Risks and Complications of Vitrectomy Surgery: What Patients in Singapore Should Know
- paul somkiat
- 1 day ago
- 6 min read
Reviewed by Dr Paul Zhao, Senior Consultant Ophthalmologist and Vitreoretinal Surgeon, Eagle Eye Centre, Singapore. M.Med (Ophthalmology), FRCS (Ed), FAMS. Vitreoretinal fellowship, Queen Mary Hospital, Hong Kong.
INFO: This article explains potential risks and complications of vitrectomy in plain language. It is not a substitute for a personalised medical consultation.
Vitrectomy is a common retinal operation used to treat problems such as retinal detachment, macular hole, epiretinal membrane, vitreous haemorrhage, and complications of diabetic eye disease.
Most patients recover well, but like any intraocular procedure, vitrectomy carries risks. The likelihood and type of complication depend on your underlying eye condition, overall health, and the complexity of surgery.
- less common but serious complications to be aware of
- what symptoms after surgery should prompt urgent review
What is a vitrectomy?
A vitrectomy removes the vitreous gel that fills the back of the eye. The surgeon makes three small openings in the sclera, typically 23, 25, or 27 gauge, and uses fine instruments to remove the vitreous and address the underlying problem: reattaching a retina, peeling a membrane, closing a macular hole, or clearing blood.
The eye is then refilled with saline, a gas bubble, or silicone oil, depending on what the retina needs during healing.
Modern vitrectomy is usually performed as day surgery under local anaesthesia with sedation. Small-gauge instruments mean the openings are often self-sealing and do not require sutures.
How common are complications after vitrectomy?
Most vitrectomies are completed without significant complication. However, the overall risk is not a single number. It depends heavily on the condition being treated.
A vitrectomy for an epiretinal membrane in an otherwise healthy eye carries a different risk profile from a vitrectomy for a complex tractional retinal detachment in advanced diabetic eye disease. When discussing risk with Your surgeon, the relevant figure is the one for your diagnosis, your eye, and your general health, not a general average.
Common complications
Cataract formation
This is the most frequent consequence of vitrectomy in patients who still have their natural lens. Removal of the vitreous changes the oxygen environment inside the eye, and this accelerates clouding of the lens.
The majority of patients over the age of 50 who undergo vitrectomy will develop a visually significant cataract within one to two years. This is expected rather than a surgical error, and it is treatable with routine cataract surgery.
For this reason, surgeons sometimes recommend combining vitrectomy with cataract surgery in a single operation, particularly where a cataract is already present. Patients who have already had cataract surgery are not affected by this risk.
Raised intraocular pressure
Pressure inside the eye can rise after surgery, particularly when a gas bubble or silicone oil has been used. This is usually temporary and managed with pressure-lowering eye drops. Less commonly it requires further intervention.
Patients with pre-existing glaucoma need closer monitoring, as their eyes tolerate pressure elevation less well.
Refractive change
Vision may be different after surgery even once healing is complete, particularly if a lens implant was placed at the same time or if silicone oil remains in the eye. A new spectacle prescription is often required, and this is usually deferred until the eye has stabilised.
Less common but serious complications
Retinal tear or new detachment
Instruments passing through the eye, and traction on the retina during vitreous removal, can create new retinal breaks. Surgeons inspect the retinal periphery carefully at the end of every case for this reason, and any break found is treated during the same operation.
A retinal detachment can still occur in the weeks or months afterwards. Sudden new floaters, flashing lights, or a shadow in the field of vision after vitrectomy should be assessed urgently, not left until a routine follow-up appointment.
Endophthalmitis
Infection inside the eye is the most feared complication of any intraocular surgery. It is rare after vitrectomy, occurring in well under one in a thousand cases in most published series, but it is sight-threatening and requires immediate treatment.
Warning signs are increasing pain, worsening redness, and deteriorating vision, typically within the first week. Any of these warrants same-day review.
Bleeding
Bleeding can occur during or after surgery. Post-operative vitreous haemorrhage is more common in eyes operated on for proliferative diabetic retinopathy, where abnormal new vessels are fragile. It often clears on its own, though sometimes a further procedure is needed.
Suprachoroidal haemorrhage, a bleed beneath the retina and choroid, is a rare but serious event that can significantly affect the visual outcome.
Anaesthetic complications
Local anaesthetic blocks around the eye carry small risks including bruising, globe perforation, and, very rarely, effects on the optic nerve. These risks are low and are weighed against the risks of general anaesthesia for each patient.
What affects an individual patient's risk?
Several factors influence the likelihood of complications:
- The underlying diagnosis. Tractional detachment in diabetic eye disease is technically more demanding than a macular hole, and carries higher risk.
- Duration before surgery. A retinal detachment involving the macula for several weeks carries a different prognosis from one repaired promptly.
- Previous eye surgery or trauma. Scarring and altered anatomy increase technical difficulty.
- Systemic health. Poorly controlled diabetes, blood-thinning medication, and cardiovascular disease all affect both surgical risk and healing.
- Whether the lens is present. This determines cataract risk, as described above.
- The state of the fellow eye. If the other eye has poor vision, the threshold for accepting risk in the operated eye changes.
Face-down positioning and gas bubbles
Where a gas bubble is used, patients are often asked to maintain a particular head position for several days so the bubble presses against the treated area. This is not itself a complication, but it is demanding, and difficulty maintaining position can affect the outcome.
Two practical points matter while a gas bubble remains in the eye:
- Air travel is not permitted. Reduced cabin pressure causes the bubble to expand, which can raise intraocular pressure dangerously. Your surgeon will confirm when it is safe to fly.
- Nitrous oxide anaesthesia must be avoided for any unrelated procedure, for the same reason. Tell any other treating doctor that you have an intraocular gas bubble.
When to seek urgent review after vitrectomy
Contact Your surgeon or attend an emergency eye service the same day if you experience:
- Increasing or severe eye pain
- Worsening vision rather than gradual improvement
- Increasing redness or discharge
- A sudden shower of new floaters or flashing lights
- A curtain or shadow across part of your vision
Mild discomfort, redness, and blurred vision in the early days are expected. It is the pattern of worsening rather than improving that matters.
Frequently asked questions
Is vitrectomy painful?
The surgery itself is not painful, as the eye is anaesthetised. Mild ache, grittiness, and a foreign body sensation are common for several days afterwards and are usually managed with simple analgesia.
How long does recovery take?
Most patients resume light activity within a week. Visual recovery is more gradual and depends on the condition treated. Where a gas bubble is used, vision remains blurred until the bubble absorbs, which can take two to eight weeks depending on the gas.
Will I need cataract surgery afterwards?
If you still have your natural lens and are over 50, it is likely within one to two years. If you have already had cataract surgery, this does not apply.
Can vitrectomy be repeated?
Yes. Further surgery is sometimes needed, for example if a retinal detachment recurs or a macular hole does not close. This is discussed at the time if it becomes relevant.
Does vitrectomy always restore vision?
No. Vitrectomy addresses the structural problem, but the final level of vision depends on the health of the retina and optic nerve, and on how long the problem was present before treatment. Your surgeon should discuss the realistic visual expectation for your specific situation before surgery.
Is vitrectomy covered by insurance in Singapore?
Vitrectomy is generally claimable under MediSave and Integrated Shield Plans, subject to your policy terms and any pre-authorisation requirements. Coverage details are discussed at consultation.
Discussing risk before surgery
An informed consent conversation should cover the specific risks relevant to your eye, the expected benefit, what happens without surgery, and any alternatives. If any part of that is unclear, it is reasonable to ask for it to be explained again before proceeding.
Questions worth asking include: what is the realistic visual outcome in my case, what is the chance further surgery will be needed, what positioning will I have to maintain, and how long before I can return to work or travel.
This article is for general education and does not constitute medical advice or a substitute for clinical consultation. Individual risk varies, and surgical decisions should be made with an ophthalmologist who has examined your eyes. Dr Paul Zhao is a Senior Consultant Ophthalmologist and Vitreoretinal Surgeon practising at Eagle Eye Centre, with clinics at Mount Alvernia, Mount Elizabeth Novena, Mount Elizabeth Orchard, and Parkway East, Singapore.
TIP: Bring a list of your medications (especially blood thinners), your medical history (e.g., diabetes), and any prior eye surgery details to your consultation.
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