Placement of adjustable suture(s) during strabismus surgery, including postoperative adjustment(s) of suture(s) (List separately in addition to code for specific strabismus surgery)
CPT4 code
Name of the Procedure:
Placement of adjustable suture(s) during strabismus surgery, including postoperative adjustment(s) of suture(s).
Summary
In this procedure, adjustable sutures are placed in the eye muscles during strabismus surgery to correct misalignment. Postoperative adjustments of suture positions allow fine-tuning of eye alignment after the patient is fully awake.
Purpose
The procedure addresses strabismus, a condition where the eyes do not properly align with each other when looking at an object. The goal is to improve eye alignment, enhance binocular vision, and provide better cosmetic appearance.
Indications
This procedure is indicated for individuals with:
- Strabismus (crossed eyes)
- Double vision (diplopia)
- Significant misalignment of the eyes
- Previous unsuccessful strabismus surgery
Suitable patients include both children and adults who meet the clinical criteria for strabismus surgery.
Preparation
- Fasting for 6-8 hours prior to surgery.
- Adjustment or discontinuation of certain medications as advised by the physician.
- Preoperative eye examination and relevant imaging studies.
Procedure Description
- Administration of Anesthesia: General anesthesia is typically used.
- Incision: A small incision is made in the conjunctiva (the mucous membrane that covers the front of the eye and lines the inside of the eyelids).
- Suture Placement: Adjustable sutures are strategically placed in the eye muscles to allow postoperative adjustments.
- Postoperative Adjustment: On the same day or the following day, the surgeon adjusts the sutures while the patient is awake to achieve optimal eye alignment.
Equipment used includes specialized eye retractors, suturing instruments, and an adjustable suture system.
Duration
The procedure typically takes 1-2 hours, including the time needed for postoperative adjustments.
Setting
The procedure is usually performed in a hospital or specialized surgical center.
Personnel
- Ophthalmic surgeon
- Anesthesiologist
- Surgical nurses
- Ophthalmic assistant
Risks and Complications
Common risks:
- Infection
- Inflammation or irritation
- Temporary double vision
Rare complications:
- Slipped or broken sutures
- Unintended overcorrection or undercorrection
- Anesthesia-related risks
Management involves follow-up visits and potential reoperation if needed.
Benefits
- Improved eye alignment
- Enhanced binocular vision
- Reduced double vision
- Better cosmetic appearance
These benefits are generally noticeable soon after the procedure and adjustment phase.
Recovery
- Use of prescribed eye drops to prevent infection and reduce inflammation.
- Avoidance of strenuous activities for a few weeks.
- Follow-up appointments for monitoring and possible further suture adjustments.
Alternatives
- Conventional strabismus surgery without adjustable sutures
- Botulinum toxin injections
- Prism glasses for minor cases
Each alternative has its specific pros and cons related to invasiveness, effectiveness, and recovery time.
Patient Experience
During the procedure, the patient will be under general anesthesia, so they will not feel any pain. Postoperatively, there might be mild discomfort, redness, and swelling, which can be managed with pain medications and eye drops. Temporary double vision may occur immediately after the procedure but usually resolves shortly.
Patients may feel anxious about the postoperative adjustment; however, it typically involves minimal discomfort as it is performed with the patient awake but with numbed eyes to ensure accurate alignment.