Vitreoretinal Surgery
Vitrectomy Surgery in Singapore
A vitrectomy is a microsurgical procedure that removes the vitreous gel from inside the eye, allowing a retina surgeon to reach and treat problems at the back of the eye.
It is used for retinal detachment, macular holes, epiretinal membranes, non-clearing vitreous haemorrhage and selected complications of diabetic eye disease.
Modern vitrectomy is generally performed through small incisions and is usually carried out as day surgery. Recovery and visual outcomes vary according to the condition being treated.
- Also called
- Pars plana vitrectomy (PPV)
- Setting
- Usually day surgery
- Anaesthesia
- Usually local anaesthesia with sedation
- Duration
- Varies by the condition and complexity
- Incisions
- Small-gauge micro-incisions, often self-sealing
- Eye may be filled with
- Fluid, air, gas or silicone oil
- Flying
- Not permitted while an intraocular gas bubble remains
- Recovery
- Functional recovery in weeks; improvement may continue for months
- MediSave / insurance
- Generally claimable when medically indicated, subject to applicable limits
Sudden flashes, new floaters or a dark curtain in your vision?
These symptoms may indicate a retinal tear or detachment. Because retinal detachment can be time-critical, contact the clinic for an urgent assessment.
On this page
What Is a Vitrectomy?
The vitreous is the transparent gel that fills the back of the eye, sitting between the lens at the front and the retina lining the inside of the eye wall.
A vitrectomy removes some or most of this gel. It may be performed to relieve traction where the vitreous is pulling on the retina, clear blood or debris that blocks vision, or create working space so instruments can safely reach the retinal surface.
The full name for the operation is pars plana vitrectomy. The pars plana is a part of the eye wall that instruments can pass through safely, a short distance behind the coloured iris, without damaging the retina or lens.
Small-gauge vitrectomy
Vitrectomy instruments are described by gauge. Common systems include 23G, 25G and 27G, with a higher number indicating a finer instrument.
Finer instruments allow smaller incisions, which frequently seal without stitches. No single gauge is inherently better for every operation. The system is selected according to the tissue being handled and the complexity of the case.
A straightforward membrane peel and a complex diabetic retinal detachment do not necessarily require the same instrumentation.
When Is Vitrectomy Used?
Vitrectomy is an approach to the back of the eye that allows several different retinal and vitreous problems to be treated.
Retinal detachment
Removing the vitreous relieves traction pulling the retina away from the eye wall and allows the surgeon to reposition and support the retina while it heals.
Vitrectomy is one of several ways to repair retinal detachment. Depending on age, lens status, the position of the retinal breaks and the type of detachment, a scleral buckle or pneumatic retinopexy may be more appropriate. Learn more on our retina surgery page.
Macular hole
Vitrectomy relieves traction acting on the centre of the retina and allows delicate peeling around the macula. A gas bubble is usually placed at the end of surgery to support the hole while it closes. More information about macular holes is available on our retinal disease page.
Epiretinal membrane
An epiretinal membrane is a thin sheet of tissue that forms on the macular surface and contracts, wrinkling the retina beneath it. Vitrectomy gives the surgeon access to lift and remove the membrane.
Vitreous haemorrhage and diabetic complications
When bleeding into the vitreous cavity does not clear on its own, vitrectomy can remove the blood. In advanced diabetic eye disease, it may also be used to remove scar tissue and relieve traction on the retina.
Other selected indications
Vitrectomy may also be used in severe eye trauma, for displaced intraocular lenses and in selected infections inside the eye.
Timing depends on the diagnosis
A retinal detachment—particularly one threatening the macula—and some macular holes may need prompt treatment. Other conditions may be monitored, with surgery considered when the effect on vision justifies it.
Have you been told you may need vitrectomy?
A retinal examination and imaging determine the condition being treated and whether vitrectomy or another procedure is appropriate.
How Is Vitrectomy Surgery Performed?
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Pre-operative assessment
Your assessment may include a dilated retinal examination and imaging, a review of current medication and general medical history, fasting instructions if sedation is planned, and confirmation that someone can take you home afterwards.
Blood-thinning medication and diabetes control are discussed at this stage. Do not stop prescribed medication unless your treating doctor instructs you to do so.
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Anaesthesia
Vitrectomy is usually performed under local anaesthesia with sedation. The eye is numbed, so patients typically notice light, movement or pressure rather than the operation itself. General anaesthesia is used in selected cases.
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Creating the micro-incisions
Usually, three small ports are placed through the sclera—the white of the eye—at the pars plana.
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The three instruments
Each port holds one instrument:
- Infusion line: continuously replaces what is removed so the eye maintains its shape and pressure.
- Light pipe: illuminates the inside of the eye.
- Vitrectomy cutter: a fine probe that cuts and aspirates vitreous in small increments rather than pulling on it.
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Removing the vitreous
The cutter removes the vitreous gel and relieves the traction it was exerting on the retina.
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Treating the retinal problem
The next steps depend on the diagnosis. The surgeon may peel membranes from the macular surface, drain fluid from beneath a detached retina, clear blood, remove scar tissue or treat retinal breaks. Laser or cryotherapy may be used during the same operation.
View during retinal surgery. -
Filling the eye
The eye is left filled with balanced salt solution, air, gas or silicone oil. The choice affects post-operative positioning, vision during recovery and flying restrictions.
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Closing and going home
Small-gauge wounds are often self-sealing, so stitches are frequently unnecessary. Most patients receive eye drops, an eye shield and written instructions before returning home on the same day.
Gas Bubble, Silicone Oil or Fluid: What Is Left Inside the Eye?
Some retinal repairs need temporary internal support while the tissue heals. This support is called tamponade. A gas bubble or silicone oil rests against the treated area long enough for a seal to form.
Not every vitrectomy needs tamponade. If the operation has not created or treated a break or hole requiring support, the eye may be left filled with balanced salt solution, which the eye replaces naturally over time.
| Fill | Approximate persistence | Flying |
|---|---|---|
| Balanced salt solution or fluid | No long-lasting bubble | No gas-related flying restriction |
| Air | Several days | Avoid until fully absorbed |
| SF6 gas | Roughly 1 to 2 weeks | Avoid until fully absorbed |
| C3F8 gas | Several weeks, commonly around 6 to 8 weeks | Avoid until fully absorbed |
| Silicone oil | Remains until surgically removed, where removal is appropriate | Does not expand at altitude in the way gas does |
Persistence varies with the concentration used and the individual eye. Your surgeon confirms when a gas bubble has completely disappeared.
The choice of tamponade depends on the position of the treated area, the duration of support required and the position you can realistically maintain after surgery.
Silicone oil and removal
Silicone oil may be used in selected complex or recurrent cases where the retina needs longer-term support than a gas bubble can provide.
Unlike gas, silicone oil does not dissolve. It remains in the eye until it is removed, and removal is a separate operation planned when the retina is stable. In some eyes, the oil may be left in place. This depends on the condition of the eye.
Silicone oil does not carry the same altitude-related expansion risk as gas, but clinical suitability comes first and the oil has its own considerations.
Combined cataract and vitrectomy surgery
If a cataract is already present, or lens surgery is clinically appropriate for another reason, cataract surgery and vitrectomy may sometimes be performed during the same operation.
The potential advantages are one operative episode, one recovery period and a clearer view for the surgeon during the retinal procedure. Whether combined surgery is appropriate depends on the state of the lens, the retinal condition and the patient's visual needs.
Recovery After Vitrectomy
The first few days
Some redness, grittiness, mild aching and blurred vision are expected. Eye drops are prescribed to control inflammation and reduce the risk of infection, and are usually tapered over several weeks.
Light activity may resume relatively quickly. Avoid strenuous exercise, swimming and rubbing the eye until you are cleared to resume them.
What vision looks like with a gas bubble
A fresh gas bubble can fill most of the eye, making vision through it extremely blurred. As it shrinks, you begin to see over the top of the bubble. Many patients notice a horizontal line that wobbles as they move, similar to a spirit level.
The line gradually drops lower. The bubble eventually becomes a small moving circle before it disappears. The duration depends on the type and concentration of gas used.
Face-down and other head positioning
Gas floats. Your head is positioned so the highest point inside the eye places the bubble against the part of the retina that needs support.
The required position may be face-down, on one side or another position. Not every vitrectomy requires posturing. For macular hole surgery, the recommended position and duration depend on factors including the size and location of the hole.
Follow the instructions given for your operation. If positioning may be difficult because of neck or back problems, sleep issues or your home setup, discuss this before surgery.
Flying and nitrous oxide: important safety information
Do not fly or travel to high altitude while any gas bubble remains in the eye. Lower atmospheric pressure allows the bubble to expand, raising pressure inside the eye and risking permanent visual damage.
Nitrous oxide anaesthesia must not be used while intraocular gas remains. Tell any doctor, dentist or anaesthetist about the gas bubble before undergoing another procedure.
Travel at normal altitude by car, bus, train or boat is not restricted by the bubble. Your surgeon confirms when the gas has fully absorbed and flying is safe.
Work, driving and visual recovery
- Light activity and desk work may resume before vision has fully recovered.
- Drive only when vision is adequate and your surgeon confirms that it is safe.
- Vision in the operated eye remains limited while a gas bubble is present.
- Retinal and macular healing continues for weeks and sometimes months after the eye feels comfortable.
- Wait until the eye has stabilised before obtaining a new spectacle prescription.
How Vitrectomy Differs for Macular Hole and Epiretinal Membrane
Both conditions are treated through vitrectomy, and both can involve peeling delicate tissue at the centre of the retina. The practical differences mainly affect what happens after surgery.
| Feature | Macular hole | Epiretinal membrane |
|---|---|---|
| Main additional step | Peeling the internal limiting membrane around the macula | Peeling the epiretinal membrane, often with internal limiting membrane peeling |
| Gas commonly required? | Often | Not always |
| Positioning | May be prescribed | Often less restrictive when no gas is used |
| Visual recovery | Gradual, as the hole closes and the macula recovers | Distortion may improve gradually over several months |
Macular hole: internal limiting membrane peeling and gas
The internal limiting membrane is the innermost layer of the retina. Peeling a small area around the hole releases forces that keep the hole open and allows the edges to come together. A dye may be used during surgery to make this transparent layer visible.
A gas bubble is usually placed to support the area while the hole closes, which is why positioning and flying restrictions commonly form part of macular hole recovery.
Epiretinal membrane: membrane peeling
The surgeon lifts and removes the membrane from the retinal surface. The internal limiting membrane may also be peeled to reduce the risk of the membrane returning.
Many epiretinal membrane operations do not require gas. If no gas is used, there is no bubble-driven positioning requirement or gas-related flying restriction.
Risks and Expected Outcomes
There is no single success rate for vitrectomy because it is used for different diseases. The risk of complications and the amount of vision that returns depend heavily on why surgery is being performed.
Common or expected considerations
- Cataract progression: in eyes that still have the natural lens, vitrectomy commonly accelerates cataract formation. Cataract is treatable with cataract surgery.
- Raised eye pressure: pressure can rise after surgery, especially when gas or silicone oil is used. It is usually temporary and treated with pressure-lowering drops.
- Refractive change: the prescription in the operated eye may change, so new glasses are deferred until the eye stabilises.
A large 2026 US IRIS Registry analysis estimated a 46% probability of cataract surgery within two years after pars plana vitrectomy in eyes that still had their natural lens. This measures subsequent cataract surgery, rather than every degree of lens change. It does not apply to eyes that have already had cataract surgery.
Less common but important risks
- A retinal tear or a new or recurrent detachment
- Bleeding during or after surgery
- Infection inside the eye, which is uncommon but sight-threatening and requires same-day treatment
- Other rare complications inside the eye and the risks associated with anaesthesia
What determines the visual outcome?
Four factors matter more than any general percentage:
- The condition being treated
- How advanced it was at the time of surgery
- Whether the macula was affected
- The health of the retinal tissue before surgery
Anatomical success and visual recovery are different outcomes. Anatomical success means that the retina is reattached, the hole is closed or the membrane is removed. Visual recovery refers to how much sight returns.
Surgery can achieve anatomical success without full visual recovery, particularly if the macula was involved or the condition was long-standing.
When to seek urgent review
Some discomfort, redness and blurring are expected during the early days. Contact the clinic on the same day if you experience:
- Increasing or severe pain
- Vision that is worsening rather than gradually improving
- Increasing redness or discharge
- New flashes of light or a sudden shower of floaters
- A new curtain or shadow moving across your vision
Vitrectomy Cost in Singapore, MediSave and Insurance
What affects the cost
- The complexity of the operation and the condition being treated
- The operating facility and type of anaesthesia
- Additional procedures performed during the operation, such as laser treatment or membrane peeling
- Whether cataract surgery is combined with vitrectomy
- Whether silicone oil removal is required as a separate operation
MediSave and insurance
Vitrectomy performed for a medically necessary retinal condition is generally eligible for MediSave withdrawal and insurance claims.
The claimable amount depends on the specific procedure code, applicable withdrawal limits, policy coverage, deductibles, co-insurance, panel arrangements and any pre-authorisation required by the insurer.
The clinic will confirm the applicable procedure code and provide an estimate of your out-of-pocket cost before surgery. If you hold an Integrated Shield Plan, inform the clinic early because pre-authorisation may take time.
Frequently Asked Questions
Is vitrectomy painful?
The operation itself is generally not painful because the eye is numbed. Most patients notice light, movement or pressure rather than the surgery. A mild ache, grittiness or foreign-body sensation can occur for several days. Increasing pain should be reported on the same day.
How long does vitrectomy surgery take?
Duration varies according to the condition and complexity. A membrane peel in an otherwise healthy eye and a complex diabetic detachment repair are different operations. Your surgeon will give you an expected duration for your case.
How long does the gas bubble last after vitrectomy?
It depends on the gas used. Air usually absorbs over several days, SF6 over roughly one to two weeks, and C3F8 over several weeks—commonly around six to eight weeks. Duration also varies with the concentration and individual eye.
When can I fly after vitrectomy?
Do not fly until a gas bubble has completely absorbed and your surgeon has confirmed it. Reduced cabin pressure allows the bubble to expand and can raise eye pressure dangerously. Fluid and silicone oil do not expand in the same way, but confirm your travel plans with your surgeon.
How long will I need to maintain a face-down position?
This depends on the operation and is prescribed individually. Not every vitrectomy requires positioning, and the required position is not always face-down. Follow the instructions given for your eye.
Why is my vision so blurred after surgery?
If a gas bubble was used, vision through a fresh bubble is very blurred. As it absorbs, you may see a wobbling horizontal line that drops lower each day. The retina also needs time to heal, so vision generally improves gradually rather than immediately.
Will I develop a cataract after vitrectomy?
If you still have your natural lens, cataract progression is common after vitrectomy. Cataract is treatable, and combined cataract and vitrectomy surgery may be discussed if a cataract is already present. This does not apply to an eye that has already had cataract surgery.
Is vitrectomy claimable under MediSave and insurance?
Generally yes, when it is performed for a medically necessary retinal condition. The amount depends on the procedure code, MediSave withdrawal limits, policy terms and insurer requirements. The clinic will provide an estimate before surgery.
Can vitrectomy be repeated?
Yes. Further surgery may be needed if a retinal detachment recurs or a macular hole does not close after the first operation. Your surgeon will explain what another operation would involve and the expected outcome.
Your Vitrectomy Surgeon
Dr Lee Shu Yen
Senior Consultant Ophthalmologist and Vitreoretinal Surgeon
MBBS, MMed (Ophthalmology), MRCSEd, FRCSEd (Ophthalmology), FAMS
Dr Lee previously served as Head of the Surgical Retina Department at the Singapore National Eye Centre. Her surgical practice includes retinal detachment repair using vitrectomy and scleral buckling, macular surgery for macular holes and epiretinal membranes, diabetic vitrectomy, and treatment of retinal complications of high myopia.
She was appointed Clinical Associate Professor at Duke-NUS Medical School and has published extensively in retinal surgery and retinal disease.
Speak to a retina specialist
If you have been told you may need vitrectomy, a retinal examination and imaging can clarify the condition and the appropriate treatment.