Excision of lesion, cornea (keratectomy, lamellar, partial), except pterygium
CPT4 code
Name of the Procedure:
Excision of lesion, cornea (keratectomy, lamellar, partial). Often referred to as a partial keratectomy or lamellar keratectomy.
Summary
In layman's terms, this procedure involves removing a lesion from the cornea (the clear, outer layer of your eye) without affecting the deeper layers. It is used when the whole cornea does not need treatment.
Purpose
The main goal is to remove abnormal or diseased tissue from the cornea to restore clarity, improve vision, or prevent further damage to the eye.
Indications
- Persistent corneal lesions or opacities not responding to other treatments.
- Superficial corneal scars.
- Corneal dystrophies confined to the upper corneal layers.
- Non-pterygium growths affecting vision.
Preparation
- Patients may be instructed to fast for several hours before the procedure.
- Cease using certain medications, especially blood thinners, as advised by the doctor.
- A comprehensive eye exam, including visual acuity tests and corneal topography, may be required.
Procedure Description
- The procedure is typically performed under local anesthesia with sedation.
- An operative microscope is used to enhance the surgeon's view.
- A microkeratome or excimer laser precisely removes the superficial corneal layers containing the lesion.
- The area is then smoothed, and any remaining irregularities are corrected.
- A bandage contact lens is placed to protect the cornea during healing.
Duration
The procedure typically takes about 30 to 60 minutes.
Setting
Usually performed in an outpatient surgical center or specialized eye clinic.
Personnel
- Ophthalmic surgeon.
- Anesthesiologist or nurse anesthetist.
- Surgical nurses and technicians.
Risks and Complications
- Infection.
- Corneal scarring.
- Vision changes, including blurriness or light sensitivity.
- Rare cases of corneal perforation.
- Delayed healing.
Benefits
- Improved vision by removing obstructions or scarring.
- Prevention of further corneal damage.
- Enhanced eye comfort.
Recovery
- Use antibiotic and anti-inflammatory eye drops as prescribed.
- Wear the bandage contact lens until advised by your doctor.
- Avoid straining the eyes; follow the doctor's guidelines on activities.
- Recovery typically takes a few weeks, with a follow-up appointment to monitor healing.
Alternatives
- Phototherapeutic keratectomy (PTK)
- Full-thickness corneal transplant (penetrating keratoplasty)
- Observation or medical treatment with eye drops. Pros and Cons: PTK is less invasive but may not remove all lesions; full transplant has a longer recovery but may be needed for deeper lesions.
Patient Experience
- Mild discomfort or gritty feeling in the eye after the procedure.
- Some vision blurriness during the initial healing period.
- Pain management through prescribed medications and over-the-counter pain relievers.
- An overall positive outcome with improved vision once healed.