Vitrectomy Surgery
Vitrectomy surgery removes the gel inside the eye through tiny openings to repair the retina, treating retinal detachment, macular hole, epiretinal membrane and diabetic bleeding. The eye is then filled with air, gas or silicone oil while the retina heals. Our retina surgeons plan the operation, head positioning and your length of stay around the gas bubble, since flying is safe only once it has cleared.
About This Department
Vitrectomy removes the gel inside the eye to reach and repair the retina. Surgery then treats detachments, macular holes and bleeding that would otherwise cost sight.
Vitrectomy surgery, or pars plana vitrectomy, is an operation in which a retinal surgeon removes the vitreous, the clear gel that fills the back of the eye, through three openings smaller than a millimeter, and then repairs the retina underneath. It treats retinal detachment, macular hole, epiretinal membrane, bleeding into the eye from diabetes, infection, injury and a lens that has slipped into the back of the eye. At the end of the operation the surgeon fills the eye with saline, a gas bubble or silicone oil to hold the retina in place while it heals. In a European trial of retinal detachment in eyes that had already had cataract surgery, vitrectomy reattached the retina with a single operation in 72 percent against 53 percent with a scleral buckle (Heimann and colleagues, Ophthalmology, 2007). This page explains what vitrectomy is, the conditions it treats and the results, the operation, the gas bubble and head positioning, recovery, risks, and how patients from abroad plan treatment and travel at Biruni Hospital in Istanbul.
What vitrectomy is
| Part | What it does | What can go wrong |
|---|---|---|
| Vitreous | Clear gel filling the eye | Clouding with blood, pulling on the retina, floaters |
| Retina | Turns light into nerve signals | Tears, detachment, scarring |
| Macula | Center of the retina, for reading and faces | Hole, wrinkled membrane, swelling |
The eye does not need the vitreous once it is removed. The space fills with the eye's own fluid within days to weeks.
Reasons for vitrectomy
| Condition | Symptoms | Urgency |
|---|---|---|
| Retinal detachment | Shadow or curtain, flashes, many new floaters | Days |
| Macular hole | Dark spot in the center, distorted reading | Weeks |
| Epiretinal membrane | Wavy lines, blurred central vision | Elective |
| Diabetic bleeding or traction | Sudden cloudy vision, dark streaks | Weeks, sooner if the retina is pulled |
| Infection inside the eye, endophthalmitis | Pain, redness, rapid loss of vision | Hours |
| Lens fragment or lens implant in the vitreous | Blur, inflammation after cataract surgery | Days to weeks |
Retinal detachment
| Measure | Scleral buckle | Vitrectomy |
|---|---|---|
| Reattached with one operation, eyes after cataract surgery | 53.4 percent | 72.0 percent |
| Redetachment, eyes after cataract surgery | 39.8 percent | 20.4 percent |
| Vision gain, eyes with their natural lens | Greater | Smaller, and cataract progressed faster |
No difference in vision was demonstrated in eyes after cataract surgery, and based on a better anatomical outcome, the investigators recommended vitrectomy in these patients (Heimann and colleagues, 2007).
Why timing matters
The macula decides the outcome.
While the center of the retina is still attached, prompt surgery gives the best chance of keeping reading vision. Surgeons schedule it within a day or two. Once the macula has come off, the cells that give sharp central vision start to suffer, and although surgery the same week still reattaches the retina, the final reading vision depends on how long the macula was detached. Days count. A detachment that has lasted weeks can also develop scar tissue, which makes repair harder and raises the chance of a second operation. For a patient abroad who notices a shadow in the vision, the first step is an eye examination at home the same day, and travel for surgery makes sense only if it does not delay treatment.
Macular hole and epiretinal membrane
| Outcome | Result | Meaning |
|---|---|---|
| Hole closure with one operation | Odds ratio 9.27 in favor of peeling | Far more holes close the first time |
| Need for another operation | Odds ratio 0.11 | Repeat surgery much less often |
| Vision at 3 months | Better with peeling | Faster recovery |
The evidence for peeling
Available evidence supports internal limiting membrane peeling as the treatment of choice for patients with idiopathic stage 2, 3 and 4 full-thickness macular hole (Spiteri Cornish and colleagues, Ophthalmology, 2014).
Diabetic eye disease
Among eyes with vitreous hemorrhage from proliferative diabetic retinopathy, there was no statistically significant difference in vision over 24 weeks between initial aflibercept injections and vitrectomy with laser, and both groups reached an average of 20/40 at two years (Antoszyk and colleagues, JAMA, 2020).
| Situation | Usual first choice | Reason |
|---|---|---|
| Bleeding without pull on the retina | Either, discussed with the patient | Similar results at two years |
| Retina pulled off at the center | Vitrectomy | Only surgery releases the traction |
| Only seeing eye, vision needed quickly | Vitrectomy | Faster clearing |
| Unfit for surgery | Injections | Avoids an operation |
Other reasons
Infection inside the eye, severe injury and a lens fragment left behind after cataract surgery also call for vitrectomy. Several need emergency care.
Floaters
Most floaters need no surgery.
Floaters come from clumps in the vitreous that cast shadows on the retina, and they grow more common with age and short-sightedness. The brain learns to ignore most of them within months. Some fade on their own. Vitrectomy for floaters is offered only when they seriously disrupt reading, work or driving for a long time, since the small risks of the operation, including cataract and retinal detachment, must be weighed against a symptom that is not dangerous in itself.
The operation
| Tamponade | How long it lasts | Main uses |
|---|---|---|
| Air or saline | Days | Membrane peeling, bleeding |
| SF6 gas | About two weeks | Macular hole, many detachments |
| C3F8 gas | Six to eight weeks | Complex detachments |
| Silicone oil | Until removed in a second operation, after months | Severe or repeated detachments, scar tissue |
The gas bubble and positioning
A gas bubble presses the retina into place from inside while it heals. It rises, so the head position decides where it presses.
Can I fly or travel to the mountains with gas in my eye?
Silicone oil does not expand, so patients with oil can fly.
Recovery
| Time | What to expect | Activities |
|---|---|---|
| Day 1 | Check-up, eye pressure measured, patch removed | Positioning if instructed, drops start |
| Week 1 to 2 | Gas bubble shrinking, vision blurred | Light activity, reading limited by the bubble |
| Weeks 2 to 8 | Gas gone, vision improving | Most normal activity, flying once cleared |
| Months 3 to 6 | Final vision after macular surgery | Glasses prescription updated |
Risks
- Cataract, the commonest consequence, developing within one to two years in most eyes that still have their natural lens.
- Raised eye pressure in the first days, treated with drops.
- A second operation, needed when the retina detaches again or a hole fails to close.
| Complication | How common | Treatment |
|---|---|---|
| Retinal detachment after other vitrectomy | A few percent | Further surgery |
| Bleeding inside the eye | Uncommon | Clears or is washed out |
| Serious infection, endophthalmitis | Rare, well under 1 in 1,000 | Same-day antibiotics injected into the eye |
For patients from abroad
The gas bubble decides the length of stay. You cannot fly until it has gone.
One coordinator from the international patients office handles arrangements from the first message through discharge and answers the same WhatsApp number once you are back home. The office works in English, Arabic, French, Russian, Serbian, Romanian and Spanish and books interpreters for other languages, and it arranges the visa invitation letter, airport transfers, daily transport and accommodation near the hospital. Halal, vegetarian and diabetic meals, a prayer room on site, and a female physician on request wherever the rota allows.
| Tamponade | Earliest flight | Note |
|---|---|---|
| Air | About one week | Surgeon confirms air has cleared |
| SF6 gas | About two weeks | Confirmed at a check-up |
| C3F8 gas | Six to eight weeks | Long stay, oil considered instead |
| Silicone oil | Within days | Second operation to remove oil, here or at home |
Plan the return flight only after the surgeon confirms the eye is ready.
Cost
| Item | Included | Priced separately |
|---|---|---|
| Before surgery | Consultation, OCT and ultrasound scans | Additional imaging such as angiography |
| Surgery | Operation, anesthesia, gas or oil, day-case or one-night stay | Combined cataract surgery and lens, silicone oil removal |
| Aftercare | Drops, check-ups during the stay | Accommodation during a long gas stay |
References
- Heimann H, Bartz-Schmidt KU, Bornfeld N, et al. Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment. A prospective randomized multicenter clinical study. Ophthalmology. 2007;114(12):2142-2154.
- Spiteri Cornish K, Lois N, Scott NW, et al. Vitrectomy with internal limiting membrane peeling versus no peeling for idiopathic full-thickness macular hole. Ophthalmology. 2014;121(3):649-655.
- Antoszyk AN, Glassman AR, Beaulieu WT, et al. Effect of intravitreous aflibercept vs vitrectomy with panretinal photocoagulation on visual acuity in patients with vitreous hemorrhage from proliferative diabetic retinopathy. A randomized clinical trial. JAMA. 2020;324(23):2383-2395.
Editor's note
Written by the Biruni Hospital medical editorial team. Reviewed by Sepide Sadık, Ophthalmology.
Medically reviewed by
Sepide Sadık
Ophthalmology
Related Treatments
View All
Cataract Surgery
The operation takes about fifteen minutes an eye and is performed the same way worldwide. The lens you choose is what differs, and it decides whether you read without glasses, see halos around headlights, or neither. This guide gives the audit numbers, what laser surgery adds and does not, the risks, and how both eyes fit into five days in Istanbul.
Cornea Transplant Surgery - Corneal Transplantation
Surgeons now replace only the layer of the cornea that has failed, the inner cells for Fuchs dystrophy, the front layers for keratoconus, the full thickness for deep scars. The choice decides how quickly you see and how likely rejection is. This guide gives the survival figures, the warning signs, the flying rule after a gas bubble and the days to plan.
Glaucoma Surgery
Glaucoma surgery lowers the pressure inside the eye to protect the sight that remains. The options run from a five-minute laser that frees many patients from drops, to stents placed during cataract surgery, to trabeculectomy and drainage tubes. This guide gives the trial results for each and explains why the larger operations need weeks of follow-up.
Ocular Oncology Surgery - Eye Cancer Surgery
Most eyes with melanoma are now saved with a radioactive plaque sewn to the eye for a few days, and survival matches removal. In children, retinoblastoma is curable when found early. This guide explains uveal melanoma by size and risk, plaque radiotherapy, treatment after spread, retinoblastoma care, and how long each treatment takes in Istanbul.
Premium IOL Implantation - Multifocal Lens Surgery
Premium intraocular lenses replace the eye's natural lens during cataract or lens replacement surgery and focus at more than one distance. A Cochrane review of 20 trials found the same distance vision as standard lenses, far better near vision and less need for glasses, with more halos at night. We explain trifocal, EDOF and toric choices.