Vitrectomy for Attorneys

An understanding of vitrectomy for attorneys can help understand the significance of this ocular procedure when it applies to clients and legal proceedings.

Vitrectomy is a surgical procedure of the eye that is used to treat a variety of problems involving the retina and vitreous.  The retina is the lining of the back wall of the eye and serves very much like the film or image sensor of a camera.  The vitreous is a clear jelly in the center of the eye.  Light is focused through the vitreous before it reach the delicate retina in the back of the eye.  A vitrectomy removes the clear jelly in the center of the eye.  In the process of vitrectomy a clear saltwater solution is used to replace the jelly that has been removed.  Eventually, this saltwater solution is replaced by clear fluid that is normally produced within the eye itself.  The vitreous jelly is useful in fetal life when it serves as a scaffold for blood vessels inside the eye.  But these blood vessels usually regress and disappear by the time humans are born.  After birth the vitreous becomes a superfluous structure that is not needed for visual function.  Understanding the process of vitrectomy for attorneys helps understand the procedure from a patient’s perspective.

Common indications for vitrectomy

A vitrectomy is sometimes needed under the following situations:

  • For certain forms of retinal detachments;
  • When bleeding into the vitreous or scar tissue develops from diabetic retinopathy;
  • Certain types of infection in the eye such as endophthalmitis;
  • Significant eye injury causing blood or a foreign body in the eye;
  • Formation of membranes on the surface of the retina;
  • Retinal holes caused by traction of the vitreous on the retina;
  • Macular holes;
  • Retained tissue in the eye after cataract surgery.

How vitrectomy is performed

A vitrectomy is performed in a hospital or surgical center by an  ophthalmologist specializing in the retina and vitreous.  Special instruments and machines are utilized for vitrectomy, and surgical technicians experienced and knowledgable in the use of vitrectomy instruments provide assistance to the ophthalmologist.  Incisions are constructed and miniature devices are inserted through these opeinings.  The miniature devices for virectomy include light probes, cutting instruments, suction devices, infusion cannula, and specialized probes for applying laser to the retina.

The vitrectomy procedure may be done with local anesthesia or with general anesthesia.  The vitreous jelly inside the eye is carefully emoved.  Sometimes laser spots are applied to help seal a retinal tear or prevent bleeding from disorders such as proliferative diabetic retinopathy or vein occlusion.  A plastic band may be applied around the eye when vitrectomy is done to treat a retinal detachment.  The plastic band is referred to as a scleral buckle.

Sometimes a gas or silicone oil is placed in the vitreous cavity to stablize the retina.  Gas placed inside the eye is reabsorbed, usually within a few weeks.  Individuals who have gas placed in the eye are usually required to position themselves face down as much as possible after surgery.  Individuals with gas inside the eye need to refrain from air travel under the gas bubble is gone.  Silicone oil in the eye is usually removed within a few months with a second surgical vitrectomy.  Vitrectomy for attorneys helps understand important details about this relatively common surgical procedure.

Vision improvement from vitrectomy

A vitrectomy may improve or stabilize vision.  Removing debris such as blood, clots, or scar tissue in the vitreous help clear the visual axis so that there is no impediment to light reaching the retina.  Lens fragments in the vitreous from complicated cataract surgery may cause inflammation and swelling of the retina.  Removing lens fragments in the vitreous may improve vision they cause blockage of the visual pathway or cause problems involving the retina.

Removing the vitreous and adjacent tissue growing on the surface of the retina may improve the quality of vision since tissue that spreads across the retina reduces vision and may cause distortion of vision.  Foreign bodies retained in the eye can prove to be significant problems, causing endophthalmitis, swelling of the eye, and scar tissue of the vitreous and retina.  In the case of macula holes, vitrectomy may partially or fully restore the architecture of the macula, the most sensitive part of the retina.  Restoration of normal macular architecture may result in appreciable improvement of vision.. 

Risks of vitrectomy surgery

Issues of possible complications are important to know as part of vitrectomy for attorneys.  All types of surgery have inherent risks and potential complications.  In the presence of apropriate indications, the benefits of vitrectomy outweighs the risk of this surgical procedure.

Risks of vitrectomy include, but are not limited to:

  • Infection;
  • Hemorrhage (bleeding);
  • Retinal tears;
  • Retinal detachment;
  • Acceleration of cataract development;
  • Elevated eye pressure.

Prognosis of vision after vitrectomy

Knowledge of vitrectomy for attorneys is also important for understanding the long-term prognosis for vision.  The prognosis for vision depends on many factors.  The amount of vision restored by vitrectomy may be significantly limited if an underlying problem has already caused permanent damage to the eye.  In many situations, the progression of cataracts or diabetic changes in the retina following vitrectomy may adversely affect vision.  In such cases, additional treatment by an ophthalmologist may be necessary to improve and stablize vision.

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