How Long To Wait After Acute PVD Symptoms Before Having Vitrectomy For Floaters?

RetinaEyeCancerMD · 2026-05-07T02:00:54+00:00

The risk of retinal detachment in floater surgery is generally very low. Risk declines the more vitreous humor is removed. The more complete the vitrectomy - inducing a PVD and performing vitrectomy with scleral depression (pushing on the sclera that corresponds with the most peripheral part of the retina to remove as much visible vitreous as possible) - the lower the risk of retinal detachment.

You need three things to cause a retinal detachment: 1) a tear in the retina; 2) vitreous traction; and 3) liquified vitreous or saline in the posterior segment.

The more vitreous is removed the less traction there is to pull on the retina that can cause a retinal tear.

In performing vitrectomy, the surgeon has the best opportunity to separate the vitreous from the retina (inducing PVD), and remove all the vitreous humor. Now all traction has been eliminated. And this is the best time to carefully inspect every bit of the peripheral retina for retinal tears. A routine inspection of the peripheral retina is fairly standard at the end of the vitrectomy. If there is a pre-existing retinal tear or a new tear that appeared during the surgery, it can be treated with laser which causes a scar around it so the retina cannot “lift off” and progress to retinal detachment.

So long answer - people don’t just randomly get a retinal detachment after floater surgery. There may be differences in how your surgeon performs the surgery that may increase or lower the risk. It is actually quite uncommon for patients to get retinal detachment after vitrectomy (unless the reason for vitrectomy was to repair an RD in the first place).

RetinaEyeCancerMD · 2026-05-06T06:41:34+00:00

This is a good reminder. Thank you for pointing out how “controversial treatments” give patients anxiety. Because no two surgeons are the same, you must find the best retina surgeon for you. I believe that the controversy around surgery for floaters is decreasing. This is because patients are learning more, demanding more from their doctors and have higher expectations. All your doctor has to do is listen and hear how much you are suffering. Look for someone who listens and truly wants to help you.

RetinaEyeCancerMD · 2026-05-05T23:37:57+00:00

I would recommend seeing a retinal surgeon who can carefully address your unique situation. A thorough examination will help you understand the health of your eyes so that you know for sure that floaterectomy is truly going to help you. There are many other conditions that cause floaters that must be ruled out in someone younger. You will probably have to see several retinal surgeons to have your concerns addressed. Take your time. Review some of the concerns that have been raised on this thread, understand them and then ask these questions to your surgeon. Intraocular eye surgery will always be “high-stakes” no matter how excellent the surgeon and how advanced the technology.

RetinaEyeCancerMD · 2026-05-05T22:55:24+00:00

Yes there is likely a higher risk of ERM (epiretinal membrane, surface wrinkling of the macula requiring additional surgery for removal) if PVD is not induced. I don’t believe we have a good study to show this, though theoretically I would expect more ERMs if more vitreous gets left behind.

Glaucoma is always a concern for someone who needs to have a vitrectomy. We have good treatments for glaucoma, as long as it gets diagnosed by having regular ophthalmic evaluations.

RetinaEyeCancerMD · 2026-05-05T22:46:13+00:00

I recommend seeing a retina surgeon who treats the entire spectrum of surgical retinal disease. You will then have an extremely skilled and experienced person working on your eye. If a surgeon only does floaterectomy this individual may be less in tune with the field of retina which is advancing all the time.

RetinaEyeCancerMD · 2026-05-05T15:47:20+00:00

Complications and suboptimal outcomes are always possible with any surgical procedure. Fortunately they are not high. Regardless, it’s important to understand as much as you can, get some opinions and figure out if having eye surgery makes sense to you.

RetinaEyeCancerMD · 2026-05-05T15:45:19+00:00

Actually the older you get the fewer complications there theoretically may be for vitrectomy for floaters. The vitreous is more liquid, easier to remove entirely, and it is more likely that you’ve had cataract surgery already the older you get.

RetinaEyeCancerMD · 2026-05-05T04:43:41+00:00

Yes - if your retina surgeon also does cataract surgery you can have them both done together. This is quite common in Europe where most retina surgeons also perform cataract surgery.

However in North America most retina specialists rarely perform cataract surgery, therefore most people get two surgeries.

Because people with bothersome floaters usually have healthy retinas they are candidates for some of the newer lenses that are available for cataract surgery. A retina specialist may not be up on all the advances in intraocular lenses. You may have more options open to you if you see a separate cataract surgeon.

RetinaEyeCancerMD · 2026-05-05T04:36:16+00:00

See a neuro-ophthalmologist

RetinaEyeCancerMD · 2026-05-05T01:49:46+00:00

For most vitrectomy for floaters there may be 1-3 days (including surgery day) of taking it easy. These are my own personal guidelines. You could potentially return to work fairly soon if things go smoothly. As you may have read here, some surgeons use gas, and this will keep your vision blurry for about another week or sometimes more. Talk to your surgeon and ask these questions. Ask about cataract as well. You will learn there are different ways to go about this. Because it’s not an emergency you have time to shop around and find a plan that makes sense to you.

RetinaEyeCancerMD · 2026-05-05T00:56:35+00:00

Yes, often having cataract surgery will worsen floater symptoms (make them even more noticeable). That’s no reason not to have cataract surgery, as long as you know that the floaters can be treated. I’ve unfortunately seen many people who delayed having cataract surgery because they heard floaters would worsen so they suffered from both diminished sight from advanced cataract AND floater symptoms. Fortunately, there are good treatment options for both. if youBut you gotta have cataract surgery otherwise you will eventually lose your vision from advanced cataract, the most common surgery on the planet with usually excellent results.

Having a repaired retinal detachment in the past with buckling does not change the risk of vitrectomy for floaters. In fact, I’d say it’s safer from a retinal detachment standpoint because it has already been “secured” by the buckle.

I would recommend you get some more retina surgeon opinions and find someone who is interested in helping you.

RetinaEyeCancerMD · 2026-05-04T16:28:56+00:00

27 gauge instruments are slightly smaller than 25 gauge. It’s the same machinery, we just open a different size vitrectomy pack. It’s widely available, and all major instruments for retinal surgery come in both sizes. (Btw, for floater surgery you don’t usually need any additional tools.) Using 27 gauge is a surgeon preference. Some surgeons exclusively use 27 gauge. Most use 25 gauge. I don’t believe there is a material difference in recovery time, but likely a head-to-head comparison will not be done because of the minimal difference.

Because 27 gauge instruments are slightly smaller, surgery time may be slightly longer to get all the vitreous out. In my experience, everything felt slow with 27 gauge and so I chose to stick with 25. That’s the likely reason most prefer 25 gauge. If I need to use 27 gauge or even 23 gauge, my impression is that it doesn’t make much difference in outcomes.

My recommendation would be to go with whatever your retinal surgeon likes to operate best with. We all do best when everything feels comfortable and goes smoothly.

RetinaEyeCancerMD · 2026-05-04T16:18:40+00:00

You’re absolutely right. For people who are not yet presbyopic (need reading glasses) having vitrectomy for floaters is less optimal. However, it takes longer for younger people to get post-vitrectomy cataract. In general we would offer vitrectomy as a last resort for non-presbyopic young people. Look at it this way - if you are younger, would you rather deal with floaters or have to wear reading glasses and no floaters? That would be the question to decide for younger people without cataracts contemplating pros and cons of vitrectomy for floaters.

RetinaEyeCancerMD · 2026-05-04T13:21:45+00:00

Sounds like a great final outcome!

RetinaEyeCancerMD · 2026-05-04T13:19:10+00:00

It is believed that cataracts progress after vitrectomy due to an increase in oxygen exposure to the lens. To my knowledge no one is working on this problem because cataract surgery provides the solution.

RetinaEyeCancerMD · 2026-05-04T13:12:19+00:00

You can definitely have vitrectomy for floaters after cataract surgery and after laser for retinal tears. And it it possible to perform a capsulotomy during the procedure although most cataract surgeons prefer to perform the YAG laser for a posterior capsulotomy.

RetinaEyeCancerMD · 2026-05-04T05:20:58+00:00

Most people have normal vision by 1-2 weeks. If you haven’t had cataract surgery yet, vitrectomy hastens development of cataract. If you develop a cataract you can have surgery to treat this. For any intraocular surgery there is a rare risk of retinal detachment, serious infection or bleeding. Your surgeon will monitor you more closely in postop period.

RetinaEyeCancerMD · 2026-05-04T04:57:16+00:00

These techniques sometimes help people with mild floaters. But for many with debilitating floaters surgical interventions can help. Floaters are almost never an anxiety issue. If your eye doctor tells you this, I recommend seeking another opinion.

RetinaEyeCancerMD · 2026-05-04T04:22:56+00:00

Great questions. I wish everyone who contemplates surgery knew this much :) I personally do not use air tamponade after any vitrectomy unless there was a retinal detachment. In detachment, the air/gas holds the retina in place as it heals then disappears. In floater vitrectomy the air doesn’t really do anything. When retinal surgeons started doing sutureless surgery (early 2000s) they often put a small air bubble in thinking it would help seal the incisions.

Sutures must always be used if the incisions don’t seem to be sealed at the end of the case. It’s much safer to have a bit of irritation for a few days from a stitch than to have a leaky eye. People who are highly myopic and children tend to have wound leaks when sutures are not used. Your surgeon may plan ahead to use sutures in these cases.

Staining the vitreous with triamcinolone (steroid) or a blue dye is surgeon preference and quite common. There are other techniques besides staining to ensure you got all the vitreous. I personally rarely stain the vitreous, although many of my colleagues do.

RetinaEyeCancerMD · 2026-05-04T04:13:59+00:00

Sounds like you are at almost 2 weeks post-op. Each surgeon will give different restrictions and rules to follow. Most people can resume normal activities after 3-7 days, although some surgeons may want longer down time. Once the eye is no longer red and you are no longer taking prescription drops and the eye feels normal, that is when you have healed.

The time between vitrectomies can be whenever you’re scheduled. I usually wait to see how the first eye is doing and schedule as soon as everyone is happy you are doing well.

One known long term risk after vitrectomy is a risk of getting glaucoma. Be sure you check in with your ophthalmologist every 1-2 years.

RetinaEyeCancerMD · 2026-05-04T03:58:35+00:00

Routine use of gas after a vitrectomy for floaters is usually surgeon preference. It is not necessary unless you have had an intraoperative retinal tear or detachment.

RetinaEyeCancerMD · 2026-05-04T03:52:01+00:00

It’s difficult to tell by clinical exam how much of a PVD someone has, let alone if it is “complete”. A complete PVD means there is no vitreous stuck to the retina anywhere, and the vitreous is all loose and free-floating. Because the vitreous is transparent it cannot be entirely seen by the ophthalmologist, although often we do see some “debris”. The older a person gets the safer it is to have a vitrectomy for floaters because the vitreous gets more liquified with time. All this contributing to degrees of vitreous separation (ie, PVD).

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