66155 Fistulization of sclera for glaucoma; thermocauterization with iridectomy

Name of the Procedure:

Fistulization of Sclera for Glaucoma; Thermocauterization with Iridectomy

Summary

This surgical procedure helps to manage glaucoma, a condition that increases pressure in the eye, potentially leading to vision loss. The surgeon creates a small hole in the sclera (the white part of the eye) using heat and removes a portion of the iris to allow fluids to drain better, thereby reducing eye pressure.

Purpose

Medical Condition:

Glaucoma, characterized by elevated intraocular pressure (IOP).

Goals:

• Reduce intraocular pressure.
• Prevent further damage to the optic nerve.
• Preserve vision.

Indications

Symptoms:

• Elevated intraocular pressure that doesn't respond to medication.
• Severe eye pain.
• Significant vision loss due to glaucoma. ##### Patient Criteria:
• Diagnosed with open-angle or angle-closure glaucoma.
• Ineffectiveness of other treatments (medications, laser therapy).

Preparation

• Fasting for a few hours before the procedure may be required.
• Discontinuation of certain medications as advised by the healthcare provider.
• Pre-operative eye exams and assessments.

Procedure Description

1. The patient is given local anesthesia to numb the eye area, and sometimes mild sedation.
2. A small incision is made in the sclera.
3. Thermocauterization is employed to create a controlled burn to form a fistula (small passage).
4. A portion of the iris is removed (iridectomy) to improve fluid drainage.
5. The incision is closed and the eye may be covered with a protective shield.

Tools/Equipment:

• Scalpel.
• Thermocauterization device.
• Microsurgical instruments. ##### Anesthesia: Local anesthesia with sedation if necessary.

Duration

Typically 1-2 hours.

Setting

Performed in a hospital or an outpatient surgical center.

Personnel

• Ophthalmic surgeon.
• Surgical nurses.
• Anesthesiologist or nurse anesthetist.

Risks and Complications

Common Risks:

• Infection.
• Bleeding.
• Inflammation. ##### Rare Risks:
• Vision loss.
• Excessive scarring.
• Failure to reduce eye pressure adequately. ##### Management: Post-operative medication and follow-up visits for monitoring.

Benefits

• Decreased intraocular pressure.
• Reduced risk of vision loss from glaucoma.
• Improved quality of life.

Recovery

• Eye patch or shield for protection.
• Avoid heavy lifting and strenuous activities for a specified period.
• Eye drops to control inflammation and prevent infection.
• Follow-up appointments to monitor healing and eye pressure. ##### Recovery Time: Several weeks; patients often can resume normal activities within a few days but should follow specific restrictions as advised.

Alternatives

• Medications (eye drops, oral medications).
• Laser therapy (Trabeculoplasty, Iridotomy). ##### Pros and Cons:
• Medications: less invasive but may be less effective.
• Laser therapy: fewer surgical risks but might not be suitable for all glaucoma types.

Patient Experience

During Procedure:

• Minimal pain due to local anesthesia.
• Pressure or discomfort during the procedure. ##### After Procedure:
• Mild pain or discomfort, managed with medication.
• Blurred vision initially, which improves over time.
• Possible need for eye drops and follow-up checks.
• Compliance with post-operative care is crucial for a successful outcome.