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Using extremely small-gauged instruments and special magnification to perform this very delicate surgery, the retina specialist starts by making three microscopic incisions in the white of

the eye to access the gel, or vitreous, cavity behind the eye's lens and in front of the retina. The three incisions, or ports, Murray explains, allow the retina specialist to: (1) put

saline solution into the eye to keep it inflated during surgery; (2) insert a light pipe into the eye; and (3) allow the doctor to introduce micro forceps, which will be used to gently

“peel” or remove the ERM. These incisions, Awh notes, are so small they are usually self-sealing and don't require sutures. With the newest techniques and instruments, Murray says, the

retinal specialist can now delicately remove a second layer, too, the internal limiting membrane (ILM), beneath the ERM, in patients who have a more advanced ERM. This, he says, prevents the

ERM from recurring. Total surgery time is usually less than one hour. A side benefit of the vitrectomy is that when the gel inside the eye is removed and replaced with saline solution, any

existing floaters and debris are also eliminated. Within 24 hours, Awh points out, the body replaces the saline solution with its own fluid. After the surgery, a patch is placed over the

eye, and the patient returns the following day for its removal and an initial exam. The white of the eye will be red for about a week. Vision recovery, Awh says, is slow. “The vision on day

one is typically a little worse than when the patient arrives. It takes most patients a few days to get back to their baseline vision.” Most patients see an improvement within three months,

and it usually takes a year for maximum vision improvement. More precisely, Awh says, “There isn't great data for vision improvement because many aspects of vision are subjective, such

as decreased distortion. Most studies measure improvement in visual acuity (for example, what line on the eye chart a patient can read). I think it's safe to say that 80 to 90 percent

of patients will ultimately have improved vision. Those who don't improve typically maintain stable vision, which is a better outcome than the progressive decline in vision that

accompanies some macular ERMs.” RISKS AND COMPLICATIONS Experts describe the risk factors for the vitrectomy as small, but caution that the surgery does increase cataract progression for

patients who still have their natural lens. “Many patients will need cataract surgery within a year,” Awh adds. About 1 in 100 patients develop a retinal detachment, which will need to be

repaired. And 1 in 2,000 patients get an infection in the eye, which can be treated with antibiotics. FINDING A RETINA SPECIALIST • Consult the American Society of Retina Specialists

website, asrs.org. Click the “Find a Retina Specialist” at the top left to locate a doctor in your area. • Ask the right questions. It's always important to feel confident in the retina

specialist you select; and it is always a good practice to get a second opinion. And ask the specialist: * How many vitrectomies have you performed? * How many complications have your

patients experienced? * How often do your patients suffer eye infections as a result of the surgery? • Don't schedule your surgery unless you are satisfied with the answers.