Ocular surface reconstruction; limbal stem cell allograft (eg, cadaveric or living donor)
CPT4 code
Name of the Procedure:
Ocular Surface Reconstruction; Limbal Stem Cell Allograft (e.g., Cadaveric or Living Donor).
Summary
This procedure involves transplanting stem cells from a donor's eye to the patient's eye to repair and regenerate the surface of the eye, particularly the cornea, which may be damaged due to disease or injury.
Purpose
The medical condition: Limbal stem cell deficiency (LSCD), which can result in pain, vision loss, and chronic eye irritation. Goals: To restore a healthy ocular surface, improve vision, and reduce discomfort.
Indications
- Severe corneal burns or injury
- Stevens-Johnson syndrome
- Aniridia (absence of the iris)
- Pterygium (benign growth on the eye)
- Genetic or acquired conditions causing LSCD
Preparation
- No food or drink for 6-8 hours before the procedure.
- Review and potentially adjust current medications with the doctor.
- Undergo comprehensive eye examination and specialized imaging tests.
Procedure Description
- Administration of local or general anesthesia.
- Removal of damaged corneal tissue from the patient’s eye.
- Harvesting of limbal stem cells from a cadaveric or living donor.
- Transplantation of these stem cells onto the patient’s cornea using microsurgical techniques.
- Application of a protective contact lens to aid healing.
Duration
Approximately 1 to 2 hours.
Setting
Typically performed in a hospital or specialized surgical center with ophthalmologic facilities.
Personnel
- Ophthalmic surgeon
- Surgical nurses
- Anesthesiologist (if general anesthesia is used)
Risks and Complications
- Infection
- Rejection of the transplant
- Inflammation
- Scarring
- Vision disturbances Complications are usually managed with medications and careful follow-up.
Benefits
- Improved corneal surface health
- Better vision clarity
- Reduced eye discomfort
- Enhanced quality of life Benefits can often be noticed within a few weeks.
Recovery
- Use of prescribed antibiotic and anti-inflammatory eyedrops.
- Avoid rubbing or applying pressure to the eye.
- Follow-up appointments to monitor healing.
- Recovery can take several weeks to months, with restrictions on certain activities like swimming and strenuous exercise.
Alternatives
- Auto-limbal stem cell transplant (using patient’s own cells if available)
- Amniotic membrane transplant
- Corneal transplantation
- Pros and cons: These alternatives may have varied success rates and availability, with different recovery times and risks.
Patient Experience
During: The procedure is minimally discomforting due to anesthesia. After: Patients may experience mild discomfort, itching, or irritation. Adequate pain management and comfort measures are provided to alleviate any discomfort.