The inside of the eye consists of a transparent, gel-like mass, the vitreous body. The vitreous body is surrounded by a fine membrane, the vitreous limiting membrane, which lies tension-free against the lens at the front and the retina at the sides and back.

As part of the ageing process, but also after traumatic events or operations, e.g. aftercataract surgery, the vitreous membrane detaches from the retina. If there is incomplete detachment of the vitreous body from the retina, tractional diseases of the macula(tractional maculopathies), tears/holes in the retina(retinal foramen) or retinal detachment(ablatio retinae) can occur. All of these diseases can lead to severe visual impairment and even blindness.

The retina lines the inside of the eyeball. Retinal detachment is the detachment of the neurosensory layers of the retina from the underlying retinal pigment epithelium. In the event of retinal detachment, these light-sensitive layers can no longer produce an image, which leads to blindness if the entire retina is detached. Retinal detachment caused by a retinal tear(rhegmatogenous retinal detachment) is an ophthalmological emergency that requires surgical treatment. Possible surgical procedures include hump surgery and vitrectomy. In Germany, around 2 in 10,000 people suffer a rhegmatogenous retinal detachment every year.

If a retinal hole with a still attached retina is detected during the examination of the retina(funduscopy), laser coagulation is the treatment of choice to reposition the retinal hole.

If there is a retinal detachment with a clear hole, hump surgery is a possible surgical procedure. The aim of the operation is to create a "hump" by indenting the eyeball from the outside by suturing a seal to the inside, which reduces the tensile forces between the vitreous body and the retina so that the retinal hole comes to rest on the hump and the retina is reattached. Hump surgery is a safe and effective procedure. The advantages lie in lens-preserving surgery, as unlike other procedures such as vitrectomy, no cataracts are created.

Vitrectomy is the removal of the vitreous body via the pars plana, a specific area at the back of the eye. The aim of the procedure is either to restore the natural structure of the area of sharpest vision(macula) by releasing the tensile forces between the vitreous body and the retina or, in the case of retinal detachment, to achieve a retinal reattachment. To do this, several access points are created under a surgical microscope to reach the inside of the eye. The vitreous body is then removed using fine instruments and existing retina-vitreous connections are loosened.

If there is also a pathological accumulation of cells(epiretinal membrane) on the retina, particularly in the case of tractive diseases of the macula, this is carefully removed with special tweezers(membrane peeling).

Depending on the diagnosis and extent of the vitreous or retinal changes, the vitreous cavity is filled with different substances(endotamponade) at the end of the operation. This can be either BSS (balanced salt solution, simplified: saline solution), air, gas or silicone oil. After the operation, it may be necessary to adopt a certain body or head posture for a few days. Sometimes a follow-up operation may be necessary, e.g. to remove the silicone oil.

In addition, a vitrectomy can also be performed in the case of pronounced opacities or thickening of the vitreous, e.g. in the case of vitreous haemorrhage or following inflammation. The removal of foreign bodies following an injury can also make a vitrectomy necessary.

A major advantage of vitrectomy is the treatment of complex vitreoretinal pathologies using minimally invasive surgery. In addition, cataract surgery can be performed at the same time in the case of pre-existing lens opacities, thus avoiding the need for a timely follow-up procedure to treat the lens opacity.

Vitrectomy is performed as an inpatient procedure. Depending on the diagnosis and severity, the operation takes between 30 and 90 minutes.

In most cases, retinal surgery is performed under local anaesthesia by injection behind the eye(retrobulbar anaesthesia). The patient is conscious during the operation but feels no pain. In selected cases, vitrectomy is also performed under generalanaesthesia.

The success of an operation depends primarily on the cause of the retinal disease.

The treatment of tractive diseases of the macula by vitrectomy is now a routine procedure with good prospects of success. Most patients show an improvement in visual acuity and a reduction in distorted vision after the operation. However, this gradual process of visual improvement can take many months until stable vision is achieved.

Retinal detachment can also be treated anatomically very successfully today. However, the visual acuity achieved after the operation depends, among other things, on the extent of the retinal detachment.

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