Vitreous surgery, also known as vitrectomy, is performed to treat a variety of serious retinal and vitreous conditions, including retinal detachment, vitreous hemorrhage, macular hole, macular pucker (epiretinal membrane), intraocular infection (endophthalmitis), ocular trauma, and complications following prior eye surgery. It is typically an outpatient procedure performed in an operating room, most often under local anesthesia with sedation (“twilight” anesthesia), though general anesthesia may be used in select cases. The term “vitrectomy” refers to the removal of the vitreous gel from the eye during the procedure.

Tiny incisions, approximately the size of a needle used for a blood test, are made through the sclera (the white part of the eye) to allow insertion of specialized surgical instruments into the vitreous cavity. A fiber optic light is used to illuminate the inside of the eye while a microsurgical cutting instrument removes the vitreous gel along with any blood, scar tissue, or lens fragments that may be present. Additional instruments, such as fine forceps and laser probes, may be used as needed to address specific problems. While sutures are occasionally required, most modern vitrectomy procedures are sutureless, thanks to advanced small-gauge techniques that allow the incisions to self-seal.

The removed vitreous is typically replaced with a saline solution that is compatible with the eye’s natural fluid. Within 24 hours, the eye begins to produce its own fluid to replace the saline. In certain cases, a gas bubble is used instead of saline to help support the retina during healing. The gas is gradually absorbed and replaced by the eye’s own fluid over several weeks. In other cases, silicone oil is used when longer-term support is needed. Because silicone oil does not absorb on its own, a second surgery is usually required to remove it after the retina has fully healed. When gas or silicone oil is used, patients may be instructed to maintain a specific head position, often face-down or on one side, to ensure the bubble applies the necessary pressure to the retina for optimal healing.