The vitreous is the clear, gel-like substance that fills the center cavity of the eye. The vitreous is commonly affected by various diseases that may cause it to cloud, fill with blood or harden, making it difficult for light to properly reach the retina. This may lead to blurred vision, tears or other serious conditions.
Patients with disease or injury to the vitreous may benefit from a vitrectomy. This procedure removes the vitreous by suctioning it out with tiny instruments that are inserted into the eye. After removal, your doctor may treat the retina with a laser, cut or remove scar tissue, flatten detached areas of the retina or repair holes or tears in the retina.
Although results vary depending on the individual condition treated, most patients experience improved visual acuity after this procedure. Vitrectomy is most effective in treating conditions such as macular hole, retinal detachment, diabetic retinopathy and vitreous hemorrhage.
Retinal detachment is a serious eye condition that occurs when the retina becomes separated from the wall of the eye and its supportive tissue. The retina cannot function when these two layers are detached and, without prompt treatment, permanent vision loss may occur. Retinal detachment can occur from injury to the eye or from very high levels of nearsightedness.
To prevent permanent vision loss, the retina must be quickly reattached. Pneumatic retinopexy, a procedure that creates a gas bubble within the vitreous gel and then expands to place pressure against the retina, can help with reattachment. In more severe cases, a vitrectomy will be performed to prevent the vitreous from tearing the retina. This is usually followed with a gas injection similar to that of a pneumatic retinopexy, except that it fills the entire eye.
Macular holes develop during the aging process, when the vitreous thins and separates from the macula. This can pull on the macula and cause a hole to form. The defect occurs in the fovea, the center of the macula and the most delicate part of the retina. Macular holes may also be caused by eye injury, intraocular inflammation, retinal detachment and other diseases.
As the hole grows over time, central vision progressively worsens. There are three stages of a macular hole: foveal detachments (stage 1), partial-thickness holes (stage 2) and full-thickness holes (stage 3). Each stage can progress to the next if not treated.
Surgery is more than 95% effective for the treatment of macular holes. The procedure is outpatient with local anesthesia. A vitrectomy is performed to remove the vitreous gel, and then a gas bubble is injected into the eye to help the hole close. As the eye heals, the fluid is naturally replaced. There is no non-surgical alternative to treat macular holes.
Retinal Membrane (ERM, ILM, SR)
A retinal membrane, also called an epiretinal membrane or macular pucker, is a thin layer of tissue that forms over the macula, the area of the retina that gives us clear central and reading vision.
Retinal membranes often develop as a part of the aging process. Particles that have drifted into the vitreous settle onto the macula and begin to obscure vision. Membranes may also result from eye conditions such as diabetic retinopathy, retinal detachment, inflammation, injury or vascular diseases. Thick membranes can create wrinkles or puckers in the macula, and blurry or distorted areas in the center of vision may appear. Vision loss increases as the membrane thickens.
Surgery is recommended for membranes that have not healed on their own. Vitrectomy is performed as an outpatient procedure with local anesthesia. During the procedure, the vitreous gel is removed, a saline solution fills the eye and the membrane is lifted from the macula. There is no non-surgical alternative to treat retinal membranes.
Implantable Miniature Telescope (IMT)
Implantable miniature telescopes (IMT) have been FDA-approved to treat patients with late stage, age-related macular degeneration (AMD). Surgically implanted in the eye, the IMT is a tiny telescope that can replace the eye’s natural lens. It magnifies images for the patient by more than two times their normal size.
AMD damages the macula and often causes a loss of vision in the central visual field. By providing magnification of objects and projecting these images onto a healthy area of the retina, the IMT can improve the eyesight of patients with this condition. It is only implanted in one eye, while the other eye is used mainly for peripheral vision, which is unaffected by AMD.