Vitrectomy, mechanical, pars plana approach; with endolaser panretinal photocoagulation
CPT4 code
Name of the Procedure:
Vitrectomy, mechanical, pars plana approach with endolaser panretinal photocoagulation
Summary
In a vitrectomy with endolaser panretinal photocoagulation, a surgeon removes the vitreous gel from the eye and uses a laser to treat the retina. This is performed through the pars plana, which is a part of the eye situated behind the lens. The procedure helps address various retinal conditions.
Purpose
This procedure is primarily used to treat conditions affecting the retina such as diabetic retinopathy, retinal detachment, and vitreous hemorrhage. The goals are to remove any opacities or hemorrhage in the vitreous gel and to use laser treatment to repair or stabilize the retina, thereby improving vision or preventing further vision loss.
Indications
- Retina detachment
- Diabetic retinopathy with vitreous hemorrhage
- Macular hole
- Epiretinal membrane
- Complications from eye injuries
- Severe infections in the eye (endophthalmitis)
Patients typically eligible for this procedure include those experiencing vision loss due to these retinal issues, unresponsive to other treatments, or at high risk for more serious complications.
Preparation
- Patients are usually advised to avoid eating or drinking for at least 8 hours before surgery.
- Medication adjustments may be necessary, particularly for those on anticoagulants or diabetic medications.
- Pre-operative assessments may include an eye examination, a thorough medical history, and imaging tests like OCT (Optical Coherence Tomography) or ultrasound of the eye.
Procedure Description
- Anesthesia: The procedure is typically performed under local anesthesia, sometimes with sedation.
- Incisions: Small incisions (sclerotomies) are made in the pars plana of the eye.
- Vitrectomy: A vitrector, a specialized tool, is used to remove the vitreous gel.
- Endolaser Treatment: A laser fiber is inserted through the sclerotomies to apply panretinal photocoagulation to targeted areas on the retina.
- Completion: The eye is usually filled with a gas bubble or silicone oil to help the retina remain in position as it heals.
- Incision Closure: The incisions may be closed with tiny sutures or left to self-seal.
Duration
The procedure typically takes 1 to 2 hours, depending on the complexity of the condition being treated.
Setting
The procedure is performed in an operating room, usually within a hospital or a specialized outpatient surgical center.
Personnel
- Ophthalmologist/Retina Specialist (surgeon)
- Anesthesiologist or Nurse Anesthetist
- Surgical nurses and technicians
Risks and Complications
- Infection
- Bleeding
- Retinal detachment or re-detachment
- Increased intraocular pressure
- Cataract formation
- Recurrence of the original condition
Careful monitoring and follow-up are essential to manage any complications effectively.
Benefits
- Improved vision or stabilization of current vision levels
- Prevention of further vision loss
- Reduced risk of future retinal detachments or hemorrhage
Benefits are typically realized within weeks to months following the procedure, depending on the specific condition and patient healing rates.
Recovery
- Patients may need to position their head in a certain way if a gas bubble is used.
- Use of prescribed eye drops to prevent infection and reduce inflammation.
- Restrictions on activities, particularly those involving heavy lifting or straining.
- Follow-up appointments to monitor healing and intraocular pressure.
Complete recovery can take several weeks, during which vision may gradually improve.
Alternatives
- Laser photocoagulation without vitrectomy (useful in less severe cases)
- Injections of medications into the eye (e.g., anti-VEGF treatments)
- Observation and monitoring for less advanced conditions
Each alternative has its own risks and benefits, often considered based on the severity and progression of the retinal disease.
Patient Experience
- During the procedure: Patients may feel pressure but usually not pain, due to anesthesia.
- After the procedure: Vision may be blurry initially, accompanied by some discomfort or redness.
- Pain management: Eye drops and medications are provided to alleviate discomfort.
- It is crucial to follow post-operative instructions closely to ensure a smooth and effective recovery.