Vitrectomy for Floaters
The eye works like a projector. It has two parts, a lens and a film. The film layer lines the back wall of the eyes and is called the retina. There is a gel called the vitreous which is very firmly adherent to the retina. The vitreous separates from the back of the eye towards the front of the eye as a normal part of aging. Adults no longer need the vitreous to see normally.
The separated gel is no longer lines the back wall of the eye, but is instead positioned in front of the film layer. Light that travels from the front of the eye towards the back of the eye can become obstructed by parts of the gel and cast a shadow on the retina. Patients perceive the shadow as black spots, black lines, or a semi-transparent veil that floats across their vision. All of these manifestations of the gel obstructing the vision are labeled under the term floaters.
Most patients experience a near complete resolution in their floaters about a year or so after their onset. There are some people who never experience an improvement in their floaters and continue to be bothered on a daily basis by them. The most common complaint is difficulty reading or driving due to the floaters temporarily obscuring their vision. For these patients, vitrectomy for floaters may be a reasonable option.
Floaters are removed by an outpatient surgical procedure called a pars plana vitrectomy. It may be performed with the patient awake (painless) or asleep (general anesthesia).
The retina specialist places 3 small ports that are approximately one half (0.5) millimeters in thickness through the white of the eye and into the vitreous cavity. Fluid is infused into the eye while the vitreous (gel) is removed. The retina specialist then carefully removes nearly all of the vitreous and carefully inspects the retina. An eye patch and eye shield are placed on the eye at the end of the case. The surgery is not typically painful. Tylenol is all most patients need for pain.
Patients will typically be re-evaluated one day after surgery. An ophthalmic technician will remove the patch, shield, and prepare the patient to see the doctor. The doctor will provide instructions on eye drops to use (typically for a period of approximately 1 month). Patients are then typically seen 1-2 weeks, 1 months, and 3 months following surgery for additional post-operative evaluations.
Vision is typically blurry the day following surgery. The vision returns to normal (with the exception of no floaters) within 2-3 days following surgery.
Patients are unable to drive immediately after surgery or the following day. Most retina specialists will ask patients to avoid lifting greater than 20 pounds for at least two weeks. It is important patients not allow water into the eye for at least one week.
This surgery is generally considered to be safe and effective. However, all surgeries have some associated risk. Your retina specialist believes the benefits outweighs the risks. Please see the primary risks of epiretinal membrane removal below.
Patients who have not already undergone cataract surgery will experience a worsening of cataracts. Patients who are 50 years or older have a 90% chance of requiring cataract surgery within 2 years of vitrectomy
There is less than a 1% chance of developing a retinal detachment following surgery. Signs of a retinal detachment include the sudden onset of new flashing lights, many new floaters, or see a new dark curtain in a previously clear area of vision. Patients experiencing these symptoms should reach out to their retina specialist promptly.
There is an approximately 1/5000 chance of developing an eye infection following macular hole repair. Patients may decrease their risk of developing this condition by avoiding touching, rubbing, or allowing water to enter the eye for at least one week. The sudden onset of severe eye redness, decreased vision, and severe sensitivity to light may be the sign of an eye infection. Patients experiencing these symptoms should reach out to their retina specialist promptly.
Floater removal is a highly successful surgery for which the vast majority of patients are extremely pleased.