Name of the Procedure:

Common names: Ocular implant surgery, Aqueous drainage assist implant Technical/Medical term: Ocular implant, aqueous drainage assist device (HCPCS Code: C1783)

Summary

An ocular implant procedure involves placing a small device within the eye to help drain excess aqueous humor, the fluid in the eye. This helps to lower intraocular pressure, reducing the risk of damage to the optic nerve and preventing further vision loss.

Purpose

The procedure aims to treat conditions such as glaucoma where there is increased intraocular pressure. By facilitating the proper drainage of aqueous humor, the implant helps to reduce pressure within the eye and protect against damage to the optic nerve.

Indications

Indications for this procedure include:

• Diagnosed glaucoma, particularly when other treatments have failed
• Uncontrolled intraocular pressure despite medication
• Progressive vision loss due to high intraocular pressure

Patient criteria include those with:

• Persistent elevated intraocular pressure
• Risk of optic nerve damage
• Adequate overall health to undergo surgery

Preparation

Patients may be instructed to:

• Fast for a certain number of hours before surgery
• Adjust or stop certain medications, particularly blood thinners
• Undergo preoperative eye examinations and imaging tests

Procedure Description

1. The patient will be prepped and anesthesia will be administered, usually local anesthesia with sedation.
2. An incision is made in the sclera (the white part of the eye).
3. The ocular implant, designed to assist in aqueous drainage, is carefully inserted into the designated area.
4. The device is positioned to facilitate the proper drainage of aqueous humor.
5. The incision is sutured or closed, and the eye is typically covered with a protective dressing.

Tools and technology:

• Microsurgical instruments
• Specialized ocular implants
• Anesthesia (local or general, depending on the case)

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

The procedure is usually performed in an outpatient surgical center or hospital.

Personnel

• Ophthalmic surgeon
• Surgical nurses
• Anesthesiologist or nurse anesthetist
• Ophthalmic technicians

Risks and Complications

Common risks:

• Infection
• Bleeding
• Inflammation Rare risks:
• Implant displacement or malfunction
• Damage to the optic nerve or other eye structures
• Vision changes Management includes close monitoring, use of antibiotics, and potential follow-up surgeries if complications arise.

Benefits

Expected benefits include:

• Reduced intraocular pressure
• Protection of the optic nerve
• Prevention of further vision loss Patients often begin to experience benefits a few weeks after the surgery as the eye heals and intraocular pressure stabilizes.

Recovery

Post-procedure care includes:

• Using prescribed eye drops to reduce inflammation and prevent infection
• Wearing a protective eye shield, especially during sleep
• Avoiding strenuous activities and keeping the eye clean
• Regular follow-up appointments to monitor healing and intraocular pressure Recovery time varies but typically ranges from a couple of weeks to a few months.

Alternatives

Other treatment options include:

• Medications (eye drops or oral drugs)
• Laser therapy (trabeculoplasty)
• Traditional surgical options (trabeculectomy) Pros and cons of alternatives:
• Medications may not be sufficient for controlling pressure in some cases.
• Laser therapy, while less invasive, may have temporary effects.
• Traditional surgical options are more invasive and come with their own set of risks and recovery challenges.

Patient Experience

During the procedure:

• Minimal discomfort due to sedation or anesthesia
• Awareness of light and movement but no pain After the procedure:
• Mild to moderate eye discomfort, which can be managed with prescribed pain medication
• Blurred vision for a few days
• Itching or tearing as the eye heals Comfort measures include using cold compresses and taking recommended medications to manage pain and inflammation.