Vitrectomy, mechanical, pars plana approach; with focal endolaser photocoagulation
CPT4 code
Name of the Procedure:
Vitrectomy, mechanical, pars plana approach; with focal endolaser photocoagulation
Summary
A vitrectomy is a surgical procedure where the vitreous gel (the clear, jelly-like substance) within the eye is removed. Using a pars plana approach, this procedure also involves the application of endolaser photocoagulation to treat retinal issues.
Purpose
This procedure is primarily performed to treat various retinal conditions such as retinal detachments, macular holes, and diabetic retinopathy. The goal is to preserve or improve vision and address underlying retinal issues.
Indications
- Retinal detachment
- Macular hole
- Diabetic retinopathy with vitreous hemorrhage
- Epiretinal membrane
- Vitreous hemorrhage
- Severe eye trauma
Preparation
- Fasting for 8 hours prior to the procedure.
- Routine blood tests and eye exams.
- Arrangements for someone to drive the patient home after the procedure.
- Possibly discontinuing certain medications as advised by the doctor.
Procedure Description
- Anesthesia: The patient is given local or general anesthesia.
- Initial Steps: Small incisions are made in the sclera, the white part of the eye, to access the vitreous cavity.
- Vitrectomy: The vitreous gel is removed using a tiny cutting and suctioning instrument.
- Laser Treatment: Endolaser photocoagulation is then applied to the target areas of the retina to repair tears.
- Completion: The eye may be filled with a gas bubble or silicone oil to help hold the retina in place.
Duration
Typically, the procedure lasts between 1.5 to 3 hours, depending on the complexity of the case.
Setting
The procedure is usually performed in a hospital or a specialized surgical center.
Personnel
- Ophthalmic surgeon
- Surgical nurses
- Anesthesiologist
Risks and Complications
- Infection
- Increased intraocular pressure (glaucoma)
- Cataract formation
- Retinal detachment recurrence
- Bleeding
- Vision loss
Benefits
- Stabilization or improvement in vision.
- Treatment of the underlying retinal condition.
- Prevention of further retinal damage.
Recovery
- The patient may need to maintain a specific head position for several days if a gas bubble is used.
- Antibiotic and anti-inflammatory eye drops.
- Avoidance of heavy lifting or strenuous activities for a few weeks.
- Follow-up visits to monitor healing and intraocular pressure.
Alternatives
- Laser photocoagulation alone without removing the vitreous.
- Cryopexy (freezing treatment) for small tears.
- Scleral buckle surgery for retinal detachment.
- Each alternative has pros and cons, such as the invasiveness of the procedure and recovery times.
Patient Experience
During the procedure, the patient is generally sedated and should not feel pain. Post-operatively, there may be discomfort and pressure in the eye, managed with medications. Vision might be blurry while the eye heals, and adherence to the post-operative instructions is crucial for a successful recovery.