Multiple punctures of anterior cornea (eg, for corneal erosion, tattoo)
CPT4 code
Name of the Procedure:
Multiple punctures of anterior cornea, also known as Anterior Stromal Puncture (ASP) or corneal micropuncture.
Summary
This procedure involves making small, controlled punctures in the outer layer of the cornea to treat recurrent corneal erosion or for corneal tattooing. It is a minor surgical technique designed to stimulate healing or to improve cosmetic appearance in the case of tattooing.
Purpose
The primary purpose is to treat recurrent corneal erosion, a condition where the cornea's outermost layer does not adhere properly, causing pain and vision problems. Additionally, it can be used for corneal tattooing to improve the cosmetic appearance of corneal scars or irregularities.
Indications
- Recurrent corneal erosion with symptoms like sudden eye pain, redness, and vision changes.
- Patients with visible corneal scars or disfigurements seeking cosmetic improvement through corneal tattooing.
Preparation
- Patients may need to discontinue certain medications, particularly those that affect blood clotting.
- Diagnostic tests such as a thorough eye examination and corneal topography may be performed.
- Fasting is usually not required, but patients should follow their doctor's specific instructions.
Procedure Description
- The patient is seated in an examination chair or lying down.
- Local anesthetic drops are applied to numb the eye.
- Using a fine needle or a specialized micropuncture tool, the surgeon makes multiple small punctures in the cornea's surface.
- The exact number and depth of the punctures depend on the severity of the condition or the cosmetic requirements for tattooing.
- The procedure is typically completed in a few minutes.
Duration
The procedure usually takes about 10-20 minutes per eye.
Setting
It is typically performed in an outpatient clinic or a specialized eye surgery center.
Personnel
- Ophthalmologist (eye surgeon)
- Ophthalmic nurse or assistant
Risks and Complications
- Temporary discomfort or pain post-procedure.
- Infection, although rare, can occur and may require antibiotic treatment.
- Potential for scarring or further vision issues.
- Recurrence of corneal erosion despite treatment.
Benefits
- Relief from recurrent corneal erosion symptoms.
- Significant improvement in corneal surface appearance if used for tattooing.
- Minimal recovery time and outpatient basis make it convenient.
Recovery
- Patients may need to use antibiotic or lubricating eye drops for several days.
- Avoid rubbing or touching the eye.
- Use of protective eyewear as recommended.
- Follow-up appointment within a week to monitor healing.
- Most patients return to normal activities within a day or two.
Alternatives
- Lubricating or antibiotic eye drops for milder cases.
- Debridement of the corneal epithelium.
- Laser therapies like Phototherapeutic Keratectomy (PTK).
- Pros and cons include the less invasive nature of drops versus the potentially more permanent solution of ASP.
Patient Experience
- Patients might feel mild discomfort or pressure during the procedure.
- Post-procedure discomfort can be managed with over-the-counter pain relievers.
- The eye may feel gritty and vision might be slightly blurred for a couple of days.