A vitrectomy is a surgical procedure that removes the vitreous, the clear gel that fills the inside of your eye, to treat problems affecting the retina or the vitreous itself. It’s one of the most common retinal surgeries performed today, with a primary success rate around 90% for conditions like retinal detachment. If your eye doctor has recommended one, here’s what the procedure involves, why it’s done, and what recovery looks like.
Why the Vitreous Gets Removed
The vitreous is a jelly-like substance that fills about 80% of the eye’s interior. It helps the eye hold its shape and transmits light to the retina at the back of the eye. In a healthy eye, you never notice it. But several conditions can turn the vitreous into a problem: it can fill with blood that blocks your vision, pull on the retina and tear it, or develop cloudy debris that won’t clear on its own.
By removing the vitreous, a surgeon gains direct access to the retina to repair damage, and eliminates whatever was clouding or tugging on your vision. The eye then functions perfectly well with a replacement fluid or gas bubble in place of the original gel.
Conditions That Lead to Vitrectomy
There are five broad categories of reasons a surgeon performs this procedure. The most common is abnormal pulling on the retina. As people age, the vitreous naturally shrinks and can tug on the retinal tissue, sometimes causing tears, detachments, macular holes, or epiretinal membranes (thin scar-like tissue on the retina’s surface). Severe diabetes, extreme nearsightedness, and eye trauma all increase the risk of this kind of traction.
The second major reason is vision-blocking cloudiness inside the eye. When bleeding from diabetic retinopathy or other conditions fills the vitreous cavity, or when old inflammation leaves persistent haze, a vitrectomy clears the obstruction and can permanently restore vision.
Beyond those two, vitrectomy is also used to assist other eye surgeries (for example, retrieving a lens fragment that falls into the back of the eye during cataract surgery), to diagnose certain infections or cancers by sampling the vitreous fluid, and to place drug-delivery devices or other therapeutic implants inside the eye. Surgery is generally recommended only when the condition is threatening your vision and unlikely to heal on its own.
How the Surgery Works
Vitrectomy is performed through tiny incisions in the white part of the eye called the sclera, in an area known as the pars plana. Through these openings, the surgeon inserts three main instruments: a light source to illuminate the inside of the eye, an infusion line that maintains the eye’s pressure with a steady flow of fluid, and a vitrectomy probe that simultaneously cuts and suctions out the vitreous gel.
The cutting probe is remarkably small. The most common sizes today are 23-gauge, 25-gauge, and 27-gauge, with higher numbers indicating thinner instruments. A 25-gauge probe is generally considered a good middle ground: thin enough that the incision often seals itself without stitches, yet rigid enough to give the surgeon precise control. The thinnest 27-gauge instruments create the smallest wounds and are favored for delicate work, while the slightly larger 23-gauge probes offer more speed and stiffness but may require a suture to close the wound.
Once the vitreous is removed, the surgeon can repair whatever underlying problem exists, whether that’s reattaching the retina, peeling scar tissue off the macula, or sealing a retinal tear with a laser. The procedure typically takes one to several hours depending on the complexity, and most patients go home the same day.
What Fills the Eye Afterward
After the vitreous is removed, something needs to take its place to keep the eye’s shape and, in many cases, to hold the retina flat against the back wall of the eye while it heals. What your surgeon uses depends on your specific condition.
For retinal detachments and tears, a gas bubble is the most common choice. Short-acting gases stay in the eye for roughly one to two weeks, while longer-acting gases can persist for six to eight weeks before the body gradually absorbs them. As the gas disappears, your eye naturally replaces it with fluid it produces on its own. During this time, the gas bubble presses against the retina to keep it in place while the laser or freezing treatment creates a permanent seal.
Silicone oil is used for more complex cases, particularly when the retina needs prolonged support. Unlike gas, silicone oil maintains a constant volume and stays in the eye indefinitely until a second procedure removes it. Surgeons typically recommend removing it once the retina is stable, because leaving it in long-term can lead to complications like elevated eye pressure or corneal damage.
For simpler cases where tamponade (the pressing force against the retina) isn’t critical, a balanced salt solution may be all that’s needed.
The Gas Bubble and Flying
If you receive a gas bubble, there is one strict restriction: no flying until the gas has fully absorbed. At cruising altitude, commercial aircraft cabins are pressurized to the equivalent of 6,000 to 8,000 feet above sea level. That reduced pressure causes the gas inside your eye to expand, which can spike the pressure to dangerous levels and threaten your vision. This applies to any significant altitude change, including driving through mountain passes. Your surgeon will tell you when the bubble has dissolved enough for travel to be safe, and you’ll typically wear a medical bracelet alerting anesthesiologists to avoid certain inhaled gases during this period as well.
Recovery Timeline
The first few days after surgery, expect blurry vision, mild to moderate pain, and a red, swollen eye. These symptoms are normal. If a gas bubble is in place, your vision will be very limited at first because you’re essentially looking through the bubble. As it shrinks over the following weeks, your field of clear vision expands from the bottom up.
If your surgeon used a gas bubble or silicone oil, you’ll likely be asked to maintain a specific head position, often face-down, for a period ranging from one day to three weeks. About half of retinal surgeons recommend face-down positioning for six to ten days. This positioning keeps the bubble pressed against the area of the retina that needs support. It can be physically uncomfortable, but specialized pillows, face-down chairs, and table-mounted mirrors make it more manageable.
Most people need two to four weeks before returning to normal daily activities. You’ll use prescription eye drops for up to six weeks to control inflammation and prevent infection. Full visual recovery takes longer and varies widely depending on the condition being treated and how long the retina was compromised before surgery. Some people notice steady improvement over three to six months.
Success Rates
For retinal detachment, one of the most common reasons for vitrectomy, a single surgery reattaches the retina successfully in about 90% of cases. When additional surgeries are needed, the final reattachment rate reaches essentially 100%, though it may take two to six procedures in difficult cases. Functional success, meaning vision recovers to a usable level, occurs in roughly 97% of patients.
Outcomes for other conditions vary. Macular holes close successfully in a high percentage of cases, and vitreous hemorrhage clears reliably once the blood-filled gel is removed. The key factor in visual recovery is often how much damage existed before surgery. A retina that was detached for weeks will generally recover less vision than one repaired within days.
Risks and Side Effects
The most predictable consequence of vitrectomy is cataract formation. In patients who haven’t already had cataract surgery, up to 52% will need cataract removal within one year, and roughly 80% will develop a visually significant cataract within two years. This happens because the surgery disrupts the environment around the eye’s natural lens, accelerating the clouding process. Many surgeons discuss this upfront, and some will combine vitrectomy with cataract removal in the same session for older patients.
Other risks include elevated eye pressure, bleeding inside the eye, infection, and new or recurrent retinal detachment. With silicone oil tamponade, there’s an additional risk of oil migrating into the front chamber of the eye if you sleep on your back, which can damage the cornea or block fluid drainage. Serious complications are uncommon, but they’re part of the reason vitrectomy is reserved for conditions where the threat to your vision outweighs the surgical risks.