do not offer and seldom recommend the vitrectomy procedure
for removal of isolated vitreous floaters because even in the best
of hands the procedure has a high rate of significant complications.
Approximately 50 per cent of patients over 50 years old get a cataract
within five years. Below age 50 the rate of cataract formation is
much less. There is also a significant rate of retinal tears and
retinal detachment, and a lesser rate of infection and leaks from
the incisions. Even with these complications, vitrectomy remains
an invaluable technology for treating some diseases.
With the vitrectomy procedure it is possible to
remove all the vitreous of the eye and any floaters it contains.
The procedure is usually quite imprecise for floaters so instead
of removing just the floaters, they attempt to remove most of the
vitreous in hopes on removing the floaters in the process. The surgical
technique and instrumentation of vitrectomy was largely perfected
at Duke University Eye Center where Dr. Karickhoff received his
ophthalmology training and remains on their Advisory Board.
The procedure consists of opening the outer
layer of the eye and then making three incisions through the inner
wall of the eye. A tube to supply saline into the eye during the
procedure is inserted into the eye through the first incision and
sewed in place. A fiberoptic light pipe is inserted through the
second incision, and a sucker-cutter instrument is inserted through
the third incision. The fluid inflow is started, the light is turned
on, and the suction and cutting is started. The vitreous is cut
and sucked up and is replaced by saline.
Vitrectomy was designed to be used to remove
blood filled vitreous, and inflammatory or infection debrie. It
can also be used in association with retinal detachment surgery
or to remove small foreign bodies from the vitreous.
By contrast, the laser treatment of floaters
we offer is the result of laser research carried out specifically
to avoid the dangers of vitrectomy noted above. What researchers
dreamed of was a non-thermal, precise disruption of tissue without
disturbing other ocular structures and without surgically opening
the eye. Our laser procedure is a much safer procedure than vitrectomy,
does get rid of the floaters not just break them into smaller floaters,
and is not associated with the problems listed above of vitrectomy
(See World Literature page this web site).
Vitrectomy may be recommended if the floater
is truly debilitating, and it is too big to be removed by the safer
laser procedure. We are more likely to recommend it if the patient
has already had cataract removal (they now can't get a cataract)
and if they have a posterior vitreous detachment (making retinal
tears and detachment less likely).
(more details pages 25-28 Our Book)