The major risks of vitrectomy, or FOV, are blindness from infection and retinal detachment. These are actually the major worries of any intraocular surgery, including cataract surgery, not just FOV.
Intraocular Infection (Endophthalmitis)
Infection inside the eye is called endophthalmitis. It usually occurs within days after surgery and can quickly cause permanent loss of vision or even blindness. Fortunately, endophthalmitis is uncommon. Compared to cataract surgery, infection occurs much less often with vitrectomy, that is, cataract surgery has a higher rate of infection compared to vitrectomy, or FOV.
The chance of endophthalmitis with FOV is somewhere around 1:10,000. In this regard, vitrectomy is safer than cataract surgery.
Chance of Retinal Detachment
Retinal tears can cause retinal detachments. Retinal tears can occur spontaneously, with trauma, following a PVD or from eye surgery.
The common denominator? The vitreous.
The vitreous is attached to certain parts of the retina. The vitreous can pull forcefully enough to cause a tear in the retina which may lead to a retinal detachment.
While retinal detachments are usually repaired successfully, there may be permanent loss of vision. While not all tears lead to a retinal detachment, it’s best to diagnose and treat a tear before a retinal detachment occurs.
The chance of a retinal tear forming has decreased dramatically with the introduction of the 25 gauge vitrectomy systems. In addition, additional safety features have developed making the Alcon Constellation Vision System my preferred vitrectomy system.
The chance of causing a retinal tear from FOV is about 1-2% and approximates that of other intraocular eye surgeries.
Other Complications of Vitrectomy
Other possible complications of FOV include:
Bleeding – Unless a retinal tear occurs during FOV, bleeding is exceptionally rare. 25 gauge vitrectomy is sutureless. This means that the entry ports (aka sclerotomies = holes in the sclera) which allow the surgical instruments to enter the eye are small enough to close by themselves. No stitches are needed.
Blood from the outside of the eye can sometimes enter the eye during the first few hours after the operation. This blood is harmless and self absorbs.
Cataract – I don’t believe FOV necessarily causes or accelerates cataract formation. In general, this has not been my experience with FOV.
While there are many anecdotal “studies” suggesting cataract formation occurs following vitrectomy, but these studies are either retrospective and/or include vitrectomy performed all reasons, not just vitreous opacities.
Remember, too, pre-existing cataracts all progress at different rates and all people get cataracts with/without vitrectomy. It’s just like gray hair.
Hypotony – This, too, is a rare event. Sutureless 25 gauge does not require stitches to close the sclerotomies. The intraocular pressure returns to normal in 24-48 hours and is not a sustained problems. I advise patient not to push on their eyes for the first few days after vitrectomy.
Overall the procedure is exceptionally successful and safe. There can be no guarantees, but when compared to cataract surgery, 25 gauge vitrectomy compares quite favorably.
Feel free to ask a question or leave a comment!
Randall V. Wong, M.D.
Fairfax, Virginia 22030