Removal of corneal epithelium; with application of chelating agent (eg, EDTA)
CPT4 code
Name of the Procedure:
Removal of corneal epithelium with application of chelating agent (e.g., EDTA)
Summary
This procedure involves removing the outermost layer of the cornea (the epithelium) and applying a chelating agent like EDTA. It is commonly used to treat certain eye conditions, helping to alleviate symptoms and promote healing.
Purpose
The procedure addresses conditions involving abnormal calcium deposits on the cornea. The goal is to remove these deposits, alleviate discomfort, improve vision, and promote corneal health by encouraging a smooth, regular surface.
Indications
- Presence of calcium deposits on the cornea (e.g., Band Keratopathy)
- Symptoms such as eye pain, redness, decreased vision, or irritation
- Patients who have not responded adequately to other treatments.
Preparation
- The patient may be advised to avoid certain medications before the procedure.
- Diagnostic eye exams and imaging studies are typically performed to assess the extent of calcium deposits.
- No fasting is generally required.
Procedure Description
- Anesthesia: Local anesthetic eye drops are applied to numb the eye.
- Epithelial Removal: The surgeon uses a specialized instrument to gently remove the outer layer of the cornea.
- Chelating Agent Application: EDTA or a similar chelating agent is applied to the corneal surface. This agent binds to the calcium deposits, making them easier to remove.
- Rinsing and Protection: The eye is thoroughly rinsed to remove the chelating agent and calcium residues. A protective bandage contact lens may be placed to aid healing.
Tools and Equipment:
- Local anesthetic eye drops
- Epithelium removal instruments (e.g., a blunt spatula)
- Chelating agent (e.g., EDTA solution)
- Protective bandage contact lens
Duration
The procedure typically takes about 30 to 60 minutes.
Setting
This procedure is usually performed in an outpatient clinic or a specialized eye surgery center.
Personnel
- Ophthalmic surgeon
- Ophthalmic nurse or technician
- Support staff
Risks and Complications
Common Risks:
- Temporary discomfort or pain
- Mild redness or irritation
Rare Risks:
- Infection
- Scarring of the cornea
- Prolonged healing time
Complication Management:
- Topical antibiotics and anti-inflammatory medications as prescribed
- Close follow-up to monitor healing
Benefits
- Relief from pain and discomfort
- Improved vision
- Smoother and healthier corneal surface
Realization Time: Benefits can often be noticed within a few days to a few weeks, depending on individual healing rates.
Recovery
- Use prescribed eye drops as directed.
- Avoid touching or rubbing the eye.
- Wear the protective bandage contact lens as recommended.
- Follow specific activity restrictions (e.g., avoid swimming).
- Attend follow-up appointments for monitoring.
Expected Recovery Time: Most patients recover within 1 to 2 weeks, with full corneal healing taking up to several months.
Alternatives
- Conservative management with lubricating eye drops and ointments
- Phototherapeutic Keratectomy (PTK), a laser-based procedure
- Corneal transplantation in severe cases
Pros and Cons of Alternatives:
- Less invasive but may provide temporary relief (conservative management)
- More precise and controlled removal but may be more expensive (PTK)
- Effective for severe cases but involves more significant risks and longer recovery (corneal transplantation)
Patient Experience
During the procedure, the patient will be awake but should not feel pain due to local anesthesia. They might experience mild pressure. Post-procedure, there can be some discomfort, foreign body sensation in the eye, and light sensitivity. Pain management includes prescribed eye drops and over-the-counter pain relievers. Comfort measures such as cool compresses and resting the eyes are also helpful.