Treatment of extensive or progressive retinopathy, 1 or more sessions, preterm infant (less than 37 weeks gestation at birth), performed from birth up to 1 year of age (eg, retinopathy of prematurity), photocoagulation or cryotherapy
CPT4 code
Name of the Procedure:
Treatment of extensive or progressive retinopathy in preterm infants
Common Names: Retinopathy of Prematurity (ROP) treatment
Technical Terms: Photocoagulation, Cryotherapy
Summary
The treatment for extensive or progressive retinopathy in preterm infants involves using either photocoagulation (laser therapy) or cryotherapy (freezing therapy) to stop abnormal blood vessel growth in the retina. This procedure is crucial for preventing vision loss in infants born before 37 weeks of gestation.
Purpose
The primary purpose of this procedure is to treat retinopathy of prematurity (ROP), a condition where abnormal blood vessels grow in the retina of preterm infants, potentially leading to blindness. The goals are to halt the progression of the disease, prevent retinal detachment, and preserve eyesight.
Indications
- Infants born before 37 weeks of gestation
- Diagnosis of stage 3 ROP or higher, where blood vessels grow abnormally and could lead to retinal detachment
- Progressive worsening of the condition despite observation
Preparation
- Detailed eye examination by a pediatric ophthalmologist
- Discussion of medical history, medications, and any allergies
- No specific pre-procedure fasting or medication adjustments are generally required
- Consent from parents or guardians after explaining the procedure and its risks and benefits
Procedure Description
- The infant is placed under gentle sedation or given local anesthesia to minimize discomfort.
- For photocoagulation, a laser is used to make controlled burns in the peripheral retina, preventing further abnormal blood vessel growth.
- For cryotherapy, a probe that freezes the retina is applied to destroy abnormal areas and prevent disease progression.
- The procedure is performed using specialized equipment like indirect ophthalmoscopes and lasers or cryoprobes.
- The duration of the treatment can vary from one to multiple sessions based on the severity of the condition.
Duration
The procedure typically takes about 30 minutes to an hour per session.
Setting
The treatment is usually performed in a hospital setting, in a specialized ophthalmology or surgical unit.
Personnel
- Pediatric Ophthalmologist
- Registered Nurses
- Anesthesiologist (if sedation is used)
Risks and Complications
- Common: Temporary swelling, redness, or mild discomfort in the eye
- Rare: Infection, bleeding, cataracts, glaucoma, or retinal detachment
- Management of complications includes medications, additional surgical interventions, or close monitoring.
Benefits
- Prevents progression to blindness
- Preservation of vision
- Stopping the disease progression soon after treatment
Recovery
- Post-procedure monitoring for any immediate complications
- Administration of eye drops or ointments to prevent infection
- Follow-up appointments to assess the effectiveness and monitor healing
- Detailed instructions on caring for the treated eye(s), usually including avoiding rubbing the eyes and protecting them from bright light
Alternatives
- Observation and close monitoring for less severe cases
- Intravitreal injections of anti-VEGF agents, though not as commonly used in infants
- Each alternative comes with its own set of risks and benefits which should be discussed with the ophthalmologist.
Patient Experience
During the procedure, the infant will be under sedation or local anesthesia to minimize pain or discomfort. After the procedure, the infant may experience mild discomfort or swelling, which is typically managed with medications. Full recovery and the prevention of further vision loss are the primary goals.