When less is more: the role of non-vitrectomized vitreous surgery in retinal diseases

Anatomically, the vitreous is not merely a transparent medium; it is a complex gel structure crucial for maintaining intraocular architecture and biochemical homeostasis. By minimizing disturbance to the vitreous, non-vitrectomized vitreous Surgery (NVS) which involves surgery with no or minimal removal of the vitreous gel, attempts to achieve the indication of the surgery while preserving the vitreous’ physiological functions, such as buffering intraocular oxygen tension and limiting the influx of inflammatory cells. This selective approach is especially relevant in younger patients with clear crystalline lenses, and in those with healthy peripheral retinas. In such cases, removing only the targeted portion of the vitreous gel or vitreoretinal interface, rather than performing a complete PPV, may reduce oxidative stress and inflammation, thereby translating to lower long-term complications such as cataract progression or peripheral retinal tears. NVS may lend itself to simple ERMs, vitreous opacities, diagnostic biopsies and localized superior rhegmatogenous retinal detachments but is not suitable for extensive vitreous or retinal pathology or advanced retinal detachment.

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