0449T Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space; initial device

Name of the Procedure:

Insertion of Aqueous Drainage Device, without Extraocular Reservoir, Internal Approach, into the Subconjunctival Space; Initial Device

Summary

This procedure involves inserting a tiny device into the eye to help drain excess fluid. It is performed internally without creating an external reservoir and aims to reduce eye pressure, which can help manage conditions like glaucoma.

Purpose

• Medical Condition: Primarily used to treat glaucoma.
• Goals: To lower intraocular pressure (IOP) and prevent further damage to the optic nerve, potentially preserving vision.

Indications

• Elevated intraocular pressure not controlled by medications or other treatments.
• Progressive glaucoma with risk of vision loss.
• Patients who have not responded to or are not suitable candidates for other surgical options.

Preparation

• Instructions: Patients may need to avoid eating or drinking for a few hours before the procedure.
• Assessments: Preoperative eye examination and possibly visual field testing. Blood tests and evaluation of overall health.

Procedure Description

1. Anesthesia: The patient receives local anesthesia to numb the eye.
2. Access: A small incision is made in the conjunctiva (eye's outer layer) to reach the subconjunctival space.
3. Insertion: The aqueous drainage device is carefully implanted to ensure proper placement.
4. Closing: The incision site is sutured or left to heal naturally depending on the technique used.

Duration

Typically takes about 30 minutes to an hour.

Setting

Performed in a hospital, outpatient ophthalmology clinic, or surgical center.

Personnel

• Surgeons specializing in ophthalmology.
• Nurses to assist and provide care before, during, and after the surgery.
• An anesthesiologist or nurse anesthetist for local anesthesia administration.

Risks and Complications

• Common Risks: Infection, bleeding, swelling, discomfort, temporary blurred vision.
• Rare Complications: Device malfunction, severe infection, significant vision loss, or prolonged inflammation.

Benefits

• Effective reduction in intraocular pressure.
• Decreased need for glaucoma medications.
• Possible stabilization or improvement in vision health within weeks to months following the procedure.

Recovery

• Post-Procedure Care: Use of prescribed antibiotic and anti-inflammatory eye drops.
• Instructions: Avoid strenuous activity, follow specific eye hygiene practices.
• Recovery Time: Generally a few weeks, with follow-up visits to monitor healing and device function.

Alternatives

• Medications: Eye drops or oral medications to reduce intraocular pressure.
• Laser Treatments: Laser trabeculoplasty or cyclophotocoagulation.
• Other Surgeries: Trabeculectomy, minimally invasive glaucoma surgeries (MIGS), or placement of drainage shunts with reservoirs.

Patient Experience

• During Procedure: Minimal discomfort due to local anesthesia; patients may feel pressure or mild movements but no sharp pain.
• After Procedure: Some soreness, redness, and temporary blurred vision are common. Over-the-counter pain relievers and prescribed drops will manage discomfort. Regular follow-up is essential for monitoring and ensuring success of the procedure.