Retinal surgery

In recent years, thanks to the development of modern technology and the introduction of new operating methods, modern apparatus and diagnostic tests, the number of diseases that can be treated using vitrectomy has increased significantly, thus giving hope for the recovery or maintenance of vision in many cases of eye diseases, until recently considered incurable.

Dr. Jarosław Kachnowicz
Ophthalmology specialist

Vitrectomy (retinal-vitreous surgery)
is a microsurgical procedure involving excision of the vitreous body (from Latin  corpus vitreum  – hence the name of the procedure) from the inside of the eyeball. This is often the last moment to regain or maintain vision in previously incurable diseases of the retina and vitreous body .

Vitrectomy operations concern vitreous-retinal structures. They consist in the excision of the vitreous body (from Latin vitreus) – a transparent gelatinous structure resembling a chicken egg white that fills the back part of the eyeball between the lens and the retina of the eye. The vitreous body is part of the eye’s optical system. The condition for creating an image on the retina lining the eye fundus is that this system is completely transparent

The indications for vitrectomy surgery are

• endophthalmitis that does not improve despite treatment and inflammatory residues in the form of thick floaters,
• hemorrhages into the eyeball that are not absorbed by themselves (in diabetes, after injuries, in anemia),
• foreign bodies penetrating inside the eyeball as a result of trauma,
• personal or artificial lens dislocation into the vitreous,
• retinal diseases:
  • retinal detachment,
  • abnormal adhesions between the retina and the vitreous,
  • pre-retinal membranes wrinkle the surface of the retina and distort the image and, over time, make it impossible to see,
  • macular holes significantly impair vision

What is the risk of non-operation?
In the above-mentioned lesions, vision improvement cannot be expected without surgery. Treatment with drops or tablets will not help. And often, such as in the case of endophthalmitis, intraocular foreign body inflammation or retinal detachment, complete and irreversible blindness can rapidly develop.

What is vitrectomy surgery?
The operation is performed under local anesthesia, after injection of an anesthetic into the eyeball area. The operator uses an operating microscope, and precise operating tools are inserted into the eyeball through 3 incisions of its walls 0.5-1 mm in diameter, removing the vitreous body with its turbidity, foreign bodies and diseased tissues. In place of the removed vitreous body, appropriate fluids are introduced to achieve the desired tension in the eyeball. In the case of significant advancement of the lesions, a bubble of gas or silicone oil is injected into the vitreous chamber. It involves the need to keep the head in a fixed position for several days after the surgery so that these substances fit in the right place in the eye, pressing the retina from the inside to the eye walls until it is fully stabilized after surgery. If silicone oil is injected into the vitreous cavity during surgery, it is usually removed surgically after a period determined by the operator.

In the final stage of the operation, the incisions in the eye were usually sutured. Our modern equipment enables seamless operations to be performed. This allows for faster rehabilitation, making the procedure safer and less invasive.

What are the chances of improving vision after vitrectomy?
The degree of improvement in vision after vitrectomy depends on the degree of damage to the retina by the disease that led to the need for the procedure. The retina is a structure made of nervous and vascular tissue arranged in 10 intertwined layers that are very sensitive to hypoxia and other damage. The visual cells of the retina are neither regenerative nor reconstructable. The longer a disease state lasts, the more eyesight cells die. Even a good result of the surgery, consisting in restoring the correct anatomical conditions, does not restore good vision if the retina has been damaged by a foreign body, by infection, or by prolonged hypoxia, such as in the case of ocular complications of diabetes. With uncomplicated vitreous haemorrhage, most patients achieve improved vision. However, if the haemorrhage was caused by severe diabetes, it cannot be ruled out that, despite successful surgery, another haemorrhage will occur. Nevertheless, surgery is necessary because without it there is no chance of improvement. In the case of a vitrectomy aimed at removing a foreign body, the further fate of the eye and its ability to see depend on the mechanical, chemical or infectious damage caused by its penetration into the eye.

Modern technologies
Performing vitrectomy surgery in our clinic is possible thanks to the purchase of the Constellation apparatus. It is a complete novelty on the ophthalmic market. The camera has been sold in Europe since September 2009, only a few were purchased in Poland. Uses NASA space technologies. In addition to the safe excision of the vitreous body of the eye, the device is integrated with an apparatus for diathermocoagulation and intraocular laser therapy, as well as a modern cataract phacoemulsification. We are very pleased that our patients receive comprehensive care at the Clinic for the Treatment of Retinal Diseases and, apart from modern diagnostics, they can also be effectively treated surgically.