VITRECTOMY
A vitrectomy is a surgical procedure that involves the removal of the vitreous gel (or vitreous humor) from the eye. This procedure is often necessary for a variety of eye conditions and problems. The vitreous is a clear, gel-like substance that fills the space between the lens and the retina in the eye. Here are some key points about vitrectomy:
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Indications for Surgery: Vitrectomy is commonly performed for conditions like retinal detachment, macular hole, epiretinal membrane, vitreous hemorrhage, and complications related to diabetic retinopathy. It may also be necessary in cases of severe eye trauma or to remove foreign bodies from the eye.
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Procedure: The surgery is typically done under local or general anesthesia. The surgeon makes small incisions in the sclera (the white part of the eye) and inserts specialized instruments. The vitreous gel is removed and often replaced with a saline solution, gas bubble, or silicone oil to help maintain the shape of the eye and support the retina.
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Recovery: Post-operative recovery can vary depending on the specific condition being treated and the complexity of the surgery. The patient may need to maintain a specific head position for several days, especially if a gas bubble is used. This positioning helps the retina to heal properly. It's common to experience some discomfort and vision changes as the eye heals.
Anesthetic Implications for Vitrectomy
Anesthesia type: General, Sedation with local anesthesia (retrobulbar block)
Airway: ETT or LMA, natural airway
Preoperative:
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Patients may have diabetes and hypertension
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The vitreous humor makes up two-thirds of the volume of the eye
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“Floaters” are deposits in the normally clear vitreous fluid
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This procedure is performed through a microscope
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Several tiny incisions are made on the sclera
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Do not use nitrous oxide
Intraoperative:
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Position: supine, slight reverse Trendelenburg, turned 90-180 degrees
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Duration: 30-90 minutes
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Monitor for bradycardia and the oculocardiac reflex
Postoperative:
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An eye patch and shield are placed over the operative eye at the end
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PONV prophylaxis
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Smooth emergence without coughing or bucking
Complications:
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Corneal edema
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Retinal detachment
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Increased intraocular pressure
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Infection
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Intraocular hemorrhage
Sources:
Elisha, S. (2010). Case Studies in Nurse Anesthesia.
Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice.
Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.).
Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.