66184 Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft

Name of the Procedure:

Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft

Summary

This surgical procedure involves adjusting or replacing an implanted device (aqueous shunt) used to manage eye pressure in conditions like glaucoma. The procedure ensures that the device continues to work properly and reduce intraocular pressure by providing a channel for the fluid to drain from the eye.

Purpose

The procedure is intended to address conditions like glaucoma where the pressure within the eye needs to be controlled. The goal is to ensure the shunt maintains optimal performance to prevent damage to the optic nerve and preserve vision.

Indications

• Uncontrolled intraocular pressure despite current treatment.
• Malfunction of the existing aqueous shunt.
• Development of complications related to the current shunt, such as blockage or displacement.

Preparation

• Fasting for a specific period before the procedure (usually from midnight).
• Adjustments or stoppage of certain medications as advised.
• Pre-operative diagnostic tests, including eye pressure measurements and imaging studies.

Procedure Description

1. Anesthesia: Local anesthesia with sedation or general anesthesia.
2. Incision: A small incision is made in the conjunctiva (the outer membrane of the eye).
3. Revision: The surgeon carefully examines the shunt and performs the necessary adjustments or replacement.
4. Repositioning: The shunt is correctly positioned so that it leads to the extraocular equatorial plate reservoir.
5. Closure: The incision is closed with sutures.

Tools used include surgical scissors, clamps, and sometimes specialized ocular instruments.

Duration

The procedure typically takes around 1 to 2 hours, depending on the complexity of the revision needed.

Setting

Performing location is usually a hospital operating room or an outpatient surgical center.

Personnel

• Ophthalmic Surgeon
• Surgical Nurses
• Anesthesiologist or Nurse Anesthetist

Risks and Complications

• Infection
• Bleeding
• Corneal damage
• Hypotony (excessively low eye pressure)
• Shunt failure or displacement

Benefits

• Improved control of intraocular pressure.
• Prevention of further optic nerve damage.
• Preservation of vision. These benefits are generally realized within weeks following the procedure.

Recovery

• Post-procedure care typically involves using prescribed eye drops to prevent infection and control inflammation.
• Avoiding strenuous activities for a few weeks.
• Follow-up appointments to monitor eye pressure and ensure proper healing.

Alternatives

• Medication adjustments to control intraocular pressure.
• Laser therapy.
• Other surgical options like trabeculectomy. Each alternative has its own set of pros and cons, often discussed with the ophthalmologist.

Patient Experience

Patients might feel minor discomfort or a scratchy sensation in the eye post-surgery. Pain is usually managed with over-the-counter pain relief or prescribed medications. Vision might be blurred for a few days, and it's common to wear an eye patch initially.