Removal of corneal epithelium; with or without chemocauterization (abrasion, curettage)
CPT4 code
Name of the Procedure:
Removal of Corneal Epithelium (Abrasion, Curettage)
- Common names: Corneal Debridement, Epithelial Debridement
- Medical terms: Corneal Epithelial Removal, Corneal Debridement with Chemocauterization
Summary
Removal of the corneal epithelium involves carefully removing the outermost layer of the cornea. This procedure can be performed mechanically (abrasion or curettage) or chemically (chemocauterization). It is typically done to treat a variety of corneal disorders.
Purpose
The procedure addresses conditions such as recurrent corneal erosions, irregular corneal surfaces, and certain infections. The primary goal is to promote healthy regrowth of the corneal epithelium, reduce pain, and restore clear vision.
Indications
- Recurrent corneal erosions
- Superficial corneal dystrophies (e.g., anterior basement membrane dystrophy)
- Non-healing corneal ulcers
- Irregular or scarred corneal surfaces
- Evaluation or removal of infectious corneal lesions
Preparation
- The patient may need to stop using certain medications, like blood thinners, prior to the procedure.
- Diagnostic tests like corneal topography or confocal microscopy might be performed to assess the extent of the corneal problem.
- The patient should arrange for someone to drive them home after the procedure.
Procedure Description
- The patient lies down in a reclining chair or on a surgical table.
- Topical anesthetic drops are applied to numb the eye.
- A speculum is used to keep the eye open.
- The surgeon removes the damaged or diseased epithelium using a sterile instrument (microsurgical blade, brush, or curette) or applies a chemical agent for chemocauterization.
- The area is thoroughly cleaned, and a bandage contact lens is often placed to promote healing and reduce discomfort.
Duration
The procedure typically takes about 20 to 30 minutes.
Setting
It is usually performed in an outpatient setting, such as an eye clinic or ambulatory surgical center.
Personnel
- Ophthalmologist or Corneal Specialist
- Nurses or Ophthalmic Assistants
- Anesthesiologist (if sedation is used, although typically only topical anesthesia is required)
Risks and Complications
- Temporary discomfort and blurred vision
- Infection
- Scarring of the cornea
- Delayed healing
- Recurrence of the initial problem
Benefits
- Alleviation of pain caused by epithelial defects
- Restoration of a smooth corneal surface leading to improved vision
- Prevention of recurrent corneal erosions
- Faster healing of corneal ulcers
Recovery
- Use of prescribed antibiotic and anti-inflammatory eye drops
- Wearing a protective eye shield or bandage contact lens
- Avoiding eye makeup and strenuous activities for a few days
- Follow-up appointments to monitor healing
- Complete recovery typically occurs within 1-2 weeks, although vision may continue to improve over a longer period.
Alternatives
- Conservative management with lubricating eye drops and ointments
- Laser treatment (Phototherapeutic Keratectomy, PTK)
- Corneal transplantation in severe cases
- Each alternative has its own set of benefits and risks, and the choice depends on the specific condition and severity.
Patient Experience
During the procedure, the patient might feel slight pressure but should not experience pain due to the topical anesthesia. Post-procedure, the eye may feel scratchy and sensitive to light. Pain management typically includes over-the-counter pain relievers and prescribed medications. Comfort measures, like using cool compresses and resting, can help with recovery.