66174 Transluminal dilation of aqueous outflow canal; without retention of device or stent

Name of the Procedure:

Transluminal dilation of aqueous outflow canal; without retention of device or stent. Also known as canaloplasty without device or stent insertion.

Summary

This procedure involves using a special catheter to enlarge the natural drainage channels of the eye, improving fluid outflow and reducing intraocular pressure, a common issue in glaucoma patients.

Purpose

This procedure is performed to alleviate high intraocular pressure caused by glaucoma. The goal is to enhance the drainage of aqueous humor, preventing damage to the optic nerve and potential loss of vision.

Indications

• Elevated intraocular pressure due to open-angle glaucoma.
• Patients who have not responded adequately to medication or laser treatments.
• Those seeking a less invasive surgical option compared to traditional glaucoma surgeries.

Preparation

Patients may be instructed to:

• Fast for several hours before the procedure.
• Temporarily stop certain medications as directed by their doctor.
• Undergo a comprehensive eye examination and preoperative imaging to assess the eye's structures.

Procedure Description

1. Local anesthesia is administered to numb the eye.
2. A small incision is made in the eye.
3. A microcatheter is inserted into the Schlemm's canal, the natural drainage channel of the eye.
4. The microcatheter is then guided around the canal using gentle pressure to dilate it.
5. The catheter is removed, leaving no device or stent behind.
6. The incision is then sealed with fine sutures.

Duration

The procedure typically takes about 60 to 90 minutes.

Setting

This procedure is usually performed in a hospital or an outpatient surgery center equipped for ophthalmic surgeries.

Personnel

• Ophthalmic surgeon specializing in glaucoma treatment.
• Surgical nurses and technicians.
• An anesthesiologist or nurse anesthetist.

Risks and Complications

• Common risks include bleeding, infection, and temporary increases in intraocular pressure.
• Rare complications may involve damage to eye structures, vision changes, or inadequate pressure reduction.

Benefits

• Significant reduction in intraocular pressure.
• Potential reduction in the need for glaucoma medications.
• Preservation of vision and optic nerve health.

Recovery

• Patients may experience mild discomfort, redness, and blurred vision initially.
• Antibiotic and anti-inflammatory eye drops are prescribed.
• Follow-up visits are scheduled to monitor intraocular pressure and ensure proper healing.
• Most patients can resume normal activities within a week but should avoid strenuous activities for several weeks.

Alternatives

• Medications: Eye drops to lower intraocular pressure.
• Laser Therapy: Trabeculoplasty to enhance fluid outflow.
• Traditional Surgery: Trabeculectomy or glaucoma drainage implants which are more invasive.

Patient Experience

Patients usually experience minimal discomfort due to local anesthesia. Post-procedure, there may be mild soreness and a gritty sensation in the eye, which can be managed with prescribed medications. Vision may be temporarily blurred but typically improves as healing progresses.