VITREORETINAL SURGERIES

VITRECTOMY

Ophthalmology for many years have effectively prevented, diagnosed and treated the diseases of the anterior segment of the eye (i.e. eyelids, conjunctiva, cornea, iris and lens). The posterior segment which is composed of 3 layers (sclera, choroid and retina) filled with vitreous humour is a place where light in the course of photo-chemical reaction is changed into an electric nerve impulse. This impulse after going thorough nerves crates in our brain an image of the world around. Due to its complicated structure and function this part of the eye remained for a long time unavailable to surgical intervention. In the last years, thanks to the development of the new technologies and new surgical methods, new equipment and clinical trials the number of diseases that can be treated using vitrectomy has significantly increased, giving hope for restoration or maintenance of vision in many cases of eye disorders, which have been considered incurable until recently.

Vitrectomy surgeries concern vitreoretinal structures. They consist in the removal of vitreous humour – transparent, gelatinous structure, resembling egg white, which fills the posterior part of the ocular between the lens and the retina. Vitreous humour is a part of the optical system of the eye. A complete transparency of this system is a condition for image creation on the retina covering the fundus of the eye.

Indications for vitrectomy:

What are the consequences of not having a surgery?

In the above-mentioned diseases one cannot expect any improvement of vision without a surgery. Taking drops or tablets will not help. Often, as in the cases of endophthalmitis, foreign body inside the eye or retinal detachment, the disease can lead to complete and irreversible blindness.

How does vitrectomy surgery work?

The surgery is performed in local anaesthesia, after the anaesthetic is injected near the ocular. The operating surgeon uses a surgical microscope, and precise surgical instruments are inserted into the ocular through three incisions in its walls of the diameter of 0.5-1 mm, removing the vitreous together with the opacity, foreign bodies and damaged tissues. The removed vitreous is replaced with appropriate fluids, allowing for desired tension of the ocular. If the lesions are very advanced, a bubble of gas or silicone oil is injected into the vitreous humour. It requires keeping the head in the appropriate position for a few days after the surgery so that these substances are in the right place in the eye, keeping the retina to the wall of the eye from the inside until its full postoperative stability is achieved. If during the surgery a silicone oil is inserted into the vitreous cavity, it is usually surgically removed after the period determined by the surgeon.

On the final stage of the surgery, usually the incisions were stitched. Our modern equipment enables stitchless surgeries. It allows for faster rehabilitation, making the whole procedure safer and less invasive.

What are the chances for better vision after vitrectomy?

The level of the improvement of vision after vitrectomy depends on the level of the damage of the retina caused by the disease which resulted in the need to perform the procedure. The retina is a structure built of nervous and vascular tissues placed in 10 alternating layers, which are very sensitive to hypoxia and other damages. The retinal vision cells are not able to regenerate or restore. The longer the disease lasts, the more vision cells die. Even the good result of the surgery consisting in the restoration of the appropriate anatomic conditions does not restore good vision if the retina has been damaged by a foreign body, infection or long term hypoxia, which occurs e.g. in the eye complications from diabetes. In the case of uncomplicated haemorrhages into the vitreous humour most of the patients achieve vision improvement. However, if the haemorrhage was caused by severe diabetes, it cannot be excluded that despite a successful surgery another haemorrhage will occur. In spite of this fact, the surgery is necessary because otherwise there is no chance for improvement. In the case of vitrectomy aiming at the removal of a foreign body, further condition of the eye and vision depends on the mechanical, chemical and infectious damages caused by the body getting to the eye.

New technologies

Vitrectomy surgery in our clinic is possible thanks to the purchase of Constellation equipment. It is a total novelty on the ophthalmology market. The apparatus has been sold in Europe since September 2009; in Poland only a few devices have been sold so far. It uses NASA cosmic technologies. In addition to the ability to safely cut off the vitreous, the apparatus is integrated with the apparatus for diatermocoagulation, intraocular laser therapy and modern cataract phacoemulsification. We are happy that our patients get comprehensive care in the Retinal Disorders Clinic and in addition to modern diagnostics they can get effective surgical treatment.

 

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  • VITA-MED Ophthalmology Clinic
  • 67-200 Głogów PL, Legnicka St. 5
  • e-mail: klinika@vita-med.glogow.pl