Repair of retinal detachment; with vitrectomy, any method, including, when performed, air or gas tamponade, focal endolaser photocoagulation, cryotherapy, drainage of subretinal fluid, scleral buckling, and/or removal of lens by same technique
CPT4 code
Name of the Procedure:
Repair of Retinal Detachment; with Vitrectomy, Including Air or Gas Tamponade, Focal Endolaser Photocoagulation, Cryotherapy, Drainage of Subretinal Fluid, Scleral Buckling, and/or Removal of Lens by Same Technique
Summary
In this procedure, various methods are employed to repair a detached retina— a medical emergency where the retina peels away from its underlying layer. Techniques used may include vitrectomy (removal of the eye's vitreous gel), and may involve air or gas injections, laser treatments, freezing therapy, fluid drainage, or securing the retina with a buckle, sometimes necessitating the removal of the lens.
Purpose
This procedure aims to reattach the retina to its proper position, thereby restoring vision and preventing permanent loss of sight. It addresses retinal detachment, a condition that, if untreated, can lead to severe and irreversible vision impairment.
Indications
- Sudden appearance of floaters or flashes
- Shadow or curtain over part of your visual field
- Severe nearsightedness (myopia causing retinal tears)
- History of retinal detachment in the other eye
- Family history of retinal detachment
- Recent eye surgery or trauma
Preparation
- Fasting may be required several hours before the procedure.
- Avoid taking certain medications as instructed by the doctor.
- Pre-procedure assessments may include a thorough eye examination and imaging tests like an ultrasound or Optical Coherence Tomography (OCT).
Procedure Description
- Anesthetic drops or general anesthesia is administered for comfort.
- Small incisions are made to remove the vitreous gel (vitrectomy).
- Air or gas may be injected to reattach the retina to underlying tissues.
- Additional techniques, like endolaser photocoagulation or cryotherapy, are used to seal retinal tears.
- Subretinal fluid is drained if necessary.
- In some cases, a scleral buckle is placed around the eye to support the retina.
- If required, the lens may be removed and replaced.
Duration
The procedure typically takes around 1 to 2 hours.
Setting
It is performed in a hospital or an outpatient surgical center.
Personnel
- Ophthalmic surgeon
- Anesthesiologist
- Surgical nurses and technicians
Risks and Complications
- Infection
- Bleeding in the eye
- Increased intraocular pressure
- Cataract formation
- Recurrence of retinal detachment
- Vision changes or loss
- Adverse reactions to anesthesia
Benefits
- Prevention of permanent vision loss
- Restoration of vision
- High success rate in reattaching the retina
Recovery
- Use of eye drops to prevent infection and inflammation
- Avoid heavy lifting and strenuous activities
- Positioning head as directed (sometimes face-down)
- Follow-up visits for monitoring and removal of gas bubbles, if applicable
- Full recovery can take several weeks to months
Alternatives
- Pneumatic retinopexy (less invasive; involves injecting a gas bubble)
- Scleral buckling without vitrectomy
- Observation in very low-risk or asymptomatic cases
Each alternative has its own set of benefits and drawbacks, and the choice depends on the specific details of the retinal detachment and patient condition.
Patient Experience
During the procedure, patients receive anesthesia, so there is no pain. Post-procedure, mild discomfort, irritation, or blurry vision can occur, managed with medication and appropriate care. Temporary visual disturbances and the need for head positioning are common until the eye heals.