How much vitrectomy is enough? A narrative review

The optimal extent of vitreous removal in modern vitreoretinal surgery remains controversial. While extensive vitrectomy has traditionally been performed to minimize traction and reduce postoperative complications, emerging evidence challenges its routine use across all indications. This narrative review critically evaluates whether extensive vitreous removal provides superior outcomes compared to limited, vitreous-sparing approaches. Current data do not demonstrate a consistent or clinically meaningful advantage of extensive vitrectomy. Although broader vitreous removal may reduce residual traction, it is associated with increased intraoperative manipulation and a higher risk of iatrogenic retinal injury, particularly during peripheral vitreous shaving. In contrast, limited vitrectomy appears sufficient in macular surgery and selected cases of rhegmatogenous retinal detachment, especially with advances in microincisional techniques, high-speed cutters and improved visualization systems. In complex tractional diseases, however, more extensive dissection may still be required. Overall, the available evidence supports a selective, pathology-driven approach rather than routine extensive vitreous removal, reflecting a shift toward more precise and minimally invasive vitreoretinal surgery.