As described in the Anatomy section, the center of the eye is filled with a substance called vitreous. Until the late 1960s diseases that affected the vitreous or the retina posteriorly, other than a simple retinal detachment, could not be repaired because there was no way to enter the vitreous cavity without further damaging the eye. In 1969 Dr. Robert Machemer, who was then in Florida and eventually moved to North Carolina (Duke University), decided to develop a technique to remove the vitreous safely. He first developed the device in his garage, and tested it by removing the white of an egg from the egg without damaging the yolk or the outside of the egg, except for the small hole that he drilled to perform the procedure. He found that with this type of device he was able to remove this material without damage to these structures, and applied this to the first patient who underwent vitrectomy. Dr. Machemer went on to develop many of the techniques and instruments used in vitreous surgery and is considered by most to be the "Father" of the entire specialty of vitreoretinal surgery.
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Robert Machemer, MD Dr. Machemer, working in his garage invents the first pars plana vitrectomy instrument and subsequently performs the first surgery restoring sight to a patient with this procedure. |
Vitrectomy, then, is removing the vitreous jelly of the eye, and is performed through an area called the pars plana of the inside of the eye, which is the area just in front of the retina and just behind the iris.
In a modern pars plana vitrectomy three incisions are made in the eye. In one incision a tube is connected to the eye which provides fluid to the eye to replace the vitreous which is being removed. Through the other two sites are placed lighted instruments and a machine called a vitrector, which is basically a Pac-Man on a stick. This machine cuts at a very high rate and has a suction attached to it, and therefore the vitreous can be cut and removed from the eye very efficiently with extremely fine bites, thus keeping the remainder of the inner components of the eye from being damaged. This procedure was a great leap forward in repairing damaged eyes. Two members of RVT were fortunate to have trained with Dr. Machemer before his retirement.
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Pars Plana Vitrectomy Two instruments are in the eye entering through the pars plana to remove scar tissue and reattach a retina with PVR (scar tissue). Not seen is the third device, a tube with fluid that fills the eye as material is removed. |
Pars plana vitrectomy has been applied to virtually every disease in the posterior portion of the eye, including diabetic retinopathy, proliferative vitreoretinopathy, retinal detachment, macular holes, epiretinal membranes (macular pucker), retinal tumors, retinal inflammations, eyes damaged by trauma, and virtually any other condition in the back of the eye of which you can think.
Vitrectomy may be the single greatest advance in repairing the eye ever. It is very highly successful in most instances. The complications of vitrectomy are like that of any surgery, and include bleeding, infection, and unique to the eye is the development of retinal detachment. Sometimes following vitrectomy surgery the pressure may go up in the eye, which is usually controlled transiently with medications. In the vast number of vitrectomies performed there are no complications, and sight can be restored to patients that had previously blinding conditions. This great leap forward was all possible because of a man who had an idea, dared to do what no one had previously done, and had an egg!
Disclaimer Stuff: The opinions expressed in this website are those of RVT. Diagnosis and therapy should be based on a thorough examination by and recommendations of a qualified eye provider.