This article will address what a pars plana vitrectomy is, its contraindications and risks, and what to expect from this type of surgery.
What Is a Pars Plana Vitrectomy?
A pars plana vitrectomy can help improve vision. It is used for several eye conditions that affect the retina (the light-sensitive tissue in the back of the eye) or the vitreous (the gel-like fluid that fills the space between the lens and retina). These include:
A detached retina, which is when the retina moves from its normal position Bleeding in the vitreous A dislocated intraocular lens, which can occur in rare cases after a surgeon removes the eye’s natural lens and replaces it with an artificial, intraocular lens during cataract surgery A macular hole, which is a small break in the area of the retina’s center called the macula that can negatively affect your vision A foreign object stuck in the eye caused by an injury Endophthalmitis, which is a serious infection or inflammation in the eye that causes vision loss Epiretinal membrane, which is a type of membrane that can form over the retina and may cause a loss of vision
An eye surgeon also may use a vitrectomy to place a device or a drug-delivery system in the eye.
How Does the Procedure Work?
A pars plana vitrectomy is usually performed in an outpatient surgical center and may take one to three hours. Depending on the reason for surgery, it can be scheduled or it can be used to treat an emergency eye problem. Both adults and children can have a vitrectomy.
Surgeons will perform a vitrectomy on one eye at a time. If both eyes need a vitrectomy, a separate procedure will be scheduled for the second eye at a later date.
You will receive numbing eye drops during a pars plana vitrectomy. Most people receive intravenous (IV) sedation. This will help you to relax during the procedure while also staying awake. Sometimes, general anesthesia is used, which will put you in a sleeplike state.
To perform a vitrectomy, the surgeon will make small cuts into your sclera, which is the white part of your eye. The surgeon often will enter the eye through an area called the pars plana, which is why this procedure is called pars plana vitrectomy. A special microscope will give the surgeon a more detailed view of the eye to assist with surgery.
Posterior: In the posterior ( (back) segment of the eye Anterior: In the anterior (front) of the eye
A retina specialist will perform a posterior pars plana vitrectomy. This medical professional is a type of ophthalmologist (eye doctor) who specializes in surgeries in the back of the eye, including the retina. Anterior vitrectomy is less common. Most ophthalmologists are trained to perform an anterior vitrectomy.
Depending on the reason for the surgery, the surgeon might:
Remove scar tissue around the retina Remove vitreous material that is cloudy: This material is replaced with a saltwater solution, a gas bubble, or oil. Move the retina to its correct position: This would be done for a retinal detachment. Place an air or gas bubble or silicone oil in your eye to keep the retina in its correct position: Air or gas bubbles will eventually go away on their own; silicone oil is later removed by the surgeon in a separate procedure. Use a laser to help fix a torn retina
The surgical staff will monitor you after surgery, after which you can return home.
Contraindications
Most patients can have a pars plana vitrectomy if needed. The one exception to this appears to be if there is a tumor in the eye. This is considered a contraindication (advised against) because of concern that the tumor may spread during surgery. However, there are some situations in which a surgeon may recommend a pars plana vitrectomy because of the threat of vision loss even if the patient has a tumor in the eye.
Potential Risks
A vitrectomy has certain risks associated with it, including:
Bleeding Formation of a cataract (cloudy area of the lens), especially in those who are age 50 or older Detached or torn retina Glaucoma (group of eye conditions that damage the optic nerve) caused by a rise in pressure in the eye Infection Loss of some vision
Your surgeon will weigh those risks against the benefits of a pars plana vitrectomy. They may determine that the risks are worth it because the surgery often will make your vision better.
Preparation
Here are some tips to help you prepare for surgery beforehand and the day of.
How to Prepare
Before surgery, your surgeon will closely examine your eye using certain tests, including:
A dilated eye exam, which provides a better view the back of the eye Optical coherence tomography, an imaging tool that uses light to take pictures of the retina Fluorescein angiography, which uses a special camera and dye to see how blood flows through the retina
If the surgery also will include the front part of the eye, even more tests will be performed.
What to Expect on the Day of Surgery
The surgical team will let you know if you can eat or drink before surgery. They may advise you to have nothing by mouth after midnight on the day of the vitrectomy. You can ask if you can take any medications on their regular schedule. They may say it’s OK so long as you take them with just a tiny amount of water.
Prior to surgery, you will change your clothes, lie down, and let the surgical team place a variety of monitors on you. These will include IV therapy, electrocardiogram (EKG, to record electrical signals from the heart), and oxygen monitors to provide medicine and to monitor your vital signs.
You will most likely receive a minimal amount of sedation for a pars plana vitrectomy, unless you are particularly anxious or unstable. In these cases—and with children—the surgical team will use general anesthesia.
Immediately After Surgery
You also will receive other medications to help prevent infection and to make the surgery painless.
After surgery, your surgeon will patch and shield the eye to keep it safe from injury.
If you received a gas bubble or silicone oil, you will be instructed on any special positioning you must maintain and for how long.
Recovery
You can expect to return to your surgeon’s office the day after surgery. You should arrange for a ride there.
During that visit, you will receive instructions on how to use certain medications and your eye patch. You will also be told when it is safe to drive again, which is typically a couple of days to a couple of weeks after surgery. Your eye doctor also may advise you to avoid strenuous exercise until the eye heals.
Generally speaking, it takes two to four weeks to recover from a vitrectomy, although getting your vision back to normal may take slightly longer.
Some normal aftereffects in the eye include:
Bruising near the eyeEyelid swellingFeeling like there is something in your eye or having a sandy, gritty sensation in the eyeRednessSome changes to your vision
Eye drops prescribed by your surgeon will help your eyes to heal more quickly. Let your surgical team know immediately or call 911 if you feel any severe pain in the eye or have sudden vision loss.
Aftercare for a Gas Bubble
If you had a gas bubble inserted in the eye, you will have to avoid certain activities for a couple of weeks, including:
Air travelNitrous gas anesthesiaTravel to higher altitudesScuba diving
These activities could enlarge the size of the bubble. You also will need to hold your head in a certain position for one to three weeks after surgery to help the bubble maintain its position. The surgical team will further instruct you on how to do this.
Aftercare for Silicone Oil
If the surgeon used silicone oil in the eye, you will need to schedule a second procedure for a couple of months later to remove it.
Summary
Pars plana vitrectomy, or vitrectomy, is a type of surgery performed to treat a variety of problems and conditions in the back of the eye, including a detached retina or a macular hole. The surgery is usually performed in an outpatient center. Most people can safely have a vitrectomy. Some risks associated with vitrectomy include bleeding and the formation of a cataract.
A Word From Verywell
If your eye doctor recommends that you have a pars plana vitrectomy, it is usually to keep you from losing a significant amount of vision. This is a scary possibility, but keep in mind that this procedure can greatly improve your chances of retaining vision and that complications are rare.
Ask any questions that you have about what to expect from the surgery and how you can take care of your eyes before, during, and after the procedure.
