vitrectomia

Vitrectomia, or vitrectomy, is a surgical procedure to remove the vitreous humor from the eye. The vitreous gel fills the eye’s posterior chamber and helps maintain its shape; removing it allows better access to the retina and posterior segment for treatment of various diseases. The most common approach is pars plana vitrectomy (PPV), performed with small-gauge instruments inserted through sclerotomies, usually 23- or 25-gauge, with newer systems using 27-gauge. A light source and a vitreous cutter are used to remove the vitreous, often after detaching the posterior hyaloid and shaving the vitreous base. Additional maneuvers may include membrane peeling (such as epiretinal membrane or internal limiting membrane), endolaser photocoagulation, and removal of intraocular foreign bodies if present.

Tamponade with intraocular substances may follow vitrectomy to aid retinal reattachment and healing. Common agents include intravitreal air, expansile gases such as sulfur hexafluoride (SF6) or perfluoropropane (C3F8), and, in some cases, silicone oil. The choice depends on the underlying condition and anticipated postoperative positioning.

Indications for vitrectomy are diverse and include retinal detachment, macular hole, epiretinal membrane, vitreous hemorrhage (often due to diabetic retinopathy), recurrent intraocular inflammation with vitreous opacities, lattice or tractional retinal detachments, endophthalmitis requiring clearance of vitreous infection, and removal of intraocular foreign bodies.

Outcomes vary with diagnosis and preoperative status. Benefits may include improved or stabilized vision and retinal reattachment, but risks include cataract progression in phakic eyes, iatrogenic retinal breaks, infection, glaucoma, and the need for additional surgery. Postoperative positioning and follow-up are typically required based on the specific procedure performed.