Ocular surface reconstruction; limbal conjunctival autograft (includes obtaining graft)
CPT4 code
Name of the Procedure:
Ocular Surface Reconstruction; Limbal Conjunctival Autograft (LCA)
Summary
Ocular surface reconstruction using a limbal conjunctival autograft involves transplanting healthy tissue from one part of the patient’s eye to a damaged area to restore normal function and appearance. This procedure is typically performed under anesthesia and can significantly improve vision and comfort for those with certain eye conditions.
Purpose
The procedure addresses damage to the ocular surface, particularly the limbal area, which is crucial for maintaining eye health. The goals are to repair or replace damaged tissue, restore vision, prevent further damage to the eye, and alleviate pain or discomfort caused by the affected area.
Indications
- Patients with limbal stem cell deficiency due to injury, disease, or chemical burns.
- Chronic or severe ocular surface disorders unresponsive to other treatments.
- Conditions like pterygium, Stevens-Johnson syndrome, or severe conjunctival scarring.
Preparation
- Patients may need to fast for several hours prior to the procedure.
- Adjustments to medications as advised by the ophthalmologist.
- A comprehensive eye examination and potentially imaging studies to map the damage.
- Discussing medical history and any potential allergies with the healthcare team.
Procedure Description
- Anesthesia: Local or general anesthesia is administered to ensure comfort.
- Harvesting the Graft: Healthy conjunctival and limbal tissue is gently harvested from an unaffected area of the patient’s eye.
- Preparing the Recipient Area: The damaged area is carefully prepared to receive the graft.
- Transplantation: The harvested graft is meticulously placed and secured in the damaged area with sutures or fibrin glue.
- Stabilization: The eye may be covered with a protective shield to aid initial healing.
Tools used include surgical microscopes, micro-surgical instruments, sutures, and fibrin sealants.
Duration
The procedure typically takes between 1 to 2 hours, depending on the extent of the damage and the complexity of the surgery.
Setting
The procedure is performed in a hospital or outpatient surgical center equipped with specialized ophthalmic operating rooms.
Personnel
- An ophthalmic surgeon specialized in corneal or ocular surface surgery.
- Surgical nurses and technicians.
- An anesthesiologist or nurse anesthetist.
Risks and Complications
- Infection at the surgical site.
- Graft rejection or failure.
- Bleeding or excessive scarring.
- Intraocular pressure changes.
Prolonged dryness or discomfort in the operated eye.
Management involves antibiotics, anti-inflammatory medications, and close monitoring post-surgery.
Benefits
- Restoration and preservation of vision.
- Enhanced ocular comfort.
Prevention of further damage and complications in the eye.
Benefits can often be observed within a few weeks post-surgery as the eye begins to heal.
Recovery
- Post-operative care includes using prescribed eye drops and medications.
- Avoidance of vigorous activities and eye strain.
- Follow-up appointments to monitor healing and graft acceptance.
- Protective eyewear might be recommended during the healing period.
- Full recovery typically takes several weeks to a few months, depending on individual healing rates.
Alternatives
- Amniotic membrane transplantation.
- Use of artificial corneal implants.
Conservative management with medications and less invasive procedures.
Alternatives may have varying effectiveness and risk profiles compared to limbal conjunctival autograft.
Patient Experience
Patients may feel some discomfort or a gritty sensation in the eye post-surgery. Pain management includes prescribed medications and the use of lubricating drops. Most patients report significant improvement in symptoms once the initial healing phase is complete. Regular follow-up ensures the best outcome and early management of any complications.