Name of the Procedure:

Vitrectomy, mechanical, pars plana approach, with subretinal injection of pharmacologic/biologic agent (C9770)

Summary

A vitrectomy is a surgical procedure used to remove the vitreous gel from the eye. In this specific procedure, the surgeon uses a mechanical pars plana approach to access the vitreous cavity and also injects a pharmacologic or biologic agent under the retina to treat certain retinal conditions.

Purpose

The procedure is designed to address retinal disorders such as retinal detachment, diabetic retinopathy, macular holes, or age-related macular degeneration. The primary goals are to remove pathological vitreous gel, repair retinal detachments, and deliver therapeutic agents directly to the affected area to improve or stabilize vision.

Indications

This procedure is typically indicated for:

• Retinal detachment
• Advanced diabetic retinopathy
• Macular holes
• Age-related macular degeneration not responding to other treatments
• Vitreomacular traction Patients experiencing vision loss, floaters, flashes, or other symptoms related to the above conditions may be appropriate candidates for this procedure.

Preparation

• Patients should fast for at least 8 hours prior to the procedure.
• Specific medications may need to be adjusted or stopped, as advised by the healthcare provider.
• Pre-procedure assessments may include blood tests, imaging studies (e.g., OCT, fluorescein angiography), and a thorough eye examination.

Procedure Description

1. The patient is placed under local or general anesthesia.
2. Three small incisions are made in the pars plana area of the sclera (the white part of the eye).
3. Surgical instruments, including a vitrectomy probe, light source, and infusion line, are inserted through these incisions.
4. The vitreous gel is carefully removed to gain clear access to the retina.
5. The pharmacologic or biologic agent is injected under the retina using specialized instruments.
6. Any additional necessary retinal repairs are conducted.
7. The instruments are removed, and the incisions are closed with self-sealing or sutured techniques.

Duration

The procedure typically takes about 1 to 2 hours, depending on the complexity of the retinal issues being treated.

Setting

The procedure is performed in a hospital operating room or a specialized outpatient surgical center.

Personnel

The team usually includes:

• An ophthalmic surgeon specializing in retinal surgery
• Anesthesiologist
• Surgical nurses
• Ophthalmic technical staff

Risks and Complications

Common risks include:

• Infection
• Bleeding
• Increased intraocular pressure
• Cataract formation Rare but serious complications may include:
• Retinal detachment
• Vitreous hemorrhage
• Loss of vision

Benefits

The expected benefits include the stabilization or improvement of vision and the successful treatment of the underlying retinal condition. These benefits are typically realized within a few weeks post-procedure.

Recovery

• Patients may need to use antibiotic and anti-inflammatory eye drops postoperatively.
• The eye may be patched for a short period after the surgery.
• Avoid strenuous activities for a specified period as advised by your doctor.
• Follow-up appointments are crucial for monitoring healing and addressing any complications.

Alternatives

Alternative treatments might include:

• Laser photocoagulation
• Intravitreal injections of pharmacologic agents
• Scleral buckling Each alternative has its own set of benefits and drawbacks, which should be discussed with the healthcare provider to determine the best course of action.

Patient Experience

During the procedure, patients under local anesthesia may feel some pressure but should not experience pain. Postoperative discomfort can be managed with medication. Patients might experience mild pain, redness, or swelling in the eye, which typically subsides in a few days. It's crucial to follow all postoperative care instructions to ensure a smooth recovery.