Vitrectomy

Introduction

If your eye doctor has recommended a vitrectomy, you are likely dealing with a condition affecting the back of your eye — perhaps a retinal detachment, bleeding inside the eye from diabetes, a macular hole, or scar tissue on the retina. Being told that surgery is needed inside the eye can feel frightening. It is one of the most delicate areas of the body, and the idea of an operation there understandably causes anxiety.

The good news is that vitrectomy is now a well-established microsurgical procedure. Over the past two decades it has evolved into a same-day operation performed through tiny openings in the white of the eye, often without stitches. Vitreoretinal surgeons use high-magnification microscopes and instruments thinner than a strand of spaghetti to repair the retina from the inside.

This guide explains what vitrectomy involves, why it is performed, what happens during and after surgery, and what vision outcomes you can reasonably expect. It is written for patients who already have a retinal diagnosis and are now planning treatment, as well as for family members supporting them through recovery.

What Is Vitrectomy?

A vitrectomy is a surgery that removes the vitreous gel — the clear, jelly-like substance that fills the back two-thirds of the eyeball. Removing this gel allows the surgeon to reach the retina, the light-sensitive tissue at the back of the eye, and repair problems that cannot be treated from outside.

• The cornea is the clear front window of the eye.
• The lens sits behind the cornea and focuses light.
• The vitreous is the gel-like material that fills the space behind the lens.
• The retina lines the back inner surface of the eye and converts light into nerve signals.
• The macula is the central part of the retina responsible for sharp, detailed vision.

In a healthy young eye, the vitreous is firmly attached to the retina. With age, it gradually liquefies and pulls away. In many people this happens uneventfully, but sometimes the vitreous tugs on the retina, becomes filled with blood, develops scar tissue, or contributes to a hole or detachment. When this happens, removing the vitreous can solve or stabilise the problem.

The full name of the operation is pars plana vitrectomy, named after the part of the eye wall through which the instruments are inserted. Modern small-gauge vitrectomy uses instruments around 23, 25, or 27 gauge — small enough that the openings usually seal themselves without stitches.

After the vitreous is removed, the eye is filled with one of the following:

• Saline solution — a salt water similar to the body's natural fluids. The eye gradually replaces this with its own fluid.
• A gas bubble — used to press the retina against the back wall of the eye while it heals. The bubble dissolves over days to weeks.
• Silicone oil — used in more complex cases where prolonged internal support is needed. Silicone oil is usually removed in a second, smaller operation months later.

Why Is Vitrectomy Performed?

Retinal Detachment

A retinal detachment occurs when the retina peels away from the back wall of the eye. Without treatment it usually leads to permanent vision loss in that eye. Vitrectomy is one of the established approaches for repairing retinal detachment, particularly when there is significant traction from the vitreous, when there are tears toward the back of the eye, or when the detachment is complex. During surgery the fluid behind the retina is drained, the retina is repositioned, retinal tears are sealed with laser, and the eye is filled with gas or silicone oil to hold the retina in place while it heals.

Diabetic Retinopathy and Vitreous Haemorrhage

Long-standing diabetes can damage the blood vessels of the retina. Fragile new vessels may grow and bleed into the vitreous, blocking vision. Scar tissue can also form and pull on the retina, causing a tractional retinal detachment. Vitrectomy is commonly performed in advanced diabetic eye disease to clear blood from the vitreous, remove scar tissue, and apply laser to the retina from the inside.

Macular Hole

A macular hole is a small break in the central part of the retina. It causes blurred and distorted central vision. Vitrectomy combined with peeling of a thin membrane on the retinal surface and a gas bubble allows most macular holes to close.

Epiretinal Membrane

An epiretinal membrane, sometimes called macular pucker, is a sheet of scar-like tissue that grows on the surface of the macula. It can wrinkle the retina and distort vision. Vitrectomy with membrane peeling is the established approach when the distortion or vision loss is significant.

Vitreous Haemorrhage from Other Causes

Bleeding into the vitreous can also occur from a retinal tear, trauma, blocked retinal veins, or other vascular problems. When the blood does not clear on its own, or when there is concern about an underlying retinal tear that needs treatment, vitrectomy is used to remove the blood and address the source.

Severe Eye Trauma

Penetrating injuries, foreign bodies inside the eye, or severe blunt trauma can damage the vitreous and retina. Vitrectomy allows the surgeon to remove foreign material, repair the retina, and clean blood from inside the eye.

Endophthalmitis

This is a serious infection inside the eye. Vitrectomy may be used to remove infected vitreous and deliver antibiotics directly into the eye.

Dislocated Lens Fragments or Intraocular Lens

If pieces of a cataract fall into the vitreous during cataract surgery, or if a lens implant becomes dislocated, vitrectomy is used to retrieve them safely.

Persistent Floaters

In selected cases where large, persistent floaters significantly affect quality of life and do not improve on their own, a vitrectomy may be considered. This indication is less common because the procedure carries surgical risks that must be weighed carefully against the symptom.

Who Is a Candidate?

Whether vitrectomy is the right operation depends on the specific condition, how much vision is at risk, and the overall health of the eye. Surgeons generally consider the following:

• The underlying diagnosis and how it has progressed
• How much the vision is already affected
• Whether the condition is likely to worsen without surgery
• The health of the macula, the optic nerve, and the other eye
• General medical health, particularly diabetes control and ability to lie still during surgery
• Ability to follow post-operative instructions, especially face-down positioning if a gas bubble will be used

For some conditions, such as a fresh retinal detachment threatening the macula, surgery is urgent and decisions are made within hours or days. For others, such as a stable epiretinal membrane, there is time to plan and consider alternatives.

Alternatives to Vitrectomy

Not every retinal condition requires vitrectomy. Depending on the diagnosis, surgeons may consider one or more of the following.

Observation

Some conditions improve on their own or remain stable for long periods. Small vitreous haemorrhages, mild epiretinal membranes with good vision, and posterior vitreous detachments without retinal tears are often monitored rather than operated on.

Laser Treatment

Laser photocoagulation can seal retinal tears before they progress to a detachment, treat abnormal blood vessels in diabetic retinopathy, and address other localised retinal problems. It is done in the clinic and avoids surgery in many cases.

Intravitreal Injections

Injections of medication into the eye — including anti-VEGF drugs and steroids — are widely used for diabetic macular oedema, age-related macular degeneration, and retinal vein occlusion. For many patients these injections reduce or delay the need for surgery.

Pneumatic Retinopexy

For certain types of retinal detachment, a gas bubble can be injected into the eye in the clinic, combined with laser or freezing treatment, to push the retina back into place. This is less invasive than vitrectomy but is suitable only for selected cases.

Scleral Buckle Surgery

A scleral buckle is a soft silicone band placed around the outside of the eye to support the retina from outside. It is an alternative or addition to vitrectomy for certain retinal detachments, particularly in younger patients or specific tear configurations. Some surgeons combine vitrectomy with a scleral buckle in complex detachments.

Which option is most appropriate depends on the diagnosis and individual factors. A vitreoretinal specialist will discuss the trade-offs based on your specific situation.

Preparing for Vitrectomy

Preparation usually starts a week or two before surgery, although in urgent cases there may be only hours.

Pre-operative Assessment

Before surgery your eye will be examined in detail. Tests commonly performed include:

• Dilated retinal examination to look at the retina and vitreous
• Optical Coherence Tomography (OCT), a scan that takes cross-section images of the retina — useful for macular holes, membranes, and swelling
• Ultrasound B-scan when the view of the retina is blocked by blood or cataract
• Fluorescein angiography, where a dye is injected into a vein to study blood flow in the retina, often used in diabetic eye disease
• Measurements of the eye, particularly if a cataract operation is planned at the same time

You will also have a general health check. Blood pressure, blood sugar (for people with diabetes), and any blood-thinning medications will be reviewed. Your surgeon and physician will advise whether medicines such as aspirin or anticoagulants should be continued or paused; this depends on the individual situation.

Before Surgery Day

• You will usually be asked not to eat or drink for several hours before surgery, particularly if sedation or general anaesthesia is planned.
• Use any prescribed eye drops as directed.
• Arrange for someone to accompany you home, as you will not be able to drive afterwards.
• Plan for the days after surgery in advance — including face-down positioning if your surgeon expects to use a gas bubble.

What Happens During Vitrectomy

Vitrectomy is almost always performed as day-case surgery. You go home the same day.

Anaesthesia

Most vitrectomies are done under local anaesthesia with sedation. A numbing injection is given around the eye so you feel no pain, and a sedative helps you relax. General anaesthesia is used in some situations — for example, in children, in long or complex operations, or when a patient cannot lie still.

During the Operation

The basic steps are similar across most vitrectomies, although the exact work varies with the diagnosis.

1. Your eye is cleaned and the area around it is draped. An eyelid holder gently keeps the eye open so you do not need to worry about blinking.
2. Three tiny openings (usually 23, 25, or 27 gauge) are made in the pars plana, the part of the eye wall just behind the iris. These openings allow access without disturbing the iris, lens, or cornea.
3. Through one opening, a thin tube provides a constant flow of fluid to keep the eye's shape. Through another, a fibre-optic light illuminates the inside. Through the third, the surgeon introduces instruments.
4. A small cutter removes the vitreous gel piece by piece. Blood, scar tissue, and membranes are cleared.
5. The retina is then treated according to the underlying condition: tears are sealed with laser, holes are addressed by peeling a thin membrane, membranes are removed with fine forceps, or foreign material is retrieved.
6. The eye is filled with saline, gas, or silicone oil, depending on the case.
7. The small openings are checked. With small-gauge instruments they often self-seal; if not, a single dissolving stitch may be used.

The operation usually takes between 45 minutes and 2 hours, although complex cases can take longer.

Combined Surgery

The lens of the eye often becomes cloudy (cataract) in the months or years after vitrectomy. For this reason, in patients who already have early cataract changes, surgeons sometimes combine vitrectomy with cataract surgery in a single operation. Whether to combine the two depends on the individual eye.

Recovery and Healing

Recovery from vitrectomy unfolds over weeks to months. The exact pattern depends on what was treated and what was used to fill the eye.

The First Few Days

Immediately after surgery, your eye will be covered with a patch and shield. Common experiences include:

• Blurred vision — expected, especially if a gas bubble was used
• A gritty or scratchy sensation
• Mild aching that responds to simple pain relief
• Redness of the white of the eye
• Watering and light sensitivity

You will be given antibiotic and anti-inflammatory eye drops to use for several weeks. Following the drop schedule carefully is important for healing and infection prevention.

If a Gas Bubble Was Used: Posturing

For macular holes and certain detachments, this means face-down positioning for much of the day and night for several days, sometimes up to a week. Surgeons increasingly tailor positioning advice to the specific case, and the duration has shortened over the years.

Practical tips for posturing include:

• Borrow or buy a face-down support cushion or chair before surgery
• Plan meals and entertainment (audio books, podcasts) that work in a face-down position
• Take short breaks as advised by your surgeon
• Sleep on the side advised by your surgeon, often the side that keeps the bubble in the right place

The gas bubble will appear as a dark line or shimmer in your field of vision and will slowly shrink over one to eight weeks, depending on the type of gas used. As it shrinks, vision through the eye gradually improves.

Important: while a gas bubble is in the eye, you must not fly in an aeroplane or travel to high altitude. Changes in air pressure can cause the gas to expand and dangerously raise pressure inside the eye. Your surgeon will tell you when it is safe to travel. If you need general anaesthesia for any other reason during this period, the anaesthetist must be informed that a gas bubble is in the eye, as certain gases used during anaesthesia can cause the bubble to expand.

If Silicone Oil Was Used

Silicone oil provides long-term internal support and does not absorb on its own. Air travel is generally safe with silicone oil. The oil is usually removed in a second, shorter operation several months later, once the retina has healed.

If Saline Was Used

• Week 1: Drops are used several times a day. Vision is blurred. Light activities are usually allowed; heavy lifting, bending, and strenuous exercise are avoided.
• Weeks 2 to 4: Redness and discomfort settle. Vision begins to clear if a gas bubble was used, as the bubble shrinks. Drops continue, often at reduced frequency.
• Weeks 4 to 8: Most patients return to normal daily activities. Many can return to work depending on the type of job and the eye's progress.
• Months 2 to 6: Vision continues to stabilise. The final level of vision is often not reached until three to six months after surgery, sometimes longer.

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What to Avoid During Recovery

• Rubbing or pressing on the eye
• Getting soap or shampoo in the eye for the first one to two weeks
• Swimming for the first month or as advised
• Heavy lifting and strenuous exercise as advised by your surgeon
• Driving until your surgeon confirms it is safe and vision meets the legal standard
• Air travel while a gas bubble is present

Risks and Complications

Modern vitrectomy is generally considered safe, but every eye operation carries risks. Knowing them helps you spot problems early.

Cataract Formation

This is the most common long-term consequence of vitrectomy in adults. Most people who have not already had cataract surgery will develop a cataract in the operated eye within one to three years. It is treatable with standard cataract surgery.

Raised Eye Pressure

Pressure inside the eye can rise after surgery, particularly when a gas bubble or silicone oil is used. It is usually controlled with eye drops and settles as healing progresses.

Infection (Endophthalmitis)

Infection inside the eye is rare but serious. Symptoms include increasing pain, worsening redness, and decreasing vision in the days after surgery. Urgent assessment is needed if these occur.

Bleeding

Some bleeding inside the eye during or after surgery is not uncommon and usually clears on its own. Significant bleeding may need further treatment.

Retinal Tear or Detachment

A new tear or detachment can occur during or after vitrectomy. This may need additional laser, freezing treatment, or a further operation.

Recurrence of the Original Problem

Retinal detachments can recur, macular holes can re-open, and membranes can grow back, although these are uncommon. Sometimes a second vitrectomy is needed.

Refractive Change

The eye's focusing power can change after vitrectomy, especially if cataract surgery is performed at the same time. New glasses are often needed once vision has settled.

Double Vision and Eye Movement Problems

Occasionally the small muscles around the eye are affected, causing temporary or rarely persistent double vision.

Loss of Vision

Although the goal of vitrectomy is to preserve or improve vision, in a small number of cases vision is worse after surgery than before. The risk varies with the underlying condition; complex diabetic detachments and severe trauma carry higher risk than uncomplicated macular hole or membrane surgery.

Life After Vitrectomy

What life is like after vitrectomy depends largely on the original problem and the state of the retina at the time of surgery.

Vision Outcomes

Several factors influence the final result:

• The condition treated (a fresh macular-on detachment typically does better than a long-standing detachment that has involved the macula for weeks)
• How much the macula was affected
• The duration of vision loss before surgery
• The presence of diabetes, scar tissue, or other retinal damage
• The development of cataract or other post-operative changes

For many conditions, vitrectomy clears blood, reattaches the retina, closes macular holes, or smooths out distortion from membranes. Vision often improves, sometimes substantially. However, if the retina or macula has been damaged for too long, some vision loss may be permanent even after a technically successful operation. This is one reason eye specialists usually recommend not delaying surgery once it has been advised.

Follow-up

You will have follow-up visits in the first day or two after surgery, then at intervals over the following weeks and months. Long-term follow-up depends on the underlying condition. People with diabetes will continue to need regular retinal checks in both eyes. People with a retinal detachment in one eye are at higher risk in the other eye and will need ongoing monitoring.

Returning to Normal Activities

• Work: Office and light work can usually resume within one to two weeks. Heavy physical or dusty work may require longer.
• Driving: Only after your surgeon confirms it is safe and your vision meets the legal standard.
• Reading and screens: Permitted from the first days, although vision will be blurred initially.
• Exercise: Walking is usually fine early. Running, gym, swimming, and contact sports are restricted for several weeks, with timing guided by your surgeon.
• Air travel: Only after a gas bubble has fully resorbed.

Long-term Care

Long-term eye care after vitrectomy usually includes:

• Regular eye examinations
• Tight control of diabetes, blood pressure, and cholesterol when relevant
• Prompt review of any new floaters, flashes of light, sudden blur, or a curtain or shadow in vision
• Protective glasses for sports or higher-risk activities, particularly if the other eye is the better-seeing eye

Vitrectomy in Children

Vitrectomy in children is performed for a different range of conditions and in different ways from adult surgery. Common paediatric indications include:

• Retinopathy of prematurity (ROP) — abnormal retinal blood vessel growth in babies born very prematurely, which can lead to retinal detachment
• Congenital cataract complications
• Persistent fetal vasculature and other developmental conditions of the eye
• Severe eye injuries
• Familial exudative vitreoretinopathy and other inherited retinal conditions

Children's eyes differ from adults' in important ways: the vitreous is more firmly attached to the retina, the lens is clearer and more easily damaged, and the eye is still developing. Surgery is almost always performed under general anaesthesia, and decisions about whether to use gas, silicone oil, or saline are individualised.

Visual recovery in children is influenced not only by the surgery but also by the developing visual system. If one eye sees poorly during early childhood, the brain may not learn to use it normally (amblyopia). Patching therapy and glasses may be needed alongside surgery. Paediatric vitreoretinal surgery is a specialised area, typically performed in centres with dedicated paediatric eye services.

Frequently Asked Questions

Is vitrectomy painful?

The surgery itself is not painful because the eye is fully numbed. During recovery, most patients describe a mild ache or gritty feeling rather than significant pain. Simple pain relief usually controls discomfort. Severe pain after surgery is not normal and should be reported to your surgeon.

Will I be awake during the operation?

Most adults are awake but relaxed under local anaesthesia and sedation. You will not see the surgery being done. You may notice lights and movement but no clear images. General anaesthesia is used in selected cases.

How long will I be in hospital?

Vitrectomy is usually a day-case procedure. You arrive in the morning and go home the same day after a short period of observation.

How long until I can see normally?

Vision recovery is gradual. If saline is used, vision often improves over the first few weeks. If a gas bubble is used, vision is very blurred at first and improves as the bubble shrinks, usually over one to eight weeks depending on the gas. Final vision often stabilises over three to six months.

How long do I need to stay face-down?

This depends on the condition. For macular holes, face-down positioning is commonly advised for several days, though shorter durations are increasingly used. For some retinal detachments, side positioning rather than face-down is appropriate. Your surgeon will give you a specific plan.

Why might I develop a cataract afterwards?

Removing the vitreous changes the environment inside the eye, and most adult eyes that have not already had cataract surgery will develop a cataract within a few years. The cataract can be treated with standard surgery and is not a sign of a failed vitrectomy.

Will I need a second operation?

Sometimes. Common reasons include removal of silicone oil, cataract surgery, or further treatment of a retinal problem. Your surgeon will discuss any planned next steps.

Can the same eye have a vitrectomy more than once?

Yes. Vitreoretinal surgeons can operate again if needed — for example, if a retinal detachment recurs or scar tissue develops. Each repeat operation carries its own risks, which your surgeon will explain.

When can I fly after vitrectomy?

Not while a gas bubble is inside the eye. The bubble can expand at altitude and dangerously raise eye pressure. Your surgeon will confirm when air travel is safe, which is usually only after the bubble has completely disappeared. Silicone oil does not have the same restriction.

Will I need glasses afterwards?

Your prescription may change after vitrectomy, especially if cataract surgery was performed at the same time. New glasses are usually prescribed once vision has settled, typically a few months after surgery.

What should I watch out for during recovery?

Contact your eye doctor urgently if you notice severe or worsening pain, sudden decrease in vision, increasing redness, a new shadow or curtain in your vision, or many new floaters and flashes. These can signal infection, raised eye pressure, or a new retinal problem.

Conclusion

Vitrectomy is one of the most important developments in eye surgery of the past few decades. Through tiny openings, vitreoretinal surgeons can now repair conditions that once routinely caused blindness — from retinal detachments and severe diabetic eye disease to macular holes and complex injuries.

The procedure is more delicate than routine cataract surgery, and recovery asks something of the patient: careful use of drops, attention to positioning when a gas bubble is used, and patience as vision gradually clears. The benefits, particularly when surgery is performed before the retina has been damaged for too long, often justify that effort. Timing matters: most retinal conditions that need vitrectomy do better when treated sooner rather than later.

If a vitrectomy has been advised for you or a family member, a careful conversation with a vitreoretinal specialist about the specific diagnosis, the realistic expectations for vision, the choice of internal filling, and the recovery plan is the most useful preparation. The procedure itself is well established; what makes the biggest difference to outcome is matching the right operation to the right eye at the right time.