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The vitrectomy is a surgical procedure to fix a macular hole in the human eye. The macula, a small spot near the center of the back of the eye (the retina), allows you to see colors and objects or faces in detail. It can develop a tear or hole for the following reasons:
 Separation or shrinking of the vitreous fluid in the eye- Eye disease due to diabetes
- Myopia or nearsightedness
- A macular fold or pucker
- A detached retina
- Best's disease
- An eye injury
I became acquainted with vitrectomies when my sister learned she had a macular hole in her eye, and had to undergo this procedure twice. I was fascinated not only by the procedure itself, but also with her recovery.
Surgery
The vitrectomy is done under local anesthesia. The patient is usually awake (with a mild sedative) and can hear what's happening, but can't see anything. In my sister's case, the nurse held her hand during the procedure, which helped to keep her calm.
 The surgeon uses a microscope and special lenses designed to provide a clear image of the back of the eye. Several 3 or 4 millimeter incisions are made on the sclera, the eye's outer layer (i.e., the white of the eye). The retinal surgeon inserts microsurgical instruments through the incisions. These instruments include a fiber optic light, an infusion line, instruments for cutting, and instruments to remove the vitreous fluid.
Next, the surgeon removes the vitreous gel to stop it from pulling on the retina. The hole is then repaired and the surgeon inserts a mixture of air and gas into the space once occupied by the vitreous fluid. This bubble of air and gas puts pressure on the edges of the macular hole, allowing it to heal.
Here's a link to a vitrectomy video that I think is fascinating; however, please be advised that it's graphic.
Recovery
During postsurgical recovery, the bubble needs to remain in place - like a bandage. The patient must lie face down or keep their head down so that the bubble remains in the proper position. This is no simple task, as the recovery period can last as long as one to three weeks! It is especially hard to keep your head down while talking as it is a natural tendency to raise your head to speak.
Although a facedown position can be difficult to maintain, it is absolutely necessary for the patient to achieve the best-possible vision. Over time, the gas/air bubble gradually dissipates. Natural eye fluids take its place while the macular hole is healing.
In order to remain in the facedown position, a patient needs special chairs, mirrors, and cushions for both daily functioning and sleep. I have a few pictured here:
Results
Unfortunately, even two vitrectomies did not work for my sister. The hole in her eye continues to open back up. To prevent permanent loss of sight, she will be having a different procedure done next. I will discuss this in another part of my series on eye surgery.
If any of you have experienced a vitrectomy or know someone who has, I would be interested in hearing the results. Please leave a comment, or send me a private message here on CR4.
Resources:
http://www.allaboutvision.com/conditions/vitreoretinal-procedures.htm
http://www.mdsupport.org/
http://www.facedownsolutions.com/
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Re: Eye Surgery: The Vitrectomy (Part 1)
