Vitreoretinal surgery is a new and evolving branch of eye surgery that involves microsurgical techniques. Surgery is performed inside the eye, allowing damage caused by an accident to be repaired, or a detached retina to be reattached.

This type of surgery requires a great deal of skill and often takes place on urgent or emergency cases. It is therefore restricted to specialist trauma centres and the larger private eye clinics.

Vitreoretinal surgeon training

Vitreoretinal surgeons are fully qualified ophthalmologists, who have completed the seven year training programme of Ophthalmic Specialist Training (OST), and who have then undergone a further two years of sub-speciality training in advanced microsurgery techniques.

Many vitreoretinal surgeons are members of the British & Eire Association of Vitreoretinal Surgeons (BEAVRS).

What is vitreoretinal surgery used to treat?

Vitreoretinal surgery is used to treat a range of conditions that affect the retina and the vitreous humour of the eye, including:

• Retinal detachment – a condition in which the retina begins to peel away from the back of the eye. If treated promptly, 90% of reattachment operations are successful. The eye is filled with gas to replace the vitreous fluid following surgery.
• Macular hole – a condition in which a small hole appears in the centre of the macula, disrupting vision. Following a vitrectomy, the inner lining membrane of the retina is removed and a gas bubble is put in place to press the sides of the hole together. This vitrectomy, peel and gas technique is successful in 90% of cases, providing that the macular hole is treated within twelve months of diagnosis.
• Epiretinal membrane – this occurs when thin layer of scar tissue forms over the macula. It is removed with delicate forceps following a vitrectomy and the eye is then filled with gas.
• Floaters – these are benign and will not cause any damage to the eye, however, in serious cases, they can significantly disrupt vision. A vitrectomy will remove both the vitreous fluid and the offending floaters.
• Diabetic vitreous haemorrhage – this occurs when weakened blood vessels bleed into the vitreous causing hazing or floaters. A vitrectomy not only removes these obstructions, but also stops the pulling effect of the vitreous on the retinal blood vessels.

The use of gas after vitreoretinal surgery

It is common for the eye surgeon to use gas after surgery. This is necessary if the bulk of the vitreous fluid has been removed. Gas stays in the eye until the space is refilled naturally with fluid but you will need regular checks (weekly or monthly) to make sure the structures that have been repaired are still being held in place.

Having gas in the eyeball also has an impact on other health procedures and daily activities:

• If you have gas in your eye after vitreoretinal surgery and then need further surgery, you must not have nitrous oxide as an anaesthetic as this can increase pressure within the eye to dangerous levels.
• For the same reason, you must not fly. Changes in pressure in the aircraft will also have a severe impact on the pressure inside your eye and could result in blindness.
• You must also not travel by any other means to a higher altitude, as the eye cannot compensate for the change in atmospheric pressure.

Risks and complications of vitreoretinal surgery

Vitreoretinal surgery involves very delicate and complex microsurgery techniques, so there will always be a risk that something can go wrong. This is especially true when the surgery takes place around the sensitive areas of the retina, such as the macula or if the surgery is required because of damage through trauma. Retinal tears and punctures resulting from surgery are rare but do happen, and further surgery may be needed to repair the damage.

Vitrectomy has been shown to increase the risk of developing cataracts, or to speed up their development in certain cases. As with all invasive surgery, vitreoretinal surgery also carries a small risk of infection.

Although it is important to be aware of what may happen, the benefits of potentially having your sight saved usually outweigh the risks.