Pars plana vitrectomy (PPV)

The vitreous body is a gel-like mass that makes up the majority of the human eye. The vitreous fills the space between the lens and the retina at the back of the eye. Its most important function is to maintain the eyeball in its round shape.

In certain diseases, it may be necessary to remove the vitreous body. In this case, we perform a procedure called a pars plana vitrectomy (PPV). In this procedure, we remove the vitreous body and fill the cavity with a replacement substance. In this way, we can stabilize or completely restore vision in many cases.

What is a pars plana vitrectomy?

Vitrectomy is the surgical removal of the vitreous humor. A pars plana vitrectomy is a special type of vitrectomy that is performed over a specific point in the back of the eye (the "pars plana"). It is a closed-system vitrectomy in which a special surgical method is used to maintain eye pressure. As a result, the eye retains its round shape during surgery and cannot collapse.

During vitrectomy, three fine tools are inserted into the eye under local or general anesthesia. These include a light source, a surgical tool, and an irrigation drain that is used to maintain eye pressure during surgery. The surgeon removes the entire vitreous body, including any opacities or foreign bodies. The vitreous body is then replaced with a special fluid or gas.

Depending on the clinical picture, the surgeon performs other treatment steps, such as removal of the lens or laser treatment of the retina. The fine surgical incisions quickly close again on their own after the procedure or are closed with a special suture material.

When is a Pars Plana Vitrectomy necessary?

We perform pars plana vitrectomy for a variety of conditions. The procedure is mainly used for retinal diseases, as in this case it is often necessary to remove the vitreous in order to reach the retina in the back part of the eye.

A retinal tear can usually be successfully treated with outpatient laser treatment. However, if left untreated, the retinal hole can develop into a retinal detachment, in which the retina lifts away from the underlying tissue. Depending on the extent of the retinal detachment, surgery is usually necessary. Pars plana vitrectomy is a proven method in this case, with which we achieve a permanent reattachment of the retina in the vast majority of patients.

Pars plana vitrectomy can also be useful for diseases and injuries of the vitreous body itself. These include, for example, hemorrhages into the vitreous, foreign bodies or inflammations inside the eye, as well as vitreous opacities that have existed for a long time. In the case of such opacities, the benefits and risks must be carefully weighed. As a rule, a pars plana vitrectomy is only performed if the patient finds the opacities massively disturbing.

What happens before a Pars Plana Vitrectomy?

Before we make the decision to perform a pars plana vitrectomy, several examinations are necessary. First of all, the anamnesis, i.e. the patient interview, is in the foreground. On the basis of your complaints, we usually receive initial indications of a possible disease. This is followed by a thorough ophthalmological examination. This includes, among other things, an eye test, an evaluation of the fundus of the eye, and an eye pressure measurement. Depending on the existing symptoms, further examinations may also be necessary, for example an ultrasound.

If we decide to perform a pars plana vitrectomy due to your symptoms, sometimes anticoagulant medications and painkillers (e.g. aspirin) must be discontinued prior to surgery. This may be done in consultation with the prescribing physician. Before the vitrectomy, you will also be personally informed about all details.

What is the procedure of a Pars Plana Vitrectomy?

Pars plana vitrectomy (PPV) usually takes place under local anesthesia, occasionally under general anesthesia. The anesthetic is injected behind or next to the eyeball. This temporarily disables the eye's ability to move and perceive pain.

In the first step, the surgeon makes three tiny accesses. Through these, the light source, working instrument and irrigation drainage are introduced into the vitreous body. The surgeon works with a special surgical microscope, which allows him to perform all steps precisely and to assess the condition inside the eye.

The gelatinous vitreous body is now aspirated from the eye, including any foreign bodies or opacities present. At the same time, the surgeon fills a special fluid solution with a cannula. In this way, the eye pressure remains largely constant during the entire operation. Depending on the findings, further steps are performed. For example, after removing the vitreous, the surgeon can reattach the retina if it has detached from the underlying supply layer.

At the end of the pars plana vitrectomy, the fluid may be aspirated and replaced by a so-called tamponade. This consists of air, gas, liquid or silicone oil and presses the retina back against the underlying layers by applying even pressure. After surgery, the gas or fluid is gradually broken down by the body and replaced by the body's own fluid. If silicone oil is used, it will need to be removed and replaced with a fluid later in a second procedure.

After the pars plana vitrectomy, the eyes are dressed with a bandage. Overall, the vitrectomy takes about 30-60 minutes, depending on the amount of work involved. After the operation, patients usually remain in the clinic for a few days, so that we can monitor the healing process closely.

What is the healing process like after the operation?

After pars plana vitrectomy, the eye is usually free of irritation and should not cause you any major discomfort except for a slight foreign body sensation. It is important that you maintain a certain positioning in the following days, which we will demonstrate to you prior to the surgery. Abrupt movements of the head should also be avoided in the initial period, as the retina must first grow firmly back into place.

Depending on the substance used, several weeks may pass before the tamponade is completely absorbed by the body. During this time, air travel, high-altitude stays and any other form of large differences in air pressure must be avoided. Furthermore, you should take it easy on yourself in the weeks following the operation. Your treating ophthalmologist will also inform you again personally about which behaviors are important in your specific case.

The day after the pars plana vitrectomy, we will perform a first follow-up examination during your inpatient stay. Further examinations will take place at regular intervals. After about eight weeks, wound healing is largely complete.

What are the risks of a pars plana vitrectomy?

Every operation always involves certain risks. This is also and especially true for eye surgeries such as pars plana vitrectomy. As a rule, patients therefore remain in our clinic as inpatients for a few days. In this way, we can guarantee close monitoring and optimal medical care after the pars plana vitrectomy.

Possible complications during and after the operation are bleeding, infections as well as injuries of the retina and other structures in the eye. Nowadays, pars plana vitrectomy is a routine ophthalmological procedure that can be performed very gently using modern surgical methods and is generally uncomplicated.

After vitrectomy, retinal detachment, intraocular pressure fluctuations or cataract (cataract) may occur in individual cases. Decisive for the risk assessment is the individual risk profile of the patient as well as the expected benefit of the surgery. The benefits and risks are carefully weighed before the decision to operate is made.

From your side it is important that you conscientiously follow all given rules of conduct. If you experience sudden pain after the operation or if you notice a significant deterioration in your vision, please contact our clinic or the emergency ophthalmological service immediately.

What effect does a pars plana vitrectomy have on my vision?

The goal of pars plana vitrectomy is to restore impaired vision or at least prevent it from worsening. In individual cases, blindness can even be prevented. The prognosis depends very much on the type of disease. Hemorrhages and vitreous opacities can usually be removed without problems, although there is a risk that hemorrhages will recur.

In the case of retinal detachment, the prognosis depends on how far the disease has progressed. In isolated cases, the retina may detach again after surgery, which usually occurs in a period of about 3 - 6 months after pars plana vitrectomy. In some diseases, such as diabetic retinopathy, irreparable damage to the retina may also already be present. In this case, despite successful pars plana vitrectomy, it is not always possible to completely restore vision.

Before a possible vitrectomy, we will discuss with you in detail whether this form of treatment is suitable for you and what the prognosis is in your specific case. Only after thoroughly weighing the advantages and disadvantages do we decide, in consultation with you, on a pars plana vitrectomy. For us, the goal of any treatment is to maximally improve or stabilize your vision.

What does a Pars Plana vitrectomy cost?

The costs for a pars plana vitrectomy are covered by statutory health insurance if the operation is medically necessary. Depending on the findings, however, certain preliminary examinations may be useful from a medical point of view, which go beyond the benefits catalog of the health insurance companies. We will inform you about this in detail prior to the pars plana vitrectomy. Vitrectomy is usually performed as an inpatient operation. The inpatient stay lasts 2-3 days.