Goniotomy
CPT4 code
Name of the Procedure:
Goniotomy
Summary
A goniotomy is a surgical procedure designed to treat certain types of glaucoma by opening up the trabecular meshwork to improve aqueous humor drainage. It involves making a small incision in the eye's drainage system to reduce intraocular pressure.
Purpose
Goniotomy is primarily used to address congenital glaucoma, a condition present at birth that results in high intraocular pressure, potentially damaging the optic nerve. The goal is to reduce intraocular pressure to prevent vision loss and damage to the optic nerve.
Indications
- Congenital glaucoma
- Elevated intraocular pressure unresponsive to medication
- Specific anatomical issues within the eye's drainage system
Preparation
- Pre-procedure fasting as per your doctor’s instructions
- Possible medication adjustments
- Comprehensive eye examination and imaging tests
- Discussion regarding current medications and allergies
Procedure Description
- The patient receives local anesthesia or sedation to prevent pain.
- A small incision is made in the cornea.
- A gonioscope is used to visualize the trabecular meshwork.
- A specialized goniotomy knife or laser is used to create an opening in the trabecular meshwork.
- The incision is closed, and protective eyewear may be used post-surgery.
Common tools include a gonioscope and goniotomy knife.
Duration
The procedure typically takes 30 to 60 minutes.
Setting
Goniotomy is usually performed in an outpatient clinic or a specialized eye surgery center.
Personnel
- Ophthalmologist (specialized eye surgeon)
- Surgical nurse
- Anesthesiologist (if sedation is used)
Risks and Complications
- Infection
- Bleeding
- Increased intraocular pressure post-surgery
- Damage to the cornea or other eye structures
- Rare risk of vision loss
Benefits
- Reduction in intraocular pressure
- Potential prevention of vision loss
- Improved drainage of aqueous humor
Some patients may notice improvement in intraocular pressure control shortly after the procedure.
Recovery
- Post-procedure antibiotics and anti-inflammatory drops
- Avoidance of strenuous activities for a recommended period
- Follow-up appointments to monitor intraocular pressure and eye health
- Typical recovery time is a few weeks
Alternatives
- Medications (eye drops or oral medications to reduce intraocular pressure)
- Other surgical options like trabeculectomy or drainage implants
- Laser therapy
Each alternative has its own pros and cons, depending on the specific patient’s condition and response to initial treatments.
Patient Experience
During the procedure, the patient will be under local anesthesia or sedation to ensure comfort. Post-operative discomfort can be managed with prescribed medications. Vision may be blurry immediately after the procedure but generally improves as the eye heals. Regular follow-up visits with the ophthalmologist are crucial to monitor recovery and manage any complications.