Vitrectomy is a procedure of ocular microsurgery used to remove the vitreous body, as in the case of appearances of vitreous opacities that results from bleeding and tractions that tend to contract and pull the retina enough to cause distortion in central vision. The vitreous body is a transparent gelatinous substance present inside the eye, to which it gives form and volume. It is primarily composed of water and substances such as hyaluronic acid. Because of its position, it is in close relationship with the retina, to which it adheres to several points. Among the main indications of vitrectomy are:
- vitreous hemorrhage (presence of blood in the vitreous)
- vitreous diseases (asteroid hyalosis, vitreous opacities, myodesopsia, etc.)
- retinal detachment
- diabetic retinopathy
- proliferation of membranes on the surface of the retina (macular pucker)
- macular hole
- macular edema
Vitrectomy is effective in situations in which the vitreous humor is as opaque as in hemorrhages or infections, or when the vitreous is responsible for the formation of a retinal pathology, such as retinal detachment, diabetic retinopathy, macular hole, and macular pucker. Vitrectomy is also used in cases of penetrating ocular trauma with or without the retention of a foreign body. It is also applied in the case of other ocular surgery complications such as the luxation of the nucleus in the vitreous that may follow a capsular rapture during a cataract surgery.
Minimally Invasive Vitrectomy
The new minimally invasive vitreoretinal surgery that is known as 27-Gauge (27-G) Vitrectomy Surgery is now available in Italy. The “G” (Gauge) indicates the needle size, so the larger the number, the smaller the diameter is. The 27-Gauge Vitrectomy Surgery is better than the 25-Gauge because it creates a smaller hole to the benefit of the patient. Vitrectomy is performed by making small holes inside the eye through which microscopic devices are inserted that allow the surgeon to perform the surgical intervention on the vitreous body and retina. The diameter of these devices determines the invasiveness of the intervention. Apparently, the smaller the diameter, the better the compliance of the patient’s eye will be. Subsequently, there will be an increase in the overall success of the surgery with quicker postoperative recovery.
The 27-Gauge corresponds to 0.4 mm diameter in incision size. We started 20 years ago from the 20-Gauge Vitrectomy, obviously, that is with a larger diameter. With a diameter of 0.4 mm, these “micro-incisions” on the eye, through which the microscopic devices enter, do not need to be sutured for postoperative recovery. They are self-sealing and do not determine the discharge of liquid in the postoperative period and presence of complications. Therefore, they are well accepted by the patient and in skilled hands of the surgeon, can allow vitreoretinal surgery to last in a very short time (15-20 minutes, an immediate functional recovery without pain (we are speaking of 24 hours), and in selected cases, surgery without anesthesia.
Video Transcript: Minimally Invasive Vitrectomy is a modern method that allows for the performing of minimally invasive interventions on the vitreous body, retina and noblest microstructures inside the eye. Thanks to the new technology of the most modern machines that we have available today, we can afford to perform minimal interventions with minimal stress on ocular tissues and likewise, to the patient. Remember that the less we are in an eye, which is an organ, the less traumatic it is and the faster the self-recovery will be.
A minimally invasive modern surgery cannot be separated from the latest generation of machines. The evolution of minimally invasive vitrectomy has led to a miniaturization of microscopic devices up to 27-Gauge. It is the minimum diameter of the needles with which we perform micro-interventions in the eye. These new machines allow us to perform any type of minimally invasive vitreoretinal surgery at 25- and 27-Gauge. What is the advantage of greatly reducing the diameter which we enter the eye through? It has the enormous advantage of causing greatly reduced stress to the micro-structures of the eye. It then allows us to achieve a lean and clean surgery and quick functional recovery of an eye (as fast as 24 hours) that almost does not show any signs of a previous surgery.
These new machines we have available allow a minimally invasive cataract surgery or a combined surgery. What does it mean? It means that we can perform a surgery on the anterior segment, then remove the cataract and implant a high-tech lens that will allow the patient to have a perfect vision at far and close distances, consequently, have a very high visual performance level. If the patient also has a vitreous and retinal pathology, it is advisable to perform a combined operation that consists of an anterior and posterior segment surgeries. It is necessary to remove the cataract and implant a high-technology crystalline lens, if the patient requests it (anterior segment), and, at the same time, perform a minimally invasive vitrectomy (posterior segment). From this comes a new concept, the refractive surgery of the vitreous. In reality, it does not exist, because it is a neologism that we coined to define all that we can do to give the patient a quality of vision that is as perfect as possible. It means that if a cataract surgery with a high-technology lens is performed on the patient and he has the desire to have a perfect vision as if he were a kid, he may have it. In the same way, he has the right to experience the visual impurities that are inside the vitreous body and associated epiretinal membranes.
Minimally invasive macular surgery with the removal of epiretinal membranes from the detached vitreous body will become a routine surgery of patients with cataracts whom will undergo refractive cataract surgery.
These new machines allow us to get closer to an increasingly minimal and quick surgery with exceptional results for the patient.
Here are some of my articles on vitrectomy that are published in paper magazines and online:
Increasingly minimally invasive techniques, with reduced to an absence of post-operative pain. The technology in the field of eye surgery continues to make progress. One of the latest news concerns vitrectomy, a surgical procedure used to remove the vitreous body usually following some types of maculopathy or retinal detachment. «The announcement touches on an evolution of the diameter of needles that is recently made available in Italy. It is at 27-Gauge, or 0.4 mm in diameter, says Dr. Alberto Bellone, a specialist in the field of refractive surgery and ocular microsurgery. Previously, the smallest available size was 25g or 0.5mm. This is a truly microscopic change but for microsurgery, it is substantial and involves numerous benefits to the patient».
Vitrectomy is the removal of the vitreous body and is necessary because of some pathologies: «The vitreous body is a transparent gelatinous substance present in the eye, composed largely of water and substances such as collagen and hyaluronic acid. It adheres to several points to the retina, so the intervention must be performed by experts to avoid damage» says Dr. Alberto Bellone.
The intervention. «Vitrectomy is effective in situations in which the vitreous humor is as opaque as in hemorrhages or infections, or when the vitreous is responsible for the formation of a retinal pathology, such as retinal detachment, diabetic retinopathy, macular hole, and macular pucker, explains the Turin Ophthalmologist. The 27-G Vitrectomy is indicated for most of the interventions. Among the main indications, is the epiretinal membrane (macular pucker) or cellophane maculopathy, as it is often called. It is another rather frequent case in which retinal detachment is observed». Vitrectomy is also used in the case of a penetrating ocular trauma with or without foreign body retention.
The technique. «In the 70s, when vitrectomy was invented, it was 17g. Twenty years ago the instrument used had a diameter of 1 millimeter. Today, after several intermediate steps, with 20- and 23-G, we have more than halved this size» explains the Turin Ophthalmologist. Vitrectomy is done by creating holes through the eye where microscopic devices are inserted that allow you to perform the surgery on the vitreous body and retina. The diameter of these microscopic devices determines the invasiveness of the intervention. It is clear that the smaller the diameter, the better the results of the surgery and the recovery in the postoperative period will be.
«With a diameter of 0.4 mm,”micro-incisions” are done on the eye for the operation, which for such small dimensions are self-sealing (without the need for sutures), do not determine the leakage of liquid in the postoperative period and they do not cause complications, says Dr. Alberto Bellone. The operation is performed in a very short time (15-20 minutes) and functional recovery takes place immediately, in 24 hours, without pain and in selected cases even without anesthesia».
Dr. Bellone has performed a considerable number of minimally invasive vitrectomy interventions in Italy and in particular, he is the first operator in Piedmont to use the 27-Gauge technique.
Minimally Invasive Vitrectomy In Diabetic Retinopathy: