Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); with endoscopic cyclophotocoagulation
CPT4 code
Name of the Procedure:
Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification); with endoscopic cyclophotocoagulation (ECP).
Summary
This procedure involves the removal of a cataract from the eye followed by the insertion of a new intraocular lens (IOL). It can be done using manual techniques or mechanical methods like phacoemulsification. It includes an additional step called endoscopic cyclophotocoagulation to treat glaucoma by reducing eye pressure.
Purpose
The procedure aims to treat cataracts, which cause blurred or cloudy vision. By removing the cataract and replacing it with a clear lens, it improves vision. Additionally, it helps manage glaucoma, reducing eye pressure to prevent further damage to the optic nerve.
Indications
- Significant vision impairment due to cataracts.
- Symptoms like blurry vision, difficulty seeing at night, or seeing halos around lights.
- Diagnosis of glaucoma that requires additional intervention to control intraocular pressure.
- Patients for whom combined cataract and glaucoma treatment is deemed beneficial.
Preparation
- Patients may need to fast for a few hours before the procedure.
- Adjustment or temporary discontinuation of certain medications, particularly blood thinners.
- Comprehensive eye examination and measurements to determine the appropriate IOL.
- Possible pre-operative antibiotic eye drops to prevent infection.
Procedure Description
- Local anesthesia or sedation is administered to ensure patient comfort.
- A small incision is made in the cornea.
- The cloudy lens (cataract) is removed using either manual techniques or phacoemulsification, which uses ultrasound waves to break up the lens.
- An artificial intraocular lens (IOL) is inserted to replace the natural lens.
- Endoscopic cyclophotocoagulation (ECP) is performed using an endoscope to visualize the ciliary body and apply laser energy to reduce intraocular pressure.
- The incision is closed, often requiring no stitches or self-healing sutures.
Duration
The procedure typically takes about 30 minutes to 1 hour.
Setting
This procedure is usually performed in an outpatient clinic or a specialized surgical center.
Personnel
- Ophthalmologist or eye surgeon
- Anesthesiologist or nurse anesthetist
- Operating room nurses and technicians
Risks and Complications
- Common: Swelling, infection, bleeding.
- Rare: Retinal detachment, prolonged or permanent vision loss, increased eye pressure.
- Specific to ECP: Inflammation, cystoid macular edema, or hypotony (low eye pressure).
Benefits
- Improved visual clarity.
- Enhanced quality of life by regaining vision.
- Reduction in intraocular pressure for glaucoma patients, decreasing the risk of optic nerve damage.
Recovery
- Use of prescribed antibiotic and anti-inflammatory eye drops.
- Avoiding strenuous activities and heavy lifting for a few weeks.
- Wearing an eye shield or glasses to protect the eye.
- Follow-up appointments to monitor healing and eye pressure.
- Full recovery and optimal vision improvement typically occur within a few weeks to a month.
Alternatives
- Phacoemulsification alone without ECP.
- Manual extracapsular cataract removal without ECP.
- Non-surgical options like stronger prescription glasses or contact lenses (temporary and less effective).
- Laser therapy or separate glaucoma surgery for intraocular pressure control.
Patient Experience
During the procedure, patients will be under anesthesia and should not feel pain, though they might experience mild pressure. Post-procedure, there might be some discomfort, redness, and blurred vision, which will improve over time. Pain management includes prescribed medications and proper eye care to ensure a comfortable recovery.