Vitrectomy surgery is not needed for every eye condition involving the vitreous or retina. It is usually considered when a problem inside the eye cannot be adequately treated with observation, medication, laser treatment, injections, or another less invasive approach—or when surgery is needed to protect the retina and preserve vision.
A vitrectomy involves removing some or all of the vitreous gel from inside the eye. This gives the eye surgeon access to the retina and other structures at the back of the eye, allowing them to remove blood or scar tissue, relieve abnormal traction, repair retinal problems, or treat certain infections and injuries.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
The timing of surgery depends heavily on the underlying condition. A retinal detachment or severe eye infection may require urgent treatment, while a macular hole or epiretinal membrane may allow more time for assessment and planning. You can learn more about the procedure on the Vitrectomy page.
What Is Vitrectomy Surgery Used For?
Vitrectomy is a type of vitreoretinal surgery. It allows the surgeon to remove the vitreous gel when it is obstructing the view or contributing to a retinal problem, and it provides access to the retina for additional treatment when needed.
Depending on the condition, surgery may be used to:
- Remove blood that is blocking vision
- Remove scar tissue pulling on the retina
- Relieve abnormal traction between the vitreous and retina
- Repair certain retinal detachments
- Close a macular hole
- Remove an epiretinal membrane
- Treat certain severe eye infections
- Remove an intraocular foreign body after an eye injury
- Address selected complications of cataract surgery
The presence of one of these conditions does not automatically mean that vitrectomy is required. The decision depends on its severity, effect on vision, progression, and whether another treatment can adequately address the problem.
When Is Vitrectomy Usually Recommended?
Vitrectomy is generally considered when the vitreous itself is causing a problem, when it is preventing adequate treatment or examination of the retina, or when access to the retina is needed to correct a structural problem.
Common situations include:
- Retinal detachment requiring surgical repair
- Persistent or severe vitreous haemorrhage
- Tractional retinal detachment
- Macular hole
- Symptomatic epiretinal membrane
- Vitreomacular traction
- Selected complications of diabetic eye disease
- Severe intraocular infection
- Serious eye trauma
- Selected retained lens material or dislocated intraocular lens problems
1. Retinal Detachment
A retinal detachment occurs when the retina separates from its normal position at the back of the eye. Some retinal detachments can be repaired with vitrectomy, depending on their type and characteristics.
During surgery, removing the vitreous can allow the surgeon to access retinal tears or other areas contributing to the detachment. The retina can then be repositioned and additional treatments, such as laser or cryotherapy, may be used. A gas bubble or silicone oil may sometimes be placed inside the eye to help support the retina while it heals.
Because retinal detachment can threaten vision, the timing of treatment is often more urgent than for conditions that develop gradually.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
2. Persistent Vitreous Haemorrhage
The vitreous can fill with blood, causing blurred or severely reduced vision. This is called a vitreous haemorrhage. Vitreous haemorrhage can occur with conditions such as proliferative diabetic retinopathy, retinal tears or other retinal disorders.
Not every vitreous haemorrhage requires immediate vitrectomy. If the cause is known, the retina can be adequately examined and the blood is expected to clear, observation may sometimes be appropriate.
Surgery becomes more relevant when the haemorrhage does not clear, prevents adequate examination or treatment of the retina, is associated with a retinal tear or detachment, or occurs in a situation where delaying treatment could put vision at risk.
3. Diabetic Retinopathy
Advanced diabetic retinopathy can cause abnormal blood vessels and scar tissue to develop inside the eye. These changes can result in recurrent vitreous haemorrhage or traction on the retina.
In selected cases, vitrectomy may be used to remove persistent blood and scar tissue and to relieve traction, particularly when tractional retinal detachment threatens or involves the macula.
However, diabetic eye disease can often be managed with other treatments depending on its stage. Vitrectomy is generally reserved for situations in which the retinal changes require surgical treatment or other approaches are insufficient.
4. Macular Hole
A macular hole is an opening in the macula, the central part of the retina responsible for detailed vision. Vitrectomy can be used to remove the vitreous traction contributing to the hole. The surgeon may also peel a very thin membrane from the retinal surface and place a temporary gas bubble inside the eye to support closure.
The decision to operate depends on factors such as the size and duration of the hole, its effect on vision and the characteristics seen on retinal imaging. Not every macular hole has exactly the same course, particularly traumatic holes and holes occurring in younger patients. In selected cases, a period of observation may therefore be considered before surgery.
5. Epiretinal Membrane
An epiretinal membrane is a thin layer of scar-like tissue that develops on the surface of the retina. It can cause blurred or distorted vision as it contracts and alters the normal shape of the macula.
Many epiretinal membranes do not require surgery, particularly when symptoms are mild and stable. Vitrectomy with membrane peeling may be considered when the membrane causes significant visual symptoms, such as persistent reduction in vision or metamorphopsia, in which straight lines may appear bent or distorted.
The decision is therefore based not only on what the membrane looks like on an eye scan, but also on how much it is affecting the person's vision and daily activities.
6. Vitreomacular Traction
Normally, the vitreous gradually separates from the retina as the eye ages. Sometimes it remains attached to the macula while pulling on it. This is called vitreomacular traction.
Mild cases may sometimes be observed, particularly if symptoms are limited and the condition is stable. Surgery may be considered when persistent traction is causing significant visual problems or structural damage to the macula. During vitrectomy, the surgeon removes the vitreous and releases the abnormal traction.
7. Tractional Retinal Detachment
Tractional retinal detachment occurs when scar tissue or abnormal fibrous tissue pulls the retina away from its normal position. This can occur in advanced diabetic retinopathy and other conditions involving abnormal retinal blood vessels.
Vitrectomy can allow the surgeon to remove the vitreous and carefully dissect or peel the tissue causing the traction. If the macula is threatened or detached, timely treatment can be particularly important for protecting central vision.
8. Severe Eye Infection
A serious infection inside the eye, called endophthalmitis, can sometimes require vitrectomy. In these cases, surgery may be used to remove infected or inflammatory material from the vitreous cavity and allow appropriate treatment of the infection.
The urgency depends on the severity of the infection and the patient's vision and clinical findings. Severe endophthalmitis is considered a potentially vision-threatening condition requiring prompt specialist treatment.
9. Serious Eye Injury
Severe eye trauma can damage the retina, vitreous and other internal structures. A foreign object can also sometimes enter the eye and remain inside it.
Vitrectomy may be required to remove blood, damaged vitreous tissue or an intraocular foreign body, or to repair associated retinal damage.
The timing depends on the type and severity of the injury. Open-globe injuries, retained intraocular foreign bodies and traumatic retinal complications require particularly careful assessment.
10. Complications During or After Cataract Surgery
Although cataract surgery and vitrectomy are different procedures, certain complications during cataract surgery can require vitreoretinal intervention.
For example, lens material may accidentally enter the vitreous cavity, or an intraocular lens may become displaced into the back of the eye. In selected situations, vitrectomy may be used to remove retained material or provide access for further repair.
Does Every Vitreous Problem Require Surgery?
No. This is an important distinction. The vitreous changes naturally with age, and many vitreous conditions do not require an operation.
Even some problems that can eventually be treated with vitrectomy may initially be managed with observation, medication, injections or laser treatment.
The decision generally depends on four questions:
- What is causing the problem?
- How much is it affecting vision or retinal health?
- Is the condition stable or progressing?
- Can another treatment adequately manage it?
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
When Can Vitrectomy Be Delayed?
Some conditions allow time for observation and further assessment. For example, a vitreous haemorrhage may sometimes be observed if the underlying cause is known, the retina can be monitored adequately and there are no signs requiring urgent surgery.
Similarly, selected macular holes or epiretinal membranes may be monitored depending on their characteristics and effect on vision.
Delaying surgery does not necessarily mean that treatment is being ignored. In selected situations, observation allows the ophthalmologist to determine whether the condition improves or remains stable without exposing the eye to surgical risks unnecessarily.
What Tests Help Determine Whether Vitrectomy Is Needed?
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
An ophthalmologist may use several tests to determine the cause of vision changes and whether surgery is appropriate. These may include:
- Dilated retinal examination: Allows the retina and vitreous to be assessed directly.
- Optical coherence tomography (OCT): Provides detailed cross-sectional images of the macula and can identify conditions such as macular holes, epiretinal membranes and vitreomacular traction.
- Ocular ultrasound: Can help assess the retina when dense vitreous haemorrhage prevents a clear view.
- Fundus photography: May document retinal and vitreous abnormalities when the retina can be visualised.
- Other imaging or examinations: May be required depending on the suspected cause.
What Are the Risks of Having Vitrectomy?
Like any eye surgery, vitrectomy carries potential risks. These can include infection, bleeding, increased or decreased eye pressure, retinal tears or detachment, inflammation and other complications.
Cataract development or progression is also a recognised consideration in some patients, particularly those who still have their natural lens.
The risks vary according to the reason for surgery, the condition of the retina, the patient's general eye health and the type of procedure being performed. The potential benefits and risks are therefore assessed individually before surgery.
The Bottom Line
Vitrectomy surgery is considered when a problem involving the vitreous or retina cannot be adequately managed with observation or other treatments, or when surgery is needed to repair or protect the retina.
Common reasons include certain retinal detachments, persistent vitreous haemorrhage, advanced diabetic retinal disease, macular holes, symptomatic epiretinal membranes, vitreomacular traction, severe eye infections and serious eye injuries.
Importantly, the diagnosis alone does not always determine whether surgery is needed. The severity of the condition, its effect on vision, how quickly it is changing and whether another treatment can work all influence the decision. Some cases can be monitored, while others require prompt surgical treatment.
For this reason, the most appropriate timing for vitrectomy is individual to each eye. A detailed retinal examination and appropriate imaging help determine whether surgery is necessary and how urgently it should be performed.
