Repair of complex retinal detachment (eg, proliferative vitreoretinopathy, stage C-1 or greater, diabetic traction retinal detachment, retinopathy of prematurity, retinal tear of greater than 90 degrees), with vitrectomy and membrane peeling, including, w
CPT4 code
Name of the Procedure:
Repair of Complex Retinal Detachment with Vitrectomy and Membrane Peeling
Common name(s): Retinal Detachment Repair, Vitrectomy
Technical or medical terms: Proliferative Vitreoretinopathy (PVR), Diabetic Traction Retinal Detachment, Retinopathy of Prematurity, Retinal Tear
Summary
This surgical procedure corrects complex retinal detachments, where the retina peels away from its underlying layer of support tissue. It involves removing the vitreous gel from the eye, peeling off scar tissue membranes, and repositioning the retina to its proper place.
Purpose
This procedure aims to reattach the retina to restore vision and prevent further vision loss. It addresses conditions such as proliferative vitreoretinopathy, diabetic traction retinal detachment, retinopathy of prematurity, and extensive retinal tears.
Indications
- Partial or complete retinal detachment
- Proliferative vitreoretinopathy (PVR), Stage C-1 or greater
- Diabetic traction retinal detachment
- Retinal tears greater than 90 degrees
- Patients experiencing vision loss, vision floaters, flashes, or a curtain-like shadow over their field of vision
Preparation
- Fasting for a few hours before the procedure
- Adjustment of medications as directed by the physician
- Comprehensive eye examination
- Imaging tests like ultrasound or optical coherence tomography (OCT) might be required
Procedure Description
- The patient is given local or general anesthesia.
- An incision is made in the eye to access the vitreous chamber.
- Vitrectomy is performed, removing the vitreous gel to prevent it from pulling on the retina.
- Membrane peeling involves removing scar tissue from the surface of the retina.
- The retina is then repositioned and may be held in place with a gas bubble, silicone oil, or laser surgery.
- The incisions are closed and the eye is patched.
Duration
The procedure typically lasts 2 to 3 hours.
Setting
The procedure is performed in a hospital or specialized surgical center.
Personnel
- Ophthalmic Surgeon
- Anesthesiologist or Nurse Anesthetist
- Surgical Nurses
- Ophthalmic Technicians
Risks and Complications
- Infection
- Bleeding
- Increased intraocular pressure
- Cataract formation
- Recurrence of retinal detachment
- Vision loss
- Discomfort or pain in the eye
Benefits
- Improved vision
- Stabilization of retinal function
- Prevention of further vision loss Results may be noticeable within weeks to months as the eye heals.
Recovery
- Use of eye drops to prevent infection and reduce inflammation
- Wearing an eye patch or shield as instructed
- Avoiding strenuous activities and heavy lifting
- Positioning face down if a gas bubble was used
- Follow-up appointments to monitor recovery Recovery time varies but typically ranges from a few weeks to several months.
Alternatives
- Pneumatic retinopexy
- Scleral buckle surgery
- Laser photocoagulation or cryopexy
- Observation for some less severe detachments Each alternative has its own pros and cons, which should be discussed with the ophthalmologist.
Patient Experience
Patients may feel light pressure during the procedure if under local anesthesia. Post-procedure, discomfort and blurry vision are common but manageable with prescribed pain relief. Strict adherence to post-op care, including positioning and activity restriction, is crucial for optimal recovery.