Vitreous Hemorrhage Surgery: A Guide to Pars Plana Vitrectomy
- sakai208
- Dec 20, 2025
- 3 min read
I. Introduction: When is Surgery Necessary for a Bleeding Eye?
While many minor eye bleeds resolve on their own, vitreous hemorrhage surgery is a life-changing intervention for patients with dense or persistent bleeding. Known medically as a Pars Plana Vitrectomy (PPV), this advanced microsurgical procedure involves removing the blood-stained vitreous gel and replacing it with a clear substitute.
For patients whose vision has been "blacked out" by a hemorrhage, this surgery often provides immediate and dramatic visual recovery. This article details the indications, the surgical process, and what makes modern vitrectomy safer and more effective than ever before.
II. Indications: Who Needs Vitreous Hemorrhage Surgery?
A retina specialist typically recommends surgery in the following scenarios:
Non-Clearing Hemorrhage: If the blood does not show signs of significant reabsorption after 1 to 3 months of observation.
Retinal Detachment or Tears: If an ultrasound (B-scan) reveals that the retina is torn or pulling away, surgery is required urgently to prevent permanent blindness.
Proliferative Diabetic Retinopathy (PDR): When aggressive new vessel growth or scar tissue (traction) threatens the macula.
Ghost Cell Glaucoma: A condition where old red blood cells clog the eye's drainage system, causing a dangerous spike in eye pressure.
Bilateral Hemorrhage: If both eyes are affected, surgery may be performed sooner on one eye to restore functional independence to the patient.
III. The Surgical Procedure: Pars Plana Vitrectomy (PPV)
Modern vitreous hemorrhage surgery is performed using "small-gauge" instruments (often 23, 25, or 27 gauge) that are so thin they frequently do not require stitches (sutureless surgery).
Step 1: Anesthesia and Access
The procedure is usually performed under local anesthesia . Three microscopic incisions are made in the "pars plana"—the safe zone of the white part of the eye (sclera).
Step 2: Removing the Vitreous (The Core Vitrectomy)
Using a high-speed "vitreous cutter," the surgeon carefully aspirates the blood-filled vitreous gel. As the gel is removed, it is simultaneously replaced with a clear, sterile saline solution to maintain the eye's shape and pressure.
Step 3: Treating the Underlying Cause
Removing the blood is only half the battle. Once the view is clear, the surgeon addresses the source:
Endolaser: Applying laser directly to the retina to seal tears or stabilize diabetic vessels.
Membrane Peeling: Removing any scar tissue that might be pulling on the retina.
Fluid-Air Exchange: The surgeon may fill the eye with a gas bubble or silicone oil to hold the retina in place during healing.
Step 4: Closing the Incisions
Because the instruments are so small, the entry sites often seal themselves naturally, leading to faster healing and less post-operative discomfort.
IV. Advanced Techniques: The Role of 27-Gauge Surgery
The evolution of vitreous hemorrhage surgery has moved toward increasingly smaller incisions. 27-gauge vitrectomy represents the cutting edge of this trend.
Benefits: Reduced inflammation, minimal "foreign body" sensation, and a much lower risk of post-operative astigmatism.
Recovery: Many patients can return to light activities within a few days, although full visual recovery takes longer.
V. Surgical Success Rates and Risks
The success rate for clearing a vitreous hemorrhage is over 90%. However, like any surgery, it carries risks:
Cataract Progression: Almost all patients who have a vitrectomy will eventually develop a cataract in that eye.
Retinal Detachment: A rare but serious risk (approx. 1-2%).
Infection (Endophthalmitis): Extremely rare due to sterile techniques.
Increased Eye Pressure: Often temporary and managed with drops.
VI. Conclusion
Vitreous hemorrhage surgery is a cornerstone of modern ophthalmology. It transforms an opaque, non-functional eye back into a clear window to the world. By removing the blood and treating the underlying retinal disease in a single session, vitrectomy offers the most direct path to visual rehabilitation.
If your vision hasn't cleared as expected, or if diagnostic tests show a high risk to your retina, a vitrectomy may be the essential step needed to save your sight.
This article was reviewed by
Dr. Daiki Sakai, MD
