will be advised if you need to keep in a certain position, in order for the eye to heal.
• You will not need to keep the eye covered, once the anaesthetic has worn off.
• You should avoid heavy lifting and straining for the first week.
• You should avoid getting shampoo and soap into your eye for about 4 weeks.
• You should avoid swimming for 12 weeks.
• You must not drive until you reach the minimum legal standard of vision.
• You should not drive until the anaesthetic has completely worn off and there is no double vision.
• It is normal for the eye to appear red and feel gritty. This is due to the membrane covering the white of the eye being sutured after the operation; some of these effects may last up to Four weeks. The stitches that are used are dissolvable but can take several weeks to dissolve completely.

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 on telephone (01482) 816658 or 608788 (8.30 am – 5.00 pm) or Out-of-Hours (01482) 604346 (Please listen to full voice message on how to access emergency out of hours service).

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

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.