What is Pars Plana Vitrectomy?

In order to perform surgery in the posterior segment of your eye, your surgeon will enter
through an area called pars plana. Your eyes contain clear internal jelly called vitreous, which may have to be removed during the procedure. It's called vitrectomy and is an important procedure required for the surgery of most retinal disorders. You need to bear in mind that pars plana vitrectomyrefers to a number of operations performed to gain access to the deeper part of your eye. Keep reading to learn more about it.

Purpose of Pars Plana Vitrectomy

In the past, it wasn't possible to treat several types of retinal disorders but it has now become possible due to pars plana vitrectomy.Your doctor will make three tiny incisions in your eye and insert three separate instruments through each of these incisions. The pars plana is the area located between the iris and retina, and your surgeon will make incisions in this area to gain access to your retina. By entering your eye through this area, your surgeon ensures that you don't experience any issues with your crystalline lens and your retina.

Pars plana vitrectomyis a suitable choice for many different disorders that require accessing the posterior segment of your eye. Common indications include vitreous hemorrhage, rhegmatogenous-tractional retinal detachment, endophthalmitis, retained lens fragments, macular hole, and intraocular foreign bodies.

Techniques Used in Pars Plana Vitrectomy

Doctors use different techniques to complete pars plana vitrectomy.Here are a few of the most commonly used techniques.

  • Endodrainage: The technique involves draining the fluid beneath your retina through an existing retinal hole. The hole is then closed by trans-scleral cryo or endolaser.
  • Intraocular Gases: The mixture of sterile air and gases such as sulfur hexafluoride are used in this technique. Air stays in the eye for about seven days but gas stays in your eye longer. Doctors use the gas to close macular holes. The technique is effective but may sometimes result in complications such as glaucoma or progression of cataract.
  • Silicone Oil: The technique works like intraocular gases, but gas is replaced with a clear viscous fluid to avoid complications and to keep the retina in place postoperatively.
  • Perfluorocarbon Liquid: Used in complicated cases, the technique involves settling the retina on the operation table. This is usually a good choice in cases involving giant retinal tears.
  • Endolaser: The technique involves using laser beams to correct issues such as retinal tears, especially in retinal detachment.
  • Microsurgical Instruments: Some doctors may prefer working with scissors, forceps, and other microsurgical instruments to remove foreign bodies and scar tissues.
  • Endoscopy: The technique lets your surgeon to view the inside of your eye while dealing with intraocular structures. It proves beneficial when the lens or cornea is too cloudy.
  • Scleral Buckling: The technique is usually used to provide your reattached retina with more support. It is not always necessary to combine sclera buckling with a vitrectomy procedure.
  • Lensectomy: The procedure refers to the removal of your eye's crystalline lenses and is usually necessary when there is cataract obstructing the view of the surgeon. This is usually a choice in diabetic retinopathy procedures.

Complications of Pars Plana Vitrectomy

Although the availability of several techniques has made pars plana vitrectomyrelatively safe, you may still end up experiencing several complications. The most common complication is bleeding. You may also end up dealing with retinal detachment and infection. It is important for you to stop using any blood-thinning medication your doctor may have prescribed to avoid complications during the procedure. It is equally important to maintain adequate IOP and take other steps to prevent choroidal hemorrhage.

Your doctor should wash your eyes with a dilute povidone-iodine solution before your surgery. Topical or sub-conjunctival antibiotics should be taken soon after the surgery to prevent any infections. Topical antibiotic drops are also available and prescribed in some cases for the first week after surgery.

Retinal detachment is one of many risk factors of pars plana vitrectomy. It usually happens when an iatrogenic retinal break takes place during your surgery. It is extremely important to repair these detachments in the same way other type of retinal detachment repair is done.

Recovery after Pars Plana Vitrectomy

As mentioned, your doctor will prescribe antibiotic drops and other medications that you should continue to use for several weeks after your surgery. These medications help improve the healing process. You may have to maintain a certain head positioning if your doctor has used a gas bubble during the procedure – you should be sleeping on your side in this case. It is important that you avoid air travel until the gas bubble goes away completely. You should always go see your doctor immediately if you notice problems such as bleeding, infections, or vision change.