A vitrectomy is the basic operation performed by retina specialists. The first step to most retinal surgery is to perform a vitrectomy to remove the vitreous. After the vitreous is removed, it becomes safer and easier to operate on the retina.
Vitrectomy is used to repair;
- Retinal detachments
- Epiretinal membranes
- Macular holes
- Floaters/vitreous opacities
- Complications from cataract surgery
- Complications of Diabetic Retinopathy
Vitrectomy Requires 3 Ports
The most common set up is called a 3-port vitrectomy. A port is simply a hole or entry port into the eye allowing us to insert instruments or tubing into the eye.
One port is used to “infuse” or “pump” saline into the eye. The fluid and vitreous removed during the operation must be replaced. At the beginning of the operation, a small “infusion” line is inserted via a port to keep the eye full with fluid. Usually artificial saline is infused into the eye. (This artificial saline is replaced with your own fluid within 24-48 hours after the operation.)
The other two ports are used to insert instruments into the eye used by each hand.
23/25 Gauge Vitrectomy
I use both 23 and 25 gauge systems when available. The gauge of the instruments refers to the thinness of the instruments. The higher the gauge, the thinner the instruments.
These systems create very small holes or incisions in the eye. These incisions are so small that stitches are not required as they “self seal.”
Original vitrectomy instruments used the larger and thicker 20 gauge instruments which required sutures to close the incisions at the end of the case so the eye did not leak.
There is a thinner 27 gauge system, but it is not widely available.
Advantages of 23/25 Gauge Vitrectomy
As we no longer need to use sutures during our operations, the length of the operations has become shorter. Technology has improved the capabilities of the thinner instruments allowing us to perform the same surgical tasks as the original 20 gauge instruments.
The biggest advantage of 23 and 25 gauge vitrectomy systems, however, is the benefit to my patients. Because there are no stitches, healing is much more comfortable, faster and often requires fewer post-operative office visits!