What is Pars Plana Vitrectomy?
Pars plana vitrectomy (PPV) is a commonly employed technique in vitreoretinal surgery that enables access to the posterior segment for treating conditions such as retinal detachments, vitreous hemorrhage, endophthalmitis, and macular holes in a controlled, closed system.
Dr. Michael Kapusta, MD, FRSCS, Ophthalmologist, talks about retinal detachment and pars plana vitrectomy as a treatment.
Pars Plana Vitrectomy to Treat Retinal Detachment
The repair of retinal detachment with pars plana vitrectomy implies an operation in the operating room, which is typically performed under local, or in some cases, under general anesthesia. The operation involves placing instruments inside the eye and removing the vitreous.
At the conclusion of retinal detachment repair, your surgeon will place a gas bubble in the eye. Gas bubbles can last in the eye from weeks to several weeks – somewhere between two and four weeks typically, depending on the type of gas chosen by your surgeon.
This will imply the need to keep your head in a particular position during the days to weeks after your operation. Many patients when told of the need to keep their head in a particular position ask “How will I do this, doctor?”
In order to achieve optimal results with retinal detachment repair, patients will require particular positioning. There are companies that provide and can sell or lease to you equipment that will facilitate your recovery by ensuring that you maintain the position that your surgeon requires for your repair.
After pars plana vitrectomy to repair the retinal detachment, there are certain restrictions. In addition to the head position, one cannot be at an elevation of higher than 3,000 feet or airplane travel. These are strict restrictions as the gas bubble that is in your eye will expand and cause pressure problems if one does not heed these restrictions.
In regards to restrictions after pars plana vitrectomy, it is best to follow your surgeon’s advice.
Local Practitioners: Ophthalmologist
What is Advanced (Proliferative) Diabetic Retinopathy and Pars Plana Vitrectomy?
Diabetic patients may experience two forms of retinopathy. One is called background, the other proliferative. Background retinopathy has changes in the retina that include swelling of the retina, or diabetic macular edema.
Proliferative diabetic retinopathy may have growth of blood vessels, which can bleed in the eye, or pull on the retina and detach the retina. Diabetic retinopathy that’s called proliferative, where there’s bleeding or pulling on the retina, may require the consultation with a vitreoretinal surgeon.
Advanced diabetic retinopathy or proliferative diabetic retinopathy can be associated with hemorrhage and traction on the retina. If these situations cannot be controlled with injections of drugs such as anti-VEGF medication or laser photocoagulation, they may require an intervention called pars plana vitrectomy.
Your ophthalmologist or retina specialist may send you for an opinion of a vitreoretinal surgeon to determine whether your disease state has reached a point that you would benefit from pars plana vitrectomy to maintain or stabilize your vision in diabetic retinopathy.
Pars plana vitrectomy is typically performed under a local – but sometimes under general anesthesia. The surgeon will enter the eye with a cutting device to remove the blood, and sometimes with a cutting device or scissors, to remove traction that is pulling on your retina.
The recovery from diabetic vitrectomy is longer than vitrectomies for other conditions. Diabetics are operated on because there’s blood or traction in their eye. Even after the operation, there may be recurrent bleeding, which can last days to weeks, and the need for restricted head position.
One should not expect a rapid improvement of vision after diabetic vitrectomy. The goal of this operation is to improve the prognosis in the long run, and to stabilize diabetic retinopathy. It is not usually an immediate recovery of central or peripheral vision.
The improvements in the technology for pars plana vitrectomy in patients who have diabetic retinopathy have offered better outcomes. That said, the ultimate improvement of vision will rely and depend upon the underlying state of the diabetic retinopathy. So that is if a patient has significant poor circulation, the vitrectomy will improve part of their vision but not everything.
Your doctor will be the best person to determine how much vision improvement can be gained by pars plana vitrectomy in your case. By following the suggestions of your surgeon, and maintaining particular head position in the aftermath of pars plana vitrectomy, you can improve the chances of improving your vision after a diabetic vitrectomy.
If you have had bleeding in your eye, or your doctor has noted progressive growth of blood vessels and traction, you may be best served by having the opinion of a vitreoretinal surgeon to determine whether or not your condition has reached the point of requiring pars plana vitrectomy.
Local Practitioners: Ophthalmologist
Dr. Michael Kapusta, MD, FRSCS, Ophthalmologist, talks about what a macular hole is and the treatment with pars plana vitrectomy surgery.