In this procedure the gel is removed, replaced by a clear salt solution initially, and eventually by the eyes own fluid. The gel is like a microscopic scaffold, allowing blood vessels a perch from which to continue growing from retina into vitreous. Scar tissue grows with the abnormal circulation. As scar tissue contracts risk of retinal detachment and macular pucker, or wrinkling that includes the sharp vision foveal area, can occur. C below shows scar tissue in the macula, where fluid has also accumulated.
Vitrectomy can be very effective, particularly when combined with intraoperative laser treatment.
A vitrectomy for this purpose is performed through 2-3 tiny incisions along the white of the eye about 0.33 inches behind the outer corneal boundary on the sclera. An instrument with a rapid, guillotine like cutter movement and hollow central opening for suction is inserted, usually along with a separate port for infusion of fluid to replace removed vitreous until the eye can make its own additional fluid, and a light pipe to improve visibility within the eye. Epiretinal Membranectomy Macular pucker and related retinal wrinkling caused by contracting scar tissue can devastate vision. A procedure known as epiretinal membranectomy can decrease traction on the retina and sometimes relieve the pucker or at least prevent it from worsening. The initial stages of epiretinal membranectomy requiring first performing a vitrectomy as above in most cases.