DOCSLIB.ORG

A Comparison Between Peripheral Iridectomy with Thermal Sclerostomy and Trabeculectomy: a Controlled Study

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
A Comparison Between Peripheral Iridectomy with Thermal Sclerostomy and Trabeculectomy: a Controlled Study Br J Ophthalmol: first published as 10.1136/bjo.65.11.783 on 1 November 1981. Downloaded from British Journal ofOphthalmology, 1981, 65, 783-789 A comparison between peripheral iridectomy with thermal sclerostomy and trabeculectomy: a controlled study GEORGE L. SPAETH AND EFFIE PORYZEES From the William and Anna Goldberg Glaucoma Service of the Wills Eye Hospital, Thomas Jefferson University, Philadelphia, USA SUMMARY In 15 patients with primary open-angle glaucoma who required surgery in both eyes because of progressive glaucomatous disease a peripheral iridectomy with thermal sclerostomy was performed in one eye and a trabeculectomy in the other eye, the choice of procedure being determined randomly. In all 15 cases at one year and 13 cases at 5 years after operation the immediate complication rate was higher in patients receiving peripheral iridectomy with thermal sclerostomy. The average final level of intraocular pressure (on no treatment) was 16 mmHg in patients receiving peripheral iridectomy with thermal sclerostomy and 22 mmHg in those in whom a trabeculectomy was performed. The control of disease was the same in both groups, there being an improvement in the visual field in approximately one-third of all cases and stability ofthe visual field in all other cases except for one. However, twice as many patients after trabeculectomy required copyright. additional medical therapy to maintain the intraocular pressure in a range that was considered satisfactory. Stability of intraocular pressure was virtually the same in both groups. The mechanism of control of intraocular pressure in patients receiving peripheral iridectomy with thermal sclerostomy appeared to be gross filtration in all cases, whereas such gross filtration was observed in only 2 eyes in which a trabeculectomy had been performed. http://bjo.bmj.com/ The purpose of this report is twofold: (1) to review the Hruby lens, and perimetry with the Goldmann the long-term results of 2 different procedures perimeter using the Armaly-Drance method. All performed for primary open-angle glaucoma, specifi- patients required surgery in both eyes to control cally peripheral iridectomy with thermal sclerostomy bilateral glaucomatous disease. The indication for and trabeculectomy; and (2) to compare and contrast surgery was progressive cupping of the optic nerve the results of these 2 operations in 15 patients entered and/or progressive visual field loss considered due to on September 27, 2021 by guest. Protected into a prospective, controlled study of 5 years' excessively elevated intraocular pressure. In all duration. Information of this nature is at present patients a peripheral iridectomy with thermal virtually unavailable. sclerostomy was performed in one eye and a 'trabeculectomy' in the other, the choice of Materials and methods procedure being decided solely on a random basis. Surgery was performed in both eyes within a period of Fifteen patients with primary open-angle glaucoma 3 months, the eye with the more advanced disease were selected for the study. All were under the care of being operated upon first. the senior author, had surgery performed by him, and The surgical technique for all eyes was the same, were followed up by him. Examination techniques with the exception of the scleral portion of the pro- included Goldmann applanation tonometry, goni- cedure. A flap of conjunctiva and Tenon's capsule oscopy with the Zeiss 4-mirror gonioprism, examina- was developed, the incision being made high in the tion of the optic disc with direct ophthalmoscopy and cul-de-sac just inferior to the insertion of the superior Correspondence to George L. Spaeth, MD, Glaucoma Service Wills rectus muscle. This was reflected to the limbus and Eye Hospital, 9th and Walnut Streets, Philadelphia, Pa 19104, USA. the episclera incised and similarly reflected to the 783 Br J Ophthalmol: first published as 10.1136/bjo.65.11.783 on 1 November 1981. Downloaded from 784 George L. Spaeth and Effie Poryzees Table I Clinical and operative details ofpatients Patient number Patient I Patient 2 Patient 3 Patient 4 PatientS Patient 6 Patient 7 Procedure T S T S T S T S T S T S T S Eve OD OS OD OS OD Os 0D Os 0D OS OD OS OD OS Age, race, sex 46 W, M 66, W, M 80, W, F 69, W, F 73, W, M (30. W,M 401 W. F Diagnosis POA POA POA POA POA+NA POA POA Intraocular pressure Initial 21 25 30 65 26 24 36 36 50 53 38 40 26 22 Oneyearpostoperatively 14 10 18 11 18 6 11 12 13 13 10 5-7 18 12 Most recent off treatment (& on treatment) 17 18 40 (18) 23 (19) 28 (12) 35 (16) 22(20) 25 (14) 26 14 18 (16) 10 Visualfield W NC B B NC NC NC NC B B NC NC Nature ofthe bleb At I year FLP HT 0 HC F HCL FL HCL FC HCL HCL HCL FP CL At 5 years 0 HCL 0 FC 0 FC C C 0 LC 0 HCL Visual acuity Initial 20/20 20/50 20/20 20/20 15/80 20/30 20/60 20/200 20/70 20/70 20/20 201/302 20/20 20/20 One year postoperatively 20/30 20/80 20/20 20/20 20/100 20/40 20/200 HM 2(0/l)0 20/70 20/20- 2(0/40-2 2(0/2(0 2(0/20 Most recent 20/30 20/100 20/30 20/15 20/100 20/70 20/200 20/200 20/20 20/4(0 20/2(0 20/20 Change between initial & most recent -1 -4 -1 0 -5 -5 -3 - I 0 -I 0 Cataract Present preoperatively No No No No Yes Yes Yes Yes Yes Yes No No No No Change? NC NC W NC CE CE W W NC NC NC NC NC NC Operative complications Hyphaema 2+ 2+ 1+ 1+ 1+ 2+ 2+ 2+ 1+ Depthofanteriorchamber 2+ 1+ 1+ 2+ 1+ 1+ Disease controlled 5 years after surgery? 0 Y YR YR OR OR OR YR Y Y YR Y Code: T=Trabeculectomy. S=Peripheral iridectomy-thermal sclerostomy (Scheie). POA=Primarv open-angle glaucoma. B=Better. NC=No change. W=Worsc. CE=Cataract extraction. Q=Disease questionably controlled on no treatment. Y=Disease controlled on no treatment. QR=Discase questionablv controlled on treatment. YR=Disease controlled on treatment. Abbreviations: F=Flat. C=Cystic. L=Limbal. H=High. T=Thick. P=Posterior. copyright. Ocular complications code: Hyphaema 2+ refers to a hyphaema of greater than 2 mm in thickness. Hyphaema I + refers to a hyphaema smaller than 2 mm. 3+ flattening of the anterior chamber indicates contact between the iris and the corneal endothelium extending from the peripherv almost all the wav to the pupillarv margin. 2+ indicates contact limited to the periphery. 1 + signifies that the chamber was shallower postoperativelv than preoperativelv. but no iris-comeal contact was present. limbus, leaving bare sclera from the superior rectus in patients having trabeculectomy than in those insertion to the corneoscleral sulcus. Light cautery treated with peripheral iridectomy with thermal was applied to bleeding vessels where necessary, sclerostomy. In all cases the following procedures http://bjo.bmj.com/ except over the area where the scleral flap was to be were employed: an effort was made to have the developed in patients who would be treated with anterior chamber well formed at the conclusion of the trabeculectomy. In peripheral iridectomy with surgery; atropine 1% was instilled throughout the thermal sclerostomy light cautery was applied 1 mm procedure so that the pupil was dilated at the con- posterior to the limbus followed by a shallow incision clusion; Tenon's capsule was closed separately with 4 mm long; cautery was then placed in the incision 8-0 locked, running chromic catgut sutures; and the the edges.' The procedure was repeated conjunctiva was closed with multiple, closely-spaced, spreading on September 27, 2021 by guest. Protected until the anterior chamber was entered with a blade. running 8-0 chromic catgut sutures. In trabeculectomy a scleral flap 5 x 5 mm and approxi- Postoperative care was essentially the same for all mately one-third the thickness of the sclera was eyes, and consisted of topical atropine I %, dexa- fashioned and dissected anteriorly to its hinged methasone 0-1%, and antibiotics, all 4 times daily attachment at the limbus.2 A block of tissue 3x3 mm until discharge and then in rapidly decreasingamounts including sclera, trabecular meshwork, and cornea thereafter. Intraocular pressure was determined and was excised in a fashion similar to that described by biomicroscopic examination performed twice daily Watson.3 (The author at present does not employ this while the patient was in hospital, which was same method, but rather makes the posterior incision customarily 5 days. Postoperative outpatient ex- more anteriorly, so that less or none of the ciliary aminations, including measurement of visual acuity, body is unroofed.) The scleral flap was sutured with intraocular pressure, biomicroscopic, and ophthal- four 8-0 virgin silk sutures. In both types of pro- moscopic examinations were performed 1, 2, and 4 cedures entry into the anterior chamber was at the 12 weeks after discharge, and at least 6-month intervals o'clock position on the globe. In all cases a peripheral after that. Visual field examinations were repeated at iridectomy was performed; this was invariably larger 6-month intervals or more often ifindicated. External Br J Ophthalmol: first published as 10.1136/bjo.65.11.783 on 1 November 1981. Downloaded from A comparison between peripheral iridectomy with thermal sclerostomy and trabeculectomy 785 Patient 8 Patient 9 Patient 10 Patien 1I Patient 12 Patient 13 Patient 14 Patient 15 T 5 T 5 T 5 T 5 T S T S T 5 T S OD OS OD OS OD OS OD OS OD OS OD OS OD OS OD OS 68.W.F 53,W.F 41,W,F 18,W.M 55,W,M 63,W,M 77,W.F 38,W.M POA POA POA POA POA+NA POA POA POA 27 30 22 20 23 35 43 40 24 18 23 33 2( 12 5 8 15 17 24 10 16 8 20 8 36 34 55 48 20(18) 16 14 10 15 12 33(20) 24(20) 18(4) 6 20(15) 6 14 8 17 15 NC BB B NC NC NC NC NC NC NC NC 17 15 B B F LC F FLC F HC 0 TC 0 FLC 0 HC F LC F LC O TC 0 HCL C LC F 0 0 HC F HC F LC 2)/2) 20/20( 20/20 20/20 20/30 LP 20/70 20/70 20/25 20/25 20/20 20/20 20/200 20/40 20/70 20/30 2(1/3(0 20/30) 2(0/2(0+ 20/25 20/20 NLP 20/70 20/70 CF 20/25 20/20 20/20 20/200 20/40 20/30 20/20 2(0/3(0 201/3(0 20/20 20/30 20/20 NLP 20/70 20/70 20/25 20/30 20/20 20/20 20/30 20/20 -2 -2 ( -I 0 -I 0 0 -8 -I 0 0 +2 +1 No No No No No No No No Yes Yes No No Yes Yes No No NC NC NC NC NC NC NC NC CE W NC NC W W NC NC I1+ I1+ 2±+ 3+ + 1+ 1 + YR Y Y Y Y Y YR YR YR Y YR Y Y Y copyright.
Load more

Recommended publications
  • Wildlife Ophthalmology
    Wildlife Ophthalmology DR. HEATHER REID TORONTO WILDLIFE CENTRE TORONTO, ON CANADA Why understand eyes? Wildlife need to have excellent vision to survive in the wild Eye related problems are common in wildlife admitted to rehabilitation centers What we will cover Anatomy of the eye Differences between birds and mammals The eye exam Recognizing common problems Prognosis Treatment options When to see the vet Anatomy Around the Eye: Muscles & nerves Skin Eye lids Nictitating eyelid Conjunctiva & sclera Tear glands & ducts Ossicles (birds) Anatomy Front of the Eye: Cornea Iris Pupil Ciliary body Anterior Chamber Aqueous humor Anatomy Back of the Eye: Lens Retina Optic nerve Choroid Pecten (birds) Posterior Chamber Vitreous humor Fundus of the Eye Mammal Eye Bird Eye The Avian Eye - Differences Small eye size in most birds and small pupil size makes it hard to examine Can control the size of their pupil Lower eyelid more developed The nictitating membrane spreads the tears allowing birds to blink less Moves horizontally across eye The Avian Eye - Differences Eyes are not as protected by skull Less muscles around eye so less eye movement Boney ossicles support the eye Three main eye shapes; flat, globose & tubular The Avian Eye - Differences Four different color receptors compared to the three in mammals means better color detail Can see in the ultraviolet range Higher flicker rate – can detect lights that flicker at more than 100 flashes per second (humans detect at 50) The Avian Eye - Differences In some species the eye
    [Show full text]
  • Ocular Surface Changes Associated with Ophthalmic Surgery
    Journal of Clinical Medicine Review Ocular Surface Changes Associated with Ophthalmic Surgery Lina Mikalauskiene 1, Andrzej Grzybowski 2,3 and Reda Zemaitiene 1,* 1 Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, 44037 Kaunas, Lithuania; [email protected] 2 Department of Ophthalmology, University of Warmia and Mazury, 10719 Olsztyn, Poland; [email protected] 3 Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, 61553 Poznan, Poland * Correspondence: [email protected] Abstract: Dry eye disease causes ocular discomfort and visual disturbances. Older adults are at a higher risk of developing dry eye disease as well as needing for ophthalmic surgery. Anterior segment surgery may induce or worsen existing dry eye symptoms usually for a short-term period. Despite good visual outcomes, ocular surface dysfunction can significantly affect quality of life and, therefore, lower a patient’s satisfaction with ophthalmic surgery. Preoperative dry eye disease, factors during surgery and postoperative treatment may all contribute to ocular surface dysfunction and its severity. We reviewed relevant articles from 2010 through to 2021 using keywords “cataract surgery”, ”phacoemulsification”, ”refractive surgery”, ”trabeculectomy”, ”vitrectomy” in combina- tion with ”ocular surface dysfunction”, “dry eye disease”, and analyzed studies on dry eye disease pathophysiology and the impact of anterior segment surgery on the ocular surface. Keywords: dry eye disease; ocular surface dysfunction; cataract surgery; phacoemulsification; refractive surgery; trabeculectomy; vitrectomy Citation: Mikalauskiene, L.; Grzybowski, A.; Zemaitiene, R. Ocular Surface Changes Associated with Ophthalmic Surgery. J. Clin. 1. Introduction Med. 2021, 10, 1642. https://doi.org/ 10.3390/jcm10081642 Dry eye disease (DED) is a common condition, which usually causes discomfort, but it can also be an origin of ocular pain and visual disturbances.
    [Show full text]
  • Documentation Dissection
    Documentation Dissection Pre and Postoperative diagnosis: Uncontrolled moderate open angle glaucoma, left eye |1|. Procedure: Trabeculectomy of externo with peripheral iridectomy |2| Anesthesia: Conscious sedation, peribulbar block. Estimated blood loss: Less than 1 cc. COMPLICATIONS: None. The patient has had progressive visual field deterioration on maximum tolerated medications, and pressures in the high teens with a diagnosis of uncontrolled open angle glaucoma, left eye. To preserve her visual field, it was felt that surgery was necessarygiven the extensive damage to her optic nerve and field already existing |3|. The risks, benefits, and alternatives to surgery were discussed with the patient as well as with her husband, and she was anxious to proceed. PROCEDURE: The patient was brought to the operating room where she was given an intravenous sedative and peribulbar block. She was then prepped and draped in customary sterile fashion for intraocular surgery. A wire lid speculum was placed, and a 6-0 Vicryl traction suture was put through the superior peripheral cornea. The globe was retracted downward. The conjunctiva was entered 12 mm proximal to the limbus. With a combination of blunt and sharp dissection it was dissected down to the surgical limbus. The Gill’s knife was used to bare the limbus, and hemostasis was achieved with bipolar cautery |4|. A 4 x 4 mm rectangular lamellar flap was outlined with the 200 to 300 micron blade, |5| after which Mitomycin C 0.3 mg/cc was applied to the surface of the sclera overlying the outlying trap door for 2 minutes 30 seconds. The sponge and all instruments used to manipulate the Micomycin sponge were removed from the field, and the eye was vigorously irrigated with balanced salt solution (BSS).
    [Show full text]
  • Smartphone-Based Dilated Fundus Photography and Near Visual Acuity Testing As Inexpensive Screening Tools to Detect Referral Warranted Diabetic Eye Disease
    Smartphone-Based Dilated Fundus Photography and Near Visual Acuity Testing as Inexpensive Screening Tools to Detect Referral Warranted Diabetic Eye Disease BRIAN C. TOY, MD,*† DAVID J. MYUNG, MD, PHD,*† LINGMIN HE, MD,*† CAROLYN K. PAN, MD,*† ROBERT T. CHANG, MD,* ALISON POLKINHORNE, MA,‡ DOUGLAS MERRELL, BS,‡ DOUG FOSTER, MBA,‡ MARK S. BLUMENKRANZ, MD* Purpose: To compare clinical assessment of diabetic eye disease by standard dilated examination with data gathered using a smartphone-based store-and-forward teleoph- thalmology platform. Methods: 100 eyes of 50 adult patients with diabetes from a health care safety-net ophthalmology clinic. All patients underwent comprehensive ophthalmic examination. Concurrently, a smartphone was used to estimate near visual acuity and capture anterior and dilated posterior segment photographs, which underwent masked, standardized review. Quantitative comparison of clinic and smartphone-based data using descriptive, kappa, Bland-Altman, and receiver operating characteristic analyses was performed. Results: Smartphone visual acuity was successfully measured in all eyes. Anterior and posterior segment photography was of sufficient quality to grade in 96 and 98 eyes, respectively. There was good correlation between clinical Snellen and smartphone visual acuity measurements (rho = 0.91). Smartphone-acquired fundus photographs demon- strated 91% sensitivity and 99% specificity to detect moderate nonproliferative and worse diabetic retinopathy, with good agreement between clinic and photograph grades (kappa = 0.91 ± 0.1, P , 0.001; AUROC = 0.97, 95% confidence interval, 0.93–1). Conclusion: The authors report a smartphone-based telemedicine system that demon- strated sensitivity and specificity to detect referral-warranted diabetic eye disease as a proof-of-concept. Additional studies are warranted to evaluate this approach to expanding screening for diabetic retinopathy.
    [Show full text]
  • Effects of Nd:YAG Laser Capsulotomy in Posterior Capsular Opacification
    Original Research Article Effects of Nd:YAG laser capsulotomy in posterior capsular opacification Praveen Kumar G S1, Lavanya P2*, Raviprakash D3 1Assistant Professor, 2Associate Professor, 3Professor & HOD, Department of Ophthalmology, Shridevi institute of Medical Sciences and Research Hospital, Sira Road, NH-4 Bypass Road, Tumkur- 572106, INDIA. Email: [email protected] Abstract Background: Posterior capsular opacification (PCO) is the most common long-term complication of cataract surgery in both phacoemulsification and extracapsular cataract extraction (ECCE). The overall incidence of PCO and the incidence of neodymium-doped yttrium–aluminum–garnet (Nd:YAG) laser posterior capsulotomy has decreased from 50% in the 1980s and early 1990s to less than 10% today. Reported complications of Nd:YAG laser posterior capsulotomy include elevated intraocular pressure, iritis, corneal damage, intraocular lens (IOL) damage, cystoids macular edema, disruption of the anterior hyaloid surface, increased risk of retinal detachment, and IOL movement or dislocation. In some patients, a refraction change is noticed after Nd:YAG laser posterior capsulotomy, but proving this remains difficult. Materials and Methods: Nd; YAG LASER capsulotomy was performed in 200 eyes of 200 patients, some with pseudophakia and some with aphakia at Kurnool medical college, Kurnool. They were followed up between October 2008 and September 2010. Results: Elevation of IOP has been well documented after anterior segment laser procedures. The IOP rise after YAG laser posterior capsulotomy is of short duration starting about 1 hr after laser procedure and lasting for 24 hrs. In this study, in 1case IOP came down to normal level after 3 days and in another case after 7 days.
    [Show full text]
  • Trabeculectomy Bleb Assessment Via Three-Dimensional Anterior Segment Optical Coherence Tomography
    Central JSM Ophthalmology Research Article *Corresponding author Takahiro Kawaji, Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Trabeculectomy Bleb Honjo, Chuo-ku, Kumamoto 860-8556, Japan, Tel: +81-96-373-5247; Fax: +81-96-373-5249; Email: Assessment via Three- Submitted: 23 February 2014 Accepted: 03 March 2014 dimensional Anterior Segment Published: 07 March 2014 ISSN: 2333-6447 Optical Coherence Tomography Copyright Takahiro Kawaji*, Toshihiro Inoue, Riyo Matsumura, Utako © 2014 Kawaji et al. Kuroda, Kei-Ichi Nakashima and Hidenobu Tanihara OPEN ACCESS Department of Ophthalmology, Kumamoto University, Japan Keywords Abstract • Glaucoma • Trabeculectomy Background: To evaluate the morphological features of filtering blebs after • Bleb trabeculectomy by using three-dimensional anterior segment optical coherence • Three-dimensional anterior segment optical tomography (3D AS-OCT). coherence tomography Methods: This retrospective cross-sectional study evaluated 47 patients who had undergone trabeculectomy with mitomycin C. All blebs were imaged with 3D AS-OCT and analyzed with our custom software. We assessed blebs quantitatively for the following features: bleb height, fluid-filled cavity height, bleb wall thickness, and bleb wall intensity. Results: The mean (± standard deviation [SD]) time period between trabeculectomy and 3D AS-OCT measurement was 9.5 ± 6.2 months; the mean (±SD) intraocular pressure (IOP) measured 14.0 ± 4.3 mm Hg at the time of 3D AS-OCT imaging. IOP and the bleb height (rs = -0.609, P = < .0001), the fluid-filled cavity height (rs = -0.381, P = 0.009), the bleb wall thickness (rs = -0.503, P = 0.0004) and the bleb wall intensity (rs = 0.612, P = < .0001) showed statistically significant correlations.
    [Show full text]
  • CACI - Glaucoma Worksheet (Updated 04/26/2017)
    CACI - Glaucoma Worksheet (Updated 04/26/2017) The Examiner must review a current status report by the treating physician and any supporting documents to determine the applicant’s eligibility for certification. If the applicant meets ALL the acceptable certification criteria listed below, the Examiner can issue. Applicants for first- or second- class must provide this information annually; applicants for third-class must provide the information with each required exam. AME MUST REVIEW ACCEPTABLE CERTIFICATION CRITERIA Treating ophthalmologist finds the [ ] Yes condition stable on current regimen and no changes recommended. Age at diagnosis [ ] 40 or older FAA Form 8500-14 or equivalent [ ] Yes treating physician report that documents the considerations below: Acceptable types of glaucoma [ ] Open Angle being monitored and stable, Ocular Hypertension or Glaucoma Suspect being monitored and stable, or previous history of Narrow Angle/Angle Closure Glaucoma which has been treated with iridectomy /iridotomy (surgical or laser) and is currently stable. NOT acceptable: Normal Tension Glaucoma, secondary glaucoma due to inflammation, trauma, or the presence of any other significant eye pathology (e.g. neovascular glaucoma due to proliferative diabetic retinopathy or an ischemic central vein occlusion or uveitic glaucoma) Documented nerve damage or [ ] No trabeculectomy (filtration surgery) Medications [ ] None or Prostaglandin analogs (Xalatan, Lumigan, Travatan or Travatan Z), Carbonic anhydrase inhibitor (Trusopt and Azopt), Beta blockers (Timoptic, etc), or Alpha agonist (Alphagan). Combination eye drops are acceptable NOT acceptable for CACI: Pilocarpine or other miotics, cycloplegics (Atropine), or oral medications. Medication side effects [ ] None Intraocular pressure [ ] 23 mm Hg or less in both eyes ANY evidence of defect or reported [ ] No Unreliable Visual Fields Acceptable visual field tests: Humphrey 24-2 or 30-2 (either SITA or full threshold), Octopus (either TOP or full threshold).
    [Show full text]
  • Medicare Quarterly Provider Compliance Newsletter Guidance to Address Billing Errors
    DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Medicare Quarterly Provider Compliance Newsletter Guidance to Address Billing Errors Updated Provider Index Now Available! See the Introduction section for more details Volume 3, Issue 4 - July 2013 ICN 908787/ July 2013 Table of Contents Comprehensive Error Rate Testing (CERT): Home Health Certification......................................................................... 1 CERT Finding: Glucose Monitoring Supplies .......................................... 3 CERT Finding: Inpatient Psychiatric Facility Prospective Payment System (PPS) ............................................................................ 5 Recovery Auditor Finding: Infusion Pump Denied/Accessories & Drug Codes Should Be Denied ............................................................. 7 Recovery Auditor Finding: Overutilization of Nebulizer Medications .... 8 Recovery Auditor Finding: Post-Acute Transfer - Underpayments ..... 10 Recovery Auditor Finding: Co-Surgery Not Billed with Modifier 62 .... 11 Recovery Auditor Finding: Pre-admission Diagnostic Testing Review ....................................................................................... 13 Recovery Auditor Finding: Duplicate Claims ...................................... 15 Recovery Auditor Finding: Add-on HCPCS/CPT Codes Without Primary Codes........................................................................... 17 Recovery Auditor Finding: Dose versus Units Billed - Bevacizumab (HCPCS J9035) and Rituximab
    [Show full text]
  • Coding Competencies for Ophthalmic Techs – 2020 Coding Update
    3/5/2020 Coding Competencies for Ophthalmic Techs – 2020 Coding Update OAO Ophthalmic Medical Technology Friday, March 13, 2020 Joy Woodke, COE, OCS, OCSR 1 Financial Disclosure Joy Woodke, COE, OCS o This presenter does not have a financial interest or relationship to disclose relative to this activity. o Academy Coding & Practice Management Executive 2 Topics 2020 Coding Updates Coding Competencies Diagnostic testing services Modifiers Tech Takeaways Understanding insurance policies Ongoing coding education Resources 3 1 3/5/2020 2020 Coding Updates Extended Ophthalmoscopy & Cataract Surgery 4 Extended Ophthalmoscopy (EO) • CPT eliminated initial and subsequent codes for EO • New codes for drawing of • Peripheral retina, with scleral depression: 5% in work value over deleted initial EO • Optic nerve or macula: 32% compared to deleted initial EO 5 Extended Ophthalmoscopy (EO) • 92225 Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; initial • 92226 subsequent 6 2 3/5/2020 Extended Ophthalmoscopy (EO) 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (eg, for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral 7 Ophthalmoscopy 92201 8 8 Extended Ophthalmoscopy (EO) 92202 with drawing of optic nerve or macula (eg, for glaucoma, macular pathology, tumor) with interpretation and report, unilateral or bilateral 9 3 3/5/2020 Ophthalmoscopy 92202 10 Extended Ophthalmoscopy (EO) • Payment was unilateral. 2020 is bilateral. 2019 2020 92225 $29.87 per eye 92201 $27.21 Only bill for the eye that has 92202 $17.21 pathology. 92226 $27.63 per eye Only bill for the eye that has pathology 11 Extended Ophthalmoscopy (EO) • Payment is the same whether one or both eyes are examined and pathology is drawn and labeled.
    [Show full text]
  • Effect of Trabeculotomy on Corneal Endothelial Cell Loss in Cases of After Penetrating-Keratoplasty Glaucoma
    CLINICAL SCIENCE Effect of Trabeculotomy on Corneal Endothelial Cell Loss in Cases of After Penetrating-Keratoplasty Glaucoma Ayaka Kusakabe, BS, MS,* Naoki Okumura, MD, PhD,* Koichi Wakimasu, MD,† Kanae Kayukawa, MD,† Masami Kondo, BS,* Noriko Koizumi, MD, PhD,* Chie Sotozono, MD, PhD,‡ Shigeru Kinoshita, MD, PhD,†‡§ and Kazuhiko Mori, MD, PhD‡ laucoma is recognized as one of the most devastating Purpose: The aim of this study was to evaluate the effect of Gcomplications that can arise after corneal transplantation, trabeculotomy (TLO) on glaucoma and endothelial cell loss after as it can often lead to corneal graft failure and glaucomatous penetrating keratoplasty (PK). optic neuropathy resulting in visual field loss. In 1969, Irvine 1 Methods: A retrospective study was conducted on consecutive patients and Kaufman reported a high incidence of intraocular who underwent PK and in whom more than 24 months of follow-up was pressure (IOP) elevation after penetrating keratoplasty (PK). available. Patients were categorized into the PK+TLO group [ie, TLO for Currently, it is widely accepted that the incidence of post-PK glaucoma (n = 10)] and the PK group [PK alone (n = 73)]. glaucoma after PK is high, ranging from 9% to 35% of all cases.2–8 Intraocular pressure (IOP) was evaluated during each follow-up fi examination. Central corneal endothelium images were obtained and Topical administration of antiglaucoma drugs is a rst- analyzed to determine corneal endothelial cell (CEC) density. line treatment for the control of IOP. However, as manage- ment of glaucoma after corneal transplantation is difficult, Results: The mean duration period from original PK to TLO for surgical treatments are often required.8 Trabeculectomy secondary glaucoma was 25.5 6 34.9 months in the PK+TLO group.
    [Show full text]
  • Endoscopic Vitreoretinal Surgery: Principles, Applications and New Directions Radwan S
    Ajlan et al. Int J Retin Vitr (2019) 5:15 International Journal https://doi.org/10.1186/s40942-019-0165-z of Retina and Vitreous REVIEW Open Access Endoscopic vitreoretinal surgery: principles, applications and new directions Radwan S. Ajlan1*, Aarsh A. Desai2 and Martin A. Mainster1 Abstract Purpose: To analyze endoscopic vitreoretinal surgery principles, applications, challenges and potential technological advances. Background: Microendoscopic imaging permits vitreoretinal surgery for tissues that are not visible using operat- ing microscopy ophthalmoscopy. Evolving instrumentation may overcome some limitations of current endoscopic technology. Analysis: Transfer of the fine detail in endoscopic vitreoretinal images to extraocular video cameras is constrained currently by the caliber limitations of intraocular probes in ophthalmic surgery. Gradient index and Hopkins rod lenses provide high resolution ophthalmoscopy but restrict surgical manipulation. Fiberoptic coherent image guides offer surgical maneuverability but reduce imaging resolution. Coaxial endoscopic illumination can highlight delicate vitreo- retinal structures difficult to image in chandelier or endoilluminator diffuse, side-scattered lighting. Microendoscopy’s ultra-high magnification video monitor images can reveal microscopic tissue details blurred partly by ocular media aberrations in contemporary surgical microscope ophthalmoscopy, thereby providing a lower resolution, invasive alternative to confocal fundus imaging. Endoscopic surgery is particularly useful when ocular
    [Show full text]
  • Glaucoma Management After Corneal Transplantation Surgeries
    HHS Public Access Author manuscript Author ManuscriptAuthor Manuscript Author Curr Opin Manuscript Author Ophthalmol. Manuscript Author manuscript; available in PMC 2017 September 05. Published in final edited form as: Curr Opin Ophthalmol. 2016 March ; 27(2): 132–139. doi:10.1097/ICU.0000000000000237. Glaucoma management after corneal transplantation surgeries Helen L. Kornmann and Steven J. Gedde Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA Abstract Purpose of review—Intraocular pressure (IOP) elevation and glaucoma progression following corneal transplantation, specifically, penetrating keratoplasty, Descemet’s stripping endothelial keratoplasty, and Boston keratoprosthesis, are well described causes of ocular morbidity. Depending on the procedure performed, the incidence of glaucoma is highly variable. Several etiologic factors have been identified, the most common being synechial angle closure and corticosteroid-induced IOP elevation. The purpose of this review is to describe the various treatment strategies for glaucoma following corneal transplantation. Recent findings—Medications and laser treatments are usually first-line therapies for postoperative IOP elevation. Surgical intervention, including filtering surgery and glaucoma drainage devices, may be necessary to control IOP and prevent progressive glaucomatous damage. Summary—Glaucoma is a common complication of corneal transplantation, and the degree of aggressiveness is often related to the indication for corneal surgery.
    [Show full text]