Vitrectomy process, which is difficult to hear in hospitals – from anesthesia to finishing (Part. 2)

“The vitrectomy process”

Hello, this is easy-to-understand ophthalmology story.

in the last post

We investigated the reasons for vitrectomy for retinal disease.

If you haven’t seen it, be sure to read this article! Please report.[click]

And at the end, I showed you a little bit about the method of vitrectomy,

In this post, I will tell you the process of vitrectomy, starting with anesthesia.


Choice of anesthesia method

“Anesthesia” is the key to success in all surgeries.

Vitrectomy is not a painful operation, but because it is a very microscopic operation performed under a microscope.

The patient should never move.

The choice between general anesthesia and local anesthesia is taken in consideration of the patient’s general condition, expected operation time, and degree of cooperation .

Local anesthesia is difficult to control pain and movement with simple eye anesthesia such as cataract surgery.

Oral anesthesia (behind the eyes) is performed using the following injection needle .

Local anesthesia (postoral anesthesia)
Local anesthesia (postoral anesthesia)

However, since only movements such as around the eyes and eye rotation are controlled, movement of the head or neck may interfere with the operation, so it is an anesthetic that requires some cooperation from the patient .

General anesthesia and examination
General anesthesia and examination

Depending on the patient, general anesthesia may be required , and blood tests and medical evaluation should be performed prior to anesthesia .

Patients should also make a decision through consultation with their attending physician for optimal results, rather than insisting on local anesthesia unconditionally.


incision

As I explained in the previous post, the current vitrectomy is not an operation that requires a large incision.

Like laparoscopic surgery, it is operated through 3 small holes . (4 in some cases)

The surgical instruments used are very thin compared to the coins below.

Small-Gauge Vitrectomy: The Future is Now
Thickness of vitrectomy instrument

Each of the three holes is inserted into the white part away from the cornea, which is the hole for the resection, the lighting device, and the perfusion tube .

Vitrectomy Procedure 1 - Incision
vitrectomy incision

vitrectomy

Vitrectomy Procedure - Resection Sequence
vitrectomy sequence

Now that everything is ready for surgery, let’s start removing the vitreous.

However, the inside of the eye is a very weak tissue, and the vitreous body is attached to the retina like a sticky jelly, so it should be approached very carefully and in order .


central vitrectomy

When you think of eating watermelon, it’s like eating the most delicious part in the middle.

The vitreous is also removed from the center. Except for the part that is attached to the shell called the retina, it can be greatly excised.


Posterior vitreous detachment

I explained that posterior vitreous detachment is a phenomenon in which the vitreous body ages and falls from the retina.

During this process, various problems such as cataract, retinal tear, and retinal detachment may occur.

Vitrectomy can be broadly divided into two categories.

  1. Posterior vitreous detachment (PVD) has already progressed and the vitreous detaches from the retina.

  2. When the vitreous body is attached to the retina because the posterior vitreous detachment does not progress
Posterior vitreous detachment
Posterior vitreous detachment

Which patients are most comfortable with surgery?

If the posterior vitreous on the right has been detached, the vitreous can be removed without much difficulty.

However, if the vitreous body is still attached to the retina as shown on the left, artificial detachment must be made.

Creating a posterior vitreous detachment
Creating a posterior vitreous detachment

As shown in the photo above, when artificial posterior vitreous detachment is made, traction occurs in the retina inevitably.

Of course , in this process, artificial tears or peeling may occur, so peeling must be done very carefully .

In particular , patients with high myopia or diabetes need to be more careful as their retina is very weak .


Peripheral vitrectomy

Now remove the remaining vitreous from the periphery .

Since it is the front and invisible part, with the help of an assistant, press it from the outside to secure the view and then remove it.

Peripheral vitrectomy
Peripheral vitrectomy

vitreous substitute

All of the vitreous body was removed except for a part of the periphery.

Shall we leave the inside empty space?

If so, the eyes will not retain their shape and will be squished.

It is a space that needs to be filled with something to replace the vitreous.

Just like there is a physiological saline solution similar to our bodily fluids.

In ophthalmology, there is an ophthalmic solution called BSS .

BSS solution
BSS solution

Fill in the voids with BSS, a solution made from optimal ingredients that are non-toxic in the eye.


Wrap-up

The vitrectomy is complete when the vitreous body has also been removed and BSS to replace the vitreous body has been filled.

The inserted instruments are removed from the eye and the incision does not need to be sutured.

Sutures may be provided in situations where there is a high risk of infection or bleeding .

suture of the incision
suture of the incision

From the next episode…

Isn’t this a very simple operation?

The part I’m talking about today is a very basic vitrectomy procedure.

Literally, it is an operation to remove only the vitreous body, and it is a surgery performed in the degree of simple vitreous opacity or vitreous hemorrhage.

“I put gas and silicone, but they said I had to lie down…”

Yes. For various retinal diseases (dissection, hole, anterior membrane), vitrectomy + additional treatment is required.

In the next post, we will explain additional procedures for each disease, including retinal detachment . [click]

Thanks for reading this long post,

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시리즈 보기유리체 절제술, 병원에서 듣기 힘든 설명, 제가 해 드립니다.(Part. 1) >>

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