Injection of vitreous substitute, pars plana or limbal approach (fluid-gas exchange), with or without aspiration (separate procedure)
CPT4 code
Name of the Procedure:
Injection of vitreous substitute, pars plana or limbal approach (Fluid-Gas Exchange) with or without aspiration
Summary
This procedure involves injecting a substance (gas or fluid) into the vitreous cavity of the eye to replace the eye's natural vitreous humor. The approach can be either through the pars plana or the limbus (two different areas at the front of the eye). It can also involve the removal of existing fluid. This can be performed as a separate procedure.
Purpose
This procedure is typically performed to treat eye conditions that affect the vitreous humor or retina. Goals include stabilizing the retina, improving vision, or reducing symptoms like floaters.
Indications
- Retinal detachment
- Macular hole
- Vitreous hemorrhage
- Diabetic retinopathy
- Other conditions requiring vitreoretinal surgery
Preparation
- Patients usually need to fast for a certain period before the procedure.
- You may need to adjust or stop certain medications, particularly blood thinners.
- A comprehensive eye exam and possibly imaging tests like an OCT (Optical Coherence Tomography) scan or ultrasound will be done.
Procedure Description
- The eye is numbed using local anesthesia.
- A small incision is made either in the pars plana or limbus.
- A tool is inserted to remove existing vitreous fluid, if necessary.
- The vitreous cavity is filled with a gas or fluid substitute.
- The procedure may involve replacing a part of the vitreous humor or all of it, depending on the condition.
- The incision is then closed, and the eye may be patched temporarily.
Duration
The procedure typically takes around 30 to 60 minutes.
Setting
This procedure is usually performed in an outpatient surgical center or a specialized eye clinic.
Personnel
- Ophthalmic surgeon
- Surgical nurses
- Sometimes an anesthesiologist or nurse anesthetist
Risks and Complications
- Infection
- Increased intraocular pressure
- Cataract formation
- Retinal tear or detachment
- Incomplete gas absorption
- Vision loss (rare)
Benefits
- Significant improvement in vision
- Stabilization of retinal conditions
- Reduction or elimination of symptoms like floaters
- Benefits can often be noticed within weeks as the eye heals.
Recovery
- You may need to keep your head in a certain position to help the gas bubble position the retina.
- Avoid strenuous activities and heavy lifting.
- Follow-up appointments are crucial to monitor healing.
- Eye drops may be prescribed to prevent infection and control inflammation.
Alternatives
- Laser photocoagulation
- Scleral buckle surgery
- Vitrectomy without fluid-gas exchange
- Pros and cons include varying recovery times, invasiveness, and suitability based on specific eye conditions.
Patient Experience
During the procedure, you will likely only feel slight pressure due to local anesthesia. Post-procedure, you may experience eye discomfort, redness, and blurred vision. Pain is usually manageable with over-the-counter pain relief, and specific positioning may be required for optimal recovery.