Vitrectomy in Moscow: vitreous removal, indications, and recovery
Vitrectomy in Moscow is performed for diseases of the internal structures of the eye, when it is necessary to remove the altered vitreous and gain access to the retina. At K+31, this surgery is performed after diagnosis, as the treatment strategy depends on the diagnosis, the duration of the disease, and the condition of the visual tissue.
We explain to the patient why vitrectomy is necessary, how it is performed, and what restrictions there will be after the procedure. The main goal of treatment is to protect the eye from further damage and support vision recovery if the tissues are still capable of doing so.
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Indications for vitrectomy
The decision to operate is made by an ophthalmic surgeon after an examination and tests. We evaluate visual acuity, the condition of the macula, the transparency of the ocular media, the periphery of the retina, and the risks for the other eye. Old reports are useful, but the treatment plan is built on the current picture.
Most often, we can recommend vitrectomy in the following conditions:
- Retinal detachment
- Vitreous hemorrhage
- Macular hole
- Epiretinal membrane
- Diabetic retinopathy with complications
- Consequences of eye injury
After the list, the doctor explains why in one case it is possible to observe, and in another it is better not to wait. With retinal diseases, the timing sometimes affects the prognosis.
Retinal detachment
With retinal detachment, the inner lining of the eye separates from its normal position. A person may experience flashes of light, a dark shadow to the side, a "curtain" in front of the eye, or notice a sudden deterioration in vision. Symptoms sometimes appear quickly, so it's important not to wait.
If the doctor detects a tear or significant displacement, retinal surgery is performed. During the procedure, the surgeon removes the cause of the detachment, reinforces the affected areas, and selects internal support. The prognosis is determined by the condition of the macula—the central area responsible for clear vision—and the timing of the consultation.
Vitreous hemorrhage
Vitreous hemorrhage can present in various ways. Some patients experience a dark cloudiness or spots in front of the eye. Others experience a sharp decrease in vision, as if a thick curtain had appeared inside the eye. It's important for the doctor to determine whether the blood gradually resolves on its own or whether the hemorrhage is caused by a rupture, detachment, or vascular complication.
If the blood persists and interferes with the examination, a vitrectomy may be necessary. The surgeon removes the blood, examines the retina from the inside, and, if necessary, strengthens the affected areas with a laser.
Macular hole
A macular hole is a defect in the central area of the retina. The macula is responsible for reading, facial recognition, and fine detail. When damaged, a person may see a spot in the center, distorted lines, or decreased clarity.
With this diagnosis, vitrectomy helps relieve tension from the vitreous. At the end of the surgery, the doctor may use internal support to better align the edges of the hole. Recovery is gradual, so the timeline is discussed before treatment.
Epiretinal membrane
This is a thin film on the surface of the retina. The epiretinal membrane can tighten the central area, causing lines to appear jagged, reading to be more difficult, and vision to become blurry. Sometimes the changes develop slowly, so the patient may not notice the problem for a long time.
If the membrane is severe, retinal surgery is necessary. The surgeon removes the membrane and reduces tension in the macular area. The outcome depends on the duration of the process and the condition of the tissue.
Diabetic retinopathy and complications
Diabetic retinopathy affects the retinal blood vessels. In severe cases, hemorrhages, scar tissue, and areas of tension may appear inside the eye. This reduces vision and increases the risk of detachment.
If diabetic retinopathy develops complications, the doctor decides whether the eye can be observed further or whether vitreoretinal surgery is necessary. Sometimes, during surgery, the following must be removed:
- Blood
- Adhesions
- Altered vitreous humor
The treatment strategy depends on the condition of the eye and how well the diabetes is controlled.
Consequences of eye injuries
After an injury, blood, opacities, foreign particles, or scarring may remain inside the eye. Sometimes the retina is damaged, resulting in a tear or detachment. In such cases, delays can worsen the prognosis.
Removing the vitreous after an injury helps the doctor examine the internal structures and eliminate the mechanical causes of the damage. The extent of treatment depends on the nature of the injury. The risks and possible outcomes are explained to the patient in advance.
General information
How is a vitrectomy performed?
Before the procedure, we conduct a diagnosis and discuss the plan. The patient must understand the surgeon's task: removing blood, relieving tension, closing the tear, supporting the retina, or performing several steps at once.
Diagnosis and preparation for the procedure
Preparation begins with a consultation with the ophthalmologist. We check visual acuity, intraocular pressure, the anterior segment of the eye, and the fundus, if the doctor can clearly see it. A vision test and an assessment of the patient's general condition are also performed.
The examination may include:
- OCT
- Ultrasound of the eye
- Fundus images and other methods as indicated
If blood or dense clouding obscures the view, an ultrasound can help identify signs of detachment and the condition of internal structures. After diagnosis, the doctor calmly explains the appropriate approach for each case.
Stages of the Surgery
Eye surgery is performed in a sterile operating room. The surgeon performs a microinvasive approach through small punctures and inserts fine instruments. This approach reduces trauma and allows for precision.
First, the vitreous is removed. Then, the doctor removes blood, membranes, scar tissue, or other changes that interfere with the retina. Laser treatment and internal tamponade are used if necessary.
Gas Tamponade and Silicone Oil: What Patients Need to Know
After surgery, the retina sometimes requires internal support. For this, the doctor may use a gas bubble or silicone oil. The choice depends on the diagnosis, the area of damage, and the risk of recurrent detachment.
| Parameter | Gas tamponade | Silicone oil |
|---|---|---|
| When to use | For a number of retinal pathologies | For more complex cases |
| What it does | Helps to press the retina | Maintains the retina for a long time |
| Features | Requires adherence to recommendations | May require subsequent removal |
| What is important for the patient | Head position monitoring, observation | Regular monitoring Doctor |
The gas gradually dissipates, but while it's in the eye, the patient must adhere to certain restrictions. Flying with gas is prohibited until cleared by a doctor. Silicone oil lasts longer and is sometimes removed with a separate procedure.
FAQ
What is vitrectomy and why is it performed?
How is a vitrectomy performed?
How long does recovery after vitrectomy take?
What restrictions are important after surgery?
Category of Clinical Guidelines of the Ministry of Health of the Russian Federation — https://cr.minzdrav.gov.ru/
Ministry of Health of the Russian Federation — https://minzdrav.gov.ru/
Journal "Ophthalmology Bulletin" — https://www.mediasphera.ru/journal/vestnik-oftalmologii
Russian Medical Journal (RMJ) — https://www.rmj.ru/
Ophthalmology portal EyePress — https://eyepress.ru/
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What is vitrectomy and when is it needed?
Vitrectomy is an ophthalmological surgery in which the surgeon removes abnormal contents within the eye. Most often, this involves the vitreous humor—the transparent, gel-like structure between the crystalline lens and the retina.
Normal vitrectomy does not interfere with vision, but it can become a problem due to hemorrhage, opacification, injury, or scarring.
Through small incisions, the doctor is able to work on the back of the eye. If necessary, they remove blood, membranes, and dense bands, treat dangerous areas with a laser, and support the retina from the inside. This approach is part of ophthalmic surgery and is used only when indicated.
What is removed and why
During surgery, the doctor may remove all or part of the vitreous humor. The extent depends on the diagnosis. If there is blood, scar tissue, or dense opacities inside the eye, they prevent light from reaching the retina and complicate treatment.
After removing the affected structures, the surgeon evaluates the retina from the inside. If there is a tear, areas of tension, or a risk of detachment, the doctor immediately addresses these areas. Therefore, a vitrectomy is often needed not for the removal itself, but to fully access the damaged area.
How does vitrectomy differ from other treatment methods?
Drops, tablets, and laser treatments do not help with all conditions. If the problem is internal, and tissue is pulling on the retina or blood is obscuring the view, conservative treatment may not be enough. In such cases, vitreoretinal surgery is required.
The laser targets the visible areas of the retina. If there is dense hemorrhage or significant changes, the doctor may not be able to see the entire fundus. Endovitreal surgery allows for internal surgery when other approaches fail to produce the desired results.