Vitrectomy, mechanical, pars plana approach; with removal of subretinal membrane (eg, choroidal neovascularization), includes, if performed, intraocular tamponade (ie, air, gas or silicone oil) and laser photocoagulation
CPT4 code
Name of the Procedure:
Vitrectomy, mechanical, pars plana approach; with removal of subretinal membrane (e.g., choroidal neovascularization), includes, if performed, intraocular tamponade (i.e., air, gas, or silicone oil) and laser photocoagulation.
Summary
A vitrectomy is a delicate eye surgery that removes the vitreous gel from the middle of the eye using specialized equipment. This particular type involves accessing the eye through the pars plana, removing any abnormal subretinal membranes and possibly using air, gas, or silicone to aid eye healing. It may also include laser treatment to seal any issues or prevent further damage.
Purpose
Vitrectomy aims to treat conditions like choroidal neovascularization, where abnormal blood vessels grow under the retina. By removing these membranes, the procedure helps restore or stabilize vision, decrease symptoms, and prevent further eye damage.
Indications
- Presence of choroidal neovascularization.
- Severe vision loss or blurriness.
- Retinal detachment or tears requiring detailed attention.
- Failed response to other treatments for subretinal membrane conditions.
Preparation
- Patients may need to fast for a few hours before the procedure.
- Specific medications might need adjustment (e.g., blood thinners).
- Pre-operative tests might include ocular imaging, blood tests, and a physical exam.
Procedure Description
- The patient receives either local or general anesthesia.
- The surgeon makes small incisions in the pars plana, the white part of the eye.
- A vitrectomy probe removes the vitreous gel inside the eye.
- Special instruments are used to excise any subretinal membranes.
- If needed, an intraocular tamponade with air, gas, or silicone oil is applied to hold the retina in place.
- Laser photocoagulation may be performed to seal retinal tears or holes.
- The incisions are self-sealing, but sometimes sutures are needed.
Duration
The procedure typically takes between 1 to 2 hours.
Setting
Vitrectomies are usually performed in a hospital's surgical suite or an outpatient surgical center.
Personnel
- Ophthalmic surgeon
- Surgical nurses
- Anesthesiologist or nurse anesthetist
- Technicians specialized in eye surgery equipment
Risks and Complications
- Infection
- Bleeding
- Increased intraocular pressure
- Cataract formation
- Retinal detachment
- Vision changes or loss
Benefits
- Improved or stabilized vision.
- Decreased symptoms associated with subretinal membranes.
- Prevention of further retinal damage.
Recovery
- Patients may need to use antibiotic and anti-inflammatory eye drops.
- Eye protection and head positioning might be required, especially if gas is used.
- Recovery time varies, but normal activities can often resume in a few days with full recovery within weeks.
- Follow-up appointments will monitor healing and address any concerns.
Alternatives
- Anti-VEGF injections to reduce abnormal blood vessel growth.
- Photodynamic therapy (PDT) for selective elimination of abnormal vessels.
- Traditional laser photocoagulation without vitrectomy.
- Observation, if the condition is not progressing rapidly.
Patient Experience
During the procedure, patients under local anesthesia may feel slight pressure but no pain. Post-procedure, mild discomfort or soreness is typical, manageable with prescribed pain relief. Visual recovery may begin immediately, but full benefits will unfold over several weeks.