Buckle Up!

Vitrectomy is a medical procedure to correct many severe visual and eye-health problems.  The term is often generically used for many medically invasive procedures involving the eyeball itself.

A normal vitrectomy involves the vitreous humor of the eye.

The vitreous humor is the gel-like substance that fills the eyeball behind the cornea.  It is formed at birth and is considered “stagnant”, meaning what one is born with stays in place and is not replenished during one’s lifetime.  Thus, if an eye is punctured and the vitreous humor is lost there is no replacement for it.  Blindness results.

The Procedure(s)
In the standard vitrectomy procedure, excess vitreous humor is removed, thus relieving pressure on the internal eye structure for patients whose vision is affected by pressure issues. 

Another use is for the patient whose eye has enough cellular debris in it to occlude vision; the vitrectomy procedure siphons off the vitreous humor, filters out the cellular debris, and thenVitrectomyCredit: Retina Care Center returns the vitreous humor, giving the patient clearer vision.

More serious is the operation, falling in the general vitrectomy group, named pars plana vitrectomy.  This term is used for a multitude of related or concurrent procedures performed invasively on the human eye. 

Pars plana vitrectomy can salvage the sight of a person with a detached or torn retina.  Although this is generally an out-patient procedure, done under local anaesthetics, the patient may elect to submit to general anaesthesia.

Regardless of which anaesthesia method is used, the first step is to prep the eye with a device that keeps it open for the duration (like that seen in the classic sci-fi dystopia film, A Clockwork Orange).  A probe is introduced into the eye through a site near the lens and the retinal tear is microsurgically repaired, either with laser “welding” or more rarely, in this day of medically advanced technology, suturing. 

There are secondary and tertiary steps to this procedure dependent upon how severe the retinal tear or detachment is.

A greenhouse gas (mixed with ordinary air for stability) is injected into the vitreous humor.  This forms a bubble in the eye, mildly over-inflating it to keep the retina pressed firmly to the wall of the eyeball, and to help stop any leaking around a retinal repair.  Dependent upon the severity of the tear or detachment the specialist may elect to insert a bubble of an oil (medical-grade, silicon based) that stays in indefinitely: this will not go away on its own and has to be removed by the doctor once he or she is satisfied there has been enough compression from the bubble to allow retinal re-attachment to be complete.  It may be left in place for up to six months.  [The silicon oil technique was invented by the French and used successfully in Europe for decades before being approved in the US.  During that pending approval period many US doctors got their hands on the product and used it anyway; the cost of the “black market” oil was around $10 US per application.  Thanks to FDA intervention and Big Pharm’s greed that same “dose” now officially sanctioned bills out at around $1000 US.]

The last stage involves (again, in some, but not all, cases) installing a scleral buckle.  This medical appliance is a thin, durable band of silicon with a tiny buckle on it (much like an ordinary belt one wears on pants).  The belt girds the eyeball (while still allowing the muscles that rotate the eye to work properly), the buckle is fastened, and the belt is sutured into place. 

This belt, with the gas bubble inside the eye, acts to keep pressure tight between the retina and the interior eye.

Scleral BuckleCredit: Healthwise, Inc.

Recovery Protocols & Expectations
Recovery time is about two to three weeks.  There is significant discomfort in the treated eye; painkillers are mandated.

The scleral buckle makes its presence known with a mild tugging sensation when one rotates the eye (this sensation goes away over time).  Because the injected gas bubble has increased the interior pressure on the eyeball, flying in a plane is out of the question; the decreased atmospheric pressure aboard an aircraft could cause the retina to leak or, in effect, “explode”.  

One must use prescription strength eye drops several times daily or a salve limned along the lower eyelid.  Also, in order to keep up constant internal pressure on the tear or detachment site, the patient should stay in positions that allow the gas bubble to continually press against the surgical site.  This makes for awkward weeks if one has to always lie, say, on one’s left side or back.  Being upright is okay for short periods but only for rudimentary tasks (bathing, toilet use, or eating).  [Normal “upright” recommendations are 15 minutes out of every waking hour.  This means the patient should keep his/her head in the recommended position for 45 minutes of every hour to allow the bubble to keep proper pressure on the affected area for full adhesion to occur.]

The patient may have to undergo “touch-up” work in a doctor’ office.  This means a lens is placed over the eye and a laser is used to spot treat areas that may need more reinforcement.

Side effects, post-surgery, can be none, few, or significant.

Most people’s vision will return to a relatively normal pre-surgery state soon enough.  Dependent upon the severity of the retinal tear or detachment, the operation itself may cause a change in the eye’s focal length, thus rendering the patient’s vision blurry (although, generally, this mostly involves adding a degree of nearsightedness due to the distortion of the retina).  In some cases, peripheral vision is lost on the side of the body of the affected eye.

The scleral buckle remains in place for the rest of the patient’s life; it is rarely surgically removed unless absolutely necessary.  Over time a protective pigment layer will cover the strap (visible on a retinal scan or with photomapping).

The greenhouse gas bubble inside the eye dissipates (usually within two weeks) but is annoying to see through, causing warped vision and a sense one is carrying a self-leveling device in one’s head while it remains.  The oil bubble, if used, of course will take longer to get rid of.

This operation takes little surgery time but is costly.  Surgery time these days is around an hour or so (but can exceed a few hours), and an expected cost for the procedure (anesthesiologist’s and surgeon’s fees, etc.) is around $20,000 US.  Fortunately, most health insurance providers cover the expense of this operation, and the patient is left with a deductible and/or nominal co-pay to meet out-of-pocket.  

But, despite the pain, annoying recovery protocols, and minor peripheral vision loss and attendant nearsightedness (correctable with prescription eyeglasses or contact lenses) it is definitely better to undergo this procedure than it is to be blind from a severely torn or detached retina.  


Author’s Note: I have undergone the more extreme version of this procedure involving the installation of the scleral buckle twice in my life.  The first time was in late 2004 to correct a severe retinal tear that almost hit the optic nerve of my right eye (blindness was a surety). Special thanks to Dr, Angelia Thompson (Lexington, KY) for saving that eye’s vision.

More recently, on March 31, 2015, I had to have the identical procedure done on my left eye—three retinal tears (two of which had merged into one larger one) had to be repaired and a buckle installed along with the gas bubble (same as before).  Special thanks to Dr. Thomas Stone (Louisville, KY) for catching that and saving my vision once again.

A second surgery was necessary on May 18, 2015—scar tissue forming from the procedure on March 31 caused my retina to pull away from the wall of the eye.  This second surgery required the silicon oil be  implanted.  I’m hoping this is the last time.

Trucker Man
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