VITROREORETINAL SURGERY
prof. Dr. Ümit İNAN, Pars plana vitrectomy (PPV) is a technique used in vitreoretinal surgery to treat conditions such as retinal detachments, vitreous hemorrhage, endophthalmitis and macular holes in a controlled, closed system. The procedure takes its name from the vitreous removal from the eye (ie vitreus + ectomy = vitreous removal) and the introduction of instruments into the eye through the pars plana.
Pars plana vitrectomy (PPV) is a surgical technique originally introduced by Robert Machemer in 1974. With this technique, clearing and removing the vitreous in the vitreous cavity in a closed system has been a major step in the surgical treatment of retinal diseases. In the intervening time, there have been great changes in the application methods of pars plana vitrectomy surgery with many innovations.
The border between the cornea and the white part of the eye is called the limbus, and in the area up to 4-5 mm behind the limbus, there is an area called the pars plana where it is safe to enter the eye with needles. Performing surgery by entering the vitreous cavity from the pars plana region allows the treatment of many vitreoretinal diseases.
In the surgical treatment of retinal detachments, techniques such as cleaning the vitreous in the eye, soothing the retina, and keeping it attached by injecting silicone or gas into the eye have become possible with this method.
Again with these methods, the cleaning of intraocular hemorrhages and the ability to soothe tractional retinal detachments again provided a significant reduction in blindness due to diabetes.
With pars plana vitrectomy, all kinds of foreign bodies falling or stuck on the vitreous cavity or retina, including cataract and intraocular lens, can be removed.
With the development of vitreoretinal surgery, it has become possible to close the macular holes and to clean the thick membranes that develop in front of the macula.
Vitreoretinal surgery requires a great deal of technical skill and knowledge to achieve good results. A successful vitrectomy can preserve or restore vision and improve quality of life in patients who develop any vitreoretinal disease. However, this surgery is also prone to complications. Although this possibility is very low when performed by experienced surgeons and with the right techniques, these complications can cause serious vision problems when they develop. Therefore, correct diagnosis and surgical technique, good timing and postoperative management are important.
Vitreoretinal surgery is a complicated procedure performed with patience, attention and care. During this surgery, vitrectomy is performed with pars plana entrances. This procedure is called pars plana vitrectomy (PPV).
The vitreous is a gel that fills the vitreous cavity and is adhered to the retina along the posterior cortical vitreous. This gel is removed during PPV. The vitreous cavity is filled with normal serum infusion during surgery.
The procedure can be performed under general anesthesia or under local anesthesia via a block around the eye. The patient is covered in a sterile manner, as in any surgical procedure. A wide viewing lens is used to allow the surgeon to view the intraocular instruments and the base of the eye through a microscope, and an eyelid speculum is inserted to keep the eye open during this procedure. Special needles, which we call trocars, are about the thickness of an insulin needle, are inserted into the eye from at least 3 points, and the vitrectomy probe, light probe, laser probe and other surgical instruments used during the surgery are passed through these special needles and surgery is performed inside the eye.
With advanced retinal surgical techniques performed during vitreoretinal surgery, it is possible to repair advanced retinal detachments and to save the patient from blindness.
Along with vitrectomy performed in vtreoretinal surgery, procedures such as cleaning the membranes on the retina, releasing the attached areas of the retina, cutting or removing operations in some parts of the retina, cleaning the subretinal bands, soothing the retina, and applying lasers to the necessary areas are also performed.
Vitreoretinal surgery is a highly technical procedure that can save vision in many patients with acute or chronic vitreoretinal pathology. A good outcome has a significant impact on the patient’s quality of life. Postoperative surveillance and management are essential for good outcome. Overall, vitreoretinal surgery plays a crucial role in preventing and restoring vision loss.
In the last 10 years, there have been very important developments in vitreoretinal surgery and surgical techniques have advanced a lot. With many developments such as new technology operating microscopes and wide imaging systems, extremely safe and fast vitrectomy devices, safer and better lighting systems, device-mounted laser systems, thinner trocars and surgical instruments, vitreoretinal surgery has become more frequent and reliable. .
Situations Requiring Vitreoretinal Surgery (Prof. Dr. Ümit İNAN)
Vitreous Bleeding
Tractional Retinal Detachment
Torn Retinal Detachment
End-stage Diabetic Retinopathy
Full Layer Macular Hole
Lamellar Macular Hole
Epiretinal Membrane
Vitreomacular Traction
Myopic Foveaschisis
Persistent Macular Edema
endophthalmitis
vitritis
Dropping of the intraocular lens into the eye
Cataract falling into the eye
Eye Traumas
Intraocular Foreign Bodies
Subretinal Bleedings
Optic Pit Maculopathy
Vitreous Biopsy
