Vitrectomy surgery is a microsurgical procedure used to treat problems affecting the vitreous and retina. It involves carefully removing some or all of the vitreous gel from inside the eye so the surgeon can reach the retina and treat the underlying problem.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Depending on the condition being treated, vitrectomy may be combined with procedures such as membrane peeling, laser treatment, removal of blood or scar tissue, or repair of a retinal tear or detachment. At the end of surgery, the eye may be filled with sterile fluid, a gas bubble or silicone oil.
Although the idea of operating inside the eye can sound complex, modern vitrectomy is performed through very small openings using specialised instruments and a surgical microscope.
The exact steps vary according to the condition being treated and the needs of the individual eye. For an overview of the procedure and the conditions it can treat, see the Vitrectomy page.
What Happens Before Vitrectomy Surgery?
The operation begins well before the first surgical instrument is introduced into the eye. Your ophthalmologist examines the eye and determines exactly what needs to be treated.
Depending on the condition, this may include a dilated retinal examination, optical coherence tomography (OCT), retinal photography, ultrasound or other imaging.
The surgeon also considers your general health, medications and any other eye conditions that could affect the procedure. Before surgery, the medical team discusses the planned procedure, expected benefits, possible risks and available alternatives. The eye to be operated on is confirmed as part of the surgical safety process.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
What Type of Anaesthesia Is Used?
Most vitrectomy procedures are performed with the eye carefully numbed so that you do not feel pain during surgery. Sedation may also be given to help you remain relaxed.
General anaesthesia is used in selected situations rather than routinely. The choice depends on factors such as the patient's age, general health, the complexity of the operation and the surgeon's and anaesthesia team's assessment.
During the procedure, your vital signs are monitored. The eye is cleaned with an antiseptic solution, a sterile drape is placed around it and an eyelid speculum gently keeps the eye open.
Where Does the Surgeon Enter the Eye?
Most posterior vitrectomy procedures are performed through the pars plana, a region in the white part of the eye called the sclera.
The surgeon creates very small openings through which specialised instruments can enter the eye. Modern small-gauge systems allow many vitrectomies to be performed through openings that may be small enough to seal on their own.
Typically, separate access points are used for the instruments needed during surgery. These may include an infusion line, a light source and the vitrectomy instrument.
How Does the Surgeon See Inside the Eye?
Because the structures being treated are extremely small, vitrectomy is performed under a surgical microscope. A specialised viewing system provides the surgeon with a magnified view of the retina and the inside of the eye.
A light pipe illuminates the surgical area, allowing the surgeon to see the vitreous, retina and other structures clearly. This detailed view is important because retinal surgery often involves delicate tissue that must be handled with considerable precision.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Step 1: Removing the Vitreous Gel
The central step in vitrectomy is removing the vitreous gel. The surgeon uses a specialised instrument called a vitrectomy probe, or vitrector. It gently cuts and removes the vitreous in a controlled manner.
Removing the vitreous provides access to the retina and can also eliminate material that is interfering with vision, such as blood or inflammatory debris.
In some conditions, the surgeon also needs to carefully separate the vitreous from areas where it is pulling on the retina. This is particularly important when abnormal traction is contributing to a retinal tear, detachment, macular hole or other retinal problem.
Step 2: Treating the Underlying Eye Problem
Vitrectomy itself is often only one part of the operation. Once the vitreous has been removed, the surgeon can perform additional procedures required to treat the underlying condition. The exact treatment depends on why the vitrectomy is being performed.
Removing blood
If blood inside the vitreous is blocking vision, the surgeon can remove the blood and clear the visual pathway. Additional treatment may be necessary if an underlying retinal condition caused the bleeding.
Removing scar tissue
Abnormal scar tissue can pull on the retina. Fine forceps or other specialised instruments may be used to remove membranes or scar tissue and relieve this traction.
Peeling a retinal membrane
Some retinal conditions involve a thin membrane growing over the retinal surface. The surgeon may carefully peel this membrane away to reduce distortion or traction.
Treating a retinal tear
If a retinal tear is present, laser treatment may be applied around the tear to create a barrier that helps prevent fluid from passing underneath the retina.
Repairing a retinal detachment
When vitrectomy is being used to repair a detached retina, the surgeon removes the vitreous traction and may drain fluid beneath the retina. Once the retina is flattened, laser treatment or another form of retinal sealing may be performed around retinal breaks.
Treating a macular hole
For a macular hole, the surgeon removes the vitreous pulling on the macula. In many cases, the internal limiting membrane is also carefully peeled before a gas bubble is placed inside the eye to support healing.
Step 3: Replacing What Has Been Removed
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Once the necessary retinal work is complete, the surgeon needs to leave the eye filled with an appropriate substance.
Depending on the condition, this may be:
- Sterile saline solution: A balanced salt solution can replace the removed vitreous and allow the eye to maintain its normal shape.
- Gas: A temporary gas bubble may be used when the retina or macula needs internal support while it heals.
- Silicone oil: In selected retinal conditions, silicone oil may provide longer-lasting support. It may later need to be removed in another procedure.
What Happens to the Small Incisions?
Modern vitrectomy commonly uses very small-gauge instruments. In many cases, the openings can seal without stitches.
However, whether stitches are needed depends on the surgical technique, the size of the instruments and the condition of the eye.
The surgeon checks the eye carefully at the end of the operation to make sure the surgical openings are secure and the eye has been appropriately filled.
How Long Does Vitrectomy Surgery Take?
There is no single operating time for every vitrectomy. A relatively straightforward procedure may be completed more quickly, while complex retinal surgery can take considerably longer.
The duration depends on the condition being treated and whether additional procedures—such as membrane peeling, laser treatment, retinal repair or removal of scar tissue—are required.
What Does the Eye Feel Like After Vitrectomy?
A mild scratchy, gritty or foreign-body sensation is common during the early recovery period. The eye may also be red or mildly swollen.
Severe pain is not typical and should be reported to your eye specialist, particularly if it is accompanied by worsening vision or other concerning symptoms.
Vision can be blurry after surgery. This is particularly expected when a gas bubble or silicone oil has been used, and visual improvement may take weeks or longer depending on the condition treated.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Does Vitrectomy Always Restore Vision?
The purpose of vitrectomy is to treat the underlying problem, but the amount of visual improvement depends on the health of the retina and the condition that required surgery.
For example, removing blood from the vitreous may clear the visual pathway, but the final vision can still be limited if the underlying retina has been damaged.
Similarly, repairing a detached retina can restore the retina's position but does not guarantee that vision will return to its previous level. This is why the expected visual outcome is discussed in relation to the specific retinal condition rather than vitrectomy alone.
What Are the Risks of Vitrectomy?
Vitrectomy is a well-established retinal procedure, but like any surgery, it carries potential risks. Possible complications include:
- Eye infection
- Bleeding
- Retinal tear or retinal detachment
- Changes in eye pressure
- Cataract development or progression
- Inflammation
- Persistent or worsening visual problems
- Need for additional surgery
The actual risk depends on the patient's eye condition, the complexity of the operation and any additional procedures performed.
Why Is Vitrectomy Different for Each Patient?
There is no single vitrectomy operation that is identical for every patient. The surgeon may use different instruments, remove different amounts of vitreous, perform membrane peeling or laser treatment, and choose a different substance to fill the eye depending on what needs to be repaired.
For this reason, two patients may both undergo a vitrectomy but have very different surgical steps and recovery instructions. The operation is planned around the underlying retinal or vitreous problem rather than around the procedure name alone.
The Bottom Line
Vitrectomy is a carefully controlled microsurgical procedure that gives the surgeon access to the retina by removing the vitreous gel from inside the eye.
Modern surgery is usually performed through very small openings using specialised instruments and a microscope. After removing the vitreous, the surgeon may perform additional treatment such as membrane peeling, laser therapy, removal of scar tissue or repair of a retinal tear or detachment.
At the end of surgery, the eye may be filled with saline, gas or silicone oil depending on the condition being treated. These choices, along with any required head positioning and activity restrictions, are tailored to the individual eye.
Understanding these steps can make vitrectomy feel less unfamiliar. The procedure is not a single standard operation; rather, it is a surgical approach that can be adapted to the specific retinal or vitreous problem that needs to be treated.
