67228 Treatment of extensive or progressive retinopathy (eg, diabetic retinopathy), photocoagulation

Name of the Procedure:

Treatment of extensive or progressive retinopathy (e.g., diabetic retinopathy), photocoagulation

Summary

Photocoagulation is a procedure used to treat retinopathy, particularly diabetic retinopathy, by using a laser to seal or destroy abnormal blood vessels in the retina. This helps to prevent vision loss and stabilize the condition.

Purpose

The procedure addresses diabetic retinopathy, a condition where abnormal blood vessels form in the retina due to high blood sugar levels damaging retinal blood vessels. The main goals are to prevent further vision loss, reduce the risk of severe bleeding, and promote the absorption of fluid that has leaked into the retina.

Indications

• Presence of abnormal blood vessels in the retina (neovascularization)
• Persistent or recurrent retinal bleeding
• Swelling in the retina (macular edema)
• Worsening of vision due to diabetic retinopathy

Preparation

• Patients may be asked to avoid eating or drinking for a few hours before the procedure.
• Adjustment or temporary discontinuation of certain medications may be necessary.
• Pre-procedure assessment may include a comprehensive eye exam and imaging tests such as optical coherence tomography (OCT) or fluorescein angiography.

Procedure Description

1. The patient receives drops to dilate the pupils and might be given local anesthesia to numb the eye.
2. A special contact lens is placed on the eye to help focus the laser.
3. The ophthalmologist uses the laser to apply small burns to the retina's abnormal blood vessels. This could take several hundred laser applications.
4. The laser burns create small scars that seal the blood vessels or reduce their abnormal growth.
5. The eye is then checked for any immediate complications, and the procedure is completed.

Tools, equipment, or technology used:

• Laser equipment
• Special contact lens for focusing the laser
• Anesthetic eye drops

Anesthesia or sedation details: Local anesthesia in the form of numbing eye drops; sedation is generally not required.

Duration

The procedure typically takes about 20-40 minutes.

Setting

The procedure is performed in a specialized outpatient clinic or ophthalmologist's office equipped with laser equipment.

Personnel

• Ophthalmologist (eye specialist)
• Ophthalmic technician
• Nurse, if required for additional support

Risks and Complications

• Temporary or permanent vision changes
• Mild pain or discomfort in the treated eye
• Bleeding or infection
• Retinal detachment (rare)
• Worsening of macular edema (rare)

Benefits

• Stabilization or improvement in vision
• Prevention of severe vision loss
• Reduction in the risk of retinal bleeding
• Improved retinal health and oxygen supply

Recovery

• Patients may experience mild discomfort and blurred vision for a few days.
• Use of prescribed eye drops to prevent inflammation or infection.
• Avoid strenuous activities and heavy lifting for a few days.
• Follow-up appointments to monitor healing and effectiveness.

Alternatives

• Anti-VEGF injections to reduce abnormal blood vessel growth
• Vitrectomy for severe or advanced cases
• Observation with regular monitoring in milder cases

Pros and cons of alternatives:

• Anti-VEGF injections can be effective but require frequent administration.
• Vitrectomy is more invasive with a longer recovery period.
• Observation avoids interventions but risks progression of retinopathy.

Patient Experience

During the procedure:

• The patient may feel brief flashes of light and mild discomfort from the laser.
• Local anesthesia generally prevents pain.

After the procedure:

• Mild discomfort and blurred vision are common.
• Pain management with over-the-counter pain relievers if necessary.
• Most discomfort subsides within a few days to a week.