Vitrectomy

The vitrectomy (Latin vitreus " glassy ", Greek ek " out " and tomein " cut") is the part of step eye surgery, specifically parts of the vitreous to be surgically removed at the. Provided that the operation unique to Vitrectomy aims, usually the whole operation is named.

Indications

A vitrectomy is often used in the framework of advanced proliferative diabetic retinopathy, required for existing retinal detachment or significant vitreous hemorrhage. You may also be performed as a diagnostic vitrectomy for vitreous opacities of unknown etiology. The vitreous samples are then analyzed for bacteriological, virological and cytologically. Retinal detachment with retinal holes are increasingly being supplied as part of a vitrectomy and represent the most common indication for vitrectomy. Also for removal of epiretinal gliosis must be a vitrectomy. Furthermore, vitrectomy has the prognosis of eye injuries with perforation of the sclera much improved, since in this process also in the eye reached foreign bodies are removed and antibiotics can be administered.

Pars plana vitrectomy

The pars plana vitrectomy ( vitrectomy or PPV) is the vitrectomy in a closed system. Access to the glass body is carried out through the wall of the eye at the level of the pars plana region, a portion which lies between the outer periphery of the retina and ciliary body, and does not contain large vessels or functional irreplaceable tissues.

During surgery, the following tools are inserted through three sections of a few millimeters Width:

• An infusion together with suction,
• A light source,
• A surgical tool ( vitrectome, special shears, grapples, check mark).

Thus, the vitreous and other tissues involved in the disease can be removed. Infusion maintains the pressure in the eye. To a detached retina back down, the vitreous cavity can be filled with gas, silicone oil or perfluorocarbons. A return to the system brought retina can then by laser coagulation and / or cold coagulation ( Durchfrierung ) are connected with the choroid. Through the sterile inflammatory stimulus, the laser heat or cold form in the episode stabilizing scars that counteract a renewed retinal detachment.

Results and complications

The operation can achieve very good results, however, operative and post- operative problems are not uncommon, which are now considered manageable. So it is almost always within one to two years after a vitrectomy to form a cataract (cataract ). Other possible complications include, inter alia, retinal detachment, which is why a vitrectomy is not recommended in harmless symptoms such as floaters. In diabetic retinopathy and other retinal disorders, the disease-related damage can be irreparable in part, so that in spite of successful vitrectomy complete restoration of sight is uncertain.

History of surgical technique

Until the sixties of the 20th century surgical procedures were avoided on the glass body, given the many complications of vitreous replacement have not been well controlled. At this time, the common technique was Tupfervitrektomie, wherein the herniated tissue is aspirated vitreous using a swab, pulled out of the eyeball, and cut with scissors. The development of special Vitrektome (suction cutting devices) later made the practice of train on the vitreous unnecessary; thus the complication rate decreased significantly.

With the development of vitrectomy in a closed system ( pars plana vitrectomy, PPV), through which a pressure drop in the eyeball during surgery can be largely avoided, was the transition from a defensive reaction to situations that make an intervention on the glass body essential for planned use of vitrectomy for a growing number of indications.

As a pioneer in the development of vitrectomy German-born U.S. citizen Robert Machemer applies ( 1933-2009 ).

• Therapeutic procedures in ophthalmology