Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine
CPT4 code
Name of the Procedure:
Extracapsular Cataract Removal with Insertion of Intraocular Lens Prosthesis (1-stage procedure), complex Common names: Cataract surgery with lens implant, ECCE with IOL
Summary
This procedure involves the removal of a cataract-affected lens from the eye and replacement with an artificial intraocular lens (IOL). The method is more advanced and complex, utilizing specialized devices and techniques not generally used in routine cataract surgeries.
Purpose
The procedure aims to remove clouded lenses caused by cataracts, thereby restoring clear vision. The ultimate goal is to improve visual acuity and quality of life for patients who suffer from significant vision impairment due to cataracts.
Indications
This procedure is indicated for patients experiencing serious vision impairment from cataracts that interfere with daily activities and are not manageable with corrective lenses. It is particularly appropriate for eyes with complex conditions, where standard cataract surgery techniques might not be sufficient.
Preparation
Patients are generally advised to fast for a few hours before surgery and may need to adjust certain medications, particularly anticoagulants. Preoperative assessments include comprehensive eye examinations, measurements of the eye for lens fitting, and reviews of medical history.
Procedure Description
- Anesthesia is administered to numb the eye (local anesthesia with sedation if required).
- A small incision is made in the cornea.
- The clouded lens is removed using either manual extraction or mechanical methods like phacoemulsification (ultrasonic vibration to break up the lens) followed by irrigation and aspiration.
- An intraocular lens (IOL) is implanted in the place of the natural lens.
- The incision is closed, often without the need for stitches.
Advanced techniques and devices, such as femtosecond lasers, may be used for precision.
Duration
The procedure typically takes between 30 to 60 minutes.
Setting
The procedure is usually performed in an outpatient surgical center or hospital.
Personnel
The healthcare team generally includes an ophthalmologist, who performs the surgery, assisted by surgical nurses and, if necessary, an anesthesiologist.
Risks and Complications
Common risks include infection, bleeding, swelling, and increased eye pressure. Rare complications may involve retinal detachment, significant vision loss, or displacement of the implanted lens. Most complications can be managed with prompt treatment.
Benefits
Patients typically experience significant improvement in vision, often within a few days after surgery. The procedure can greatly enhance the quality of life by restoring the ability to perform everyday tasks without reliance on strong corrective lenses.
Recovery
Post-procedure care includes using prescribed eye drops to prevent infection and manage inflammation. Patients are usually advised to avoid strenuous activities and protect the eye from injury. Follow-up appointments are critical to monitor healing and ensure proper lens positioning. Full recovery generally takes several weeks.
Alternatives
Alternative treatments include non-surgical options like updating eyeglass prescriptions or using magnifying lenses, though these are usually temporary fixes. Other surgical options include the simpler phacoemulsification procedure for less complex cataracts. However, these alternatives might not be suitable for all patients and might not offer the same outcomes as the described procedure.
Patient Experience
During the procedure, patients might feel slight pressure but no pain, due to effective anesthesia. Post-surgery, mild discomfort, and itching may occur, easily managed with medications. Patients often report a dramatic improvement in vision almost immediately after the procedure, with full stabilization over the recovery period. Pain management includes over-the-counter pain relievers and prescribed eye drops, while care guidelines help ensure comfort and optimal healing.