CPT® Code 66155

1. Indications

The procedure described by CPT® Code 66155 is indicated for the treatment of glaucoma, particularly in cases where intraocular pressure needs to be effectively managed. The following conditions may warrant the performance of this procedure:

• Glaucoma A condition characterized by increased intraocular pressure that can lead to optic nerve damage and vision loss.
• Inadequate response to medical therapy Situations where patients do not achieve sufficient pressure reduction through medications alone.
• Secondary glaucoma Glaucoma that occurs as a result of other medical conditions or treatments, necessitating surgical intervention.

2. Procedure

The procedure for CPT® Code 66155 involves several critical steps to ensure effective treatment of glaucoma:

• Step 1: Preparation and Anesthesia The patient is positioned comfortably, and local anesthesia is administered to minimize discomfort during the procedure. The eye is then prepared and draped in a sterile manner to maintain a clean surgical field.
• Step 2: Incision of the Conjunctiva An incision is made in the conjunctiva near the limbus, which is the junction between the cornea and sclera. This incision allows access to the underlying scleral tissue, which is essential for the subsequent steps of the procedure.
• Step 3: Exposure of the Sclera The conjunctival incision is carefully dissected to expose the sclera, the white outer layer of the eye. This exposure is crucial for the creation of the fistula necessary for fluid drainage.
• Step 4: Creation of the Scleral Opening Using a Fugo blade, a small opening is created in the pars plana of the ciliary body. The Fugo blade utilizes plasma energy to cut through the tissue while simultaneously cauterizing it, which minimizes bleeding during the procedure.
• Step 5: Iridectomy A small section of the iris is removed to create an iridectomy. This step is vital as it allows aqueous humor to drain from the posterior chamber into the subconjunctival lymphatics, thereby lowering intraocular pressure.
• Step 6: Closure of the Scleral Incision After the iridectomy is completed, the scleral incision is closed with sutures to ensure proper healing and to maintain the integrity of the eye.
• Step 7: Closure of the Conjunctiva Finally, the conjunctiva is closed over the scleral incision, completing the procedure and providing protection to the surgical site.

3. Post-Procedure

After the completion of the procedure, patients are typically monitored for any immediate complications. Post-operative care may include the use of topical medications, such as antibiotics and anti-inflammatory agents, to prevent infection and manage inflammation. Patients are advised to follow up with their ophthalmologist to assess the success of the procedure in lowering intraocular pressure and to monitor for any potential complications. Recovery time may vary, but patients are generally encouraged to avoid strenuous activities and to adhere to any specific post-operative instructions provided by their healthcare provider.