Vitrectomy Eye Surgery for Macular Pucker

This is my first patient education video.  I uploaded this last evening to YouTube.  It is one of the best I’ve seen for a super niche like eye surgery.

Vitrectomy Surgery

As I state in the video, vitrectomy surgery is performed by retina specialists.  I completed extra training to specialize and to perform retinal surgery.

A vitrectomy is the core operation for many of the surgical diseases we treat.  For instance, a vitrectomy is used to remove an epiretinal membrane (ERM), fix a macular hole or repair a retinal detachment.  A vitrectomy can remove floaters.

It is very similar to arthroscopic surgery or laparoscopic surgery in that all the systems are “closed.”

Patient is Awake and Comfortable

Most of my procedures are performed while the patient is awake.  Before surgery, the patient receives a sedative, putting them to sleep for a few minutes while the entire eye is numbed.

This “IV sedation” or “twilight” form of anesthesia is quite popular in most outpatient surgical settings.  It avoids the rigors of general anesthesia.

By the way, the operation is completely painless!  I am usually able to talk to my patients while operating.

25 Gauge Instrumentation:  No Stitches!

The instruments used have revolutionized vitrectomy surgery.  The instruments are so thin, that we no longer have to take time to stitch the eye.  This improves efficiency (shortens operating times), but also causes less tissue damage and greatly speeds up healing time (fewer office visits).

What Does This Mean?

You’ve probably noticed that you see more and more video.  It’s a great medium, it captures your attention via audio and video, the costs of equipment are miniscule and the video quality is exeptional.

I produced this entire video at home using iMovie (Apple).  The operation took about 16 minutes in real time.  Many thanks to Meredith Maclauchlan for her skill in adding the special effects and background!

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Comments

  1. Dear DR Wong, I have had 3 surgeries for detached retina and am now returning for oil removal,vitectomy,laser again and a peel of membrane. I am anxious to hear what your thoughts are on how the oil removal is compared to vitrectomy and sceral buckle surgery. Also, does the complicated detachment patient ever see the light at the end of the tunnel? I have been super positive and doing all that I am suppose to do as far as drops and positioning. Have not slept on my back since December, just wondering if this usually settles down after a period of time? My surgery is scheduled for this Wed am. Thanks so much!

  2. Dear Jen,

    I hope your surgery went well. I apologize for the delay in responding. I have been away.

    Oil removal is a tedious process. Basically one flushes out the oil through a very tiny hole. It can take anywhere from 15-30 minutes depending upon the viscosity of the oil and the gauge (size) of the hole. Unlike retinal detachment surgery with a scleral buckle, tissue manipulation is minimal, so discomfort/recovery should be minimized.

    Retinal detachment surgery can be all consuming as you are experiencing. As I have become more experienced (fancy word for older) I have realized that much can be gained by using silicone oil early in the redetachment process.

    I hope you are doing well. There is a light at the end of the tunnel.

    r

  3. Dr Wong:
    I have had retinal tears and 2 lasers/cryo in my ‘good’ eye. It also has a cataract that we were monitoring prior to retinal tears. In other eye, had 3 laser/cryo procedures and then the buckle – all in approx 6 wks. I now have a pucker and substantial floaters in the buckle eye, with much distortion such that the eye is not of much value. I must soon make a decision about vitrectomy. What information is available to help with this decision as far as success rates, etc.? Thanks.

  4. Larry Parker says:

    Hello Dr. Wong,

    I had Lasik surgery about 7 years ago and have developed noticeable floaters in recent years. I’m attributing this to being very near-sighted and having the lasik performed. I wore glasses and contacts for more than 30 years so, it was a real miracle for me. Now however, I find almost daily frustration in dealing with these floaters. My left eye is particularly bad, like having a smudge in my field of view. I’ve consulted with specialists over the last two years (annual visits) and both have stated that a vitrectomy is very dangerous and should be considered only as a last resort. I’m curious if you agree and do you know and could recommend anyone in the South Florida (West Palm Beach) area with whom I could consult? Thank you.

    Larry

  5. Dear Larry,

    The Lasik has nothing to do with your present floaters. Perhaps the fact that you are naturally near-sighted may impact the chance of having annoying floaters.

    Regardless, the facts are that vitrectomy is actually safer, or as safe, as cataract surgery. Blinding infection rates (called endophthalmitis) are lower with retina surgery compared to cataract surgery. The chance of retinal detachment with vitrectomy is comparable to cataract surgery, too.

    Don’t know of anyone in FL…sorry.

    So, I don’t agree it’s dangerous and can be performed as long as you agree and understand the risks I stated above.

    I wish you all the best!

    Randy

  6. Dear Rick,

    Success rates vary with ERM surgery. In my opinion, “vision success” is dependent upon the timeliness of the operation. Most surgeons wait too long before offering the surgery.

    I recommend operating the ERM as soon as you notice a change in your vision (either decreased and/or distortion) and your surgeon agrees. If she doesn’t, get another opinion.

    The reason…noone can guarantee full restoration of vision with ERM surgery once the membrane is removed.

    In most cases, the ERM should be removed easily.

    r

  7. Dr. Wong, thank you for your very informative website. I’ve undergone a number of retinal repairs over the past year and a half and am now trying to more fully understand all that has happened. I’m curious as to what fluid is used to replace the vitreous during a vitrectomy (assuming it’s not silicone oil.) Is it a simple saline solution? Does it remain in the eye or is it absorbed and replaced by the body with a natural vitreous? Thank you in advance for taking the time to answer my questions.

  8. Dear Patrick,

    You are correct.

    The vitreous is mostly water. I think it’s about 94% water mixed with protein. When removed, it is replaced with artificial saline which is then absorbed and replaced by aqueous (basically your own saline) within 48 hours.

    r

  9. Dr. Wong. I was diagnosed with a macular pucker on 12/ 3 from a scleral buckle surgery on 9/13. I am definitely considering a vitrectomy because my vision is now very poor. Is there a timeframe I should be considering? My doctor said the vision is not going to get worse and there is not a rush to decide on when or if to get the surgery. Your thoughts would be greatly appreciated. Thanks

  10. Dear Dave,

    I advocate removing the ERM as soon as you (the patient) is aware of vision loss. If the vision loss is mild (mild blurring +/- barely noticeable distortion), perhaps you can sit on it for a while. The reason I advocate operating as soon as you become aware is that noone can guarantee complete restoration of vision with ERM surgery… the earlier the better.

    Be careful; however, your doc may not feel the same way I do.

    Best of luck.

    Randy

  11. Thank you Dr. Wong. Your website is very informative. My Dr. recommended we wait a few more weeks because I may still be producing scar tissue from the original surgery.

  12. Dear Dave,

    All the best. Sounds good!

    Stay in touch?

    Randy

  13. Hello Dr. Wong. I know there are no guarantees but what is a realistic timeframe to see an improvement in distorted vision following a vitrectomy? My doctor has said that the retina is attached and lying flat. However, there was a fold in it at one time. Thanks.

  14. maribel whalen says:

    I am desperate to find a surgeon who will remove scar tissue on the inside of my eyelids. It’s from calcium deposits that were scapeled off that are now irritating my cornea.
    I am so frustrated because I can’t find a specialist or anyone who will even take care of the problem for me. Thank you if you can refer someone to me. I live in Sarasota, FL.

  15. Dear Maribel,

    I will refer you to an oculoplastic surgeon located in Sarasota, FL.

    He will be a great place to start.

    All the best!

    Randy

  16. Dear Dave,
    If the macula was involved, it could be six months to a year. A realistic timeframe would be within 3 months…this is just a generalization.

    r

Trackbacks

  1. [...] you have had retinal surgery for removal of an ERM (macular pucker), repair of a macular hole, a vitrectomy for vitreous hemorrhage, floater only vitrectomy (FOV) or [...]

  2. [...] Detachments 2.  Epiretinal Membranes 3.  Macular Holes 4.  Floaters 5.  Blood, aka Vitreous [...]

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