Vitrectomy
Vitrectomy is one of the most complex microsurgical procedures and is often the only therapeutic option for diseases of the posterior segment of the eye. At Milmedic Clinic, both types of procedure are performed: conventional pars plana vitrectomy and microincisional vitrectomy (MIVS 23G). MIVS 23G is our standard, as it represents the most advanced platform for performing this procedure.
When is vitrectomy needed?
Vitrectomy is used for a wide range of diseases of the posterior segment:
Vitreous haemorrhage
Macular diseases (epiretinal membrane, macular hole)
Vitreo-macular proliferations and retinal scarring
Complicated cataract surgery with retained lens fragments
Foreign bodies following eye trauma
Endophthalmitis (serious eye infection)
How is it performed?
The eye is accessed through three small openings in the sclera measuring only 0.62 mm - self-sealing openings that require no suturing. Through them, instruments are introduced: a cold light source, an infusion port maintaining pressure in the eye, and a vitrectome that controlled removes opacities, blood, and fibrous membranes from the vitreous body.
This relaxes the retina from traction and returns it to position if it has detached. The retina is reattached by endolaser photocoagulation to the vascular layer.
In the most severe cases, when additional pressure on the retina is needed, one of the following substances is introduced into the eye:
Gas bubble - naturally absorbed over 1–6 weeks
Air - naturally absorbed within 1–7 days
Silicone oil - not absorbed and usually needs to be surgically removed later
The procedure is performed under local anaesthesia, even in the most severe forms of disease, with thorough pre-operative preparation.
What to expect?
The success rate of vitrectomy in standard cases averages 90% - 9 in 10 patients achieve a good anatomical result. The most important factor determining the course of recovery and final outcome is the pre-operative state of the retina and the duration of the underlying disease. Regardless of the anatomical success achieved, in long-standing diseases (diabetic retinopathy, retinal detachment) it is sometimes not possible to achieve an optimal functional result - which is precisely why timely consultation with an ophthalmologist is so important.
After surgery, you can expect:
Blurred vision for several weeks
Sensitivity, swelling, and redness of the eye
Prescribed drops to prevent infection and reduce inflammation
Mandatory face-down head positioning if gas or silicone oil has been introduced - sleeping face down is necessary so that the substance exerts pressure on the central part of the retina and supports healing
Follow-up appointments are required the next day after surgery, then after 7 days, and thereafter as agreed with the vitreoretinal surgeon.
Note for patients with gas or air in the eye: You must not travel by plane. The reduced atmospheric pressure in the cabin can cause the gas to expand and dangerously raise intraocular pressure.
Most patients develop cataract earlier than usual due to metabolic changes in the lens after vitrectomy. If a cataract is already present, the procedures can be combined (Phaco + MIVS). If silicone oil has been introduced, a further procedure - silicone oil removal - is usually required at least three months after vitrectomy. It is important to note that silicone oil in the eye shifts refraction towards plus, so post-operative vision will be blurred until the oil is removed.
Vitrectomies at Milmedic Clinic are performed by an experienced team of vitreoretinal surgeons led by Prof. Dr Miroslav Vukosavljević and Dr Nenad Petrović.
Frequently asked questions
How long does the operation itself take?
Duration depends on the complexity of the case. A standard procedure usually takes between 30 minutes and one hour, while complex cases may take longer. The team will inform you in advance of the estimated duration.
Do I need to bring someone with me?
Yes, after the procedure the eye will be covered for safety reasons until the mandatory follow-up the next day, so bringing a companion is essential.
Is vitrectomy a one-time procedure, or might a repeat operation be needed?
In most cases a single vitrectomy is sufficient, but in more complex conditions - such as severe retinal detachment or proliferative diabetic retinopathy - a further procedure is sometimes needed. If silicone oil has been introduced, its subsequent removal is also planned.
The most delicate retinal surgery - one step away.
Vitreoretinal surgery is one of the most demanding fields in ophthalmology, and our team is among the largest and most experienced in the region.