Vitreoretinal Surgery

Vitreoretinal Surgery is a specialised procedure addressing conditions affecting the retina and vitreous of the eye. At CHEC, our experienced surgeons and state-of-the-art technology ensure the best possible care and outcomes for patients with retinal conditions, such as epiretinal membranes and macular holes.

Understanding the macula

The retina lines the back of the eye, functioning like the film in a camera. It captures light and images, sending them to the brain via the optic nerve. The macula, the central part of the retina, is critical for sharp central vision, enabling us to read, recognise faces, and see in colour.

Epiretinal Membrane (ERM)/Vitreomacular Traction (VMT)

An epiretinal membrane is a thin, fibrous tissue layer that forms on the macula’s surface, potentially causing blurred or distorted vision.

ERMs can develop due to:

Idiopathic: Most commonly, ERMs form as part of the natural aging process.
Other eye conditions: They can also result from diabetes, retinal vein occlusion, inflammation, or previous retinal surgery.

Symptoms of ERM:

Distorted or wavy vision, particularly when looking at straight lines.
Blurred central vision.
Difficulty with tasks requiring sharp vision, such as reading or driving.

Diagnosis of ERM:

Diagnosis typically involves a comprehensive eye examination, including:

Dilated eye exam: To examine the back of the eye and assess the retina and macula.
Optical Coherence Tomography (OCT): A non-invasive imaging test that provides detailed cross-sectional images of the retina, helping confirm the presence of an ERM.

Macular Hole

A Macular Hole is a small gap in the macula, leading to blurred and distorted vision. This condition is different from age-related macular degeneration.

Causes of Macular Holes:

Idiopathic: Most common in people aged 60-80.
Trauma, short-sightedness, or previous retinal conditions: Severe eye injury, retinal detachment, or chronic macular edema can also lead to macular holes.

Symptoms of Macular Holes:

Blurred or wavy central vision.
A dark spot or missing area in the center of vision.

Diagnosis of Macular Holes:

Dilated Eye Exam: Similar to ERM diagnosis, this allows the eye doctor to view the macula closely.
OCT: This test is essential for diagnosing and evaluating the size and depth of the macular hole.

Surgical Treatment

Vitreoretinal Surgery, often involving a procedure called a vitrectomy, is used to treat these conditions. This surgery removes the vitreous gel and repairs the retina.

Vitrectomy Procedure

Duration: Typically lasts 40-80 minutes.
Anesthesia: Most patients undergo the procedure under local anesthesia.
Technique: The surgeon makes three small incisions in the eye’s white part (sclera). Using fine instruments, the vitreous gel is removed, and the epiretinal membrane/internal limiting membrane around the macula is delicately peeled away to reduce traction and facilitate healing.

Intraocular Gas

After vitrectomy, a gas bubble may be inserted into the eye to aid healing. In most cases, we use SF6 gas (short-acting) which dissolves in 2-3 weeks.

Vision Recovery

Initial vision: Expect blurred vision for the first few weeks post-surgery. Vision improves gradually as the gas/air bubble diminishes.
Gas/air bubble observation: As the gas dissipates, patients may see a horizontal line moving downward, indicating the shrinking bubble, and returning vision.