66183 Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach

Name of the Procedure:

Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach

Summary

This procedure involves the surgical insertion of a device into the eye's anterior segment to help drain excess aqueous fluid, aiming to relieve intraocular pressure without using an extraocular reservoir.

Purpose

This procedure primarily addresses conditions like glaucoma, where intraocular pressure is elevated, risking optic nerve damage. The goal is to reduce intraocular pressure to prevent vision loss and improve eye health.

Indications

• Diagnosed glaucoma unresponsive to medication or laser treatments
• Elevated intraocular pressure (IOP)
• Progressive optic nerve damage
• Visual field loss due to high IOP

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustments to current medications, particularly anticoagulants, should be discussed with a doctor.
• Preoperative assessments may include an eye examination, visual field test, and measurement of intraocular pressure.

Procedure Description

1. The patient is administered local anesthesia to numb the eye.
2. A small incision is made in the external part of the eye.
3. The drainage device is carefully inserted into the anterior segment of the eye.
4. The device helps facilitate the outflow of aqueous fluid, thereby reducing intraocular pressure.
5. The incision is then closed, often with sutures.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

This procedure is usually carried out in a hospital or outpatient surgical center.

Personnel

• Ophthalmic surgeon
• Nursing staff
• Anesthesiologist (if sedation is used)

Risks and Complications

• Infection
• Bleeding
• Inflammation
• Device malfunction or displacement
• Continued elevated intraocular pressure
• Vision changes or loss

Benefits

• Reduction in intraocular pressure
• Prevention of further optic nerve damage
• Preservation of existing vision
• Improved quality of life

Recovery

• Patients may need to wear an eye patch temporarily.
• Use of prescribed eye drops to prevent infection and control inflammation.
• Avoid heavy lifting, strenuous activity, and rubbing the eye for a few weeks.
• Regular follow-up appointments to monitor intraocular pressure and device functionality.
• Recovery typically spans a few days to a few weeks.

Alternatives

• Medication (eye drops or oral drugs)
• Laser therapy (trabeculoplasty)
• Traditional glaucoma surgery (trabeculectomy, implant with extraocular reservoir) Pros and cons:
• Medications may not be effective for all patients.
• Laser therapy is less invasive but may have limited effectiveness.
• Traditional surgery involves longer recovery but may be necessary for more severe cases.

Patient Experience

During the procedure, patients might feel some pressure but should not experience pain due to anesthesia. Post-procedure, there may be discomfort, redness, and mild pain for which pain management measures, like prescribed medications, are provided. Most patients return to normal activity after a brief recovery period, with improved vision health as the drainage device begins to function.