Question: What is vitrectomy, when is it used to treat diabetic retinopathy and what are the risks/benefits of this procedure?
Answer: Vitrectomy is an operation on the eye which involves actual surgical instruments, but it's microsurgery. It's done under the microscope with very delicate and specialized instruments. Vitrectomy is named after the vitreous. The vitreous is a jelly that fills up the inside of the eye, and in people with diabetic retinopathy the most common reason to need a vitrectomy is from bleeding into the vitreous jelly -- bleeding that doesn't go away or can't be treated just with laser.
And in those cases, the doctors, usually a retinal specialist, can perform the vitrectomy, remove all the jelly from the eye and all the blood, and during the operation itself can treat the retina with laser to prevent more bleeding. The risks of that surgery: like any other surgery, there is a small risk of infection, there is a small risk of creating a tear or a hole in the retina and resulting in a retinal detachment. Usually we can fix those.
The other risks are having the pressure in the eye go up afterwards. That's usually temporary. If it's more than temporary it can lead to glaucoma, but in most cases that can be controlled. Vitrectomy can also be used to treat another complication of diabetic retinopathy which is known as retinal detachment. In retinal detachment from diabetes, there's usually scar tissue growth on the retina, and the scar tissue pulls like I'm pulling on my shirt and detaches the retina. So in a vitrectomy operation, the doctor can go inside the eye, take out the vitreous jelly, and then use tiny little specialized scissors to cut and peel and remove the scar tissue from the retina and reattach it.
The complications there are similar to the complications for a vitrectomy for blood in the vitreous -- namely infection, detached retina, glaucoma. The other risk of vitrectomy surgery is cataract formation, which is a clouding of the lens of the eye, but those problems are easily handled by our colleagues who do cataract treatment.