Destruction of localized lesion of choroid (eg, choroidal neovascularization); photodynamic therapy (includes intravenous infusion)
CPT4 code
Name of the Procedure:
Destruction of localized lesion of choroid (e.g., choroidal neovascularization); photodynamic therapy (includes intravenous infusion)
Common Name(s): Photodynamic Therapy (PDT) for Choroidal Neovascularization
Summary
Photodynamic Therapy (PDT) is a minimally invasive procedure used to treat abnormal blood vessels in the eye, specifically those found in the choroid layer. This involves using a photosensitizing drug and a special light to target and destroy the neovascularization.
Purpose
Medical Condition: Choroidal neovascularization, often associated with age-related macular degeneration (AMD).
Goals/Outcomes: To halt or slow the progression of vision loss by destroying the abnormal blood vessels without damaging surrounding healthy tissue.
Indications
Symptoms/Conditions:
- Sudden or progressive vision loss
- Distorted vision (metamorphopsia)
- Diagnosis of choroidal neovascularization through imaging
Patient Criteria:
- Patients with age-related macular degeneration (AMD) and other conditions causing choroidal neovascularization.
- Candidates suitable for intravenous infusion.
Preparation
Pre-Procedure Instructions:
- No specific fasting required.
- Avoid sun exposure before and after the procedure due to increased photosensitivity.
- Temporary discontinuation of photosensitizing medications if applicable.
Diagnostic Tests:
- Comprehensive eye examination
- Fluorescein angiography or optical coherence tomography (OCT) to identify and evaluate the lesion.
Procedure Description
- Intravenous Infusion: A photosensitizing drug (e.g., Verteporfin) is injected into the patient's bloodstream.
- Activation: The drug travels to the blood vessels in the eye. A low-intensity laser light is then directed onto the abnormal blood vessels for about 90 seconds.
- Destruction: The light activates the drug, producing a reaction that destroys the abnormal blood vessels while sparing healthy tissue.
Tools/Equipment: Intravenous catheter, photosensitizing drug, laser light source
Anesthesia: Usually none required, but local anesthesia for the eye may be used to enhance comfort.
Duration
Approximately 20-30 minutes.
Setting
Performed in an outpatient clinic or office setting with specialized ophthalmologic equipment.
Personnel
- Ophthalmologist
- Nurse or medical assistant to assist with the intravenous infusion and preparation
Risks and Complications
Common Risks:
- Temporary vision changes
- Increased photosensitivity to light
Rare Risks:
- Severe vision loss
- Inflammation or infection at the injection site
- Allergic reaction to the drug
Management: Close monitoring and follow-up, use of protective measures against light exposure.
Benefits
- Stabilizes or improves vision in a significant number of patients
- Minimally invasive with a short recovery time
- Targets abnormal tissue with minimal damage to surrounding healthy tissue
Recovery
Post-Procedure Care:
- Avoid bright lights for at least 48 hours.
- Wear protective clothing and sunglasses outdoors.
Expected Recovery Time:
- Most patients can resume normal activities within 1-2 days, with caution regarding light exposure for a few days.
Follow-Up:
- Regular eye exams to monitor treatment effectiveness and any recurrence of symptoms.
Alternatives
Other Treatment Options:
- Anti-VEGF injections
- Laser photocoagulation
- Observation with regular monitoring
Pros and Cons:
- Anti-VEGF injections may be more effective but require frequent treatments.
- Laser photocoagulation is less precise and can damage surrounding tissues.
- Observation allows monitoring but may delay treatment.
Patient Experience
During Procedure:
- Mild discomfort during intravenous drug administration.
- Possibly slight warmth when the laser is applied.
After Procedure:
- Some initial blurriness or visual disturbances.
- Photosensitivity requiring careful light exposure management.
- Pain managed with typical analgesics if needed.