Surgical Vitrectomy
The surgical removal of the vitreous humor is known as a vitrectomy. This is a complex microsurgical procedure which is usually performed by an ophthalmic surgeon with special training. The surgeon performs the procedure by viewing the interior of the dilated eye through a microscope and special lenses designed to provide a clear image of the back of the eye. Two or three tiny incisions just a few millimeters in length are made on the sclera. The surgeon then inserts microsurgical instruments through the incisions such as:

• Fiber optic light source to illuminate inside the eye
• Infusion line to introduce replacement fluid to maintain the eye's shape during surgery
• Instruments to cut and remove the vitreous

Vitrectomies are typically performed to relieve a variety of conditions which threaten the health of the eye or obscure light as it passes through the eye to the retina. Many surgeons are reluctant to perform a vitrectomy solely for the removal of floaters unless they obscure vision and/or significantly reduce quality of life.

Depending upon the amount of vitreous removed and the technique employed the procedure may be referred to as a pars plana vitrectomy (PPV), a floater only vitrectomy (FOV), or a sutureless vitrectomy.

Pars plana vitrectomy (PPV)
The general vitrectomy is usually reserved for complicated posterior segment disease. It has a well-known risk profile and there is reluctance to offer this surgery to treat floaters only. In eyes that have an established posterior vitreous detachment (PVD); however, the PPV may be associated with a lower incidence of both intraoperative and post-operative complications. The three main postoperative complications that one must worry about in vitrectomy are:

• development or progression of nuclear sclerosis cataract
• retinal detachment and choroidal
• vitreous hemorrhage (bleeding) in the eye

Floater Only Vitrectomy (FOV)
A vitrectomy for other purposes is not the same as vitrectomy for floaters only (FOV). The duration of a floater only vitrectomy is approximately 30 minutes (now only 15 with Sutureless Vitrectomy) compared to 1 or 2 hours for the vitrectomy associated with other eye problems. The unique circumstances of each patient will determine the amount of vitreous removed. In most cases, vitreous near the lens will be left in place. Retinal vitreous may or may not be removed dependent upon the state of PVD. Floater only vitrectomies incur fewer complications than general vitrectomy, due to the selective removal of vitreous material. However, limited vitreous removal may result in remnants of floaters remaining even after surgery. Other patients report being able to see the edges of their vitreous, which they claim is very annoying.

Sutureless Vitrectomy
The standard vitrectomy involves cutting through the conjunctiva, or fleshy part of the front of the eye, and making openings in the pars plana area which require stitches at the end of the surgery. In the sutureless technique, small tubes or canulas or trochars are placed through the pars plana area and very tiny instruments are placed through these tubes. Once the surgery is complete, the tubes are removed and no stitches are needed. Only in certain cases can sutureless vitrectomy surgery be performed.