Vitrectomy is a type of eye surgery that treats disorders of the retina and vitreous. The retina is the light-sensing tissue at the back of the eye. The vitreous is the clear, jelly-like substance that fills the middle of the eye. The vitreous is removed during vitrectomy surgery and usually replaced by a saltwater solution. Why do you need a vitrectomy? Your ophthalmologist (medical eye doctor) may recommend vitrectomy surgery to treat the following eye problems:
-  Diabetic retinopathy, where there is bleeding and scar tissue;
-  Some retinal detachment;
-  Infection inside the eye;
-  Severe eye injury;
-  Wrinkling of the retina (macular pucker)
-  Macular hole (partial loss of vision for fine details)
-  Certain problems after cataract surgery.

How can a vitrectomy improve your vision?
Vitrectomy surgery often improves or stabilizes your vision. The operation removes any blood or debris (from infection or inflammation) that may be blocking or blurring light as it focuses on the retina. Vitrectomy surgery removes scar tissue that can displace, wrinkle or tear the retina. Vision is poor if the retina is not in its normal position. A foreign object may be stuck inside the eye as the result of an injury. Most foreign objects will damage vision if they are not removed.

What happens if you decide to have vitrectomy surgery?
Before surgery your ophthalmologist will decide whether local or general anesthesia is best for you. You may have to stay overnight in the hospital. Before surgery you will need to have a physical examination to alert your ophthalmolgist to any special medical risks. A painless ultrasound test may be performed before the surgery to view the inside of the eye.

Vitrectomy surgery
The length of the operation varies from one to several hours, depending on your condition. In certain situations, your ophthalmologist may do another surgical procedure at the same time, such as repairing a detached retina or removing a cataract. Your ophthalmologist does the operation while looking into your eye with a microscope. Various miniature instruments are placed into the eye through tiny incisions in the sclera (white part of the eye) In order to get the best possible vision for you, your ophthalmologist will do one or more of the following:
-  Remove all cloudy vitreous
-  Remove any scar tissue present, attempting to return the retina to its normal position;
-  Remove any foreign object that might be in the eye;
-  Treat the eye with laser to reduce future bleeding, or to fix a tear in the retina;
-  Place an air or gas bubble in the eye to help the retina remain in its proper position. The bubble will slowly disappear on its own;
-  Inject a special fluid that is later removed from the eye.

After surgery 
You can expect some discomfort after surgery. You will need to wear an eye patch for a short time. Your ophthalmologist will prescribe eye drops for you and advise you when to resume normal activity. If a gas bubble was placed in your eye, you ophthalmologist may recommend that you keep your head in special positions until the gas bubble is gone. Do not fly in an airplane or travel up to high altitudes until the gas bubble is gone! A rapid increase in altitude can cause a dangerous rise in eye pressure. What are the risks of your vitrectomy surgery? All types of surgery have certain risks, but the risks are less than the expected benefits to your vision. Some of the risks of vitrectomy include:
-  Infection;
-  Bleeding;
-  Retinal detachment;
-  Poor vision;
-  High pressure in the eye;
-  Cataract is uncommon right after surgery - elderly patients often develop cataract over many months.

How much will your vision improve?
Your vision after surgery will depend on may variables, especially if your eye disease caused permanent damage to your retina before the vitrectomy. Your ophthalmologist will discuss your situation with you and how much improvement in your eyesight is possible.

American Academy of Ophthalmology
P. O. Box 7424 San Francisco, CA 94120-7424
http://www.eyenet.org
Copyright 1984 American Academy of Ophthalmology Glaucoma

Don't lose sight of glaucoma Information for people at risk

What is glaucoma?
Glaucoma is an eye disease in which the normal fluid pressure inside the eyes slowly rises, leading to vision loss - or even blindness. This brochure is about open-angle glaucoma, the most common form of the disease.

What causes it?
At the front of the eye, there is a small space called the anterior chamber. Clear fluid flows in and out of the chamber to bathe and nourish nearby tissues. In glaucoma, for still unknown reasons, the fluid drains too slowly out of the eye. As the fluid builds up, the pressure inside the eye rises. Unless this pressure is controlled, it may cause damage to the optic nerve and other parts of the eye and loss of vision.

Who is most likely to get it?
Nearly 3 million people have glaucoma, a leading cause of blindness in the United States. Although anyone can get glaucoma, some people are at higher risk. They include:
-  Blacks over the age of 40;
-  Anyone over the age of 60;
-  People with a family history of glaucoma.

Among Blacks, studies show that glaucoma is:
-  Five times more likely to occur in Blacks than in Whites.
-  About four times more likely to cause blindness in Blacks than in Whites.
-  Fifteen times more likely to cause blindness in Blacks between the ages of 45-64 than in Whites of the same age group.

What are the symptoms?
At first, there are no symptoms. Vision stays normal and there is no pain. However, as the disease progresses, a person with glaucoma may notice his or her side vision gradually failing. That is, objects in the front may still be seen clearly, but objects to the side may be missed. As the disease worsens, the field of vision narrows and blindness results.

How is it detected?
Many people may know of the "air puff" test or other tests to measure eye pressure in any eye examination. But this test alone cannot detect glaucoma. Glaucoma is found most often during an eye examination through dilated pupils. This means drops are put into the eyes during the exam to enlarge the pupils. This allows the eye care professional to see more of the inside of the eye to check for signs of glaucoma.

How can it be treated?
Although open-angle glaucoma cannot be cured, it can usually be controlled. The most common treatments are:
-  Medications
-  These may be either in the form of eyedrops or pills. Some drugs are designed to reduce pressure by slowing the flow of fluid into the eye. Others help to improve fluid drainage.
-  For most people with glaucoma, regular use of medications will control the increased fluid pressure. But these drugs may stop working over time. Or they may cause side effects. If a problem occurs, the eye care professional may select other drugs, change the dose, or suggest other ways to deal with the problem.
-  Laser Surgery During laser surgery, a strong beam of light is focused on the part of the anterior chamber where the fluid leaves the eye. This results in a series of small changes, which makes it easier for fluid to exit the eye. Over time the effect of laser surgery may wear off. Patients who have this form of surgery may need to keep taking glaucoma drugs.

Surgery
Surgery can also help fluid escape from the eye and thereby reduce the pressure. However, surgery is usually reserved for patients whose pressure cannot be controlled with eyedrops, pills or laser surgery.

What research is being done?
A large amount of research is being done in the U.S. to learn what causes glaucoma and to improve its diagnosis and treatment. For instance, the National Eye Institute (NEI) is funding a number of studies to find out what causes fluid pressure to increase in the eye. By learning more about this process, doctors may be able to learn the exact cause of the disease and learn better how to prevent and treat it. The NEI also supports clinical trials of new drugs and surgical techniques that show promise against glaucoma.

What can you do to protect your vision?
Studies have shown that early detection and treatment of glaucoma, before it causes major vision loss, is the best way to control the disease. So, if you fall into one of the high-risk groups for the disease, make sure to have you eyes examined through dilated pupils every two years by an eye care professional.