Discission of vitreous strands (without removal), pars plana approach
CPT4 code
Name of the Procedure:
Discission of vitreous strands, pars plana approach
Summary
This procedure involves using a surgical technique to cut through and separate vitreous strands without removing any vitreous tissue. Vitreous strands are fibrous tissues in the eye that can interfere with vision. The procedure is carried out using the pars plana approach, a method that minimizes damage to the eye.
Purpose
The purpose of this procedure is to address issues caused by vitreous strands, which can tug on the retina or other parts of the eye, potentially causing visual disturbances or worsening existing eye conditions. The goal is to relieve tension and improve or stabilize vision.
Indications
- Presence of vitreous strands causing visual disturbances
- Vitreous traction resulting in retinal tears or detachment
- Persistent floaters that significantly impair vision
- Vitreous opacities unresolved by other treatments
Patient criteria often include:
- Confirmed diagnosis of vitreous strands affecting quality of life
- Age and general health allowing for surgical intervention
Preparation
- Fasting may be required a few hours before the procedure.
- Adjustment or temporary discontinuation of certain medications, such as blood thinners.
- Pre-procedure diagnostic tests like an ocular ultrasound or OCT (Optical Coherence Tomography) to assess the extent of vitreous strands.
Procedure Description
- The patient is administered local anesthesia around the eye, sometimes accompanied by sedation for comfort.
- The eye is cleaned and covered to maintain a sterile environment.
- A tiny incision is made in the pars plana, the white part of the eye, about 3-4 mm behind the cornea.
- Specialized micro-instruments and a vitrectomy machine are inserted through the incision.
- Using these tools, the surgeon carefully cuts through the vitreous strands without removing any vitreous humor.
- Once the vitreous strands are separated, the instruments are removed, and the incision is closed, often without stitches.
Duration
The procedure typically takes between 45 minutes to 1 hour.
Setting
The procedure is usually performed in a hospital or outpatient surgical center equipped with specialized ophthalmic surgical tools.
Personnel
- Ophthalmic surgeon
- Operating room nurses
- Anesthesiologist or nurse anesthetist (if sedation is used)
- Surgical technician
Risks and Complications
- Infection
- Bleeding
- Increased intraocular pressure
- Retinal detachment
- Cataract formation
- Vision changes or loss
Benefits
- Relief from visual disturbances caused by vitreous strands
- Reduction in vitreous traction, decreasing the risk of retinal tears or detachment
- Stabilization or improvement of vision
Benefits are often realized within a few days to weeks after the procedure, as the eye heals.
Recovery
- Post-procedure antibiotics and anti-inflammatory eye drops are usually prescribed.
- The patient may wear an eye patch or shield for protection.
- Avoid strenuous activities and heavy lifting for a specified period, usually a few weeks.
- Follow-up appointments with the ophthalmologist to monitor healing and assess the effectiveness of the procedure.
Typical recovery time is around two weeks, with restrictions on certain activities to ensure proper healing.
Alternatives
- Observation and monitoring for mild symptoms
- Laser photocoagulation for specific types of vitreous strands or retinal issues
- Vitrectomy, which involves the removal of vitreous humor and may be considered for more severe cases
Each alternative carries its own set of pros and cons, such as varying degrees of invasiveness and different risk profiles.
Patient Experience
During the procedure, the patient may feel slight pressure but should not experience significant pain due to the local anesthesia and possible sedation. Post-procedure, mild discomfort or irritation is common, and pain can usually be managed with over-the-counter pain relief medications. Vision may be blurry initially but generally improves as the eye heals.