Vitrectomy is a high level modern micro-ophthalmic surgery developed in the early 1970s. It is considered a revolution in the history of ophthalmic treatment, breaking many previously untreatable surgical confines and bringing sight to countless eye patients. In eye treatment centers in developed countries, vitrectomy is the second major ophthalmic surgery after cataract extraction IOL implantation.
The basic role of vitrectomy is to remove the cloudy vitreous or remove the vitreoretinal tract, restore the clear refractive interstitium and promote retinal repositioning, and treat vitreoretinal disease in order to restore the patient’s visual function.
The indications for vitrectomy are increasingly expanding, with the scope of surgery spanning almost the entire eye in addition to the cornea and sclera. Specifically, the indications are divided into those for the anterior segment and posterior segment of the eye.
Anterior segment indications
1.Soft cataract
Vitrectomy function to remove the crystalline cortex more thoroughly so that the pupillary collar is completely transparent without posterior cataract.
2.Pupillary membrane
pupillary membrane can be removed for various reasons.
3.Ocular segment perforation injury
anterior segment perforation injury combined with traumatic cataract, especially when there is vitreous detachment, crystal and anterior vitreous excision can be done immediately after suturing the wound, which can improve visual acuity and reduce posterior cataract.
4. Crystal detachment is located in the anterior chamber. Crystals can be pre-excised if there is no sclerosis.
5.Vitreous corneal contact syndrome
During cataract surgery, if the vitreous body enters the anterior chamber through the pupil and contacts with the corneal endothelium, it can cause the corneal endothelium to lose its function. Therefore, the vitreous body entering the anterior chamber should be completely removed.
6, malignant glaucoma
Removal of the anterior vitreous cortex to release the blockage of atrial aqueous forward drainage, so that high intraocular pressure can be controlled.
Posterior segment indications
1.Vitreous hemorrhage
It is a major indication for vitrectomy. Vitrectomy should be done when vitreous hemorrhage is not absorbed after 3-6 months of conservative treatment. However, surgery should be performed promptly once retinal detachment is observed. In children, early surgery is generally advisable to prevent amblyopia. Surgery for traumatic vitreous hemorrhage may be performed earlier.
2.Intraocular foreign body
vitrectomy to remove foreign bodies is performed under direct vision, especially for non-magnetic foreign bodies, or when accompanied by other eye tissue damage, to facilitate treatment together.
3, endophthalmitis
surgery can remove bacteria and their toxins, remove necrotic tissue and inflammatory material, and inject drugs directly into the vitreous cavity.
4.Retinal detachment
Retinal detachment combined with vitreous opacity, giant fissure combined with proliferative vitreoretinopathy, macular fissure, tractional retinal detachment caused by vitreous proliferation, retinal detachment caused by diabetic retinopathy, etc. are suitable for vitrectomy. Some recurrent retinal detachments may also be selected for vitrectomy.
5.Other
Dislocation of the lens into the vitreous, cataract surgery with debris falling into the vitreous, macular folds, macular anterior membrane and macular dry hole, intravitreal pig cysticercus, etc. are also indications for vitrectomy.
As a highly sophisticated surgery in ophthalmology, the advantages of vitrectomy are obvious. Specifically, vitrectomy has the following advantages.
1, vitrectomy is performed under local anesthesia, which is less traumatic and safer, and has a wide range of surgical indications;
2, with the progress of society, the aging process intensifies, age-related macular degeneration is increasing, while myopic patients and diabetic patients are increasing, and vitreoretinal diseases are increasing. The vitrectomy surgery can greatly improve the symptoms of such patients and avoid more blindness or eye atrophy caused by the disease;
3.By removing the cloudy or mechanized vitreous, pus and blood accumulation, both bacteria and toxins can be removed, and the refractive interstitial transparency in the vitreous cavity can be restored;
4.The foreign body can be accurately removed under direct vision, avoiding blindness and reducing the damage to the surrounding tissues to a minimum;
5.It can improve the rate of foreign body removal in the vitreous cavity, and can remove multiple foreign bodies at the same time, especially non-magnetic foreign bodies, wrapped foreign bodies, retinal embedded foreign bodies, etc;
6.It can directly and accurately obtain the specimen of vitreous lesion and improve the positive rate of pathogenetic examination;
7.It can be performed simultaneously for traumatic cataract, retinal detachment, retinal fissure, silicone oil filling, etc. This reduces the number of operations, avoids multiple operations to damage the intraocular structure of the affected eye, reduces the hospitalization cost of the patient, and maximizes the restoration of the visual function of the affected eye.
Since vitrectomy is a high level modern micro-ophthalmology surgery, with difficult surgery, long operation time, expensive equipment, high technical content, and high requirements for surgeons, it gradually becomes the embodiment of a hospital’s technical level and comprehensive strength.