Vitreoretinal Surgery: Indications, Techniques & Common Conditions Treated

What Is Vitreoretinal Surgery?

Microsurgical procedures performed inside the eye’s posterior segment to remove vitreous gel (vitrectomy) and repair retinal pathology. Performed under microscope with 23–27 gauge instruments through pars plana sclerotomies.

Primary Indications

• Retinal Detachment (Rhegmatogenous): Scleral buckle ± vitrectomy; pneumatic retinopexy for select cases.
• Macular Hole: Vitrectomy + internal limiting membrane (ILM) peel + gas tamponade (SF6/C3F8). Face-down positioning post-op.
• Epiretinal Membrane (ERM): Vitrectomy + membrane peel for visual distortion/acuity loss.
• Vitreous Hemorrhage: Non-clearing hemorrhage (diabetic, trauma, Terson’s); vitrectomy clears visual axis & treats source.
• Proliferative Diabetic Retinopathy (PDR): Vitrectomy for tractional detachment, combined with endolaser.
• Dropped Nucleus/IOL: Cataract surgery complication retrieval.
• Endophthalmitis: Vitrectomy + intravitreal antibiotics (tap/inject vs. vitrectomy per EVS criteria).

Surgical Approaches

• 23/25/27-Gauge Transconjunctival Sutureless Vitrectomy: Standard; faster healing, less inflammation.
• Scleral Buckling: Encircling or segmental band; often combined with vitrectomy.
• Pneumatic Retinopexy: Office-based gas injection + laser/cryo; specific detachment criteria.
• Laser Photocoagulation / Cryotherapy: Adjunct for retinal tears, lattice, PDR.

Postoperative Essentials

• Positioning (face-down, lateral) per gas bubble/tamponade.
• Topical steroid/antibiotic drops 4–6 weeks.
• Gas bubble: no air travel/high altitude until absorbed (2–8 weeks).
• Silicone oil: requires second surgery for removal.

Visual Outcomes

Depend on preoperative macular status, duration of detachment, and comorbid ocular disease. Modern small-gauge vitrectomy achieves anatomic success >90% for primary rhegmatogenous detachment; functional recovery varies.