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04-13-2015, 01:36 PM
Vitrectomy for Vitreous Floaters (FOV):

Vitrectomy surgery, or Floater Only Vitrectomy (FOV), to remove vitreous opacities, aka floaters. This surgery is performed using 25 gauge instruments (i.e. no stitches) and is done as an outpatient. Generally, patients are awake and completely comfortable.

Vitrectomy was originated by Robert Machemer with contributions from Thomas M. Aaberg, Sr in late 1969 and early 1970. The original purpose of vitrectomy was to remove clouded vitreous—usually containing blood.

The success of these first procedures led to the development of techniques and instruments to remove clouding and also to peel scar tissue off the light sensitive lining of the eye—the retina—membranectomy, to provide space for materials injected in the eye to reattach the retina such as gases or liquid silicone, and to increase the efficacy of other surgical steps such as scleral buckle.

The development of new instruments and surgical strategies through the 1970s and 1980s was spearheaded by surgeon/engineer Steve Charles, M.D. More recent advances have included smaller and more refined instruments for use in the eye, the injection of various medications at the time of surgery to manipulate a detached retina into its proper position and mark the location of tissue layers to allow their removal, and for long term protection against scar tissue formation.

Indications
Conditions which can benefit from vitrectomy include:

Vitreous floaters – deposits of various size, shape, consistency, refractive index, and motility within the eye's normally transparent vitreous humour which can obstruct vision. Here pars plana vitrectomy has been shown to relieve symptoms. Because of possible side effects, however, it is used only in severe cases.

Retinal detachment– a blinding condition where the lining of the eye peels loose and floats freely within the interior of the eye. Steps to reattach the retina may include vitrectomy to clear the inner jelly, scleral buckling to create a support for the reattached retina, membranectomy to remove scar tissue, injection of dense liquids to smooth the retina into place, photocoagulation to bond the retina back against the wall of the eye, and injection of a gas or silicone oil to secure the retina in place as it heals.

Macular pucker – formation of a patch of unhealthy tissue in the central retina (the macula) distorting vision. Also called epiretinal membrane. After vitrectomy to remove the vitreous gel, membranectomy is undertaken to peel away the tissue.

Diabetic retinopathy – may damage sight by either a non-proliferative or proliferative retinopathy. The proliferative type is characterized by formation of new unhealthy, freely bleeding blood vessels within the eye (called vitreal hemorrhage) and/or causing thick fibrous scar tissue to grow on the retina, detaching it. Often diabetic retinopathy is treated in early stages with a laser in the physician's office to prevent these problems. When bleeding or retinal detachment occur, vitrectomy is employed to clear the blood, membranectomy removes scar tissue, and injection of gas or silicone with scleral buckle may be needed to return sight. Diabetics should have an eye exam yearly.

Macular holes – the normal shrinking of the vitreous with aging can occasionally tear the central retina causing a macular hole with a blind spot blocking sight.

Vitreous hemorrhage – bleeding in the eye from injuries, retinal tears, subarachnoidal bleedings (as Terson syndrome), or blocked blood vessels. Once blood is removed, photocoagulation with a laser can shrink unhealthy blood vessels or seal retinal holes.

Complications of vitrectomy
Along with the usual complications of surgery, such as infections, vitrectomy can result in retinal detachment. A more common complication is high intraocular pressure, bleeding in the eye, and cataract, which is the most frequent complication of vitrectomy surgery. Many patients will develop a cataract within the first few years after surgery.

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