Vitrectomy involves the severance and removal of vitreous matter from the posterior chamber of the eye. The procedure involves three functions: cutting, suction, and infusion. Some vitrectomy systems combine all three functions in a single probe, while others use two probes—one for cutting and suction and the other for infusion. Using an operating microscope, a primary incision into the sclera is made, where the vitrectomy suction cutter is inserted. When suction is initiated, gelatinous vitreous tissue is drawn through a port in the probe tip and then severed by a rotating blade piece. Infusion of saline ensures that the globe remains distended so that vitreous strands, vitreous retraction, retinal detachments, or proliferative retinopathy may be treated.

The three basic kinds of vitrectomy procedures are:

1. Anterior vitrectomy using scissors or needle, often performed as part of a cataract extraction or corneal transplant;
2. Anterior vitrectomy using instruments such as VISC or rotoextractors, often involving cutting of membranes and freeing of adhesions;
3. Posterior vitrectomy using VISC or rotoextractors, frequently done in diabetic patients with massive vitreous hemorrhages and membranes.

Vitrectomy is considered medically necessary for the treatment of vitreous strands, vitreous retraction, retinal detachments, or proliferative retinopathy. Indications for when vitrectomy is medically necessary are listed under Policy Guidelines.

Indications for vitrectomy include the following:

• Severe proliferative diabetic retinopathy, including vitreous hemorrhage, retinal detachment, and combined traction/rhegmatogenous retinal detachment (retinal tear associated with retinal detachment);
• Traumatic penetrating ocular injury;
• Culture-proven, rapidly progressing endophthalmitis;
• Cataract extractions complicated by vitreous loss or underlying inflammatory condition; and
• Non-diabetic vitreous hemorrhage.

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It is possible for other eye procedures to be performed at the same time as a vitrectomy. When this occurs, multiple surgical procedure guidelines should be followed.

A search of literature was completed through the MEDLINE database for the period of January 1993 through April 1995. The search strategy focused on references containing the following Medical Subject Headings:

– Vitrectomy

Research was limited to English-language journals on humans.

See also:

TEC Evaluation 1989: p. 121

Vitrectomy