Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graft
CPT4 code
Name of the Procedure:
Aqueous Shunt to Extraocular Equatorial Plate Reservoir, External Approach; Without Graft
Common name(s): Glaucoma Drainage Device Implantation
Summary
This procedure involves inserting a small tube called an aqueous shunt into the eye to divert fluid to an external reservoir. This helps lower intraocular pressure and manage glaucoma, a condition that can damage the optic nerve and lead to vision loss.
Purpose
The main goal is to reduce intraocular pressure in patients with glaucoma. By diverting the eye fluid to an equatorial plate reservoir, pressure on the optic nerve is alleviated, preventing further damage and loss of vision.
Indications
- Uncontrolled intraocular pressure despite medication or other treatments.
- Severe glaucoma cases not responding to conventional therapies.
- Patients who have had previous unsuccessful glaucoma surgeries.
Preparation
- Patients may need to fast for a few hours before the procedure.
- Adjustments in medication, particularly blood thinners, might be required.
- Comprehensive eye exam and imaging tests to determine the suitability and precise placement.
Procedure Description
- Anesthesia: Local anesthesia is typically used to numb the eye.
- Incision: A small incision is made in the conjunctiva.
- Implantation: The aqueous shunt is inserted and its tube is positioned within the anterior chamber of the eye, while the plate is placed in the equatorial region.
- Attachment: The shunt is securely sutured to the sclera.
- Closure: The conjunctival incision is closed.
Duration
The procedure usually takes about 1 to 2 hours.
Setting
Performed in a surgical center or hospital operating room, often on an outpatient basis.
Personnel
- Ophthalmic surgeon
- Anesthesiologist or nurse anesthetist
- Surgical nurses and technicians
Risks and Complications
- Infection
- Bleeding
- Hypotony (abnormally low eye pressure)
- Diplopia (double vision)
- Device malfunction or migration
Benefits
- Significant lowering of intraocular pressure
- Stabilization or improvement in vision
- Reduced reliance on glaucoma medications
Recovery
- Initial recovery time is about 1 to 2 weeks.
- Patients should avoid strenuous activities and follow their surgeon's guidance on eye care.
- Regular follow-up appointments are necessary to monitor eye pressure and device function.
Alternatives
- Medications (e.g., eye drops to reduce intraocular pressure)
- Laser therapy (e.g., trabeculoplasty)
- Conventional glaucoma surgeries (e.g., trabeculectomy)
- Pros: Less invasive options may have fewer risks.
- Cons: They may be less effective for severe glaucoma.
Patient Experience
During the procedure, patients will feel minimal pain due to local anesthesia. Postoperatively, they may experience discomfort, blurred vision, and mild pain, which can be managed with prescribed medications and proper eye care.