Conditions Treated · Vitreoretinal Surgery

Vitrectomy Surgery

Written by Mr Robert Henderson BSc MBBS MD FRCOphth · Consultant Vitreoretinal Surgeon, Moorfields Eye Hospital & GOSH

What is Vitrectomy?

Vitrectomy — more precisely, pars plana vitrectomy (PPV) — is a microsurgical procedure in which the vitreous gel that fills the eye is carefully removed and replaced with a clear fluid, gas bubble, or silicone oil. This allows the surgeon direct access to the retina to repair, reattach, or treat the underlying condition.

The operation is performed through three tiny incisions (typically less than 0.6mm) in the white of the eye, through which fine instruments are introduced under microscopic visualisation. Modern vitrectomy is minimally invasive — most patients experience surprisingly little discomfort and recover more quickly than they expect.

Conditions Treated with Vitrectomy

Vitrectomy forms the cornerstone of treatment for many serious retinal and vitreous conditions, including:

• Retinal detachment — reattaching the retina to restore and preserve vision
• Macular hole — closing a full-thickness hole in the central retina
• Epiretinal membrane — removing scar tissue from the retinal surface
• Diabetic vitreous haemorrhage — clearing blood from the vitreous cavity
• Proliferative diabetic retinopathy — removing traction and treating new vessel growth
• Dropped nucleus or lens fragments — following complicated cataract surgery
• Endophthalmitis — severe intraocular infection requiring urgent intervention
• Vitreomacular traction — relieving abnormal adhesion between the vitreous and macula
• Paediatric retinal conditions — including retinopathy of prematurity (ROP) and familial exudative vitreoretinopathy (FEVR)
• Retinal gene therapy — vitrectomy is required to deliver subretinal gene therapy injections for inherited retinal dystrophies such as RPE65-associated Leber congenital amaurosis

What to Expect: The Procedure

Before Surgery

You will attend a pre-operative assessment where I will examine your eye in detail, explain the procedure, discuss the risks and benefits, and answer your questions. Biometry measurements are taken if lens exchange is planned alongside the vitrectomy.

Anaesthesia

Vitrectomy is most commonly performed under local anaesthesia with sedation — you will be relaxed and comfortable but awake. General anaesthesia is available and is routinely used for children and for patients who prefer it. The choice is made together with you and the anaesthetic team.

During the Operation

The operation typically takes between 45 minutes and two hours, depending on the complexity of the underlying condition. Using a high-magnification operating microscope and wide-angle viewing system, I work within the eye using a 25-gauge instrument system — ports measuring just 0.5mm — allowing precise, minimally invasive surgery with rapid wound healing and minimal discomfort. At the end of the procedure, the eye may be filled with a gas bubble or silicone oil to support the retina during healing.

After Surgery

If a gas bubble has been used, specific positioning advice will be given depending on the condition treated. For retinal detachment repair and large macular holes, maintaining a particular head position is important to ensure the gas bubble sits against the area of retina being treated. For smaller macular holes, the principle is more about keeping still and avoiding sudden head movements that could disturb the delicate fluid currents inside the eye — the key is to avoid the gas washing the hole open during the critical healing period.

The type of gas used depends on the condition and its severity:

• SF6 (sulphur hexafluoride) — used for smaller macular holes (under 400 microns); vision typically begins to improve by around 10 days as you can see over the top of the bubble, with the gas fully absorbed by approximately 3 weeks
• C2F6 (perfluoroethane) — used for medium-sized holes; gas absorbs over approximately 6 weeks
• C3F8 (perfluoropropane) — used for larger holes (over 600 microns); lasts 8–10 weeks, with vision improving once the bubble has reduced past the halfway mark

Important: You must not fly while gas is present in the eye. Changes in cabin pressure at altitude can cause the gas to expand dangerously, leading to a sudden and severe rise in intraocular pressure. You will be given a card to carry confirming that you have gas in your eye, and flying must be avoided until your surgeon confirms the gas has fully absorbed.

Silicone oil, when used in complex cases, requires a further procedure to remove it at a later date.

You will be given a detailed written guide covering your postoperative care, drops regimen, activity restrictions, and warning signs to look out for. A member of my team is always available to answer questions in the recovery period.

Recovery and Visual Outcomes

Recovery varies significantly depending on the underlying condition and the complexity of surgery. For straightforward macular hole surgery, many patients notice improvement in their central vision within six to eight weeks. For retinal detachment repair, visual recovery may continue for six to twelve months.

It is important to understand that vision cannot always be fully restored — particularly if the retina has been detached for some time, or if there is pre-existing damage to the macula. My goal in every case is to give your retina the best possible chance of recovery through meticulous surgical technique and careful postoperative management.

Risks and Complications

Vitrectomy is a well-established and generally safe procedure, but as with any eye surgery, risks exist. These include:

• Cataract formation (very common in phakic patients — often addressed at the time of or shortly after vitrectomy)
• Raised intraocular pressure
• Re-detachment of the retina (particularly relevant in complex cases)
• Infection (endophthalmitis) — rare but serious
• Bleeding within the eye
• Double vision (usually temporary)

These risks will be discussed with you in detail at your consultation. For most patients, the risk of not operating significantly outweighs the surgical risks.

Why Choose a Specialist Vitreoretinal Surgeon?

Vitrectomy requires a level of surgical skill and subspecialty training that goes beyond general ophthalmology. Vitreoretinal surgeons dedicate their careers to this narrow but technically demanding field. My practice encompasses the full breadth of vitreoretinal surgery — from routine macular procedures to the most complex re-operative and paediatric cases — at Moorfields Eye Hospital, the leading centre for eye care in the United Kingdom, and at Great Ormond Street Hospital, where I serve as Clinical Lead for Ophthalmology.

With over 68 peer-reviewed publications and two decades of specialist surgical experience, I am committed to delivering outcomes that reflect the highest standards of modern vitreoretinal practice.

Private Vitrectomy Surgery in London

Private vitrectomy surgery is available at 1 Welbeck, Marylebone (opening September 2026), offering the convenience of a central London location with the same surgical standards as the NHS specialist centre. Consultations are currently available at Moorfields Eye Hospital and at Great Ormond Street Hospital for paediatric cases.

To arrange a consultation, please contact Alison Anscombe, my personal secretary, who will be happy to discuss your needs and arrange an appointment at a time that suits you.

Mr Robert Henderson BSc MBBS MD FRCOphth is a Consultant Vitreoretinal Surgeon at Moorfields Eye Hospital and Great Ormond Street Hospital, and Clinical Lead for Ophthalmology at GOSH