CPT Code: 67041 (Vitrectomy, mechanical, pars plana approach; with removal of preretinal cellular membrane [eg, macular pucker])
Introduction
A patient presented several months after surgery to repair a chronic retinal detachment complaining of decreased vision to 20/125. During the prior surgery, silicone oil was used for tamponade and was subsequently removed. Upon examination, it was found that he had developed a very thick epiretinal membrane (ERM). However, because the patient was traveling outside the country, he was unable to have surgery for over 6 months, during which time the membrane progressively got worse.
Surgical Plan
The patient was eventually scheduled for a pars plana vitrectomy with removal of the ERM. For membrane peeling, we selected the Ultra Peel forceps (DORC). These forceps are designed for single-movement peeling of thicker, more fibrotic membranes. The blunt, rounded tip design and optimal shaft stiffness provide precise control for smaller-gauge surgery, while the micro-serrated forceps provide a broad grasping surface for fibrous or adherent membranes.
Surgical Steps and Outcome
The membrane was tightly adherent, requiring force to remove it. The membrane was removed atraumatically and a complete air-fluid exchange was performed. The patient’s vision remained stable after the procedure, and he is recuperating well as he visits his home country.
Discussion
While many membranes can be removed with a surgeon’s go-to set of forceps, it is crucial to stock other varieties of forceps for those membranes which require more delicacy, or more force. In my hands, I have found that the rounded tip and flat platform on the Ultra Peel forceps are advantageous, as they allow a strong grip on the membrane but may reduce the risk of puncturing the retina when starting the peel. For this membrane in particular, the Ultra Peel was a fantastic choice—the rounded tip minimized trauma to associated structures and minimized tearing of a membrane that is actively being engaged. Further, the serrated grasping platform has a generous surface area to maximize grip strength. All in all, for tough membranes such as post-silicone oil epiretinal membranes or proliferative vitreoretinopathy, I am glad to have these forceps in my armamentarium.
