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 “Type a quote here.” “Blurred Vision due to Scattering of Light on the Retina” Chapter VII H00-H59 Eye and Adnexa ??.?????? ?????????? ??? ?? ?????????? ?????????????????? ????????? Cataract 1 3 Cataract meaning “Waterfall” [cataracta in Latin] ‘originally thought that congealed brain fluid was flowing in front of lens’ 4 translate vision into reality. Warren Bennis 2 Leadership is the capacity to Classification Morphology Etiology Maturity Capsular cataract Anterior capsular cataract Posteriot capsular cataract Subcapsular cataract Anterior subcapsular cataract Posteriot subcapsular catract Nuclear cataract Cortical cataract Lamellar cataract Sutural cataract Polar cataract Morphologic Classification 6 Nuclear Older patients, most common type of senile cataract Slow progression Brunescent color Poor night vision (brunescent blocks blue wavelengths) Posterior subcapsular (Polar) Congenital cataract Incipient cataract Age-related cataract Immature cataract Juvenile cataract Intumescent cataract Presenile cataract Mature cataract Senile cataract Hypermature cataract Secondary cataract Morgagnian cataract After surgery Other ocular diseases Systemic diseases Traumatic Blunt/Penetrating cataract Irradiation Electrical shock Drug-induced cataract 5 Younger patients Rapid progression Vision decreases early (cataract at nodal point of eye) Vision changes with pupil diameter (sunglasses or mydriacil help by pupil dilation) Associated with: renal failure, chronic uveitis, RA, SLE Cortical Moderate progression Whitish, crystalline appearance, ‘Sproke wheel’ Growth is best associated with dilation Sometimes associated with radiation therapy Morganian End stage tp cortical cataract Nucleus floating in a liquified cortex 7 Zonular (Lamellar) Congenital (most common type) Associated with hypothyroidism Congenital Congenital, present at birth Minimal vision affected Traumatic Rapid progression Opacity radiates from the site of the injury Look for iris and corneal involvement 8 Senile cataract: develops at or after 40 years of age Morphology : Nuclear cataract [~40%] : Cortical cataract [~60%] : Posterior subcapsular cataract [~20%] : Mixed type Human Crystalline Lens 9 10 Age-related Cataract Senile Cataract 11 Presenile cataract: develops before 40 years of age Morphology Maturity Classification Infantile Cataract Juvenile Cataract Presenile Cataract Senile cataract 12 : Polar cataract : Sutural cataract : Nuclear cataract : Capsular cataract : Lamellar cataract : Complete cataract Congenital cataract: present at birth Infantile cataract: develops during the first of life Senile Cataract Nuclear cataract Older patients; Slow progression; Poor night vision Cataracta rubra Cortical cataract 14 Cortical cataract Incipient cataract Immature senile cataract [Intumescent cataract] Mature senile cataract Hypermature senile cataract [Morgagnian cataract] Cataracta brunescens Cataracta nigra Incipient cataract Immature senile cataract Mature senile cataract Hypermature senile cataract Senile Cataract Moderate progression; Whitish, crystalline appearance 15 Maturity of Lens 13 Senile Cataract Nuclear cataract ??????????????????????????????????????? ??????????? immature ??? mature cataract ?????????????????????????????????? ?????????????? (nucleus) ???????????? Cataracta brunescens [brown colour] Cataracta nigra [black colour] Cataracta rubra [red colour] Senile Cataract 16 18 After Cataract ‘Posterior Capsular Opacity’ ? Treat by YAG laser capsulotomy [13.64] Acute event or Rapid progression cataract Opacity radiated from the site of the injury ‘Rosette-shaped’ Look for iris and corneal involvement from previous trauma It is visually insignificant Traumatic Cataract 17 19 Combined forms of senile cataract H25.9 Senile cataract, unspecified H26 Other cataract Excludes: congenital cataract ( Q12.0 ) H26.0 Infantile, juvenile and presenile cataract H26.1 Traumatic cataract Use additional external cause code (Chapter XX), if desired, to identify cause. H26.2 Complicated cataract Cataract in chronic iridocyclitis Cataract secondary to ocular disorders Glaucomatous flecks (subcapsular) H26.3 Drug-induced cataract Use additional external cause code (Chapter XX), if desired, to identify drug. H26.4 After-cataract Secondary cataract Soemmerring's ring H26.8 Other specified cataract H26.9 Cataract, unspecified Disorders of lens (H25-H28) H25 Senile cataract Excludes: capsular glaucoma with pseudoexfoliation of lens ( H40.1 ) H25.0 Senile incipient cataract Senile cataract: Version for 2010 · · coronary cortical 349 · punctate Subcapsular polar senile cataract (anterior)(posterior) Water clefts H25.1 Senile nuclear cataract Cataracta brunescens Nuclear sclerosis cataract H25.2 Senile cataract, morgagnian type Senile hypermature cataract H25.8 Other senile cataract Combined forms of senile cataract H25.9 Senile cataract, unspecified H26 Other cataract 20 Elshning’s pearls – vasculated subcapsular epithelial cells are clustered like soap bubbles‘Secondary Cataract’ Gradual clouding of the capsule – posterior capsular opacity Develops in 20% of patients Soemmering’s ring – thick ring formed behind the iris After Cataract Cataract Summary Discharge for Coding ?????????????? ??????????????????? ??????????????????????? ????.2562 After cataract Complicated cataract Congenital cataract Diabetic cataract Drug-induced cataract ???????????? 40 ?? Infantile cataract Juvenile cataract Presenile cataract ??????????? 40 ???????? “Type a quote here.” Senile cataract [detail of lens opacity] ? ?????????????? ?????????????????????????? Congenital cataract, Traumatic cataract, Complicated cataract, Drug-induced cataract, Irradiational cataract, After cataract – nuclear cataract ? ????????????????? ?????????????????????????? Irradiational cataract Infantile cataract, Juvenile cataract, Presenile cataract, Senile cataract Myotonic cataract ? ???????? senile cataract ?????????????????????????????????? Senile incipient cataract, Senile nuclear cataract, Senile hypermature cataract ? ??????????????????????????? ???????????????????????????????? ?????????????????? VA ????????????????????????? – cortical cataract – brunescens cataract – incipient cataract Secondary cataract – combined cataract Toxic cataract Traumatic cataract –Johnny Appleseed – mature cataract – hypermature cataract 22 Cataract ??????????????????????????????????????????????? ????.2562 ? ?????????????????? ???????????????????? ????????? ???????? ??????????????????? ????????? ?????? ??????????? ? ???????????????? ?????????????????????? ??????????????? ??????????????????? ????????????????????????????????????? ? ??????????????????????????????? ????????? ?????? ??????????????????? ????????? ???????? ??????????? Senile Cataract Summary Discharge for Coding No Underlying Disease and Age >40 years Summary Diagnosis ICD-10 Senile nuclear cataract Senile cortical cataract 23 24 H25.1 H25.0 Senile brunescens cataract Senile coronary cataract Senile incipient cataract Senile cataract, Morgagnian type / Nigra Senile subcapsular cataract Senile combined cataract H25.1 H25.0 H25.0 H25.1 H25.0 H25.8 Senile mature cataract Senile hypermature cataract H25.9 H25.2 Senile cataract H25.9 Cataract Summary Discharge 21 ??????????????????????????????????????????????????????????? ??????????????? ??????????????????????????????????????????? ??????????????????????????? Slit lamp ?????? bilateral white punctuate or snow flake anterior and posterior sub capsular opacity ????????????? sudden and progressive myopia ????????????????????? ??????? 1 [Diabetes Mellitus type 1] Cataract Summary Diagnosis ICD-10 Coronary cataract Cortical cataract Embryonal nuclear cataract Immature cataract Incipient cataract Cataract No defined ‘Senile Cataract’ 25 Q12.0 H26.9 Q12.0 H26.9 H26.9 H26.9 Senile coronary cataract Senile cortical cataract Senile incipient cataract Senile nuclear cataract Senile cataract H25.0 H25.0 H25.0 H25.1 H25.9 26 Diabetic Cataract Specific characteristic of Lens 27 Non-proliferative DR [NPDR] – microaneurysm, haemorrhage, hard exudate Damage to the Blood Vessels of Retina Proliferative DR [PDR] – neovascularisation, vitreous haemorrhage, traction retinal detachments, macular oedema Diabetic Retinopathy Diabetic Retinopathy 28 Phacolytic glaucoma ??????????????????????????????????????? trabecular meshwork ???? mature ???? hypermature cataract Phacomorphic glaucoma ????????????????? ??????????? ???????? secondary closured glaucoma ???? brunescent cataract ???? intumescent cortical cataract Phacotoxic uveitis ??????????????????????????????????????? trabecular meshwork ????????????????????????????????????? ???????????????????????? Phacoanaphylactic endophthalmitis [uveitis] ??????????????????? ?????????????????????????? ???????????????????????? 31 Diabetic Retinopathy 29 Secondary Cataract Difference from Secondary Cataract in ICD-10 Summary Diagnosis ICD-10 Diabetic cataract Diabetic retinopathy 30 Complication of Cataract E1-.3 + H28.0 E1-.3 + H36.0 After cataract Cataract in hypoparathyroidism Cataract due to ocular disorders Drug-induced cataract Irradiational cataract Myotonic cataract Secondary cataract Traumatic cataract H26.4 E20.- + H28.1 H26.2 H26.3 H26.8 G71.1 + H28.2 H26.4 H26.1 Cataract Complication of Cataract Summary Procedure ICD-10 Phacolytic glaucoma Phacomorphic glaucoma Phacotoxic uveitis Phacoanaphylactic endophthalmitis H40.5 H40.5 H20.2 H44.1 PAE 32 ????????????? ????. ?????????????????????????: <20/200 ??????????????????????????????????????????????????????? (backlog cataract) ????????????????????????????????????? Diagnosis ICD-10 Diagnosis ICD-10 binocular blindness H54.0 monocular blindness H54.4 binocular severe impairment H54.1 monocular severe impairment H54.5 binocular moderate impairment H54.2 monocular moderate impairment H54.6 binocular mild or no impairment H54.3 binocular impairment, unspecified H54.9 ??????????????????????????? ????????????????????? 33 Cataract Surgery ? Couching ? Intracapsular cataract extraction [ICCE] ? Extracapsular cataract extraction [ECCE] ? Conventional ECCE ? Manual with small incision cataract surgery [MSICS] ? Lensectomy ? Phacoemulsification [Phaco] ? Cryoextraction ? Lasers capsulotomy 35 Visual Acuity 800 BC Sushruta Samhita, Couching 1748 Jacques Daviel, opened capsule with cystotome (Conventional ECCE) 1900 Henry Smith, capsule forceps for remove lens – erysophake 1957 Joaquim Barraquer, alpha-chymotrypsin dissolve the zonule for removal the lens 1991 Jack Dodick, Nd:YAG capsulotomy 2010 Zoltan Nagy, femtosecond lasers 1961 Krawicz, cryosurgery for lens extraction 36 1967 Chalres Kelman, phacoemulsification and Christmas tree capsulotomy category presenting distance VA < > 6/18 0: mild or no impairment 3/10 (0.3) 20/70 6/18 1: moderate impairment 3/10 (0.3) 20/70 6/60 1/10 (0.1) 20/200 6/60 2: severe impairment 1/10 (0.1) 20/200 3/60 1/20 (0.05) 20/400 3/60 3: blindness 1/20 (0.05) 20/400) 1/60* 1/50 (0.02) 5/300 (20/1200) 4: blindness 1/60* 1/50 (0.02) 5/300 (20/1200) light perception 5: blindness no light perception 9: undetermined or unspecified * or counts fingers at 1 meter 34 Intracapsular Cataract Extraction ‘For completed case, lens subluxation’ 39 Couching ????????????? Sushruta samhita ???????? (800 B.C.) ?????????? ?????? limbus ??? zonule ??? ???????????????????????????????? ????????????????????????????????????? vitreous 13.11 ICCE by temporal inferior route ????????????????????????????????????????? 13.19 ICCE ??????????????????????????????????? 37 Extracapsular Cataract Extraction Intracapsular Cataract Extraction ????????????????????????????????????? ??????????????????????? ???? vitreous loss, retinal detachment, cystoid macular oedema ???????????????????????? ???????????????????????????????????????????? ??????????????? vitreous loss ??????????????? ICCL ????????????????????????? The removal of almost the entire lens while posterior capsule is left intact’ ???????????????????????????????????? ???? - Phacofragmentation - Phacoemulsification 38 40 - Cryosurgery - Lasers capsulotomy The removal of the lens and the surrounding lens capsule in one piece Extracapsular Cataract Extraction 41 Extracapsular Cataract Extraction The removal of almost the entire lens while posterior capsule is left intact’ 42 13.2 ECCE by linear extraction technique ????????????????????????? 13.3 ECCE by simple aspiration ?????????????????? ??????? traumatic cataract 13.51 ECCE by temporal inferior route ???????????????????????????????? [?????????????????????] 13.59 ECCE by laser phacofragmentation 13.43 ECCE by mechanical phacofragmentation and aspiration ??????????????????????????????????????????? ????????????????????????????????????????????????????????????? ???? ??????????????? Conventional ECCE For hypermature cataract, incision 10-12 mm. 43 13.42 ECCE by mechanical phacofragmentation and aspiration by posterior route ????????????????????????????????????????????????????????????????? (pars plana) ??????????????? Pars plana lensectomy 13.41 ECCE by ultrasonic phacofragmentation [phacoemulsification] ??????????????????????????????????????????????????????????? 44 ?????????????????????????????? ??????? ???????????????????? (pars plana) ?????????????????????????????????????? (pars plana vitrectomy) ?????????????????????????????????????????????????? ?????????????????????????????????????????????? ( 5–6 mm) ??????????? Manual with Small Incision Cataract Surgery [MSICS] 45 Manual Phacofragmentation ‘Manual deterioration of the crystalline lens nucleus and Removal of Lens pieces’ ???????????????????????????????????????????????????????????????? Incision 3–5 mm Self-sealing 46 ???????????????????????????????????????????????????????????? ????????? ?????????????????????????? ‘Emulsified the lens by ultrasonic handpiece machine and remove by aspiration’ ????????????? ???????????????? ????????????????????????? Phacoemulsification Laser Phacofragmentation 47 ??????????????????????????????????????? ??????? ???????????? ???????? (pars plana) Pars Plana Lesectomy 48 ???????????????????????? ???????????????????????????????????????? ?????????????? after cataract For Congenital Cataract 13.01 Removal of foreign body from lens with use of magnet 13.02 Removal of foreign body from lens without use of magnet 13.1 Intracapsular extraction of lens Code also any synchronous insertion of pseudophakos (13.71) 13.11 Intracapsular extraction of lens by temporal inferior route 13.19 Other intracapsular extraction of lens ICCE Cataract extraction NOS Cryoextraction of lens Erysiphake extraction of cataract 13.2 Extracapsular Extraction extraction of lens NOS of Erysiphake Extraction lens by linear of extraction lens NOS extraction of cataract technique ? 13.2 Extracapsular extraction of lens by linear extraction technique ? Code also any synchronous insertion of pseudophakos (13.71) 13.3 Extracapsular extraction of lens by simple aspiration (and irrigation) technique ? Irrigation of traumatic cataract Code also any synchronous insertion of pseudophakos (13.71) 13.4 Extracapsular extraction of lens by fragmentation and aspiration technique ? ECCE Code also any synchronous insertion of pseudophakos (13.71) 13.41 Phacoemulsification and aspiration of cataract 13.42 Mechanical phacofragmentation and aspiration of cataract by posterior route Code also any synchronous vitrectomy (14.74) 13.43 Mechanical phacofragmentation and other aspiration of cataract 13.5 Other extracapsular extraction of lens Code also any synchronous insertion of pseudophakos (13.71) 13.51 Extracapsular extraction of lens by temporal inferior route Ш New code ? Revised code ? 4th digit required 45 49 13.2 13.3 13.51 13.59 13.59 13.42 13.43 13.43 13.41 50 Cataract Procedure Summary Procedure ICD-9-CM Laser phacofragmentation Manual small incision cataract surgery [MSICS] Mechanical phacofragmentation Mechanical phacofragmentation by posterior route# Ultrasonic phacofragmentation Phacoemulsification [PE] Pars plana lensectomy [PPL] Cataract Procedure Summary Procedure ICD-9-CM Intracapsular cataract extraction [ICCE] ICCE by temporal inferior route ‘Harold Ridley 1950’ 13.19 13.11 Extxacapsular cataract extraction [ECCE] ECCE by simple aspiration ECCE by temporal inferior route / Conventional ECCE ECCE by laser phacofragmentation ECCE by manual small incision cataract surgery [MSICS] ECCE by lensectomy / Pars plana lensectomy ECCE by mechanical phacofragmentation Anterior lensectomy Phacoemulsification [PE] 13.59 13.59 13.43 13.42 13.41 13.41 13.42 # Add 14.74 Vitrectomy if performed51 Monofocal Lens Astigmatic Lens – Totic IOL Accommodative Lens Multifocal Lens 52 Intraocular Lens ‘Pseudophakos’ ‘Prosthetic Lens’ 13.7 Insertion of prosthetic lens [pseudophakos] Excludes: implantation of intraocular telescope prosthesis (13.91) 13.70 Insertion of pseudophakos, not otherwise specified 13.71 Insertion of intraocular lens prosthesis at time of cataract extraction, one-stage Code also synchronous extraction of cataract (13.11- 13.69) 13.72 Secondary insertion of intraocular lens prosthesis 13.8 Removal of implanted lens 54 Insertion of Prosthetic Lens Summary Procedure ICD-9-CM Primary insertion of prosthetic lens Secondary insertion of prosthetic lens ???????????????? ??????????????????????????????????????????? ‘IOL - Primary or Secondary’ Secondary insertion of prosthetic lens PDx: Acquired aphakia H27.0 PDx: Congenital aphakia Q12.3 13.71 13.72 Insertion of prosthetic lens 13.70 Primary insertion of prosthetic lens PDx: Cataract H25, H26, H28 Op: Extraction of cataract 13.11 - 13.69 55 Intraocular Lens Optics Haptics PMMA, silicone, acrylic 53 Complications of Cataract Surgery Anesthetic Complication Retrobulbar hemorrhage, Brainstem anesthesia, Globe perforation, Optic nerve trauma, Subconjunctival hemorrhage Intraoperative Complication Zonular dehiscence, Posterior capsular rupture, Profuse bleeding, Dislocation of lens fragments, Posterior dislocation of IOL Early Postoperative Comp. (up to 4 weeks) Wound dehiscence [wound leak], Iris prolapse, Hyphema, Striate keratopathy, Toxic anterior segment syndrome, Anterior uveitis, Ophthalmitis Late Postoperative Comp. (after 1 month to years) Cystoid macular edema, Pseudophakic bullous keratopathy, Chronic endophthalmitis, Vitreous syndrome, Retinal detachment, Glaucoma, IOL dislocation, After cataract 56 ?????????????????? ?????? 2 ??? ? ???????????????????????????????????????????? ‘Primary insertion of intraocular lens prosthesis’ ? ?????????????????????????????????????????? ‘Secondary insertion of intraocular lens prosthesis’ Intraocular Lens Prosthesis Pseudophakic Bullous Keratopathy Retinal thickening of the macula due to a disruption of the normal blood- retinal barrier Causes leakage from the peritoneal retinal capillaries and accumulation of fluid within the intracellular spaces fo the retina – ‘multiple cyst-like form within the macula’ ‘Irvine-Gass Syndrome’ Decrease VA, Loss of contrast sensitivity and colour vision, Metamorphopsia, Central scotoma Irreversible corneal oedema, resulting of the corneal endothelium to maintain the normally dehydrated state of the cornea Subendothelial fluid-filled bullae form on the corneal surface, and they undergo painful ruptures releasing their fluid content into the surface ‘Aphakic Bullous Keratopathy’ Eye discomfort, Decreased VA, Loss of contrast, glare, Photophobia, Pain, FB sensation Cystoid Macular Edema 57 59 Complications of Cataract Surgery H59 · early (secondary) · Postprocedural late ( A52.7? ) ( A51.4? disorders ‘Late ) Complications’ of eye and adnexa, H59 not Postprocedural disorders of eye a H59 Postprocedural elsewhere classified disorders of eye and adnexa, not elsewhere classified elsewhere Excludes: classified mechanical complication of: Excludes: mechanical · intraocular complication lens ( T85.2 of: ) Excludes: mechanical complication o · intraocular lens ( T85.2 ) · other ocular prosthetic devices, implants and grafts ( T85.3 ) pseudophakia ( Z96.1 ) H59.0 Keratopathy (bullous aphakic) following cataract surgery Vitreous (Touch) Syndrome Vitreal Corneal Syndrome H59.8 Other postprocedural disorders of eye and adnexa Bleb associated endophthalmitis Chorioretinal scars after surgery for detachment Inflammation (infection) of postprocedural bleb Postprocedural blebitis T79.9 H59.9 Unspecified Postprocedural early complication disorder of of trauma eye and adnexa, unspecified Complications elsewhere (T80-T88) Complications elsewhere (T80-T88) classified classified of of surgical surgical for Early and and complications, m medical care, not Complications of surgical and m elsewhere classified Prosthetic-related (T80-T88) complicitions & NEC Use additional external cause code (Chapte 60 The vitreous burger through the pupillary aperture, and touches and attaches to the corneal epithelium [Vitreous Wick] ‘Vitreous Syndrome’ ‘Vitreous Touch Syndrome’ Mucous threadlike substance protruding from the surgical site, Irregular pupil, Corneal haze, Eye redness, Eye discharge Late complication of intracapsular cataract extraction Pain, Blurred vision, Itchiness, FB sensation, Gush of warm fluid Vitreous Wick Syndrome 58 Complications Complications of Cataract Surgery of Cataract Surgery ‘Anesthetic & Intraoperative Complications’ ‘Early Complications’ Summary Diagnosis ICD-10 Summary Diagnosis ICD-10 Retrobulbar haemorrhage Postoperative hyphema Globe perforation Wound dehiscence / Wound leak / Wound gapping Optic nerve trauma Postoperative ophthalmitis Unnecessary summary: Vitreous loss, Lens fragments dislocation, Posterior dislocation of IOL 61 T81.0 T81.0 T81.2 T81.3 T81.2 T81.4 Intraoperative profuse bleeding Striate keratopathy Posterior capsular rupture Toxic anterior segment syndrome Zonular dehiscence T81.0 T81.8 T81.2 T85.7 T81.2 Postoperative complication [from cataract procedure] Y83.1 Intraoperative complication [of cataract procedure] Y60.0 62 Complications of Cataract Surgery ‘Late Complications’ Summary Diagnosis ICD-10 Pseudophakic [Aphakic] bullous keratopathy Vitreous syndrome / Vitreous touch syndrome Vitreous corneal syndrome 63 H59.0 H59.0 H59.0 Postoperative lens dislocation T85.2 Intraoperative complication [of cataract procedure] Postoperative complication [from cataract procedure] Y60.0 Y83.1 “Progressive optic neuropathy with loss of retinal neurons and the nerve fibre layer, resulting in blindness if left untreated” 64 Glaucoma ????????????????????????????????????????????? ?????? ??????????????????????????????????? ???????????????????????? (acute angle closure glaucoma, AACG) ??????????????????????? ????? ??????????????????????? (chronic glaucoma) ?????????????????? ???? ?????????????????? ???????????????? ?????????????????????? ??????? ???/???????????????????????? ????? 65 95% of patients with elevated IOP will never have the damage associated with glaucoma Glaucoma One-third of patients with glaucoma do not have elevated IOP Primary glaucoma Secondary glaucoma Congenital glaucoma Hereditary glaucoma Adult [Most common] Narrow angle glaucoma Open angle glaucoma Inflammatory glaucoma Traumatic glaucoma Rubeotic glaucoma Phacolytic glaucoma etc. 67 Glaucoma Congenital Glaucoma Symptoms Signs Irritablity Photophobia Epiphora Poor vision Onset: Antenatally to 2 year old Elevated IOP Buphthalmos Haab’s striae Corneal clouding Glaucomatous cupping Field loss 68 Glaucoma 66 Open Angle Glaucoma Symptoms Signs Usually none May have loss of central and peripheral vision late Glaucoma Onset: 50+ years of age Elevated IOP Congenital glaucoma Summary Diagnosis ICD-10 Visual field loss Closed angle glaucoma Glaucomatous disk changes Open angle glaucoma Phacolytic glaucoma Postinfectiuos glaucoma Corticosteroid-induced glaucoma Traumatic glaucoma 69 Q15.0 H40.2 H40.1 H40.5 H40.4 H40.6 + Y56.5 H40.3 Glaucoma suspect Ocular hypertension Absolute glaucoma H40.0 H40.0 H44.5 70 Glaucoma Surgical treatment Laser treatment Goniotomy Iridotomy Iridectomy Trabeculotomy Trabeculectomy Sclerectomy Viscocanalostomy Shunt implantation Canaloplasty Glaucoma Procedures: Technique Inflow procedures Outflow procedures Transscleral cyclophotocoagulation Endoscopic cyclophotocoagulation 71 Procedures: Concept Trabeculoplasty External filtering surgery Sclerotomy – Trabeculectomy ab externo Cycloablation – Shunt implantation Cyclophotocoagulation – Iridotomy/Iridectomy/Iridencleisis – Transciliary filtration Internal filtering surgery – Goniotomy – Laser trabeculoplasty – Trabeculotomy – Viscocanalostomy/Canaloplasty 72 Goniotomy Incision of the obstructing trabecular meshwork tissue allows direct conduit between anterior chamber and schlemn’s canal For congenital OAG, juvenile OAG, secondary OAG 74 Glaucoma Procedure Trabeculectomy Creates fistula anterior chamber to subconjunctival space with a partial thickness scleral flap Gold standard for glaucoma procedure Glaucoma Procedure 73 75 Glaucoma Procedure Trabeculotomy Cannulating the schlemm canal from an external approach with subsequent centripetal rupture through the trabecular meshwork into the anterior chamber For corneal oedema, after failure of 2 previous goniotomies Glaucoma Procedure Laser Trabeculoplasty: Argon LT, Selective LT Increase outflow facility through the trabecular meshwork For chronic open angle glaucoma, exfoliative syndrome, pigmentary glaucoma, glaucoma in aphakia or pseudophakia 76 Glaucoma Procedure Iridotomy Create a hole in the iris by laser to enhance the drainage passages blocked by a portion of the iris Iridectomy Remove a small piece of the iris to allow flow of fluid 78 Drainage device: Canaloplasty Small devices create an alternative passageway, bypassing or clogged filtrationGlaucoma Procedure 77 79 Glaucoma Procedure Deep sclerectomy Create a new outflows pathway, by removing a deep scleral flap [external wall of Schlemm’s canal – corneal stroma], without perforating the eye ‘non-penetrating glaucoma surgery (NPGS) Glaucoma Procedure Canaloplasty: Ab interno, Ab externo Ab interna – catheter is inserted through either a corneal or limbal micro-incision into the Schlemm’s canal Ab externa – catheter is inserted via superficial and deep cuts on the sclera into Schlemm’s canal ab externa ab interna 80 Glaucoma Glaucoma Procedures Procedures Summary Procedure ICD-9-CM Summary Procedure ICD-9-CM Goniopuncture Scleral trephination with iridectomy 12.61 Laser goniopuncture Thermal sclerotomy with iridectomy 12.62 Goniotomy Iridencleisis 12.63 Laser goniotomy Trabeculectomy ab externa / Trabeculectomy 12.64 Goniotomy with goniopuncture Anterior sclerectomy 12.65 Trabeculotomy ab externa Laser trabeculoplasty [LT] / Argon LT / Selective LT Cyclodialysis Facilitation of Intraocular Circulation Scleral Fistulization 81 82 Glaucoma Procedures Summary Procedure ICD-9-CM Cyclodiathermy Cycloelectrolysis Cyclocryotherapy Cyclophotocoagulation Cycloablative therapy 12.51 12.59 12.52 12.52 12.53 12.54 12.59 12.55 Glaucoma Procedures Ciliary body Destruction Miscellaneous Summary Procedure ICD-9-CM 12.71 Laser iridotomy 12.12 12.71 Peripheral iridectomy 12.14 12.72 Canuloplasty 12.69 12.73 Gonioimplant surgery 12.69 12.74 Implantation of glaucoma drainage device 12.69 Subconjunctival injection of mitomycin-C 10.91 + 99.25 Subconjunctival injection of 5-FU 10.91 + 99.25 Retrobulbar injection of 80% alcohol 16.91 + 99.29 Enucleation 16.49 83 84 H11.0 H11.1 ..????? ??? ..?? 87 Glaucoma Procedures Complication of Procedure Summary Summary ICD-10 Postprocedural conjunctival bleb Postprocedural blebitis Bleb associated with endophthalmitis 85 H59.8 H59.8 H59.8 Summary Procedure ICD-9-CM Revision of filtering bleb Bleb needling Laser suture lysis of filtering bleb 12.66 10.91 12.79 Pterygium Procedures Surfer’s eye Summary Procedure ICD-9-CM Excision of pterygium Excision and transposition of pterygium 88 11.39 11.31 Excision of pterygium with corneal graft with conjunctival graft with amniotic graft with transposition of conjunctiva with Strontium radiation 11.32 11.39 + 10.44 11.39 + 10.44 11.39 + 11.49 11.39 + 92.21 “A mass of tissue that may have started as ” Pterygium 86 Dacryostenosis Procedures Summary Procedure ICD-9-CM Dacryocystorhinostomy [DCR] Conjunctivodacryocystorhinostomy [CDCR] Conjunctivocystorhinostomy Conjunctivodacryocystorhinostomy with stenting Conjunctivocystorhinostomy with stenting Dacryostenosis Procedures Summary Procedure ICD-9-CM Probing of lacrimal punctum 09.81 Probing of lacrimal canaliculi [c/s punctum] 09.82 Probing of nasolacrimal duct [c/s punctum or canaliculi] 09.82 Probing of lacrimal canaliculi with stunting [c/s probing] 09.83 09.83 Removal of nasolacrimal stent Removal of conjunctivorhinostomy stent 09.41 09.42 09.43 09.44 Incision/Drainage of lacrimal punctum Snip incision of lacrimal punctum Incision/Drainage of lacrimal sac 09.51 09.51 09.53 Repair of canaliculi Repair of canaliculi with stenting 97.39 97.39 90 Laser in Eye Surgery Summary Procedure ICD-9-CM ATL [Argon laser trabeculoplasty] ECCE [Extracapsular cataract extraction] FAX [Fluid air exchange] FGX [Fluid gas exchange] FFA [Fundus fluorescein angiography] ICCE [Intracapsular cataract extraction] LASIK [Laser assisted in situ keratomileusis] LK [Lamella keratoplasty] LPI [Laser peripheral iridotomy] MP [Membrane peeling] 09.73 09.73 89 Laser in Eye Surgery Summary Procedure ICD-9-CM 12.59 PDT [Photodynamic therapy] 14.24 13.2 PE [Phacoemulsification] 13.41 14.75 PPL [Par plana lensectomy] 13.42 14.75 PRP [Pan retinal photocoagulation] 14.24 95.12 YAG capsulotomy 13.66 13.19 11.71 11.62 12.12 14.9 91 92 ................
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