Vitrectomy, mechanical, pars plana approach; with removal of internal limiting membrane of retina (eg, for repair of macular hole, diabetic macular edema), includes, if performed, intraocular tamponade (ie, air, gas or silicone oil)
CPT4 code
Name of the Procedure:
Vitrectomy, mechanical, pars plana approach with removal of internal limiting membrane of retina (e.g., for repair of macular hole, diabetic macular edema), includes, if performed, intraocular tamponade (i.e., air, gas, or silicone oil).
Summary
A vitrectomy is a surgical procedure that involves the removal of the vitreous gel from the eye. This particular method involves making an incision through the pars plana (a part of the eye), mechanically removing parts of the retina's internal limiting membrane to treat conditions such as macular holes or diabetic macular edema. The procedure may include inserting substances like air, gas, or silicone oil to help the eye heal.
Purpose
This procedure is performed to address issues like macular holes or diabetic macular edema, which can cause significant vision problems. The goal is to improve or stabilize vision by eliminating the factors causing retinal damage and assisting in the retinal healing process.
Indications
- Macular hole: A small break in the macula (part of the retina responsible for central vision).
- Diabetic macular edema: Swelling in the macula due to diabetes.
- Any patient experiencing significant visual impairment due to these conditions may be eligible for this surgery.
Preparation
- Fasting: Patients might be instructed not to eat or drink for several hours before the procedure.
- Medication adjustments: Certain medications may need to be paused or adjusted.
- Diagnostic tests: Comprehensive eye exams, imaging tests like Optical Coherence Tomography (OCT), and occasionally blood tests.
Procedure Description
- Anesthesia is administered; usually, local anesthesia combined with sedation.
- A small incision is made in the pars plana region of the eye.
- The vitreous gel is removed using a specialized cutting tool.
- The internal limiting membrane of the retina is carefully peeled off.
- If necessary, an intraocular tamponade substance (air, gas, or silicone oil) is injected to help maintain the retinal position and facilitate healing.
- The incisions are then closed, and an antibiotic ointment is applied to prevent infection.
Duration
The procedure typically lasts between 1 to 2 hours.
Setting
Performed in a hospital operating room or an outpatient surgical center.
Personnel
- Ophthalmic surgeon
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Common risks: Infection, bleeding, increased intraocular pressure.
- Rare complications: Retinal detachment, cataract formation, recurrent macular hole.
- Management of complications may require further medical or surgical intervention.
Benefits
- Enhanced or stable vision.
- Relief from symptoms related to macular holes or diabetic macular edema.
- Improvement can often be noticed within several weeks post-surgery.
Recovery
- Patients must wear an eye patch for a few days.
- Specific positioning of the head may be required if a gas bubble is used.
- Avoid strenuous activities and heavy lifting for several weeks.
- Follow-up appointments to monitor healing and manage potential complications.
Alternatives
- Intravitreal injections: Medication injections directly into the eye.
- Laser treatments: Used primarily for diabetic macular edema.
- Observation: In some cases, the condition might be monitored over time rather than immediately treated.
Patient Experience
- Some discomfort and mild pain post-surgery, managed with prescribed pain relievers.
- Blurred vision initially, which gradually improves as the eye heals.
- Strict adherence to post-operative instructions is crucial for optimal recovery and outcome.