Surgical Excellence: Advanced Vitreoretinal & Anterior Segment Microsurgery

When your vision requires surgical intervention, our clinic utilizes the most advanced microsurgical platforms in the world. We specialize in Micro-Incisional Vitrectomy Surgery (MIVS), a "sutureless" approach that allows for faster healing and minimal postoperative discomfort. Our goal is to combine technical precision with a clear, supportive recovery plan tailored to your specific needs.

    • The Procedure: This is the foundation of most retinal surgeries. We delicately remove the vitreous gel—the clear substance filling the eye—to gain direct access to the retina.

    • Why it Matters: Removing the gel allows us to clear away blood, debris, or scar tissue that is blocking or pulling on your vision. Once the gel is removed, and the retinal repair is completed, it is replaced with a clear saline solution or a temporary gas bubble to support the retina during healing.

    • Instrumentation: We perform micro-incisional pars plana vitrectomy using 23-, 25-, and 27-gauge systems, choosing the gauge that best fits each case.

    • The Procedure: A specialized, multi-step surgery used when a large bleed occurs directly beneath the macula (the center of your vision).

      • The Vitrectomy: First, we remove the vitreous to reach the area.

      • The "Clot-Buster": We use an ultra-fine needle to inject a specialized enzyme (tPA) under the retina to "liquefy" the clotted blood.

      • Displacement: A gas bubble is placed in the eye. With specific head positioning after surgery, this bubble acts as a gentle "cushion," pushing the liquefied blood away from your central vision and into the periphery where it can be naturally absorbed.

    • Why it Matters: Blood is toxic to the delicate photoreceptors of the retina. By moving the blood quickly, we prevent permanent scarring and provide the best chance for central vision recovery.

    • Note on Long-Term Care: This surgery addresses the immediate crisis, but the underlying condition usually requires ongoing office-based injections to prevent future bleeding.

    • The Procedure: Depending on the nature of the detachment, we use several methods—including a vitrectomy, placing a scleral buckle with laser or cryotherapy (freezing) —to seal retinal tears and move the retina back into its attached position.

    • Why it Matters: A detached retina is a medical emergency. Our goal is to "tack" the retina back down as quickly as possible to restore the flow of nutrients and prevent permanent vision loss.

    • The Procedure: Initially, a vitrectomy is performed. Using high-powered magnification and microscopic forceps, we gently peel away a "cellophane-like" layer of scar tissue (the membrane) or close a small gap (the hole) in the macula.

    • Why it Matters: These conditions cause central vision to become blurred or distorted. By removing the physical tension on the macula, we allow the tissue to flatten and heal, improving your ability to read and recognize faces.

    • The Procedure: We specialize in complex "secondary" lens surgeries. This includes placing an Intraocular Lens (IOL) when there is no capsular support, exchanging an existing lens that is no longer optimal, or repositioning a lens that has shifted.

    • Why it Matters: Whether due to previous trauma or surgical complications, a displaced lens can cause blurry vision and inflammation. We use advanced suturing or "friction-fit" techniques to ensure your lens is centered and stable.

    • The Procedure: This involves the surgical implantation of a microscopic tube (or "shunt") that directs excess fluid out of the eye to a small reservoir.

    • Why it Matters: When eye drops or laser treatments cannot sufficiently lower eye pressure, a GDD provides a reliable "safety valve" to prevent further damage to the optic nerve and preserve your remaining vision.

Where your surgery happens

Retinal surgery is performed at HCA Florida Memorial Hospital and Baptist Medical Center Jacksonville. Which facility is used depends on the type of case, the equipment required, and how urgently you need to be in the operating room. Most retinal surgery is same-day: you arrive in the morning or early afternoon, and you go home a few hours later.

Dr. Elkeeb spent a decade performing vitreoretinal surgery as a university faculty surgeon and clinical trial investigator before opening this practice. You are seen the day after surgery and at every post-operative visit that follows.

Anesthesia and what the day looks like

Most vitreoretinal surgery is done under local anesthesia with sedation rather than general anesthesia. An anesthesiologist gives you medication through an IV so that you are relaxed and comfortable, and the eye itself is numbed with an injection around it. You are not awake in the way you might imagine, and you will not see the surgery.

Plan on being at the facility for roughly half a day even though the surgery itself is usually much shorter. You will need someone to drive you home. You will be given specific instructions about eating, drinking, and which of your regular medications to take beforehand — follow those exactly, because a case can be cancelled on the day for something as simple as a morning cup of coffee.

Gas bubbles, positioning, and flying

Many retinal operations end with a gas bubble placed inside the eye. The bubble is not a lens — it is a temporary internal splint that holds the retina in position while it heals, and it works by floating upward. That is why positioning instructions matter so much.

  • Vision through a gas bubble is poor. Patients often describe a dark, wobbling line across their sight that gradually falls as the bubble shrinks. This is expected, not a complication.
  • Positioning is part of the treatment. If you are told to keep your face down or your head turned to one side, that instruction is doing real work. Ask how many hours per day and for how many days — and ask about equipment rental if face-down positioning is required.
  • Do not fly, and do not drive to high altitude, while a gas bubble is present. Gas expands as outside pressure drops, and this can raise the pressure inside the eye to a dangerous level. Dr. Elkeeb will tell you when the bubble has gone and it is safe to travel.
  • Tell any anesthesiologist about the bubble. Certain anesthetic gases can expand it. This matters if you need unrelated surgery or dental work in the weeks afterward.

Some cases use silicone oil instead of gas. Oil does not absorb on its own and is usually removed in a second, shorter operation months later. If oil is planned for your eye, that will be discussed with you beforehand.

Recovery

Every eye is different, and the honest answer to "when will I see again" depends far more on what the retina looked like going in than on the surgery itself. That said, some things are common to nearly all retinal surgery:

  • The first week. Expect redness, a gritty or scratchy feeling, some aching, and light sensitivity. Several eye drops are used — typically an antibiotic, a steroid, and sometimes a pressure-lowering drop. You will be given a written schedule.
  • Activity. Walking and normal daily movement are fine. Avoid heavy lifting, straining, and bending at the waist. Keep water out of the eye, and do not rub it. No swimming pools or hot tubs until you are cleared.
  • Cataract. Vitrectomy accelerates cataract formation in most adult eyes that still have their natural lens. This is expected rather than a complication, and cataract surgery is straightforward when the time comes.
  • Follow-up. You will be seen the day after surgery, again within the first week or two, and then at intervals that depend on how the eye is healing.

Call us, don't wait

After any retinal surgery, contact the office right away if you have worsening pain that is not controlled, vision that is getting worse rather than better, a new shower of floaters or a curtain across your vision, or increasing redness and discharge. These are uncommon, and nearly all are manageable when caught early. Call (904) 666-5050 — do not wait for your next scheduled appointment.

Conditions these operations treat

Retinal detachment · Macular hole · Epiretinal membrane · Advanced diabetic retinopathy · Macular degeneration with submacular hemorrhage · Endophthalmitis

In-office procedures  ·  What to expect at your visit  ·  Insurances we accept

This page describes retinal surgery in general terms for patient education. It is not medical advice about your eye. What applies to your case will be discussed with you directly before any operation is scheduled.