Editing Vitrectomy (section)

==Additional surgical steps==
[[Image:Vitrectomy.jpg|thumb|right|250px|Vitrectomy instruments]]

Additional surgical steps involved as part of modern vitrectomy surgeries may include:

'''[[Membranectomy]]''' – removal of layers of unhealthy tissue from the retina with minute instruments such as forceps (tiny grasping tools), picks (miniature hooks), and visco-dissection (separating layers of tissue with jets of fluid.) This layer of unhealthy tissue is called an epiretinal membrane and it can occur in anyone, but is more likely to occur in the elderly or in people who have had prior eye disease or eye surgery.<ref name=eyewiki>{{cite web |url=https://eyewiki.aao.org/Epiretinal_Membrane |website=American Academy of Ophthalmology |title=Epiretinal Membrane |access-date=3 December 2019}}</ref> If the patient has an epiretinal membrane and is also complaining of symptoms such as decreased visual acuity, then a membranectomy is performed in addition to the vitrectomy. Complications of this additional step are similar to complications of the standard vitrectomy procedure.<ref name=eyewiki/>

'''[[Fluid/air exchange]]''' – injection of air into the eye to remove the intraocular fluid from the posterior segment of the globe while maintaining intraocular pressure to temporarily hold the retina in place or seal off holes in the retina. The air pressure is temporary as the posterior segment will soon re-fill with fluid.

'''[[Air/gas exchange]]''' – In some cases, gas can be used to help hold the retina in place. Gas, or more typically mixed gas and air, is injected through the sclera and into the posterior segment of the globe. This procedure is often referred to as pneumatic retinopexy. Typical gases used are [[perfluoropropane]] or [[sulfur hexafluoride]]. The gases are mixed with air to neutralize their expansive properties to provide for a longer acting (than air alone) retinal [[tamponade]]. The retinal tamponade acts to hold the retina in place or temporarily seal off holes in the retina. The mixed gases disappear spontaneously once they have accomplished their purpose and the posterior segment re-fills with fluid.<ref name="thomson">{{cite book|title=Surgical Technology for the Surgical Technologist|publisher=Delmar Learning|year=2004|isbn=978-1-4018-3848-5|edition=2|pages=[https://archive.org/details/surgicaltechnolo0002unse/page/580 580–581]|chapter=16|chapter-url=https://archive.org/details/surgicaltechnolo0002unse/page/580}}</ref>

'''[[Silicone oil injection]]''' – Similar to an air/gas exchange, or pneumatic retinopexy, the eye can also be filled with [[Silicone oil|liquid silicone]] to hold the retina in place.<ref name="thomson" /> In contrast to the pneumatic retinopexy, however, the silicone oil remains in the eye until it is later removed surgically. Oils have less surface tension and buoyancy than gases so the tension exerted by the oil is about 30 times less than that of the gas.<ref>{{cite journal |last1=Petersen J. |title=The physical and surgical aspects of silicone oil in the vitreous cavity. |journal=Graefes Arch Clin Exp Ophthalmol |date=1987 |volume=225 |issue=6 |pages=452–6 |doi=10.1007/bf02334175 |pmid=3678857|s2cid=9857386 }}</ref>

'''[[Photocoagulation]]''' – In cases when there is a tear in the retina, or when there are unhealthy damaging blood vessels (which can be seen in patients with diabetic retinopathy), laser treatment can be used.<ref name="thomson" /> In such cases, the laser is used to seal the hole or prevent growth of the unhealthy, damaging blood vessels.

'''[[Scleral buckle|Scleral buckling]]''' – placement of a support positioned like a belt around the eyeball to maintain the retina in a proper, attached position. This is referred to as an "exoplant". Placement of the scleral buckle for patients who have had a retinal detachment has been shown to lead to reattachment approximately 80 to 90 percent of the time after one surgery. In cases of failure, most patients are treated with vitrectomy.

'''[[Cataract surgery|Lensectomy]]''' – In some cases, a lensectomy, or "cataract surgery", is done in conjunction with the vitrectomy. This extra procedure is performed when the lens of eye is cloudy (cataract), damaged during the vitrectomy, if there is attached to scar tissue, or if the pressure in the eye needs to be lowered (as in the case with some glaucomatous patients).<ref name="thomson" />