Vitrectomy Surgery With the Constellation System
What Is Vitrectomy Surgery
Vitrectomy is a surgical procedure that removes the vitreous, the clear gel that fills the inside of the eye. When the vitreous becomes problematic, whether from bleeding, scar tissue, or abnormal pulling on the retina, a retina specialist can remove it to gain direct access to the back of the eye. This makes it possible to treat a wide range of serious retinal conditions.
The vitreous gel occupies most of the interior of the eye and helps maintain its shape. Under healthy conditions it is perfectly clear, allowing light to pass through and reach the retina, the thin layer of tissue at the back of the eye that converts light into the signals your brain interprets as vision. When the vitreous is clouded by blood or distorted by scar tissue, it can interfere with vision and put the retina at risk.
Retina specialists recommend vitrectomy when conditions affecting the vitreous or retina cannot be adequately treated with medications or laser treatment alone. Removing the vitreous gel gives the surgeon a clear path to repair damage, remove scar tissue, or reattach a detached retina. It is a well-established procedure performed with high frequency in eye surgery centers across the country.
Vitrectomy is performed by retina specialists, ophthalmologists who have completed additional fellowship training in the medical and surgical management of diseases affecting the retina and vitreous. At our practice, Dr. Gaurav Gupta and Dr. Pranjal Thakuria are our fellowship-trained retina specialists and perform vitrectomy procedures for a wide range of retinal conditions.
How the Constellation Vision System Works
The Constellation Vision System is a surgical platform that integrates all of the tools needed for vitrectomy into one precise, coordinated machine. It was designed specifically for the demands of retina surgery, where the structures involved are extremely delicate and the margin for error is very small. Understanding how it works can help patients feel more confident going into their procedure.
At the center of the Constellation system is a dual-pneumatic vitrectomy cutter, a tiny probe that cuts and removes the vitreous gel. Unlike older systems that relied on a spring mechanism to reset the cutter between strokes, the Constellation uses two separate airflows to independently control the opening and closing of the cutting port. This design allows cutting speeds of up to 10,000 cuts per minute, which enables smoother, more controlled removal of the vitreous with less pulling on the retina during surgery.
Duty cycle refers to the ratio of time the cutting port stays open compared to the time it stays closed during each cutting cycle. The Constellation system gives the retina specialist precise control over this ratio through three surgical modes, each suited to a different stage of the procedure.
- CORE mode keeps the port open longer than closed, used for efficiently removing large volumes of vitreous gel.
- 50/50 mode balances open and closed time equally, providing steady cutting and suction.
- SHAVE mode keeps the port closed longer than open, designed for delicate work very close to the surface of the retina.
This flexibility allows the surgeon to adapt in real time based on the task at hand, improving both safety and precision throughout the operation.
Maintaining stable pressure inside the eye during surgery is critically important. Pressure that drops too low can cause the eye to soften and collapse, while pressure that rises too high can damage delicate tissue. The Constellation system uses non-invasive flow sensors that continuously monitor and automatically adjust the infusion pressure during surgery, keeping it stable within a very narrow range. This reduces the risk of pressure-related complications throughout the procedure.
The Constellation platform includes a built-in laser that retina specialists can use during surgery without switching to a separate machine. This laser can seal retinal tears, treat areas of abnormal blood vessel growth, and reinforce weakened areas of the retina. Having this capability integrated directly into the surgical system saves time and reduces disruption to the procedure.
The Constellation system supports surgical instruments in multiple sizes, including 23-gauge, 25-gauge, and 27-gauge options. Gauge refers to the diameter of the instruments and the incisions required to insert them. Smaller gauge numbers indicate larger instruments, while larger gauge numbers indicate smaller ones. The 27-gauge instruments create incisions so small that stitches are often not required and recovery may be faster for appropriate patients.
Conditions Treated With Vitrectomy
Vitrectomy is used to treat a range of serious conditions affecting the retina and vitreous. Some of these conditions develop gradually over time, while others require urgent attention. Our retina specialists will evaluate your specific situation and discuss whether vitrectomy is the most appropriate course of treatment.
A retinal detachment occurs when the retina separates from the supportive tissue beneath it. Without prompt treatment, this can lead to severe and permanent vision loss. Vitrectomy allows the retina specialist to remove vitreous gel that may be tugging on the retina, then flatten and reattach it. Laser treatment or a freezing technique is then applied to seal the retina in place. In many cases, a gas bubble or silicone oil is placed inside the eye at the end of surgery to hold the retina against the wall of the eye while it heals.
Diabetic retinopathy, damage to the blood vessels of the retina caused by diabetes, is one of the most common reasons vitrectomy is performed. Diabetes can cause blood to leak into the vitreous gel, a condition called vitreous hemorrhage, which clouds vision. It can also lead to the formation of scar tissue that pulls the retina away from the back of the eye, known as a tractional retinal detachment. The Constellation system allows the surgeon to carefully remove blood and scar tissue while minimizing any disturbance to the retina itself.
The macula is the central part of the retina responsible for the sharp, detailed vision needed for reading, recognizing faces, and seeing fine detail. A macular hole is a small break in this area that causes blurry or distorted central vision. An epiretinal membrane is a thin sheet of scar tissue that forms on the surface of the macula and causes similar symptoms. In both cases, vitrectomy gives the retina specialist access to peel away the membrane or prepare the macular hole for closure, typically followed by placement of a gas bubble to support healing.
When blood leaks from damaged blood vessels into the vitreous gel, it blocks light from reaching the retina and causes cloudy, dark, or severely reduced vision. If this blood does not clear on its own over a reasonable period of time, vitrectomy can remove the blood-filled vitreous and restore a clear path for light. The retina specialist will also address the underlying cause of the bleeding, such as a retinal tear or diabetic retinopathy, during the same procedure.
What to Expect Before, During, and After Surgery
Preparing for vitrectomy and knowing what recovery involves can help reduce anxiety and set realistic expectations. Our retina specialists will walk you through every step of the process, from your preoperative evaluation to your final follow-up visit. The information below gives you a general overview of what most patients experience.
Before surgery, your retina specialist will perform a thorough eye examination and may order imaging tests such as optical coherence tomography (OCT), which creates detailed cross-sectional images of the retina, or an ultrasound of the eye. If you have diabetes, your blood sugar should be well-controlled in the period leading up to surgery, as elevated glucose levels can increase the risk of complications. Your specialist will also review all current medications, because certain blood thinners may need to be temporarily adjusted. Most vitrectomy procedures are performed on an outpatient basis, meaning you return home the same day, and you will need someone to drive you.
Vitrectomy is typically performed under local anesthesia, which numbs the eye and the surrounding area while you remain awake. A mild sedative is often given to help you relax during the procedure. The retina specialist makes several very small incisions in the white part of the eye to insert the surgical instruments. Using the Constellation system, the surgeon removes the vitreous gel and addresses the specific retinal problem. Depending on the complexity of the condition being treated, the procedure can take anywhere from 30 minutes to two hours.
If a gas bubble is placed inside the eye at the end of surgery, you may be instructed to maintain a specific head position, often face-down, for a period of several days to a few weeks. This is because the gas bubble rises to the top of the eye, and the correct head position allows it to press against the area of the retina that needs support. Maintaining this position as instructed is important for the success of the surgery. Special positioning aids such as support pillows and rental chairs are available if you need them. If you have physical limitations that make positioning difficult, discuss this with your retina specialist before the procedure so alternatives can be considered.
While a gas bubble is present in the eye, air travel and travel to high altitudes are not permitted. Changes in air pressure at altitude can cause the gas bubble to expand, which raises pressure inside the eye to a dangerous level. Your retina specialist will tell you when the bubble has dissolved sufficiently to make travel safe again. The gas dissolves on its own over a period of several weeks, depending on the type of gas used.
Vision improvement after vitrectomy is gradual and varies depending on the underlying condition and how much damage was present before surgery. If a gas bubble was placed, vision will be significantly blurred until the bubble shrinks and is absorbed, a process that typically takes two to eight weeks. Final visual results may not be fully apparent for several months after the procedure. Your retina specialist will monitor your recovery closely and adjust your treatment plan as needed.
Risks and Possible Complications
Like all surgical procedures, vitrectomy carries some degree of risk. Serious complications are uncommon, but it is important to understand what they are and what signs to watch for during recovery. Our retina specialists take every precaution to minimize risk, and they will discuss the specific risks that apply to your situation before you consent to surgery.
Some redness, mild discomfort, and blurry vision in the days following surgery are normal and expected. These symptoms typically improve within the first few weeks. Antibiotic and anti-inflammatory eye drops are prescribed after surgery to prevent infection and reduce swelling. Sensitivity to light is also common during the early stages of recovery.
A cataract is a clouding of the natural lens inside the eye. If you have not already had cataract surgery, vitrectomy will likely accelerate cataract development in the treated eye. Most patients over the age of 50 who still have their natural lens develop a visually significant cataract within one to two years following vitrectomy. When this happens, cataract surgery can be performed to restore clarity.
Although uncommon, more serious complications can occur after vitrectomy and should be discussed with your retina specialist before surgery.
- Retinal detachment, which may require additional surgery to repair.
- Endophthalmitis, a severe infection inside the eye that requires urgent treatment.
- Elevated eye pressure, which can damage the optic nerve if left unmanaged.
- New bleeding inside the eye after surgery, known as recurrent vitreous hemorrhage.
- Hypotony, or very low eye pressure, which can occur if the small surgical incisions do not seal properly.
The Next Generation of Vitrectomy Technology
The Constellation Vision System represents a significant step forward in vitreoretinal surgery, and the technology continues to evolve. Understanding where vitrectomy platforms are headed helps put current capabilities in context and reflects our commitment to staying current with surgical advancements that benefit patients.
In 2024, the manufacturer received regulatory clearance for the next-generation Unity VCS, which is designed to succeed the Constellation platform over time. The new system is intended to improve surgical workflow and introduce updated technology while maintaining compatibility with the techniques retina specialists currently use. The transition from the Constellation to the Unity platform is expected to take place gradually over a number of years.
Recent developments in vitrectomy probe technology include high-speed probes capable of reaching 10,000 cuts per minute and newer dual-blade designs capable of up to 20,000 cuts per minute. Both feature improved tip designs that position the cutting port closer to the end of the probe, allowing retina specialists to work with greater precision near the surface of the retina when removing membranes or scar tissue. These advances represent meaningful improvements in safety and control during the most delicate parts of retinal surgery.
Recognizing When to Seek Urgent Care
Knowing when a symptom requires immediate attention is an important part of recovering safely from vitrectomy. While some discomfort and visual changes are expected in the early recovery period, certain symptoms signal a possible complication that needs to be evaluated right away. When in doubt, contact our office or seek care promptly.
Mild redness, a scratchy or gritty feeling, and fluctuating vision are all common in the days following surgery and are not usually a cause for concern. However, symptoms that are severe, sudden, or getting noticeably worse rather than better should always be evaluated. It is better to reach out and be reassured than to wait on a symptom that turns out to require treatment.
Contact your retina specialist immediately or go to the nearest emergency room if you experience any of the following after vitrectomy.
- Sudden decrease or loss of vision in the treated eye.
- Severe or worsening eye pain that is not relieved by prescribed medications.
- Increasing redness that does not improve or gets worse over time.
- New flashes of light or a sudden significant increase in floaters.
- A shadow, dark curtain, or dark area appearing in any part of your field of vision.
Frequently Asked Questions
These answers are meant to address common questions that go beyond the general information covered above. If you have specific questions about your own situation, your retina specialist is the best person to guide you.
Vitrectomy is almost always performed on one eye at a time. Treating both eyes simultaneously would create a period during which neither eye is functioning reliably, and it would significantly increase the risk of bilateral complications, including infection. When both eyes require surgery, the second procedure is typically scheduled after the first eye has had time to heal, usually several weeks to a few months later.
Positioning requirements depend on whether a gas bubble or silicone oil is used and where in the eye the repair was made. If face-down positioning is physically difficult for you due to back, neck, or mobility issues, it is important to tell your retina specialist before surgery rather than after. In some cases, positioning aids can make it manageable. In other situations, the surgical plan or the type of tamponade agent used can be modified to reduce the positioning burden.
Vitrectomy does not correct refractive errors such as nearsightedness or farsightedness, so any need for glasses you had before surgery is likely to remain afterward. Some patients experience a temporary shift in their prescription during recovery, and your glasses prescription may need to be updated once your eye has fully healed. If you subsequently develop a cataract and require cataract surgery, that procedure may offer an opportunity to reduce your dependence on glasses for distance or near vision.
Most patients are able to resume light daily activities within a few days to a week following surgery, though this varies based on the procedure and how recovery is progressing. Strenuous exercise, heavy lifting, and swimming are generally restricted for several weeks. If a gas bubble is present, air travel is not allowed until the bubble has fully dissolved. Your retina specialist will give you a personalized timeline based on your specific condition and how your eye is healing.
Significant blurring in the days immediately following vitrectomy is common and does not necessarily indicate a problem. If a gas bubble was placed inside the eye, it will fill most of your visual field and cause blurry, dimmed, or distorted vision until it gradually shrinks. This is expected and resolves on its own over weeks. Vision tends to improve incrementally as the eye heals, and the final outcome may not be clear for several months. Unusual changes such as sudden darkening or a new curtain effect should always be reported promptly.
Schedule a Consultation With Our Retina Specialists
If you have been told you may need a vitrectomy, or if you are experiencing symptoms that concern you, we encourage you to schedule a consultation at Rhode Island Eye Institute. Our fellowship-trained retina specialists, Dr. Gaurav Gupta and Dr. Pranjal Thakuria, bring specialized expertise and a patient-centered approach to the evaluation and surgical management of complex retinal conditions. We are proud to serve patients across Rhode Island and southeastern Massachusetts, and we are here to help you understand your options and move forward with confidence.