What vitrectomy is
The vitreous is the clear gel filling the large cavity behind the lens. In a young eye it is firm and attached to the retina; with age it liquefies and separates. It serves no ongoing function in adult vision, which is what makes removing it feasible.
A vitrectomy removes that gel through instruments passed into the eye via very small openings in the white of the eye. With the gel out of the way, the surgeon can reach the retina directly — to reattach it, peel membranes off it, clear blood, or treat traction pulling on it.
Modern vitrectomy uses micro-incision instruments small enough that the openings usually seal themselves without stitches.
When it is needed
- Retinal detachment — to drain fluid under the retina, treat the breaks and support the retina while it reattaches
- Vitreous haemorrhage — clearing blood that is blocking vision, common in advanced diabetic retinopathy
- Tractional retinal detachment — where scar tissue from diabetes is pulling the retina off
- Macular hole — a gap at the centre of the retina causing distorted or missing central vision
- Epiretinal membrane — a fine scar sheet on the macular surface, wrinkling it and distorting vision
- Dropped lens fragments after complicated cataract surgery
- Endophthalmitis — severe infection inside the eye
- Diagnostic sampling of the vitreous in some inflammatory or infective conditions
What happens during surgery
The eye is anaesthetised, usually by local injection, occasionally under general anaesthesia. Three small ports are made. One maintains pressure with fluid, one carries a light source, and one carries the cutting instrument.
The vitreous is removed. Then the surgeon does whatever the underlying condition requires — peeling a membrane with fine forceps, applying laser around retinal breaks, drawing off fluid beneath the retina, or clearing blood.
At the end the eye is filled. Which filler is used depends on the problem:
- Balanced salt solution where no internal support is needed
- Gas, which presses the retina into place and absorbs on its own over weeks
- Silicone oil, used for complex or recurrent detachments, giving longer support but usually requiring a second operation to remove it
Recovery
Vision is poor immediately after surgery and clears slowly. If gas was used, you will see a dark line across your vision that descends as the bubble shrinks — this is expected, not a complication.
Drops are prescribed on a tapering course. Posturing, if required, starts straight away and matters.
Two restrictions are strict while a gas bubble is present: no air travel and no high-altitude road travel, and tell any anaesthetist that you have an intraocular gas bubble before any other surgery, because certain anaesthetic gases expand it.
Avoid heavy lifting, straining, swimming and dusty environments until cleared. Follow-up appointments check pressure, healing and whether the retina is holding.
Final vision depends much more on the condition treated than on the surgery. A macular hole repaired early behaves very differently from a long-standing macula-off detachment, and your surgeon should give you a realistic expectation before the operation rather than after it.
Availability in the Malabar region
Vitrectomy needs a surgeon trained specifically in vitreoretinal surgery and the equipment to match, which is why patients from Malappuram district were historically referred well outside it. Sampada VR was established as the first centre in the region dedicated to vitreoretinal disease, and vitrectomy is the operation at the centre of that work.