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Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach, into the trabecular meshwork; each additional device insertion (List separately in addition to code for primary procedure)
CPT4 code
Name of the Procedure:
Insertion of Anterior Segment Aqueous Drainage Device, Without Extraocular Reservoir, Internal Approach into the Trabecular Meshwork; Each Additional Device Insertion
Common Names:
- Aqueous drainage device insertion
- Trabecular meshwork stent placement
Summary
This is a surgical procedure designed to help drain fluid from inside the eye. An additional aqueous drainage device is inserted via an internal approach into the trabecular meshwork, the eye’s drainage system, to help reduce intraocular pressure.
Purpose
Medical Condition:
- Glaucoma with high intraocular pressure (IOP)
Goals:
- To enhance fluid drainage within the eye.
- To reduce intraocular pressure, thereby preventing vision loss and optic nerve damage.
Indications
Symptoms:
- Elevated intraocular pressure
- Progressive vision loss
- Diagnosis of glaucoma
Patient Criteria:
- Patients with uncontrolled glaucoma on maximum medical therapy.
- Patients with open-angle glaucoma.
- Suitable anatomical features in the anterior segment.
Preparation
Pre-Procedure Instructions:
- Fasting typically required from midnight before the procedure.
- Discontinuation or adjustment of certain medications as advised.
Diagnostic Tests:
- Comprehensive eye examination.
- Measurement of intraocular pressure.
- Visual field test and optical coherence tomography (OCT).
Procedure Description
- Administration of local anesthesia or sedation.
- A small incision is made in the eye.
- The anterior segment aqueous drainage device is inserted through the trabecular meshwork.
- The device is positioned to allow proper fluid drainage.
- If necessary, additional devices are inserted following similar steps.
Tools/Equipment:
- Micro-surgical instruments
- Anterior segment imaging systems
- Aqueous drainage device
Anesthesia/Sedation:
- Local anesthesia with or without mild sedation.
Duration
- The main procedure takes approximately 30-60 minutes.
- Additional device insertions might add 10-15 minutes per device.
Setting
- Outpatient surgical center or hospital operating room.
Personnel
- Ophthalmic surgeon
- Surgical nurse
- Anesthesiologist or nurse anesthetist
Risks and Complications
Common Risks:
- Eye discomfort or pain
- Temporary blurred vision
Rare Risks:
- Infection
- Device displacement
- Failure to reduce intraocular pressure
- Hyphema (blood in the anterior chamber)
Management:
- Follow-up visits for monitoring.
- Possible revision surgery if complications arise.
Benefits
- Lowering intraocular pressure.
- Prevention of further optic nerve damage.
- Reduction in dependence on glaucoma medications.
- Potential for improved vision stabilization.
Recovery
Post-Procedure Care:
- Use of prescribed eye drops to prevent infection and inflammation.
- Avoidance of strenuous activities and heavy lifting.
Recovery Time:
- Initial recovery in a few days.
- Full recovery and assessment in 1-2 weeks.
Follow-Up:
- Postoperative visits for monitoring intraocular pressure and healing.
Alternatives
Other Treatments:
- Medications (eye drops).
- Laser therapy (e.g., SLT).
- Other surgical options (e.g., trabeculectomy, drainage implants).
Pros and Cons:
- Medications are non-invasive but may not control IOP effectively.
- Laser therapy is less invasive but may have limited duration of effectiveness.
- Other surgeries may provide better control but pose different risks.
Patient Experience
During the Procedure:
- Mild discomfort due to anesthesia.
- Possible pressure sensation in the eye.
After the Procedure:
- Initial blurry vision and mild pain manageable with prescribed medications.
- Improvement in vision as the eye heals.
- Regular check-ups to monitor progress.
Pain Management:
- Over-the-counter pain relievers and prescribed medications as needed.
- Instructions for cold compress application to reduce swelling.