C1818 Integrated keratoprosthesis

HCPCS code

#### Name of the Procedure:
Integrated Keratoprosthesis (C1818)

Common Names:
- Artificial Cornea Implant
- Synthetic Cornea Surgery

Technical/Medical Terms:
- Keratoprosthesis

#### Summary
An integrated keratoprosthesis procedure involves the surgical implantation of an artificial cornea to replace a damaged or diseased natural cornea, thereby restoring vision. 

#### Purpose
This procedure addresses severe corneal diseases and injuries that result in significant vision loss. The goals are to improve visual acuity, restore corneal clarity, and reduce dependency on corrective lenses or other vision aids.

#### Indications
- Severe corneal scarring
- Corneal dystrophies
- Penetrating corneal injuries
- Corneal infections unresponsive to medications
- Prior failed corneal transplants
- Conditions not amenable to traditional corneal transplant

#### Preparation
- Patients may be instructed to fast for 8-12 hours before surgery.
- Medication adjustments, such as discontinuing blood thinners, may be necessary.
- Preoperative eye exams, blood tests, and imaging studies to assess eye health and suitability for the implant.

#### Procedure Description
1. **Anesthesia:** The patient will receive local or general anesthesia.
2. **Preparation:** The surgical area is sterilized and draped.
3. **Incision:** A precise incision is made in the cornea.
4. **Removal:** The damaged portion of the cornea is removed.
5. **Placement:** The artificial cornea (keratoprosthesis) is carefully inserted and secured.
6. **Closure:** The incision is closed with fine sutures.

#### Duration
The procedure typically takes 2 to 3 hours.

#### Setting
The procedure is performed in a hospital operating room or an outpatient surgical center.

#### Personnel
- Ophthalmic Surgeon
- Surgical Nurses
- Anesthesiologist or Nurse Anesthetist

#### Risks and Complications
- Infection
- Implant rejection or failure
- Glaucoma
- Retinal detachment
- Inflammation
- Postoperative pain or discomfort
- Healing problems that may require additional surgeries

#### Benefits
- Significant improvement in vision
- Rapid restoration of corneal clarity
- Long-term solution for chronic corneal problems
Patients may notice visual improvements within a few weeks after the procedure.

#### Recovery
- Postoperative care includes using prescribed antibiotic and anti-inflammatory eye drops.
- Patients may need to wear an eye patch for a few days and avoid heavy lifting or strenuous activities.
- Follow-up appointments are critical to monitor healing and implant status.
- Recovery time ranges from a few weeks to several months, depending on individual healing rates.

#### Alternatives
- Traditional corneal transplant
- Phototherapeutic keratectomy (PTK)
- Scleral contact lenses
- Each alternative has its own pros and cons, such as varying success rates, recovery times, and suitability based on the underlying condition.

#### Patient Experience
During the procedure, the patient may be under anesthesia and will not feel pain. Postoperatively, they might experience mild to moderate discomfort, which can be managed with prescribed pain medications. Vision improvements are usually gradual, starting a few weeks post-surgery, with significant gains typically seen within a few months. 

Pain management and comfort measures, such as the use of lubricating eye drops and protective eyewear, will be provided to facilitate recovery and enhance patient comfort.

Medical Policies and Guidelines for Integrated keratoprosthesis

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