Name of the Procedure:

Aqueous Shunt (HCPCS L8612) Common name: Glaucoma Drainage Device
Technical term: Aqueous Shunt

Summary

An aqueous shunt is a small device implanted in the eye to help drain excess fluid and lower intraocular pressure (IOP) in patients with glaucoma. This procedure aims to prevent further damage to the optic nerve and preserve vision.

Purpose

The procedure addresses high intraocular pressure associated with glaucoma.
Goals:

1. Lower intraocular pressure.
2. Prevent progression of optic nerve damage.
3. Protect remaining vision.

Indications

• Patients with glaucoma not controlled by medication.
• Patients suffering from significant side effects from glaucoma medications.
• High-risk patients for conventional glaucoma surgery.

Preparation

• Fasting may be required before the procedure.
• Discontinuation of certain medications (e.g., blood thinners) under doctor’s advice.
• Comprehensive eye exam and measurement of eye pressure.
• Pre-procedure antibiotic eye drops may be prescribed.

Procedure Description

1. Local or general anesthesia is administered.
2. A small incision is made in the conjunctiva (the white part of the eye).
3. The aqueous shunt device is implanted under the conjunctiva.
4. The shunt is positioned to allow fluid to drain from inside the eye to a reservoir created under the conjunctiva.
5. The incision is closed with stitches that dissolve or need removal later.

Tools used:

• Scalpel
• Sutures
• Aqueous shunt device
• Microscopes for precision

Duration

The procedure typically takes 30 to 60 minutes.

Setting

• Hospital operating room
• Outpatient surgical center

Personnel

• Ophthalmologist or glaucoma specialist
• Ophthalmic surgical team
• Anesthesiologist (if general anesthesia is required)

Risks and Complications

Common risks:

• Infection
• Bleeding
• Temporary increased IOP Rare complications:
• Device migration or failure
• Chronic ocular inflammation
• Vision changes or loss Management: Regular follow-up visits to monitor and manage any complications.

Benefits

• Significant reduction in intraocular pressure.
• Slowing or halting the progression of glaucoma.
• Preservation of vision, with benefits noticeable in the weeks following the procedure.

Recovery

• Use prescribed antibiotic and anti-inflammatory eye drops.
• Avoid strenuous activities and heavy lifting for several weeks.
• Wear a protective eye shield while sleeping.
• Follow-up appointments to monitor eye health and pressure.

Expected recovery time: Several weeks to a couple of months.

Alternatives

• Medication (various eye drops or oral medications)
• Laser treatments (Trabeculoplasty)
• Non-shunt surgical procedures (Trabeculectomy) Pros and cons vary:
• Medications may have side effects or become less effective over time.
• Laser treatments are less invasive but may need repeated sessions.
• Non-shunt surgeries carry different risks and benefits.

Patient Experience

During the procedure:

• Minimal discomfort with local anesthesia; sedative may be given for relaxation.
• General anesthesia may be used for more complex cases.

After the procedure:

• Mild pain or discomfort in the eye, which can be managed with prescribed painkillers.
• Blurred vision initially, which improves as healing progresses.
• Some redness and swelling around the eye, typically subsiding within a few days.