What is Vitrectomy?

The vitreous is a clear, gel-like substance that fills the large cavity of the eye — roughly the volume of a grape. It provides structural support, maintains the shape of the eye, and allows light to pass directly to the retina without scattering. Think of it as the eye's internal packing material.

A vitrectomy, or more precisely a pars plana vitrectomy (PPV), is a minimally invasive surgical procedure in which the vitreous gel is removed from the eye and replaced with a clear substitute — usually sterile saline solution, or sometimes a gas bubble or silicone oil if the retina needs longer-term support.

Once the vitreous is removed, the surgeon has a clear, direct view of the retina and can address pathology — reattach a detached retina, seal a macular hole, remove scar tissue, treat bleeding, or manage inflammation. In most cases, the eye heals well without the vitreous present. The body gradually replaces the gas bubble or saline with its own natural fluid (aqueous humor) over weeks to months.

"Vitrectomy is the most versatile tool in vitreoretinal surgery. It allows the surgeon to directly address pathology deep inside the eye — something that would be impossible with external surgery alone."

— Dr. Chee Wai Wong

When is Vitrectomy Needed?

Vitrectomy is the primary surgical treatment for a wide range of retinal and vitreous conditions. Here are the most common indications:

How the Surgery is Performed

Modern vitrectomy is performed using a technique called sutureless pars plana vitrectomy. Here's a step-by-step overview of what happens:

1

Anaesthesia and patient positioning

You will receive local anaesthesia (eye block or topical drops with sedation) or general anaesthesia depending on your preference and the surgeon's recommendation. You lie supine (on your back) and your eyelids are held open gently with a speculum.

2

Three small ports (trocars)

The surgeon makes three tiny incisions (25-gauge or 27-gauge, roughly 0.6–1mm wide) in the sclera (the white part of the eye), typically at the 10, 2, and 4 o'clock positions about 3.5–4mm behind the limbus (the junction of the cornea and sclera). These ports allow instruments to enter the eye without damaging structures in the anterior segment.

3

Illumination and visualization

One port houses an endoilluminator — a thin, fibre-optic light source that illuminates the retina from inside the eye, giving the surgeon a brilliantly lit, magnified view. The operating microscope provides additional magnification.

4

Vitreous removal

A high-speed vitreous cutter (vitrector) is inserted through another port. This instrument cuts and suctions the vitreous gel at up to 5000 cuts per minute, removing it from the eye systematically. The surgeon controls the pace carefully to avoid damaging the retina.

5

Addressing the pathology

With the vitreous cleared, the surgeon now has direct access to treat the underlying condition — peel a macular membrane, reattach a detached retina by draining subretinal fluid and applying laser, remove scar tissue, treat bleeding vessels, or close a macular hole using specialised instruments (forceps, scissors, lasers, probes).

6

Endolaser or retinopexy

Laser marks are typically placed around breaks or treatment areas to create a permanent adhesion between the retina and the underlying tissue. This prevents redetachment.

7

Internal tamponade (if needed)

The eye is then filled with a clear substitute. For simple cases, this is balanced salt solution (BSS) or sterile saline. For cases requiring longer-term support, the surgeon injects a gas bubble (SF6, C3F8) or silicone oil. The tamponade acts like a cushion, pressing the retina flat against the eye wall while healing occurs.

8

Closure

The three ports are sutureless — they seal themselves due to the self-sealing design of the instruments and the eye's natural integrity. In most modern 25 or 27-gauge vitrectomy, no stitches are needed. The eye naturally regains its integrity within hours. Occasionally, if there were complications during surgery, the surgeon may place a suture.

Procedure duration

A straightforward vitrectomy typically takes 30–60 minutes. Complex cases, particularly those requiring extensive membrane peeling or reconstruction, may take 60–90 minutes.

Gas Bubble vs Silicone Oil: The Decision

One of the most important decisions during vitrectomy is what to fill the eye with after removing the vitreous. Each has distinct advantages and drawbacks.

Gas Bubble vs Silicone Oil

Gas Bubble (SF6 or C3F8)
  • Advantages: Gradually absorbed by the body over 2–8 weeks (SF6) or 6–12 weeks (C3F8); the eye's own fluid replaces it naturally; minimal refractive change long-term; no second surgery needed for removal
  • When used: Straightforward retinal detachments, macular holes, simple PVR cases
  • Posturing required: Yes — often strict face-down or side-down positioning for 5–14 days. Vision is very poor while the bubble is present (looks like a cloudy mass in your visual field)
  • Flying restriction: CRITICAL — cannot fly or travel to high altitude until bubble fully absorbed. Expansion at altitude causes dangerous eye pressure spikes
  • Refractive change: Temporary hyperopic shift (makes reading glasses stronger) while bubble present; normalizes after resorption
Silicone Oil
  • Advantages: Provides long-term, stable support for multiple months; no posturing requirement; allows normal head positioning and air travel; can be left in place for months if needed for complex cases requiring repeated surgery
  • When used: Severe PVR, giant retinal tears, inferior breaks in complex cases, cases requiring multiple procedures, patients unable to posture
  • Disadvantages: Requires a second procedure to remove after 2–4 months; causes permanent hyperopia (far-sightedness) unless corrected; slightly higher risk of cataract and glaucoma; silicone can emulsify and seep into anterior chamber over time
  • Vision while in situ: Blurred initially; improves somewhat but remains suboptimal until oil removed and replaced by eye's own fluid
  • Removal timing: Usually 2–4 months after initial vitrectomy, once the retina has firmly reattached and healed

Your surgeon will discuss which option is best for your specific condition. Gas is preferred for most uncomplicated cases because it avoids a second surgery. Silicone oil is reserved for complex situations where prolonged support is essential.

Recovery and Aftercare

Recovery after vitrectomy depends largely on which tamponade was used and the complexity of the condition treated. Here's what to expect on a typical timeline:

Days 1–3: Immediate Post-operative Period

Your eye will feel scratchy, gritty, and mildly uncomfortable. There will be some redness and swelling. Vision is typically very poor at this stage, especially if a gas bubble was used (the bubble blocks much of your vision). Do not be alarmed — this is normal.

You will be prescribed antibiotic and anti-inflammatory eye drops, often used every 2–4 hours for the first week, then tapered. Pain is usually mild and controlled with paracetamol or ibuprofen; if sharp pain develops, contact your surgeon urgently.

If a gas bubble was placed, posturing is critical from day 1. Your surgeon will specify the exact head position — typically face-down or prone, sometimes to one side — and you must maintain this position for 5–14 days. This keeps the gas bubble pressing against the treated area. Even sleeping requires you to position yourself correctly, which is challenging and demands practical preparation (a positioning pillow or prone table can help significantly).

Week 1–2: Early Healing

Redness and swelling gradually diminish. If posturing is required with a gas bubble, you are typically released from strict positioning at 1–2 weeks, although some elevation may still be recommended. Vision begins to improve as the bubble starts to shrink and a water-liquid interface appears in your visual field.

Activity restrictions remain: no heavy lifting, strenuous exercise, or bending. Driving is not permitted yet. You will attend your first post-operative review around day 5–7 to check intraocular pressure, confirm reattachment, and assess healing.

Weeks 3–4: Improved Vision

If a gas bubble was used, it continues to absorb. Vision typically improves significantly at this stage as the bubble shrinks and clears. You can gradually increase activity — light walking is fine, but still avoid exercise and heavy lifting. You may begin to drive once your visual acuity is sufficient and your surgeon has cleared you.

Return to work depends on your job. If you work at a desk and your vision allows, you may return in 2–3 weeks. If your work involves physical activity or driving (courier, construction, etc.), 4–6 weeks is more typical.

Weeks 5–8: Gas Resorption and Spectacle Refraction

By week 5–6, the gas bubble is usually completely resorbed and replaced by the eye's own fluid. Your vision should be substantially better, though it may still be slightly blurred. This is the time to seek a new spectacle prescription — your refraction (the lens power needed) will have changed significantly after vitrectomy and gas resorption.

By 8 weeks, most improvement has occurred. Some eyes continue to improve slightly over 3–6 months as any residual inflammation settles.

Month 3+: Stable Recovery

By 3 months, your recovery is essentially complete. You can resume all normal activities — exercise, swimming, international travel, etc. Most patients notice their final visual outcome clearly by 3 months, though subtle improvements can continue up to 6–12 months.

Posturing tips for gas bubble cases

Maintaining the required head position for 5–14 days is the most challenging aspect of vitrectomy recovery. Practical aids include: a prone (face-down) surgical pillow with a facial recess for breathing, a positioning bed frame, or a reclined chair positioned correctly. Ask your surgeon for specific recommendations. Your eye clinic may also have an occupational therapist who can advise on practical positioning strategies.

Risks and Complications

Vitrectomy is a safe procedure, especially when performed by experienced vitreoretinal surgeons at specialist centres. Serious complications occur in fewer than 5% of cases. Here are the main risks:

Cataract Acceleration (Most Common Long-term Risk)

The most frequent long-term complication is accelerated cataract formation in phakic eyes (eyes that still have their natural lens). If you are already in your 60s or older, vitrectomy may speed up cataract development by 1–2 years. If you have a pre-existing cataract, it will progress faster. Cataract extraction and lens implantation can be performed if vision is affected. For a detailed discussion of cataract surgery in post-vitrectomy eyes — including combined phaco-vitrectomy — see our guide to cataract surgery and complex cataracts.

Raised Intraocular Pressure (IOP)

Temporary elevation of intraocular pressure can occur in the immediate post-operative period, particularly if a gas bubble or oil is used. This is usually managed with pressure-lowering eye drops and typically normalizes within weeks. Persistent or severe elevation is uncommon.

Infection (Endophthalmitis)

Post-operative infection is rare, occurring in fewer than 1 in 1000 cases at specialist centres. If infection does develop (presenting with increasing pain, redness, and vision loss), it requires urgent treatment with intravitreal antibiotics and possible repeat vitrectomy.

Retinal Re-Detachment

If vitrectomy was performed for retinal detachment, re-detachment can occur. Primary single-operation anatomical success rates are approximately 85% at specialist centres; when a second procedure is needed, final anatomical success approaches 95% or higher. Re-detachment is almost always treatable with revision surgery.

Bleeding

Mild bleeding into the eye (haemorrhage) can occur during or after surgery, particularly if blood vessels were involved in the condition being treated. Usually resorbs spontaneously over days to weeks without lasting effect.

~85%

Primary single-operation success rate for retinal detachment repair
Final success after all surgeries exceeds 95% at specialist centres

Vitrectomy vs Scleral Buckle: When Each is Used

For retinal detachment, both vitrectomy and scleral buckling are effective surgical options. The choice depends on the location and characteristics of the detachment:

Vitrectomy is preferred for:

Scleral buckling may be preferred for:

Combined approach:

For complex cases — particularly inferior breaks with PVR, or repeated detachment after initial repair — combining vitrectomy with a buckle provides the most robust support. The buckle provides permanent peripheral support while vitrectomy addresses posterior pathology.

For detailed discussion of retinal detachment surgery, see our article on retinal detachment: warning signs, surgery and recovery.

Frequently Asked Questions

Is vitrectomy surgery an emergency?

It depends on the condition. Vitrectomy for acute retinal detachment with macula involvement is urgent (ideally within 24 hours). Vitrectomy for macular hole, epiretinal membrane, or floaters is usually performed electively on a waiting-list basis. Vitrectomy for vitreous haemorrhage obscuring the view is time-sensitive (days to weeks), as prolonged haemorrhage can lead to proliferative changes.

How much vision will I regain after vitrectomy?

This depends on the condition being treated and its duration before surgery. For macular holes, over 90% achieve functional closure with good vision recovery. For retinal detachments, if the macula was still attached at surgery (macula-on), most recover to pre-detachment vision levels. If the macula was detached (macula-off), recovery is more guarded and depends on the duration of macular detachment. The longer the macula was detached, the more photoreceptor loss occurs and the less recovery is possible even after successful reattachment.

Can I wear glasses or contact lenses after vitrectomy?

Yes. After vitrectomy, your refractive error (the lens power needed) typically changes, often becoming more hyperopic (far-sighted), particularly if a gas bubble or oil was used. Once your eye has stabilised (6–8 weeks post-op), you will need a new glasses prescription. Contact lenses can usually be resumed, though some patients find them less comfortable than before due to changes in corneal curvature or dry eye.

Will I need a second surgery?

If silicone oil was used, yes — a second procedure is required to remove the oil after 2–4 months. If a gas bubble was used, a second surgery is not routine unless re-treatment is needed for recurrent pathology (e.g., re-detachment).

Can I do sports or exercise after vitrectomy?

Yes, once healing is complete (typically 4–6 weeks). Contact sports involving head or eye trauma should be cautiously approached and discussed with your surgeon, as a blow to a recently operated eye could potentially dislodge the tamponade or cause re-detachment if the retina was treated.

What if the vitrectomy does not work?

Vitrectomy has very high success rates (~85% primary single-operation anatomical success for retinal detachment, >90% for macular hole closure). If the initial procedure does not achieve full reattachment, revision surgery is almost always possible and final anatomical success after all procedures exceeds 95%.

How much does vitrectomy cost in Singapore?

The cost varies depending on the complexity of the case and the facility. At private institutions like Gleneagles Hospital, vitrectomy typically costs SGD $15,000–$25,000 (inclusive of surgical fees, facility, and equipment). Medisave coverage is available for certain conditions (retinal detachment, macular hole). For detailed pricing, contact the clinic directly. Hospital bills can often be structured into instalment plans if needed.

Will my vision be blurry while the gas bubble is present?

Yes. The gas bubble appears as a large cloudy mass in your visual field — imagine looking through a cloudy water droplet. As the bubble shrinks over 2–8 weeks, a watery interface appears and vision gradually clears. Once the bubble is completely gone and replaced by the eye's own fluid, vision should be much clearer (though final acuity depends on the underlying condition and the success of retinal repair).