Vitrectomy, this is a surgical operation that is successfully used in the hemorrhages in the vitreous body, detachment of the retina, severe injuries visual analyzer And with diabetes mellitus.

All listed diseases were previously considered incurable and eventually led to loss of vision. To date, modern medicine offers vitrectomy as an effective way to correct and treat disease diseases.

Vitrectomy is understood as an operation to remove from the eye fiscame body. This structure occupies the largest volume. The body can be removed in part, i.e. Make a subtotal vitrectomy, and can be completely.

After Vitrectomy, an ophthalmologist receives full access to the retinal tissue. This allows the photocoagulation ("soldering") of the retina, moving from it a scar cloth, or restore the integrity of the shell.

When removing the vitreous body of the eye, gas or a special fluid is introduced instead.

This operation can be carried out under local or under general anesthesia.

The main reasons for the operation are:

1. Eye injuries, for example, due to the penetration of the foreign object;
2. The retinal detachment that occurred as a result of severe myopia, diabetes or from aging of the vitreous body. The retina can also be squeezed due to sulfur-shaped cell anemia or penetrating eye injuries;
3. Impregnating the blood of a vitreous body - hemophthalm;
4. Intraocular infection in severe;
5. Retinopathy - Diabetic retinal pathology complicating detachment mesh shell tracting type, hemophthalm, or swelling spots;
6. A serious staging of the vitreous body;
7. Large sizes of retinal rupture;
8. Hole in Makula (Yellow Stain) or a gap;
9. Dislocation of the lens or an intraocular lens replaced it (in the case of a surgical treatment of cataracts);
10. Removal of scar tissues in turbidity or multiple hemorrhages. Hemorrhage can provoke a fiber detachment, emergency measures will be required.

Before the operation, about 18:00, the patient must take food for the last time. After that, before the operation, it is impossible, nor drink. Operational intervention lasts about 2 hours.

Vitrectomy eyes can be carried out after instilcing anesthetic agent, or under general anesthesia. The solution depends on the state of the patient, the presence of other diseases and the total number of intended procedures.

The surgical operation itself is performed on the patient, which is located in the pose lying on the back. After combined or local anesthesia, a special eyelid is inserted into the eye, it will fix the eyes during the procedures performed by the surgeon.

After that, there are 3 small outbreaks in the eye, where the tools are injected, which give the surgeon to manipulate on the retina and the vitreous body.

The surgeon uses the following toolkit during operation:

1. Vitreot - a special cylinder with a knife,
2. Lighting device
3. Cannula for regular feeding in the eyeball of a sterile saline solution. The substance supports an apple eye in a normal tone.

The vitreous body must completely suck the vacuum. From the body after that they are removed: scars, pathological tissues, blood. Next, the doctor conducts manipulation on the retina.

The vitreous body, which was removed, replaced:

• Air mixture or sterile air with gas, if there is a goal to rub the retina, as well as keep it in a normal position (in the event of a rupture of the region yellow spots. The mixture is resolved in 3 weeks. After this time, its intraocular fluid appears;
• Fluoroorganic liquid, i.e. Water, which is saturated with fluorine or silicone oil. Liquid by weight is heavier than water. Silicone oil is much heavier than water, it presses the retina for 3-4 months, after which the doctor removes it.

Microfervasive Vitrectomy

A variety of surgical intervention is the extraction of a whole vitreous body or its part. The operation is carried out in three microscopic punzes with a size of 0.3-0, 5 mm. An even smaller tools are introduced into the punctures.

It is characteristic that the frequency of the work of the Vitreotoma with microinvasive vitrectomy is higher, and is not 2500 per minute, but twice as much. In addition, another type of illuminators is used - self-locking multipoints.

Features of the operation are as follows:

• Low traumatic level;
• Reducing the risk of bleeding, which is important when excessive springs of vessels in fiber;
• Operation is performed in amublastic conditions, without hospitalization;
• Reduced postoperative rehabilitation.

Microsvasive vitrectomy is not performed in all ophthalmic centers.

Vitrectomy reviews directly depend on the qualifications of the doctor and the presence of a special tool.

Features of the postoperative period

After a standard vitrectomy, the patient for 1-3 days should be in a medical institution under strict control of doctors.

Patient's vision is restored after a while after the operation. The degree of recovery and duration depends on the following factors:

• The presence of severe pathologies of the mesh shell;
• Penalty of optical eyes for the light beam;
• The state of the optic nerve.

If the vitreous body was replaced by brine, then some time the blood elements will be fluent in the eye. Patient reviews indicate that a few weeks can be maintained.

If the vitreous body was replaced with a gas mixture, then black wrench will appear, which will leave for seven days.

With late treatment, when the retina has already acquired irreversible changes, rehabilitation activities are held for a long time.

After the vitrectomy for 3-6 months is prohibited:

1. Lift gravity weighing more than two kilograms;
2. Read more than 30 minutes;
3. Bend over the fire of the gas stove or stand over open fire;
4. Play sports where tilts are present;
5. Testing any intense physical exertion.

Please note, after surgery, you do not need to comply with a special diet.

The following complications may arise:

1. Eye pressure hanging, which is as dangerous for people suffering from glaucoma;
2. Retinal detachment;
3. Hemorrhage in the vitreous body;
4. Formation of an infectious intraocular process;
5. Leakage of lens;
6. Cataract;
7. Swelling of the areas under the cornea - the outer shell of the eye;
8. The emergence of the mass of new vessels in the iris, which can provoke glaucoma.

The better the preparation for operation and preoperative research will be carried out, the greater the likelihood of avoiding complications.

Vitrectomy is the most common operation if you need to remove the vitreous body of the eye, especially with type 2 diabetes mellitus. Often, the operation is the only condition for the rescue of the human view. Currently, Vitrectomy is performed on modern equipment in good medical conditions.

A few more than a few years ago, the problems of the eye organs in the form of: heavy injuries of the visual analyzer, hemorrhages in the vitreous body of the organ or the process of penetration of the retina, treated severe diseases. They were not able to cure them and as a result, a person completely losing sight. To date, these diseases are effectively cured by holding a special operation - Vitrectomy. The rescued the ocular organ is completely restored and continues to perform its anatomical functions.

Vitrectomy eyes are successfully held both foreign and domestic ophthalmologists. Modern methods of conducting and special equipment make it possible to restore the eye body even outpatient. This article will help to understand the peculiarities of this surgical intervention, and will also talk about possible complications and measures that will help them avoid.

Vitrectomy Eyes

Vitrectomy Eyes - Operational intervention, during which a vitreous body is extracted from the eye organ, which occupies most of the organ. Depending on the lesion area, the body can be deleted partially or completely. Partial removal is called subtotal vitrectomy. The total seizure of the vitreous body is total vitrectomy.

The removal of the vitreous body allows the doctor an ophthalmologist to access the retina tissues and implement:

• photocoagulation (peculiar retinal soldering);
• reproduce the restoration of the integrity of the shell, which could be broken upon receipt of severe injury;
• move the resulting scarsing tissue from the surface of the retina interfering with the eye organ.

Simultaneously with these procedures, additional (consider further).

The remote vitreous body is replaced with silicone oil or gas mixture - special means that the retinal contact and vascular shell also minimize the risk of postoperative complications.

Important: Today, winctomy is the only way to solve problems related to the disease of the eye body. These are various hemorrhages, retinal detachment or injury to the visual analyzer.

Such an operation requires not only the use of high-tech equipment, but also high qualifications of the doctor.

What is the testimony for Vitrectomy?

Vitrectomy discovered new opportunities in ophthalmology for the treatment of many diseases, which were considered complex and did not respond to treatment earlier. The man had to be blinded without hope for recovery. Among such diseases:

• the presence of an eye infection, which is manifested in a heavy form;
• cases of retinal detachment due to: penetrating injury to the eye body, as the result of diabetes, with a high degree of myopia (myopia), in the presence of sickle-cell anemia, as well as due to the physiological obsolescence of the vitreous body in the eyeball;
• penetration into the East Original Observation;
• the resulting hole or a gap in the Maculeu (yellow spot);
• retinal gap of large sizes;
• in the structure of the vitreous body there was significant vestion;
• hemophthalm - the vitreous body is partially or completely soaked in blood;
• the presence of diabetes is often caused by the formation of retinopathy - the defeat of the vascular vessels of the ocular organ, which is why the process of blood supply to the retina is disturbed;
• in cases of dislocation of a lens or an intraocular lens, which during the surgical treatment of cataracts it was replaced.

Repeated hemorrhages and coarse cloues lead to the scarring of retinal tissues. These scars prevent a person clearly to see. The purpose of surgical intervention is their removal.

What can serve as a contraindication to Vitrectomy?

Vitrectomy refers to modern and unique methods of conducting surgical intervention, but not to all patients can be used. Among the contraindications, there is a significant closer to the cornea, allergic reactions to medical preparations, the general difficult condition of the patient, as well as problems with blood intake, which can provoke serious complications at the time of operation and postoperative period.

How is the operation?

Initially, a specialist solves vitratectomy under local or general anesthesia. Preliminary analyzes can play a big role in this decision. If surgery implies a large amount of different manipulations, the patient has concomitant diseases, and also if local anesthesia cannot be carried out due to the special state of the patient, the operation will pass under general anesthesia. With small volumes of operational intervention, local anesthesia is most often used using anesthetic droplets.

The patient is located on the operating table. After anesthesia acts, the specialist spreads the eyelids using a special device and fixes them in this position.

A special surgeon instrument performs several cuts on the scler. They will be required to introduce the necessary tools into the eye body. Further, for the operation, the specialist will require: lighting device, vitreot, as well as infusion cannula. With their help, the vitreous body from the eye organ is separated and "sucking". The cavity formed in its place is filled with special means (Consider further), which pressed the retina to the bottom layers, followed by holding it in the desired position.

The average operation time is made up half an hour. But if the pathological process is in a serious degree or need to carry out additional manipulations, the execution time can increase significantly.

Compositions replacing the vitreous body

In ophthalmology to replace the vitreous body: liquid perfluororanganic compounds, silicone oils, gas mixtures. Each of these compositions is distinguished by its structure and requires compliance with certain rules in the postoperative period, but they are all intended for close contact and fixing the retina to the vascular shell, as well as to prevent possible complications. Read more about these compositions.

1. Use of silicone oil. This substance has a unique structure characterized by chemical and biological inertness, which contributes to the messenger tolerability by the organism. The substance contributes to the correct anatomical position of the retina and the rapid restoration of all its functions. The risk with the occurrence of an allergic reaction is minimal. If we consider the refractive index of light using this filler, it is 90% coincided with natural refraction, which is reproduced by the eye organ. Unlike other types of vitreous bodies, silicone oils are used with the greatest service life (about a year).
2. The use of perfluororganic liquid connections. The second name of these fillers "heavy water". This name was obtained due to the molecular weight of these compounds, which has a weight of 2 times more of ordinary water. After filling the resulting cavity due to the removal of the vitreous body, the patient does not need to comply with special modes in the postoperative period. The filler holds the retina for 3-4 months in the desired position, after which is extracted by a specialist.
3. The use of gas mixtures. The resulting cavity is filled with a gas bubble. From the main advantages of such a filler, I would like to note that the gas bubble is completely absorbed in 2-3 weeks. Its composition is gradually replaced by anatomical intraocular fluid. Of course, there are significant disadvantages. The patient has to comply with certain rules in the postoperative period. One of them - the head should be in a certain position for a long time.

Important: With the use of gas mixtures, the patient is prohibited in the postoperative period to engage in air travel. Changes in atmospheric pressure provoke gas expansions, which leads to an uncontrolled increase intraocular pressure.

Basic Rules after Vitrectomy, which will reduce rehabilitation

If the surgical intervention has not been associated with the extremely difficult state of the patient, he is released home on the same day. Previously, the specialist gives recommendations necessary for emergency recovery, which will also help to avoid postoperative complications.

• it is not worth overwork the visual apparatus (read, write, sit behind the monitor, etc. more than half an hour);
• the first 2 weeks are prohibited to lift the weight of over 3 kg.
• physical activity with sharp movements to the side and tilt movements are contraindicated;
• mandatory use eye dropswhich were prescribed by an ophthalmologist for healing the eye body and preventing the increase in intraocular pressure;
• in the first month after Vitrectomy, a visit to a saunoo or a bath;
• it is impossible to lean over the fire (it can be an oven, a gas stove or just an open fire).

Special difficult cases may require a beddown patient for several weeks. Also, special behavior will be required of the patient if a gas bubble was used during the surgery for retinal retardation. The recommendations of the specialist in this case will relate to the special position of the head in the period of rehabilitation, and these are about three weeks. For example, during sleep, a person will need to sleep on one particular side or face down. In some cases, the patient is recommended to rent a special system that is intended to ensure that the head is constantly in the face of the face down. It was specially designed for the rehabilitation period after the vitrectomy and is designed for use within 5 days and up to 3 weeks.

Failure to comply with recommendations often leads to bleeding, returning the initial state of the eye body, postoperative infection and much more. This is at best additional treatment, and at worst irreversible processes of vision loss.

Compliance with all rules will affect the time limits of vision in the postoperative period.

What time after the operation is the vision restores?

The time of rehabilitation and the restoration of the visual functions of the eye organs depend:

• from the applied filler, which was used instead of a vitreous body;
• the number of additional surgical stages;
• from the volume of operation;
• on the degree of transparency of the optical environment of the ocular organ;
• the initial and postoperative state of the retina and the optic nerve.

For example, if anterior vitrectomy was carried out at which a small amount of vitreous body was removed, positive results with the return of vision are observed during the first week. Running stages are often accompanied by irreversible changes in the tissues of the visual organ. The goal of the operation is to prevent complications, and noticeable improvements in visual acuity in this case may not be observed.

Features of rehabilitation associated with vitreous bodies are manifested in the following. Substitutes based on saline solutions have low viscosity, and in the cavity of the eye body there are blood and cell elements that need several weeks for resorption. In this case, the recovery of vision is not immediately.

Patients who during the operation the resulting cavity was filled with silicone oils, often for correction we prescribe the wearing of positive glasses.

The use of gas mixtures is manifested by the presence of black pellets before our eyes, but this negative rehabilitation moment is corrected during the first week - the paddle leaves.

When detaching the retina, there is disorders of its function. If the patient appealed in a timely manner for help and the operation passed without complications, these functions will be restored quickly. But when tightening the problem, these changes become irreversible. There are disorders in the audience nerve and in the functioning of the retina. Rehabilitation is very complicated, even if during the operation, the maximum positive result was achieved by the retinal adjacent.

Any postoperative results are fixed by an ophthalmologist for a long time, so the patient is registered.

Additional stages of surgical intervention

During the Vitrectomy, a specialist can carry out additional surgical stages that include:

1. Air injection. It is performed in order to extract intraocular fluid located in the rear segment of the eyeball. This procedure allows you to maintain intraocular pressure, which is necessary to seal the available holes in the retina and hold it in place. The pressure resulting from the air soon passes, and the back of the rear again begins to fill with liquid.
2. Procedure screed screed. A peculiar support for the "belt" is installed around the eyeball, which after fixing the retina supports it in proper position.
3. Removal of lens - lensoectomy. Often such intervention is required if you have cataracts on it, as well as when it is bonded with the tissues of the available scar.
4. Laser processing - photocoagulation. Performed during damage blood vessels For their closure. Often, such damage occurs due to diabetes in the patient. Also, the procedure perfectly copes with the sealing of the resulting hole in the retina.

These additional stages of surgical interventions are able to significantly extend the period of rehabilitation.

What postoperative complications may arise?

Among the complications of Vitrectomy marked:

1. The presence at the time of surgical intervention in the patient of cataract often turns its progression in the first year after surgery. This is especially true when the vitreous body was replaced with silicone oil.
2. If during the operation in the cavity of the eye, an excessive amount of substitutes was introduced, the patient enhances intraocular pressure. To eliminate it by-effect The specialist should appoint special preparations against glaucoma.
3. Recurities are possible with retinal detachment.
4. Complications in the form of endophthalmita - infectious-inflammatory process.

Important: Toxic impact of substitutes can contribute to the clouding of the cornea.

Microfervasive Vitrectomy is considered less traumatic

Features of microenvasive vitrectomy

The essence of the operation remains the same - partial or complete replacement of the vitreous body with retinal fixation, but the intervention itself is carried out through three punctures having a hole diameter of 0.3-0.5 mm. Such microscopic punctures require the use of a small tool. This allows:

• achieve less traumatization of healthy fabrics;
• reduce the risk of possible bleeding, which often occur due to the pathological growth of vessels;
• the rehabilitation period is significantly reduced;
• such an operation is often carried out in outpatient conditions.

For microcinvasive vitrectomy, special equipment and high qualifications of a specialist are required, so the method is not applied in all vision recovery clinics.

Patient reviews about Vitrectomy are mostly positive. Everyone speaks of different time recovery time, but it still happens. And this is already a big plus in favor of Vitrectomy.

Vitrectomy is an operational intervention, during which a complete or partial removal of the vitreous body occurs. For the first time, R. Machemer was held in 1971.

This is a rather complicated operation that requires high-tech equipment and good surgeon qualifications. But, at the same time, it is the only solution of some eye diseases.

Indications and Contraindications to the operation

Vitrectomy is advisable in the following cases:

• Hemophthalm (hemorrhage in the cavity of the vitreous body);
• Exudative, rimotogenic or traction retinal detachment;
• Heavy injuries and injuries of the eye, accompanied by hemophthalm, the penetration of the retina, penetrate the inwards of the foreign body;
• Macular retinal gap;
• Diabetic proliferative retinopathy;
• Clouding the vitreous body after uveitis;
• Subretinal blood hemorrhage (hemorrhage under the retina);
• Heavy flow intraocular infectious diseases (endophthalmite);
• Macular swelling;
• Sealing the surface layer of the retina (epitinal fibrosis).

Vitrectomy do not do in the presence of blood diseases (especially in violation of the coagulation system), strong turbidity of the cornea and severe condition patient.

Stages of the operation of Vitrectomy

Nowadays, Vitrectomy is performed in outpatient conditions under local anesthesia. The patient is in a lying position, it is fixed by a special device.

Surgeon's sequences are:

Infusion cannula

Anesthesia eye.

1. Breeding and fixing the eyelid with the help of the eyelid.
2. The execution on the scler of three microscopic cuts through which several tools are introduced into the cavity of the vitreous body: infusion cannula, vitreot and lighting device.
3. Branch of the vitreous body with a vitreotoma.
4. Removing a vitreous body by sucking. If necessary, electrocoagulation of bleeding vessels, excision of scars and fibroids are additionally carried out.
5. Introduction to the cavity of a vitreous body substitute.

The duration of the vitrectomy varies from 2 to 3 hours, depending on the qualifications of the surgeon and the severity of the patient's condition.

Fiberglass substitutes

Currently there are several vitreous bodies.: silicone oil, complex saline, liquid perfluororganic compound or sterile gas bubble. The use of these substances provides close contact of the vascular shell and retinal and prevents the development of complications.

Using silicone oil

The refractive indemnification coefficient of silicone oil is almost the same as in natural refractive media

Silicone oil is a unique substance in nature, which is characterized by biological and chemical inertia.

Thanks to this property, the oil is easily transferred to patients and does not cause allergic reactions. Its refractive index of light is almost the same as in natural refractive eyes.

These features allow you to leave silicone oil in the cavity of the eye for a long time (up to 1 year).

Silicone oil provides the correct anatomical position of the mesh shell and fast recovery Its functions.

Use of gas mixes

Introduction to the cavity of the eye bubble air requires a patient strictly comply with certain rules. It mainly concerns long-term holding of the head in a certain position, which is negotiated with the doctor and depends on the volume of operation.

The advantage of the gas bubble is that it is completely cleaned over time (12-20 days) and is replaced by natural intraocular fluid.

Throughout this period, the person is categorically contraindicated by air travel. This is due to the fact that the change in atmospheric pressure expands gas and may cause an uncontrolled increase in intraocular pressure.

Use of liquid perfluororganic compounds

They are also known as the "heavy water" name, since their molecular weight is almost twice as much as the ordinary water.

After the introduction of such a substance in the cavity of the vitreous body from the patient, there is no compliance with some special regime.

The only drawback of liquid perfluororganic compounds is that they must be changed every two weeks.

Postoperative period after Vitrectomy

After the intervention, the patient on the same day can go home. For speedy recovery, the following recommendations must be performed:

• For the first 12-14 days, it is strictly forbidden to raise gravity over five kilograms.
• Avoid overwork of the visual analyzer.
• Any physical activity accompanied by sharp movements is contraindicated.
• Do not visit the pool, bath or sauna for the first month after surgery.
• Several times a day to use eye drops assigned to an ophthalmologist.

The timing of recovery of visual functions is directly dependent on the volume of the operation and how the substitute for the vitreous body was used.

For example, if only a part of the vitreous body was removed during the vitrectomy, the improvement of vision may occur in the first week. If the operation was carried out at the launched stage of the disease, when the tissue changes have become an irreversible nature, the noticeable improvement in view may not come.

Complications that may develop after Vitrectomy

Like any surgical intervention, Vitrectomy carries a certain risk of early postoperative complications.

Possible postoperative complications:

• Cataract progression. If the patient has already had a cataract at the time of intervention, then there is a chance of its progression in the first six months or a year after the intervention. More often this occurs when used as a substitute for the vitreous body of silicone oil.
• Development of secondary glaucoma.
• Recurney (repetition) retinal detachment.
• Ophthalmogypertification, or an increase in intraocular pressure. This complication occurs when the eye is introduced into the cavity of an excessive amount of substitute. To eliminate this complication, the patient must use drops against glaucoma for some time.
• Infectious inflammatory complications (for example, endophthalmite).
• Roarling of the cornea. It is rarely due to the toxic effects of a vitreous body substitute.

Vitrectomy reviews and postoperative period

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Leave your feedback after transferred Vitrectomy, as well as to tell your feelings in the postoperative period you can in the comments to this article.

Vitrectomy is an operation to remove the vitreous eye body. This operation refers to the most complex, sufficiently young microsurgery industry eye - vitreoretinal surgery. Thanks to this operation, today it is possible to preserve and return the vision of patients previously doomed to blindness.

Anatomy and vitreous body physiology

eyes structure

The vitreous body (Corpus vitreum) is a gel substance that fills in our eyeball inside our eye. In structure, it is represented by microscopic collagen fibers intertwined. In cells formed by these fibers, there are hyaluronic acid molecules that retain water well. Water is 99% of the composition of the vitreous body.

The vitreous body on the periphery has a denser structure than in the center. The vitreous body is limited to a dense hyaloid membrane, it arrives in front of the front, rear - to the retina of the eye. In the region of the gear line, the vitreous body is quite tightly snapped with a border membrane of the retina. This is the so-called the base of the vitreous body.

The vitreous body is a lighting structure of the organ of vision. Through it, the rays of light penetrate the lens to the retina. Therefore, if pathology arises in the vitreous body, leading to a decrease in its transparency, human vision will deteriorate.

With age in the vitreous body, changes occur: sections of the ignition occur and at the same time - seal sections. If a person suffers from chronic diseases associated with the metabolic disorder (the most common - diabetes mellitus), these changes occur faster.

retinal detachment

Violation of the structure and transparency of the vitreous body can occur after injuries (blood entering the eye apple), hit foreign languages.

If the blood cells get into the vitreous body after the retinal detachment, it starts the processes of proliferation, it is formed by heavy and pathological membranes, closely soldered with the retina. These membranes have a property to shrink, which leads to a tracting retinal detachment, new microinders of vessels and new proliferative processes. The retina is wrinkled, folds are formed on it, the next edge is wrapped.

Since our retina is receptors that perceive light signals, it leads to a significant loss of vision and even to blindness.

The retinal retinal detachment in the field of yellow spots is especially dangerous (this is the retinal area that is responsible for the color perception and substantive vision).

Why do you need to remove the vitreous body

Based on the foregoing, the removal of the vitreous body is necessary in case of violation of its transparency, as well as to access the retina and carrying out the necessary manipulations during its detachment.

Basic testimony for Vitrectomy:

1. Blood entering the vitreous body (hemophthalm).
2. Eye injury with hemophthalm, ingress of foreign bodies inside the eye, traumatic retinal detachment.
3. Heavily flowing inflammation of the eye shells (endophthalmite, wipe).
4. Extensive retinal detachment.
5. The central retinal detachment in the threat of spreading on the maculus.
6. Heavy proliferative retinopathy with the threat of a tracting detachment.
7. Dislocation of a lens or intraocular lens ( artificial lens) In the vitreous body.
8. Macuine gap.

Surveys and preparation for Vitrectomy

The following surveys are held to clarify the diagnosis:

• Ophthalmoscopy is an inspection of the structures of the eye through the pupil. Ophthalmoscopy is difficult for severe injuries, when the cornea is clouded, with cataract, with hemophthalm and pronounced turbidity of the vitreous body. In such cases, the study of light and color vehicles gives an indirect idea of \u200b\u200bthe functional state of the retina.
• Ophthalmobiomicroscopy (study on the slit lamp).
• Ultrasonic scanning eyeballs. Determines the dimensions of the eyeball, an anatomical ratio of intraocular structures. B-scan allows you to see the retinal detachment and fibrosis of the vitreous body.
• CT eyes.
• Electrophysiological research retinal (EFI). Registration of potentials with receptors makes it possible to judge the functional state of the retina.

Vitrectomy in most cases is planned operation. For 10 to 14 days, a planned preoperative examination (analyzes are general and biochemical, coagulogram, fluorography, electrocardiography, inspection of the therapist).

With accompanying chronic diseases, it is inspected by the appropriate specialists. The bulk of patients sent to the vitrectomy are patients with severe diabetes and concomitant arterial hypertension. They are all inspected by an endocrinologist, which should adjust them to the maximum compensation of blood glucose.

With some pathologies of light conductive eye systems, the vitrectomy is difficult. For example, with significant closets of the cornea or lens, it is possible to pre-remove the cataract or keratoplasty. Facoemulsification (removal of a magnificent lens) with implantation artificial lenses It can be carried out and simultaneously with a vitryoretinal operation.

When glauer is prescribed instillation of solutions that reduce intraocular pressure, as well as the reception of diakar inside.

It is also very important to achieve a stable reduction in blood pressure to normal numbers.

On the eve of the day of operation, drops with atropine to expand the pupil are prescribed.

Anti-vitrectomy:

1. In case of severely general condition of the patient.
2. Blood coagulation disorders.
3. Acute infectious diseases.
4. Confirmed atrophy of the optic nerve (the operation will not give effect).
5. Tumor nature of retina pathology.

In some cases, it is necessary to conduct emergency vitrectomy (for example, blood hemorrhage during thrombosis central Vienna retina). Preparation in such cases is minimal, but it is necessary to achieve an adequate decrease in blood pressure and controlled hypotension.

Types of Vitrectomy

By volume:

• Total vitrectomy.
• Subtotal vitrectomy (front or rear). In proliferative retinopathies, the rear vitrectomy with excision of epitinal heavy and membranes is most often carried out.

Equipment for Vitrectomy Operation

Vitrectomy is a kind of high-tech medical care. When conducting it, complex equipment is applied.

For such operations, a special operating table is used, very steady, with a device for fixing the head. Around the head end is a horseshoe table for the arrangement of the surgeon's hands. Surgeon operates sitting on a comfortable chair, hands are located on the table.

All operational control is carried out through a powerful operational microscope.

Surgeon's legs are also involved: he controls the microscope pedal (adjusting the increase), the other foot controls the Vitreotoma pedal.

Vitreot is a microscopic tool for disseminating the vitreous body and its aspiration, as well as blood clots, fibrinous membranes, foreign bodies. Vitreot has a view of a tube with a cutting tip and hole for suction and irrigation.

To improve the review through the microscope, various contact lenses apply.

Applied during surgery microsurgical instruments - scissors, tweezers, spatulas, diathermoagulators, laser -ugoagulators.

Fiberglass substitutes

In the equipment of microfalmoshurirs, there are special substances that are introduced into the cavity of the eyeball after removing the changed vitreous body. Fill the cavity is necessary to maintain normal intraocular pressure, as well as for the retina tamponade after its detachment.

Used for these purposes:

1. Sterile saline.
2. Gases (expanding, non-resistant fluoride compounds).
3. Liquid perfluororganic media (PFOS) ("Heavy Water").
4. Silicone oil.

Salt solutions and gases do not require operations to remove them, they are absorbed after some time and replaced by intraocular fluid.

Perfluorogenic fluid inert, almost as ordinary water, but has a higher molecular weight. Thanks to this property, it acts as a press on the retinal area.

The disadvantage of PFOS is that it is undesirable to leave more than 2 weeks. This time is usually enough for the full adhesion of the retinal breaks. However, it is not resolved independently, and its deletion requires a re-operation.

Sometimes a longer honey apple tamponade is required, then silicone oil is used. It is quite indifferent for eye structures, the eye after the introduction it begins to see almost immediately. You can leave silicone in the cavity for several months, sometimes - up to the year.

Anesthesia

The choice of anesthesia depends on the intended time of operational intervention, the general state of the patient, the presence of contraindications, etc. Depending on the volume of operation, the vitrectomy can last from 30 minutes to 2-3 hours.

With a long-term operation, general anesthesia is preferable, since when such complex manipulations on the microscopic level requires complete immobility of the patient.

If a smaller intervention duration is assumed (up to 1 hour), as well as in the presence of contraindications to general anesthesia, local anesthesia is performed:

• Intramuscular premedication by a sedative preparation.
• Retrobulbar administration of local anesthetic for 30 -40 minutes before surgery.
• During the entire operation, a mixture of fentanyl and midazolam (neuroleptinalgesia) is periodically introduced.

Course of operation

After anesthesia, proceed directly to the operation. The eyelids are fixed by the eyelids, the operating field is placed sterile napkins. The main stages of Vitrectomy:

Video: Vitrectomy - Treatment of retinal retinal detachment

Microfervasive Vitrectomy

Most modern method Vitrectomy is a 25G method. This technique uses tools with a diameter of 0.56 mm. This ensures small-acting operation, there is no need to impose seams.

Cuts are not conducted, access to the eyeball is carried out using punctures. Through them, ports for tools are introduced into the cavity: illuminator, irrigator and for the working tool. Thanks to these ports, the position of the tools can be changed alternately. This is an important advantage that provides a full-fledged approach to all zones of the vitreous body.

After removing the ports of the opening from them, they are self-metrics, the seams are not superimposed.

The microenvasive technique expands the testimony for the vitrectomy, allows its patients previously considered hopeless. Minimally invasive vitrectomy can be carried out in an outpatient basis - a few hours after the operation, the patient can be sent home.

The only minus is such an operation only in some major ophthalmic centers.

Postoperative period

After an ordinary Vitrectomy, the patient usually is under the supervision of doctors. With micro-operating technology, an outpatient execution of the operation is possible.

The gulling bandage can be removed in a day. A few days will need to be attached to the eye a bandage-curtain, protecting it from dust, dirt and bright light. Of the sensations are possible pain that can be removed by the admission of painkillers.

• Limit lifting weights (limit - 5 kg).
• Read, write, watch TV no more than half an hour, then need to take a break.
• Limit physical exertion, head slopes.
• Do not rub the eye, do not put pressure on it.
• Do not visit the bath, sauna, do not approach open fire and other sources of intensive heat.
• Use sunglasses.
• Do not get into the eye or detergent (soap, shampoo).
• When the gas mixture is introduced to hold a certain position of the head, do not fly on airplanes, do not rise high in the mountains.
• With the introduction of "heavy water", do not sleep on the stomach, do not bend.
• Apply anti-inflammatory I. antibacterial dropsprescribed by the doctor. Drops are prescribed for several weeks on a decreasing scheme.

Vision after the operation is not restored immediately. According to the reviews of patients who have undergone operation, immediately after the procedure in the eyes there is a paddle, when filling with gas - black. There is a bone, distortion of lines. Within 1-2 weeks, the "fog" is usually scattered and vision gradually returns.

Dates of the recovery of vision are different in different patients, fluctuate from a few weeks to six months. They will be more durable in patients with myopia, diabetes, in the elderly. For this period, you may need to choose a temporary correction. The final spectacle is performed at the end of the rehabilitation terms.

The degree of vision recovery depends on the functional state of the retina.

Terms of disability after winctomy make up about 40 days.

Possible complications

1. Bleeding.
2. Damage to the back capsule of the lens.
3. Increase intraocular pressure.
4. The development of cataracts.
5. Iridocyclite, take away.
6. The blockade of the front chamber silicone.
7. Roarling of the cornea.
8. Emulsification and clouding of silicone.
9. Recurring retinal detachment.

Cost of operation

Withectomy's operation refers to the types of high-tech medical care. In each region there are quotas for such a medical device for free.

However, the situation does not always allow to wait for the queue for the quota. The cost of the operation varies depending on the category of complexity, the rank of clinics, the type of equipment used (25G-technology is more expensive). The price of the Witrectomy operation ranges from 45 to 100 thousand rubles.

Vitrectomy, this is a surgical operation that is successfully used in the hemorrhages in the vitreous body, detachment of the retina, severe injuries of the visual analyzer and with diabetes mellitus.

All listed diseases were previously considered incurable and eventually led to loss of vision. To date, modern medicine offers vitrectomy as an effective way to correct and treat disease diseases.

Vitrectomy is understood as an operation to remove from the eyes of a vitreous body. This structure occupies the largest volume. The body can be removed in part, i.e. Make a subtotal vitrectomy, and can be completely.

After Vitrectomy, an ophthalmologist receives full access to the retinal tissue. This allows the photocoagulation ("soldering") of the retina, moving from it a scar cloth, or restore the integrity of the shell.

When removing the vitreous body of the eye, gas or a special fluid is introduced instead.

This operation can be carried out under local or under general anesthesia.

The main reasons for the operation are:

1. Eye injuries, for example, due to the penetration of the foreign object;
2. The retinal detachment that occurred as a result of severe myopia, diabetes or from aging of the vitreous body. The retina can also be squeezed due to sulfur-shaped cell anemia or penetrating eye injuries;
3. Impregnating the blood of a vitreous body - hemophthalm;
4. Intraocular infection in severe;
5. - the diabetic pathology of the retina, complicating the detachment of the mesh shell of tracting type, hemophthalm, or electoral spots;
6. A serious staging of the vitreous body;
7. Large sizes of retinal rupture;
8. Hole in Makula (Yellow Stain) or a gap;
9. Dislocation of the lens or an intraocular lens replaced it (in the case of a surgical treatment of cataracts);
10. Removal of scar tissues in turbidity or multiple hemorrhages. Hemorrhage can provoke a fiber detachment, emergency measures will be required.

Conducting an operation

To perform surgical treatment, the patient is hospitalized for several days. After a preliminary careful examination, it is prescribed a date of operation.

Before the operation, about 18:00, the patient must take food for the last time. After that, before the operation, it is impossible, nor drink. Operational intervention lasts about 2 hours.

Vitrectomy eyes can be carried out after instilcing anesthetic agent, or under general anesthesia. The solution depends on the state of the patient, the presence of other diseases and the total number of intended procedures.

The surgical operation itself is performed on the patient, which is located in the pose lying on the back. After combined or local anesthesia, a special eyelid is inserted into the eye, it will fix the eyes during the procedures performed by the surgeon.

After that, there are 3 small outbreaks in the eye, where the tools are injected, which give the surgeon to manipulate on the retina and the vitreous body.

The surgeon uses the following toolkit during operation:

1. Vitreot - a special cylinder with a knife,
2. Lighting device
3. Cannula for regular feeding in the eyeball of a sterile saline solution. The substance supports an apple eye in a normal tone.

The vitreous body must completely suck the vacuum. From the body after that they are removed: scars, pathological tissues, blood. Next, the doctor conducts manipulation on the retina.

The vitreous body, which was removed, replaced:

• A mixture of air or sterile air with a gas, if the target is to shift the retina, as well as keep it in a normal position (in the event of a break of the yellow spot area. The mixture is solved on 3 weeks. After this time, its intraocular fluid appears;
• Fluoroorganic liquid, i.e. Water, which is saturated with fluorine or silicone oil. Liquid by weight is heavier than water. Silicone oil is much heavier than water, it presses the retina for 3-4 months, after which the doctor removes it.

Microfervasive Vitrectomy

A variety of surgical intervention is the extraction of a whole vitreous body or its part. The operation is carried out in three microscopic punzes with a size of 0.3-0, 5 mm. An even smaller tools are introduced into the punctures.

It is characteristic that the frequency of the work of the Vitreotoma with microinvasive vitrectomy is higher, and is not 2500 per minute, but twice as much. In addition, another type of illuminators is used - self-locking multipoints.

Features of the operation are as follows:

• Low traumatic level;
• Reducing the risk of bleeding, which is important when excessive springs of vessels in fiber;
• Operation is performed in amublastic conditions, without hospitalization;
• Reduced postoperative rehabilitation.

Microsvasive vitrectomy is not performed in all ophthalmic centers.

Vitrectomy reviews directly depend on the qualifications of the doctor and the presence of a special tool.

Features of the postoperative period

After a standard vitrectomy, the patient for 1-3 days should be in a medical institution under strict control of doctors.

Patient's vision is restored after a while after the operation. The degree of recovery and duration depends on the following factors:

• The presence of severe pathologies of the mesh shell;
• Penalty of optical eyes for the light beam;
• The state of the optic nerve.

If the vitreous body was replaced by brine, then some time the blood elements will be fluent in the eye. Patient reviews indicate that a few weeks can be maintained.

If the vitreous body was replaced with a gas mixture, then black wrench will appear, which will leave for seven days.

With late treatment, when the retina has already acquired irreversible changes, rehabilitation activities are held for a long time.

After the vitrectomy for 3-6 months is prohibited:

1. Lift gravity weighing more than two kilograms;
2. Read more than 30 minutes;
3. Bend over the fire of the gas stove or stand over open fire;
4. Play sports where tilts are present;
5. Testing any intense physical exertion.

Please note, after surgery, you do not need to comply with a special diet.

The following complications may arise:

1. Eye pressure hanging, which is as dangerous for people suffering from glaucoma;
2. Retinal detachment;
3. Hemorrhage in the vitreous body;
4. Formation of an infectious intraocular process;
5. Leakage of lens;
6. Cataract;
7. Swelling of the areas under the cornea - the outer shell of the eye;
8. The emergence of the mass of new vessels in the iris, which can provoke glaucoma.

The better the preparation for operation and preoperative research will be carried out, the greater the likelihood of avoiding complications.

Vitrectomy is the most common operation if you need to remove the vitreous body of the eye, especially when. Often, the operation is the only condition for the rescue of the human view. Currently, Vitrectomy is performed on modern equipment in good medical conditions.

Vitrectomy - Operation on the retina and a vitreous body used to treat a wide range of vitreoretinal pathology. Currently, the Witrectomy operation has taken the most important place in the system of vitreoretinal surgery, so that it is possible to return and maintain vision, to provide social adaptation and the usual lifestyle for patients previously considered inoperable.

For the first time in the conditions of the clinic, the vitrectomy eye was held in 1971 by Robert Machemer with a ruggous retinal detachment. Over the next years, vitreoretinal surgery represented one of the fastest growing directions of ophthalmology. Contemporary microenvasive vitrectomy of the caliber of 25G and 27G is a unique tool of a vitreoretinal surgeon, providing stable high efficiency Vitreoretinal operations, which made it possible to expand the list of indications for vitreoretinal surgery, reduce the number of operating and postoperative complications and reduce the duration of postoperative rehabilitation of patients.

In our clinic, the microinvasive vitrectomy of 25G and 27G is carried out with a wide spectrum of vitreoretinal pathology:

• PET folding the back of the eye of rematogenic, traction and exudative etiology.
• Proliferative diabetic retinopathy, complicated by the retinal tracting detachment, macular edema, hemophthalm.
• Hemorrhage into the vitreous body (hemophthalm of the eye) of any etiology and limitations.
• Mackered retinal gap.
• Flamellar retinal hole.
• Vitremeracular traction syndrome: Epirtytal fibrosis, traction macular swelling.
• Heavy dull injury and injuries of the organ of vision, accompanied by the peeling of the retina, hemophthalm, intraocular ingredients.
• The pronounced turbidity of the vitreous body after suffered by uveitis.
• Subregional hemorrhage with a humid form of maculodystrophy with a subretinal neovascular membrane.
• Dislocation into the cavity of the glass lens or intraocular lens.
• Severe intraocular infection (take away, endophthalmite).

Vitrectomy Eyes in a 25G format is a complex high-tech eye surgery, which, despite the increased requirements for equipment, tools, qualifications, skills and knowledge of the surgeon, reliably proved its high efficiency.

Therefore, our clinic, following the global trend, has long implemented microenvasive vitreoretinal interventions of the caliber of 25G in everyday operating practice. The development of new vitreoretinal tools and methods of surgical manipulations allowed us to conduct vitrectomy 25G with the entire spectrum of vitreoretinal pathology. If necessary, the removal of cataracts with an implantation of artificial lens is carried out in the amount of one surgical intervention.

Microforval vitrectomy eye. Technique operation

In the conditions of our clinic, the operation of micro-invasive vitrectomy in 25G format is carried out on seamless technology. The use of 25G tools with a working part of 0.56 mm allows you to maximize the injury of the eye shells and provides self-metrics of operational access, which ensures the surgical treatment of retinal diseases at a new better level, gentle and painlessly for the patient, outpatient, in conditions of just local Anesthesia.

The standard transciliary vitrectomy 25G is carried out according to the typical three-port method. 3 ports are installed in a flat part of the ciliary body between the irrigation and the retina, one port is used to irrigation of the fluid during the operation, the remaining two are for a vitreotoma or a vitreoretinal tool and an endoightener (fiber). Using ports allows not only to minimize operational injury, but also avoid damage to intraocular structures.

The main task of the Vitrectomy ("Vitreum" is a vitreous body; "Extractomy" - removal) - the most complete removal of the modified vitreous body, as technically possible, is safe and shown in each specific situation - the so-called subtotal vitrectomy (rear whittomy). Further stages of surgical treatment will vary depending on the specific type of vitryoretinal pathology.

Total durability operational treatment It is 30-90 minutes depending on the severity of the disease and the volume of performed surgical intervention. In severe cases of retinal diseases and a vitreous body, the operation can be carried out in two stages with an interval between the steps of 7-14 days, the so-called 2-stage vitrectomy, about the possibility of which a vitreoretinal surgeon is usually a pre-warning patient.

Witretomy operation. Removal hemophthalma	Vitrectomy completed

At the end of the operation in the eye cavity, one of the vitreous bodies or a combination of them is introduced, for example, a balanced saline, gaseous or liquid perfluororodorganic compounds, sterile air or silicone oil. The use of vitreous bodies substitutes provides in the postoperative period a dense retinal contact with a vascular shell, stabilizes the wall of retinal vessels, prevents repeated intraocular hemorrhages.

The tamponade of the glaze body of the air-gas mixture or sterile air is performed in order to block the retinal gaps, pressing and retinal retaining in its physiological position. As a rule, in the case of a gas tamponade from the patient, observance of a certain position of the head is required for some time, for example, in the treatment of a macular discontinuity.

The advantage of the gas tamponade is that the air-gas mixture, and sterile air is solved independently and replaced with their own intraocular fluid. Typically, the gas bubble is completely eliminated for 10-20 days, during which it should be refrained from flights and hikes to the mountains, since the change in barometric pressure leads to an expansion of the gas inside the cavity of the vitreous body, and, consequently, an uncontrolled increase in intraocular pressure.

This shortage is deprived of liquid perfluororganic compounds (PFOS). Perfluorodorganic compounds, the so-called "heavy water", are a chemically inert organic compound about two times heavier than ordinary water, transparent, imbuming with other liquids. High molecular weight allows the use of PFOS as an intraoperative as the "third hand of the surgeon", which reduces the risk of damage to the retina during operational treatment and for the postoperative tamponade of the glaze body cavity as a "press" for disgraceing and retaining the retina in the physiological position, which eliminates The need to apply coarse methods for retinal fixation.

The only drawback of liquid perfluororganic compounds is to need to remove them after 10-14 days, for a longer time to carry out a tamponade of the cavity of the vitreous body "heavy water" undesirable. Therefore, immediately after mobilization, fragrances and pressing the retina to the subjectable tissues, its fixation is carried out with a laser that "solder" the retina to the vascular shell. Endolasers make it possible to produce an accurate, dosed barrier laser coagulation around the retina gaps along the central edge of the giant passages or by the perimeter of retinotomy for the formation of a durable chorioretinal spike for the formation of the tamponade of the tamponade, which holds the retina in the normal position.

After 10-14 days of the Tamponade, the oral cavity is completed by the removal of "heavy water" with a replacement for a special balanced saline, sterile air or an air-gas mixture, which over time is replaced by their own intraocular fluid. In cases of severe retinal pathology and the vitreous body, a long-term tepreal cavity tamponade is required, then surgical treatment is completed by the introduction of silicone (silicone oil).

Tamponade retina. Introduction of PFOS	Holding laser coagulation Seth

Silicone oil is a liquid vitreous substitute with high chemical and biological inertness, transparency and refractive index of which close to the refractive indemnation of the optical media of the eye. The tampony effect of silicone oil is achieved primarily due to its high viscosity, and an indisputable advantage is quite high inertia and, as a result, the good tolerability of silicone oil with fabrics of the eye, which allows you to leave silicone in the eye cavity after the vitrectomy for a long period.

During the tamponade cavity of the glassy body with silicone, the mesh shell retains its correct position, its functions are restored, and the spikes in the laser coagulation places become very durable, which makes it safe to remove silicone oil on average after 2-4 months. However, the term of silicone tamponade, depending on the volume of operation and the existing retinal pathology, it can be as reduced to 1 month and increased to 6-12 months.

The 2G vitratectomy operation is extremely gentle by surgery, which allows for surgical treatment in outpatient conditions and under local anesthesia, without immersing the patient into common anesthesia. Upon completion of the operation, the patient on the same day may be discharged from the clinic to outpatient treatment. The attending physician will give individual for each patient recommendations and destination.

• limit within two weeks, lifting weights over 5 kg,
• avoid intense visual and physical exertion, sharp slopes,
• within 3-4 weeks to use antibacterial and anti-inflammatory physician eye drops
• limit a visit to the sauna, bath and swimming pools for 1 month after Vitrectomy
• comply with a certain position of the head and body for 4-7 days, depending on the teponal cavity used.

Microspinal vitrectomy 25G allows you to qualitatively reduce postoperative rehabilitation. Usually, the early postoperative period after the vitrectomy does not exceed 7-10 days, during which the patient is preferably located on an outpatient treatment under the dynamic observation of the operating ophthalmic surgery. In a week, the patient already forgets the transferred operation, and, as a rule, can lead a familiar lifestyle and proceed to its worker officials.

Restoration of vision after winctomy

Dates and forecast of the reduction of vision in the postoperative period depend on the substitute for the vitreous body, the transparency of the optical media, the anatomical and functional state of the mesh shell and the optic nerve. In uncomplicated cases, the postoperative period is characterized fairly fast, usually during the first week, the restoration of visual functions. Often, patients have functional changes in the mesh shell, which, as a rule, occurs when engaging in the pathological process of the macular zone of the retina, then it takes time to restore them, which can occupy 1.5-3 months.

However, in some difficult cases, even when the complete anatomical adjacent of the mesh shell is achieved and the restoration of the ideal transparency of the optical media, the vision remains low due to the irreversible organic changes in the retina and the optic nerve.

Possible complications of the operation

Vitratectomy Eyes, like any other strip eye operation, carries certain risks and can be fraught with a number of complications. Due to the decrease in the diameter of the working tools, minimizing the damage to the covering fabrics and the eye sclera, the lack of need for seams, the microinvasive vitrectomy allowed the maximum to reduce the possible intraoperative and postoperative complications, which are currently occurring in less than 1% of cases.

• Reactive ophthalmogypertension. As a rule, an increase in intraocular pressure after surgical treatment occurs due to excess volume of the vitreous body substitute. Treatment of reactive increase in intraocular pressure is to appoint antiguchaukomatous droplets or carrying out laser intervention.
• Secondary glaucoma. The development of secondary glaucoma in the early postoperative period arises due to the pupil block, in the remote period - due to the block of the trabecular apparatus.
• Ruede Rubes after Vitrectomy leads to the development of the so-called, secondary neovascular glaucoma in their eyes with severe proliferative diabetic retinopathy. Treatment of glaucoma is to appoint antiguucomatous droplets, carrying out a laser or surgical anti-flavomatous operation.
• Cataract. Usually within 6-12 months after surgical treatment, it appears or progresses the available cataract. Especially intensively progression of crustal closets can be observed under Tamponade of a vitreal cavity with silicone oil. The treatment consists in a standard replacement of a lens, which can be performed simultaneously when the silicone is removed.
• Recurring retinal detachment. As a rule, this complication is developing due to an insufficient chorioretinal spike between the retina and the vascular shell after the absorption of the gas or after the removal of silicone oil.
• Burning the cornea (rhinestone dystrophy of the cornea) - develops due to the toxic effect of silicone oil on the endothelium of the cornea when the silicone is accumulated in the front chamber of the eye.
• Infectious complications of vitrectomy (endophthalmite).

The cost of the operation of vitrectomy. Price in Moscow

The cost of operational treatment in Moscow is determined by the severity of the vitreoretinal pathology, the category of complexity, the volume and number of steps of the operation, the authority of the clinic and the operating surgeon and fluctuates in a wide range of prices from 75 to 175 thousand rubles.

The cost of any new technology is higher than the previous one, especially if all modern surgical equipment and foreign-made consumables. Operation of Vitrectomy Eyes in Format 25G allowed not only to assist and optimize treatment prediction even in the most difficult cases, but also to reduce the duration of the rehabilitation of patients of workable age, which is extremely beneficial to the state from economic positions. However, the quotas of the Ministry of Health and Social Development of Russia increased costs in the use of microinvasive vitrectomy do not take into account.

Vitrectomy. The cost of the operation in the clinic Fedorov

20.11. Network operations. Vitrectomy, price for one eye, rub.

Our clinic is not entitled to abandon the technologies of treatment, the effectiveness of which with a number of rows of retinal and vitreous body is incomparably higher than the traditional methods of vitreoretinal surgery. Therefore, we try to maximize the cost of surgical treatment for our patients, providing the opportunity to citizens Russian Federation Receive high-tech medical care according to preferential programs.

Read more about High-tech programs medical care You can read on the appropriate site page.

10.10.2017

Vitrectomy is a surgical intervention aimed at removing a vitreous body. It looks like a transparent gel substance, which is located in the cavity of the eyeball. It consists of 99% water, also contains collagen fibers, proteins and hyaluronic acid.

Such an operation is associated, as a rule, not with its changes. It is often necessary to access the rear segment of the eye at various pathological states of the retina. For the first time this microsurgical intervention was made in 1970. The vitrectomy has since more than changed many changes, but has not lost its relevance in modern ophthalmic surgery.

There are 2 types of vitrectomy based on a surgical approach used to remove the vitreous body, namely the front and rear.

The most common method of intervention is the rear or Pars Plana. This operation is sometimes the only method to return vision to man.

When the operation of the Vitrectomy Eye is shown

Microsurgical removal of the vitreous eye body is performed under the following pathological conditions:

Proliferative diabetic retinopathy (including hemorrhages in the vitreous body).

Broken Makula.

Epirtyal fibrosis.

Complicated, traction or recurrent retinal detachment.

Intraocular foreign body.

The displacement of an artificial lens after its implantation about cataracts.

Giant retinal gaps.

Age macular degeneration.

Traumatic damage.

Often, vitrectomy is performed in emergency clinical situations. It can be contraindicated in a certain category of patients, for example, with a reliably known absence of light perception or inability to restore vision. The presence or suspicion of active retinoblast or choroidal melanoma eyes questioned the operation due to the high risk of dissemination of malignant tumor.

When removing the epiretinal membrane or the treatment of macular discontinuities, use medicinal preparations From the group of system anticoagulants and disagregantes (for example, aspirin or warfarin) is a relative contraindication for the operation of the vitrectomy. Heavy systemic coagulopathy also require close attention from the doctor, therefore, during the operation of the Withectomy operation, it is necessary to monitor the condition of coagulation and anticorant systems, and if necessary, to conduct correction.

Technical features of the operation

Vitrectomy is an outpatient intervention, that is, after its end, short surveillance and receipt of the recommendations, the patient may leave the clinic. Anesthesia, as a rule, is local using eye drops supplemented by intravenous sedation. During intervention, the patient is in consciousness, but does not feel pain, there may be light discomfort. Sometimes, during the operation of the vitrectomy, retrobulbar blockade is used as anesthesiological manual.

During the surgical operation, vital functions are carefully controlled, such as pulse, arterial pressure and ECG.

In the region of the eyeball, in Latin called Pars Plana, microscopic cuts are made and three trocar with a diameter of 27G are installed. These fixtures are conductors for which a special surgical instrument is delivered inside the eye.

One ports are used for the infusion line necessary to introduce a special solution to the eye cavity during the operation. The second port for vitrectomy is necessary for the camcorder with the illuminator, thanks to which the ophthalmoshurgerg may be monitoring the work in a special monitor. The third trocar is used for a vitreotoma - a tool that performs the basic actions with a vitreous body. All manipulations on the eye during the performance of the vitrectomy are produced by a microsurgurgomeh with a high-precision microscope.

A surgical microscope equipped with a special powerful lens provides a clear and enlarged image of the inside of the eye.

During the operation, the vitrectomy is aspiration of the vitreous body of the eye, and the released cavity is filled with sterile silicone oil or a special gas-air mixture. The vitreous body will not return back, and the eye can function normally without it.

If there is no retinal detachment, air or saline can be used (which is absorbed in a couple of days). However, if the patient has a retinal detachment, then for its tamponade, either sulfur hexafluoride (which is kept in the eye for 10-14 days), or in more complex cases, another gas is used, for example, fluorosexane or fluoropropane.

Recovery period

The duration of the operation of the vitrectomy depends on the underlying eye disease, the presence of concomitant ophthalmological pathology and averages from 1 to 3 hours. After Vitrectomy was held, the patient leaves home with a bandage, which an ophthalmologist removes from the eyes at the first postoperative visit. Sometimes eye drops with glucocorticosteroids are prescribed to minimize inflammatory changes, as well as local antibiotics to reduce the risk of developing bacterial complications.

Sometimes doctors recommend patients postoperative positioning. This means that after the operation was completed, the patient will have to spend a "head down" or lying on the stomach. Such a position contributes to the pressed gas bubble to the rear wall of the eye, which prevents the retinal detachment. A certain position of the head should be held at least 45 minutes every 60 minutes. These 15 minutes are designed to eat food, visiting the rest room.

If during the operation of the vitrectomy, the eye cavity was filled with a gas-air mixture, the vision in the early postoperative period will be dramatically reduced. This doctor should warn the patient in advance. Restoration of the visual function is observed as gas dissipation. It is also permissible in the eyes and glare after the operation.

In the postoperative period, it is impossible to raise gravity and, if possible, avoid psycho-emotional loads, as this may lead to an increase in intraocular pressure and the development of various complications.

Complications

Although Vitrectomy produced a revolution in the treatment of violations of the rear segment of the eye and significantly improves the vision in patients with retinal diseases that require surgical intervention, it is also associated with concomitant diseases and complications.

Complications after Vitrectomy:

• Bleeding.

  Infection.

  Retinal disinsertion.

  Formation of scar tissue.

  Loss of view.

  Increased eye pressure or glaucoma.

  Cataract progression, requiring surgical removal of cataracts at a later stage.

It is believed that the formation or progression of cataracts is the most common complication associated with vitrectomy.

Often nuclear sclerotic cataracts that are developing after vitrectomy, reduce visual sharpness, reach such an extent that will lead to its surgical removal. The exact pathogenesis of the formation of cataracts or the acceleration of the pathological process in the lens after the vitrectomy is still unknown.

If surgery was performed by a professional ophthalmic surgery and the patient strictly performed all the recommendations of the doctor, the risk of complications is minimized.

Withectomy is an integral part of many manipulations aimed at treating retinal diseases and vision recovery. Modern technologies and equipment make the Withectomy Operation to the eye and comfortable for patients.

Prices for Witrectomy Eye


№	Service name	Price in Rubble
2011039	Vitrectomy with uncomplicated hemophthalm or clouding of the vitreous body of the second category	53 750

For the first time, the operation to remove the vitreous body in the eye was spent only in 1970, but since then the methodology has undergone significant changes. Today, vitratectomy eyes are a high-tech modern operation, conducted in ultra-modern equipment with high-class specialists, most often in outpatient conditions.

Surgical intervention to remove the vitreous body eye is called Vitrectomy. At the same time, during surgical intervention, it is most often carried out to remove blood clots, heavy, protein structures and scars formed in it. Often the main reason for this operation is the need to access the central part of the retina - Makula. Removing a vitreous body allows you to block retinal breaks, remove the retinal detachment.

The vitreous body is a liquid that is filled with a central part of the eye, by 99% it consists of water, after removing the affected part, a special saline solution, gases, perfluororganic compounds, silicone oil or artificial polymers are injected into its place.

Over time, the eye after the vitrectomy is filled with its own liquid, and salt solutions or gases are solved, artificial polymers can be in the eye no longer than 10 days, and silicone oil is several years old, and then it is required to replace it.

Despite the complexity of the operation, it is often carried out under local anesthesia, in which the patient does not feel pain, but may experience some discomfort.

Testimony for vitrectomy eyes

Operation Vitrectomy Eyes is carried out to eliminate pathological conditions, it is assigned if the following is required.

• Restoration of integrity with retinal breaks. This is the most frequent cause Conduct operation.
• Removal of the effects of hemorrhage into a vitreous body (total or subtotal hemophthalm), in the absence of improvements from drug treatment.
• Preventing the formation of heavyness leading to the retinal detachment, in the presence of proliferations (inflammation, increased insight, germination in the vitreous body) of pathological vessels.
• Removal of curtain tissue formed as a result of diabetic retinopathy, treatment of pathology.
• Restoration of the quality of vision in injuries with the introduction of the vitreous body of the foreign object.

Vitratetomy is also carried out by offsetting artificial lens after implantation.

When the surgical intervention is prohibited

Although microinvasive vitrectomy operation with minimal traumatic intervention and is often carried out in an emergency order, but it has several contraindications, so do not carry out operation:

• with a reliably established absence of light perception;
• if it is impossible to restore vision;
• with tumor processes (retinoblastoma, choriodeal melanoma);
• during pregnancy;
• with strong turbidity of the cornea.

If during the vitrectomy, the treatment of macular gaps or the removal of the epiretinal membrane is carried out, then the reception of such drugs as disaggregants and systemic anticoagulants are taken into account.

With caution, this operation is prescribed in the presence of heavy system coagulopaths.

How is the vitrectomy eye

With microforvasive vitrectomy, injury to the eye structures is minimal. The operation may continue from half an hour to three hours. Duration depends on the complexity of the disease and the volume of surgical intervention. In the most difficult cases, the operation is carried out in 2 stages. Repeated operational intervention is carried out 7-10 days after the first, but its need for a surgeon warns the patient before the first operation.

Vitratectomy is carried out in 25G format. On the initial stage Fixed eyelid and in the cavity of the vitreous body between the iris and the retina are installed 3 ports in 25G format. At the end of the operation, after their removal, the samotamponade of the operating holes occurs and the seams are not required.

There are two types of operations.

• Total vitrectomy. A complete removal of the vitreous body is carried out and the filling of its volume with substitutes.
• Subtotal. In its course, only a part of a modified or affected fluid is removed, and gas, saline or silicone oil is injected into its place. This type of surgical intervention is divided into another two subspecies.

• Front Vitrectomy. It is used to remove the particles of the vitreous body from the front eye.
• Rear vitrectomy. The most frequently used operation is used to treat retinal pathologies (detachment, breaks, chips).

Depending on the type of intervention, further actions of the surgeon will be carried out. In one of the ports (conductors), the light guide (endoightener) is introduced, the other is used for the infusion line (a special solution is introduced through it necessary for the operation). First, the affected area of \u200b\u200bthe vitreous body is removed in the volumes that are necessary. Then other actions are carried out (scars are deleted, coagulation of breaks and so on).

The operation is carried out under a strong special microscope, in time of it is monitored, blood coagulation is carried out, a cardiogram is made.

After carrying out the necessary surgical intervention, one of the substitutes is injected into the place of remote vitreous body:

• Air gas mixture or sterile air. They are intended for tamponads, with their help, the detailed retina is held in the natural position, the retinal gaps are blocked. Tamponade requires compliance after the operation of a certain position of the head, but its advantage is an independent absorption of the mixture (within 10-20 days) and replacing it with intraocular fluid.
• PFOS (perfluororganic compounds) or severe water. It better keeps the press, and is suitable for more rude methods of retinal holding, but it must be removed after 10-14 days. The larger period is undesirable.
• Silicone oil. It has high inertia and does not interact with the tissues of the eye, and its transparency is almost equal to the eye media, silicone oil allows you to more tightly lay down the peelled retina, and the scars from laser coagulation become very durable. Remove the oil on average in 2-4 months, but by decision of the doctor it can be removed a month after surgery or remain in the eye to one year.

Rehabilitation period after surgery

After the operation of vitrectomy, which is often carried out in an outpatient basis, the patient takes a period of rehabilitation. On an outpatient treatment, the patient is from 7 to 10 days. Whole this period is observed at the ophthalmic surgeon who has conducted an operation. And then can lead a normal lifestyle.

From the hospital after the operation, the patient leaves with a special bandage, which is filmed on the second-third day. Perhaps the doctor will recommend dripping ophthalmic drops.

With the rear vitrectomy with the blockade of the air-gas mixture, the first few days will be performed by the special "head down" mode. With it, every hour you need to carry out 45 minutes lying on the stomach and 15 to use for rest.

In uncomplicated cases, vision is restored for 10-14 days. In the presence of details or tensions of the retina (rear vitrectomy), this period is delayed at the time of adjacent it in place (by 1.5-2 months).

In some cases (infrequently), even with the full restoration of the anatomically correct position of the retina, vision is not restored.

Possible complications after surgery

Among possible complications in the postoperative period, ophthalmologists are called the following.

• Increase intraocular pressure.
• Secondary glaucoma (Clothing form).
• Cataract education.
• Hemorrhage into a vitreous body.
• Recurrent retinal detachment.
• Burning of the cornea (ribbon form of dystrophy).
• Infectious lesions of the vitreous body (endophthalmite).

The cost of the operation in various regions of Russia will differ significantly and depends not only on the level of the clinic, the qualifications of the ophthalmic surgeon and the quality of equipment, but also on the complexity of the disease, the size of the necessary surgery, the quality of the substitute used. On average, it ranges from 34 thousand rubles. up to 160 thousand rubles.