0191T Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach, into the trabecular meshwork; initial insertion

Name of the Procedure:

Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach, into the trabecular meshwork; initial insertion
Common name(s): Trabecular Meshwork Stent Placement, Glaucoma Stent Insertion

Summary

In this procedure, a tiny device is inserted into the eye to help drain excess fluid, relieving high pressure inside the eye often caused by glaucoma. The device is placed directly into the trabecular meshwork, which is a part of the eye's drainage system, and does not involve any external reservoirs.

Purpose

The main goal of this procedure is to reduce intraocular pressure (IOP) in patients with glaucoma. By lowering the IOP, the procedure helps to prevent further damage to the optic nerve and preserve vision.

Indications

• Elevated intraocular pressure (IOP)
• Primary open-angle glaucoma
• Inadequate response to maximum tolerable medication therapy
• Progressive optic nerve damage despite medical treatment

Preparation

• Patients may need to stop certain medications prior to the procedure.
• Fasting may be required for a few hours before the procedure.
• Pre-procedure tests may include a comprehensive eye exam, visual field test, and ocular coherence tomography (OCT).

Procedure Description

1. The patient is given local anesthesia to numb the eye.
2. A small incision is made in the cornea.
3. A microscopic drainage device is inserted into the trabecular meshwork using a specialized delivery system.
4. The device helps facilitate the outflow of aqueous humor from the anterior chamber.
5. The incision may be closed with a tiny suture or may heal on its own.

Tools/Equipment:

• Microsurgical instruments
• Trabecular meshwork stent
• Microscope
• Anesthesia administration tools

Duration

The procedure typically takes about 10 to 20 minutes.

Setting

This procedure is usually performed in an outpatient surgical center or a hospital outpatient department.

Personnel

• Ophthalmic surgeon
• Surgical nurse
• Anesthesiologist or nurse anesthetist

Risks and Complications

• Infection
• Bleeding
• Increased intraocular pressure
• Corneal decompensation
• Device migration or obstruction
• Need for additional glaucoma surgery

Benefits

• Significant reduction in intraocular pressure
• Decreased need for glaucoma medications
• Preservation of optic nerve functionality and vision
• Minimally invasive with a quick recovery time

Recovery

• Patients may need to use prescribed antibiotic and anti-inflammatory eye drops.
• Avoid strenuous activities and heavy lifting for a few days.
• Follow-up appointments are essential to monitor eye pressure and device position.
• Full recovery typically occurs in a few weeks.

Alternatives

• Medicinal treatment (eye drops to lower IOP)
• Other surgical options (laser therapy, trabeculectomy, conventional glaucoma drainage devices)
  • Pros of alternatives: Potentially suitable for different severity stages and patient preferences
  • Cons of alternatives: May involve more invasive procedures or have different side effect profiles

Patient Experience

During the procedure, patients may feel some pressure but should not experience pain due to the local anesthesia. Post-procedure, there may be mild discomfort, redness, or blurry vision, which usually subsides within a few days. Pain management includes prescribed medications and cold compresses to ease discomfort. Regular follow-up visits are crucial to ensure the device is functioning and properly positioned.