Name of the Procedure:

Implantation of intravitreal drug delivery system (e.g., ganciclovir implant), includes concomitant removal of vitreous

Summary

This procedure involves the implantation of a small drug delivery device directly into the eye, which releases medication over time to treat certain eye conditions. During the same procedure, part of the vitreous gel inside the eye is removed to facilitate the implant placement.

Purpose

This procedure is primarily used to deliver long-term medication directly to the eye to treat conditions like cytomegalovirus (CMV) retinitis. The goal is to provide sustained drug delivery to manage chronic eye conditions effectively and to improve or stabilize vision.

Indications

• CMV retinitis, particularly in immunocompromised patients
• Severe or persistent ocular infections that require long-term treatment
• Conditions where systemic drug delivery is less effective or unsuitable
• Patients who have not responded well to other treatments

Preparation

• The patient may be instructed to fast for a few hours before the procedure.
• Detailed medical history and current medications will be reviewed.
• Preoperative eye examinations and imaging tests may be performed.
• Patients might need to arrange for someone to drive them home post-procedure.

Procedure Description

1. The patient is given local anesthesia to numb the eye, often combined with a mild sedative.
2. An eye speculum is used to keep the eyelids open.
3. A small incision is made in the eye, and part of the vitreous gel is removed through vitrectomy.
4. The drug delivery implant, such as a ganciclovir device, is carefully inserted into the back of the eye.
5. The incision is then closed, often with small sutures, and the eye is covered with a protective shield.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

This procedure is performed in a hospital operating room or an outpatient surgical center with specialized eye care facilities.

Personnel

• Ophthalmic surgeon
• Surgical nurse
• Anesthesiologist or nurse anesthetist (if sedation is used)
• Operating room support staff

Risks and Complications

Common risks:

• Infection
• Bleeding
• Increased intraocular pressure
• Inflammation

Rare risks:

• Retinal detachment
• Implant displacement
• Vision loss

Management of complications may involve additional medications, treatments, or surgeries.

Benefits

• Targeted, sustained drug delivery directly to the site of the problem
• Reduced need for frequent eye injections
• Potential stabilization or improvement of vision
• Convenience, particularly for chronic conditions

Recovery

• The patient will be monitored briefly post-procedure for immediate complications.
• Instructions will include using prescribed eye drops to prevent infection and reduce inflammation.
• Avoid heavy lifting, strenuous activities, and rubbing the eye for the first few days.
• Follow-up appointments will be scheduled to monitor the healing and effectiveness of the implant.

Alternatives

• Oral or intravenous medication
• Intravitreal injections administered more frequently
• External laser treatments
• Advantages of the implant include convenience and sustained drug delivery, while alternatives may require more frequent interventions and may have different risk profiles.

Patient Experience

• The patient may feel pressure but should not experience pain during the procedure due to anesthesia.
• Mild discomfort and redness in the eye post-procedure are common and usually temporary.
• Pain management typically involves over-the-counter pain relievers and prescribed eye drops.
• Normal activities can often be resumed within a few days, but specific recovery guidance will be provided.