Vitrectomy is a foundational surgical procedure in vitreoretinal surgery. The term derives from “vitreous” (the clear gel filling the eye’s posterior chamber) and “-ectomy” (surgical removal). During vitrectomy, the vitreous gel is carefully removed and replaced with sterile balanced salt solution (BSS), a gas bubble (C3F8 or SF6), or silicone oil — depending on the underlying condition. Removal of the vitreous gives the surgeon unobstructed access to the retina and resolves traction that may be threatening retinal integrity.

Modern vitrectomy uses a three-port system: a continuous infusion cannula to maintain intraocular pressure; a fibre-optic light pipe for intraocular illumination; and a high-speed vitreous cutter (operating at 5,000–10,000 cuts per minute) that simultaneously cuts and aspirates the vitreous. All three instruments enter through very small incisions in the pars plana — the non-functional periphery of the retina — approximately 3.5 mm behind the limbus in pseudophakic eyes and 4 mm in phakic eyes. Modern microincision vitrectomy surgery (MIVS) using 23-gauge (0.6 mm) or 25-gauge (0.5 mm) instruments allows sutureless, self-sealing incisions with rapid post-operative recovery.

Conditions treated by vitrectomy include: rhegmatogenous and tractional retinal detachment; vitreous haemorrhage (from PDR, trauma, or vascular occlusion); macular holes (Gass stages 2–4); epiretinal membrane (macular pucker); diabetic tractional retinal detachment; posterior segment foreign bodies; dropped nucleus complicating cataract surgery; endophthalmitis; giant retinal tears; and proliferative vitreoretinopathy (PVR).

The procedure is performed under local (peribulbar or sub-Tenon’s) anaesthesia as day-care surgery, typically lasting 30 to 90 minutes. When a gas tamponade is used, patients must maintain a specific head posture (face-down or tilted) for up to 14 days to keep the gas bubble in contact with the repair site. Silicone oil is used for complex detachments and removed in a second procedure after healing. At Suraj Eye Institute, vitrectomy is performed using cutting-edge 25-gauge MIVS platforms with wide-field viewing and intraoperative OCT guidance.

Retinal detachment (RD) is a sight-threatening ocular emergency in which the neurosensory retina — the layer containing the photoreceptors and their supporting cells — separates from the underlying retinal pigment epithelium (RPE) and choroid. Separated from its blood supply, the detached retina progressively degenerates; if not surgically repaired promptly, the result is permanent, irreversible vision loss.

There are three principal types. Rhegmatogenous RD (most common, ~85% of cases) occurs when a break, tear, or hole in the retina allows liquid vitreous to pass through and accumulate in the subretinal space, lifting the retina away from the RPE. Risk factors include high myopia (short-sightedness), prior cataract or other intraocular surgery, blunt or penetrating eye trauma, lattice degeneration, and a family history of RD. The vitreous liquefies and detaches with age (posterior vitreous detachment, PVD), and if it tears a retinal vessel or creates a retinal break during this process, RD may follow. Tractional RD occurs when fibrovascular membranes — most commonly from proliferative diabetic retinopathy — pull the retina off without a primary break. Exudative (serous) RD results from fluid accumulation under the retina without a break or traction, usually from choroidal tumours, inflammation, or severe hypertension.

The cardinal symptoms of RD are: a sudden dramatic increase in floaters (dark spots, strings, or cobwebs in the vision); flashes of light (photopsia), particularly in the temporal peripheral field; and a dark shadow or curtain advancing from the periphery toward the centre of vision — this last symptom indicates the detachment is progressing and the macula may be threatened. A macula-off retinal detachment is a true ocular emergency: the sooner the macula is re-attached, the better the visual outcome. Even a delay of hours can impact the final visual acuity.

Treatment options at Suraj Eye Institute include pneumatic retinopexy (office-based gas injection with laser), scleral buckling (an external silicone explant to indent the eye wall and close the break), and pars plana vitrectomy (PPV) with internal tamponade — all combined with laser photocoagulation or cryotherapy to seal the retinal break. The choice of procedure depends on the type, location, and extent of the detachment and the surgeon’s assessment. If you develop new floaters, flashes, or a visual curtain, please attend our Eye Emergency service immediately. Time is vision.