No, you don't always get cataracts after a vitrectomy, but it's a very common complication, especially for older adults, with studies showing rates from 50% to nearly 100% developing significant cataracts within a couple of years, often because removing the vitreous gel increases oxygen exposure and protein clouding in the lens. Many ophthalmologists now perform combined cataract and vitrectomy surgery (phacovitrectomy) to avoid a second surgery and improve outcomes.
This condition can be prevented by increasing vitreous volume through the use of an intravitreal injection through the pars plana with a small needle using a standard technique.
What are the risks of vitrectomy?
Vitrectomy can lead to the formation and accelerated progression of cataracts, most commonly, the nuclear sclerotic (NS) type. A meta-analysis of 51 studies found that the incidence of post-vitrectomy cataract varies considerably from 6-100%.
On the first day after vitrectomy, the vision is typically quite blurry, especially if a gas bubble is placed in the eye. Although most of the visual recovery usually happens within a few weeks of surgery, the vision often does not reach its maximum improvement until several weeks or even months after surgery.
A cataract is formed when the lens inside the eye goes cloudy. This is usually a slow process that occurs naturally with age, but it commonly follows vitrectomy within a year or two. There are many symptoms of cataract, including reduced vision, blurring, glare from bright lights and increasing short-sightedness.
Patients may experience mild discomfort and redness for several days after this procedure. The vitreous that is removed does not grow back, but is replaced by fluid that is normally produced by the eye.
Most cataracts develop when aging or injury changes the tissue that makes up the eye's lens. Proteins and fibers in the lens begin to break down. This causes vision to become hazy or cloudy.
The use of intraocular gases can result in postoperative intraocular pressure elevation, cataract formation, gas migration, and temporary vision impairment due to the a high difference in refractive indexes between the gas and the lens.
Repeat vitrectomy should be considered in patients with persistent macular hole after failure of primary surgery.
What Are Vitrectomy Surgery Risks?
This is the most common question patients ask. The answer is yes – vitrectomy surgery is considered a major eye surgery because it involves delicate work inside the eye, often under local or general anesthesia.
Other Activities: You may resume most of your activities around the house including most routine chores. However, do not bend below your waist, move suddenly, straining or lifting more than 20 pounds for the first 2 weeks after surgery. Bending should be from the knees, to keep your head above your heart.
Additionally, if you already have cataracts, these vitamins and nutrients may slow their progression.
You should continue to wear your eye shield at night and outside for at least a week. You can, if you prefer, wear sunglasses when outdoors instead of the eye shield.
Are in poor health or have a serious medical condition. Have advanced macular degeneration. Have a detached retina. Have a medical condition of the eyes, such as an infection.
You must not fly or travel to high altitude on land while the gas bubble is still in your eye (up to 12 weeks after surgery). If you ignore this, the bubble may expand at altitude, causing very high pressure inside your eye. This can result in severe pain and permanent loss of vision.
Pars plana vitrectomy (PPV) is a well-recognized risk factor for cataract progression. In almost all cases, a visually significant cataract develops months to years after surgery. Rarely, a cataract develops 1 to 7 days after a vitreous procedure.
You might have some pain in your eye and your vision may be blurry for a few days after the surgery. You will need 2 to 4 weeks to recover before you can do your normal activities again. It may take longer for your vision to get back to normal.
Cataract Risk Factors
While screen time alone does not directly cause cataracts, it can contribute to the overall strain and aging of your eyes. Excessive screen use can lead to symptoms like dry eyes, fatigue, and blurred vision, which may make it harder to notice early signs of cataracts.
Reducing sodium intake is also recommended as studies have shown a high salt intake can make you more prone to developing cataracts. Avoid highly processed foods, white bread, among other bakery items that contain refined sugars and grains.
Complications or risks of a vitrectomy include infection, bleeding, a retinal tear and low or high eye pressure.
Your surgeon may replace the vitreous humor with sterile salt water, silicone oil or a gas bubble. This step helps your eye keep its shape and your retina stay in position.
As the bubble dissipates, vision will slowly be restored. When the bubble reaches half its size, you will be able to see a horizontal line across your vision. As the eye refills with aqueous humor, the bubble will shrink, vision will improve and finally the bubble will resolve on its own.