Vitrectomy Surgery: What Patients Need to Know
Understanding Vitrectomy
Vitrectomy, also called vitreous surgery, is a procedure that removes some or all of the vitreous gel from the eye. The vitreous is a jelly-like substance that fills the space between the lens and the retina. When disease or injury affects this gel or the retina behind it, a retina specialist may recommend vitrectomy to treat the problem.
The full name for the most common form of this procedure is pars plana vitrectomy. The pars plana is a safe zone in the white part of the eye, called the sclera, where the surgeon can enter the eye without damaging important structures. During surgery, the specialist uses a small cutting instrument called a vitrector to carefully remove the vitreous gel.
Since the first vitrectomies were performed in the 1970s, the instruments used have become much smaller and more precise. Early surgeries used large 20-gauge instruments that required stitches and longer recovery times. Modern vitrectomy systems now use 25-gauge or even 27-gauge instruments. These smaller tools create incisions about half a millimeter wide, roughly the width of an eyelash.
These advances in small-gauge, sutureless surgery have led to shorter operating times, fewer complications, and faster recovery for many patients. In many cases, the tiny incisions seal on their own without stitches.
Once the vitreous gel is removed, the eye must be filled with a substitute to maintain its shape. Depending on the condition being treated, a retina specialist may use sterile saline (salt water), a gas bubble, or silicone oil. Gas bubbles are absorbed naturally by the body over days to weeks. Silicone oil may need to be removed in a later procedure. The eye gradually produces its own fluid, called aqueous humor, which replaces the saline or gas over time.
Who Is Affected and Why Vitrectomy Is Needed
Vitrectomy can treat a range of conditions that affect the retina or vitreous. Some of the most common reasons a retina specialist may recommend this surgery include:
- Diabetic retinopathy with bleeding into the vitreous (vitreous hemorrhage) or scar tissue pulling on the retina
- Retinal detachment, where the retina separates from the back wall of the eye
- Epiretinal membrane (a thin sheet of scar tissue on the retina surface)
- Macular hole (a small break in the central retina)
- Vitreomacular traction, where the vitreous pulls abnormally on the macula
- Endophthalmitis (a severe infection inside the eye)
- Removal of foreign objects from inside the eye after trauma
Diabetic retinopathy is the most frequent reason for vitrectomy worldwide, accounting for about 40% of all vitrectomy procedures globally (Market Growth Reports, 2024). In advanced diabetic eye disease, abnormal blood vessels can bleed into the vitreous, clouding vision. Scar tissue can also form and pull on the retina. Vitrectomy removes the blood and scar tissue and allows the retina specialist to treat the damaged retina directly.
Interestingly, while overall vitrectomy rates in the United States increased by 31% from 2001 to 2012, the rate of vitrectomy among people with diabetes actually decreased by 43% during that same period (Ophthalmology, 2016). This decline likely reflects improvements in earlier detection and treatment of diabetic eye disease, including the use of anti-VEGF injections.
People aged 65 and older have the highest overall rates of vitrectomy (Ophthalmology, 2016). Other factors may also affect who undergoes this surgery. Research has found that men have somewhat higher odds of undergoing vitrectomy than women, and people with diabetes have a slightly increased likelihood compared to those without diabetes (Ophthalmology, 2016). A retina specialist will recommend vitrectomy only when the benefits are expected to outweigh the risks for a specific patient.
Signs and Symptoms That May Lead to Vitrectomy
The symptoms that lead to vitrectomy depend on the underlying condition. Common symptoms that may indicate a serious retinal problem include a sudden increase in floaters, flashes of light in your vision, a shadow or curtain moving across your field of vision, or sudden blurred or lost vision in one eye.
If you experience any of these symptoms, see a retina specialist or go to the emergency room immediately. These can be signs of retinal detachment or vitreous hemorrhage, which may require urgent surgical treatment.
Not every retinal condition requires surgery right away. A retina specialist may first try non-surgical treatments such as anti-VEGF injections or laser therapy. However, vitrectomy is generally recommended when four conditions are met: the problem is causing or threatening vision loss, the condition is unlikely to heal on its own, the potential benefits of surgery outweigh the risks, and the patient understands those risks and benefits. Very few retinal conditions are resolved by vitrectomy alone. Most procedures include at least one additional step, such as laser treatment, membrane removal, or gas bubble placement.
For some patients with vitreomacular traction who are not candidates for surgery, a pharmacologic option exists. Ocriplasmin (Jetrea), a medication derived from a natural human enzyme, can be injected into the eye to help release the vitreous from the macula. Clinical trials showed that a single injection of ocriplasmin can effectively treat symptomatic vitreomacular adhesion or traction in selected patients. A retina specialist can determine whether this approach is appropriate based on the specific characteristics of the condition.
Diagnosis and Testing Before Vitrectomy
Before recommending vitrectomy, a retina specialist performs a thorough dilated eye exam to evaluate the retina and vitreous. The specialist places drops in your eye to widen the pupil, then uses special lenses and lights to look inside the eye. This exam helps identify problems such as retinal tears, detachments, bleeding, or scar tissue.
Advanced imaging plays a key role in planning surgery. Optical coherence tomography, commonly called OCT, uses light waves to create detailed cross-sectional images of the retina. This test can reveal epiretinal membranes, macular holes, vitreomacular traction, and swelling within the retina. Ultrasound imaging may also be used, especially when blood in the vitreous prevents a clear view of the retina.
Before scheduling vitrectomy, the retina specialist reviews your overall eye health and medical history. This includes evaluating the status of the lens, because vitrectomy is known to accelerate cataract formation. In some cases, the specialist may recommend combining vitrectomy with cataract surgery in the same session to avoid a separate procedure later. Blood sugar control, blood pressure, and any blood-thinning medications are also reviewed, as these factors can affect surgical outcomes.
Treatment Options and the Vitrectomy Procedure
Vitrectomy is most often performed as an outpatient procedure, meaning you go home the same day. The surgery typically takes between 30 minutes and two hours, depending on the complexity of the condition being treated. Most procedures are done under local anesthesia, which numbs the eye and the area around it. You may also receive sedation to help you relax.
The surgeon makes three tiny openings through the pars plana. One opening is for a light source to illuminate the inside of the eye. A second is for an infusion line that keeps the eye properly inflated with fluid. The third is for the vitrector and other surgical instruments. Through these small ports, the retina specialist removes the vitreous and performs any additional necessary procedures on the retina.
Depending on the diagnosis, the retina specialist may perform several other steps during the same surgery. These can include:
- Laser photocoagulation (thermal laser) to seal retinal tears or treat areas of abnormal blood vessel growth
- Membrane peeling to remove scar tissue from the retina surface
- Placement of a gas bubble or silicone oil to hold the retina in place
- Cryopexy (freezing treatment) to seal retinal breaks
- Endodrainage of fluid from under a detached retina
When a gas bubble is placed in the eye, it acts as an internal bandage that presses the retina against the back wall of the eye. If your retina specialist uses a gas bubble, you may need to maintain a specific head position for several days or even weeks after surgery. This is called face-down positioning, and it helps the bubble press against the correct area of the retina while it heals.
You cannot fly in an airplane or travel to high altitudes while a gas bubble is in your eye. Changes in air pressure can cause the bubble to expand, which may dangerously increase pressure inside the eye. Your retina specialist will tell you when it is safe to fly, typically after the gas has been fully absorbed.
What to Expect After Vitrectomy
After surgery, your eye will likely be patched for the first day. Some discomfort, redness, and swelling are normal. Most patients describe a mild aching or scratchy feeling rather than sharp pain. The retina specialist will prescribe eye drops, usually including an antibiotic to prevent infection and a steroid to reduce inflammation. You will use these drops for several weeks as directed.
Vision is often blurry in the days following vitrectomy. If a gas bubble was placed, your vision may be very limited until the bubble shrinks. As the gas is slowly absorbed, you may notice a line in your vision where the bubble meets the fluid that your eye is producing. This is normal and will resolve as the bubble disappears, typically over two to eight weeks depending on the type of gas used.
Most patients can return to light daily activities within a few days, though heavy lifting, bending, and strenuous exercise should be avoided for several weeks. Your retina specialist will provide specific guidelines based on the type of surgery performed and whether a gas bubble or silicone oil was used. Follow-up visits are usually scheduled within the first week after surgery and continue regularly for several months.
Full visual recovery can take weeks to months. The final visual outcome depends on the underlying condition that required surgery. For example, a patient who had vitrectomy for a simple vitreous hemorrhage may recover excellent vision, while someone with long-standing retinal detachment or advanced diabetic eye disease may have more limited improvement.
One of the most common long-term effects of vitrectomy is cataract development. The surgery increases oxygen exposure to the lens of the eye, which can accelerate the clouding of the natural lens. Research shows that about 46% of patients need cataract surgery within two years after vitrectomy (AAO, 2025). A large study from the United Kingdom found that cataract surgery rates after vitrectomy reached approximately 50% at one year and 85% at five years (published in peer-reviewed literature). If you already have a cataract at the time of vitrectomy, your retina specialist may recommend removing it during the same surgery.
Risks and Possible Complications
Like any surgery, vitrectomy carries risks. Serious complications are uncommon, but patients should be aware of them. Possible risks include:
- Infection inside the eye (endophthalmitis)
- Bleeding during or after surgery
- High or low eye pressure
- New retinal detachment caused by the surgery
- Cataract formation or worsening of an existing cataract
- Changes in the refractive error (eyeglass prescription)
- Problems with eye movement after surgery
- In rare cases, significant loss of vision
Advances in small-gauge vitrectomy instruments have significantly reduced the complication rate compared to older techniques. Sutureless incisions cause less inflammation and discomfort, and they heal more quickly. The retina specialist carefully evaluates each case to weigh the benefits of surgery against the risks. In some situations, suturing the incision sites at the end of surgery can reduce wound-related complications, though this may add some discomfort during recovery.
Living With Recovery After Vitrectomy
During recovery, it is important to be patient with your vision. Floaters, blurriness, and sensitivity to light are common in the weeks following surgery. If a gas bubble is present, you may see its edge as a dark circle or line that gradually moves lower in your field of vision as it shrinks. These temporary changes can be frustrating, but they are a normal part of healing.
If silicone oil was used instead of a gas bubble, your vision may remain blurry until the oil is surgically removed in a later procedure. Silicone oil provides longer-term support for the retina and is typically used in more complex cases such as severe retinal detachments.
After recovery, regular follow-up visits with a retina specialist are important to monitor the health of your retina and check for complications such as cataract progression or recurrence of the original condition. Some patients may need additional treatments, including anti-VEGF injections such as Eylea (aflibercept), Avastin (bevacizumab, used off-label for eye conditions), or Vabysmo (faricimab), depending on the underlying disease.
Maintaining overall health also supports eye health after vitrectomy. For patients with diabetes, keeping blood sugar, blood pressure, and cholesterol at target levels can help protect the retina from further damage. Wearing sunglasses outdoors and following all post-operative instructions from your retina specialist also supports long-term recovery.
When to See a Retina Specialist
Contact your retina specialist or go to the emergency room immediately if you experience any of the following after vitrectomy: a sudden increase in pain that is not relieved by prescribed medication, a sudden increase in floaters, new flashes of light, a curtain or shadow moving across your vision, or a sudden decrease in vision. These symptoms may indicate a serious complication such as infection or retinal detachment that requires urgent treatment.
Even if your recovery goes smoothly, you should continue seeing a retina specialist for regular check-ups as recommended. Many of the conditions that lead to vitrectomy, such as diabetic retinopathy, can recur or progress over time. Early detection of any new problems gives you the best chance of preserving your vision in the long term.
Questions and Answers
Visual recovery varies depending on the condition treated and whether a gas bubble or silicone oil was used. Many patients notice gradual improvement over two to six weeks. If a gas bubble was placed, vision may remain very blurry until the bubble is mostly absorbed. Full visual recovery can take several months in some cases. Your retina specialist can give you a more specific timeline based on your individual situation.
Face-down or specific head positioning is required in some cases, particularly when a gas bubble is used to repair a retinal detachment or macular hole. This positioning helps the bubble press against the area of the retina that needs to heal. The duration varies, but it is commonly required for several days to two weeks. Not all vitrectomy procedures require positioning, and your retina specialist will explain what is needed for your case before surgery.
Yes. In some cases, a second vitrectomy may be necessary if the original condition recurs or if a new problem develops. For example, a retinal detachment may return after the first surgery, or silicone oil placed during the first procedure may need to be removed in a subsequent surgery. Each situation is evaluated individually by a retina specialist.
Cataract formation is the most common long-term effect of vitrectomy. About 46% of patients require cataract surgery within two years after the procedure (AAO, 2025). The surgery increases oxygen exposure to the lens, which accelerates clouding. If a cataract develops and affects your vision, it can be treated with a standard cataract surgery, which is a common and well-established procedure.
Vitrectomy treats the effects of a condition on the eye but does not typically cure the underlying disease. For example, removing blood from the vitreous in diabetic retinopathy restores clearer vision, but diabetes itself continues to affect the eye. Ongoing treatment, monitoring, and management of the underlying condition are usually necessary after vitrectomy to protect your vision over time.