CPT® Code 66683

1. Indications

The implantation of an iris prosthesis is indicated for patients who have experienced significant loss or damage to the iris, which may result from various conditions or injuries. The following are specific indications for this procedure:

• Partial or Complete Iris Loss - This may occur due to trauma, congenital defects, or surgical complications that lead to the absence of the iris.
• Photophobia - Patients who suffer from increased sensitivity to light due to iris damage may benefit from this procedure to alleviate discomfort.
• Incessant Glare - Individuals experiencing persistent glare from bright lights as a result of iris loss may find relief through the implantation of an artificial iris.
• Loss of Visual Acuity - Patients with compromised vision due to iris defects may require this procedure to improve their overall visual function.

2. Procedure

The procedure for the implantation of an iris prosthesis involves several detailed steps to ensure successful placement and stabilization of the artificial iris. The following outlines the procedural steps:

• Step 1: Incision Creation - The procedure begins with the creation of a paracentesis incision in the anterior chamber of the eye, along with a temporal corneal incision. These incisions provide access to the internal structures of the eye.
• Step 2: Vitrectomy - Instruments are inserted through the incisions to perform a vitrectomy, which involves the removal of the vitreous gel from the eye to facilitate the procedure.
• Step 3: Injection of Viscoelastic Material - Viscoelastic material is injected into the anterior chamber to maintain its shape and protect the corneal endothelium during the surgery.
• Step 4: Release of Synechiae - Any synechiae, which are adhesions between the remaining iris and the lens capsule, are carefully released to allow for proper placement of the artificial iris.
• Step 5: Removal of Damaged Tissue - Any damaged or necrotic tissue within the eye is removed to prepare for the implantation of the prosthesis.
• Step 6: Centering of Intraocular Lens (if present) - If a synthetic intraocular lens (IOL) is already in place, its position is centered and stabilized using a tension ring to ensure optimal visual outcomes.
• Step 7: Scleral Sutures - Scleral sutures may be placed as needed to secure the structures within the eye.
• Step 8: Release of Fibrosis - Any fibrosis of the anterior capsule is released to facilitate the implantation process.
• Step 9: Dissection of Anterior Lens Capsule - A needle and viscoelastic syringe are utilized to dissect the anterior lens capsule from the surface of the lens, allowing for proper placement of the artificial iris.
• Step 10: Sizing the Artificial Iris - The artificial iris implant is sized appropriately by measuring the white-to-white distance of the eye to ensure a proper fit.
• Step 11: Loading the Implant - Two peripheral incisions are made in the implant, which is then loaded into an injector cartridge for placement.
• Step 12: Placement of the Artificial Iris - The tip of the injector is placed through the corneal incision, and the artificial iris is positioned into the anterior chamber. It is carefully placed within the lens capsule, if free of the lens surface, or in the sulcus in front of the capsule or IOL complex.
• Step 13: Stabilization of the Implant - The implant is stabilized with sutures as necessary to ensure it remains securely in place.
• Step 14: Aspiration of Viscoelastic and Residual Vitreous - Any remaining viscoelastic material is aspirated from the eye, along with any residual vitreous gel.
• Step 15: Eye Pressure Check - The intraocular pressure is checked and adjusted using saline solution to ensure it is within normal limits.
• Step 16: Incision Testing and Patching - All incisions are tested for leaks before the eye is patched to promote healing.

3. Post-Procedure

After the implantation of the iris prosthesis, patients may require specific post-procedure care to ensure proper healing and recovery. This includes monitoring for any signs of complications, such as infection or increased intraocular pressure. Patients are typically advised to avoid strenuous activities and to follow up with their ophthalmologist for regular assessments. Eye drops may be prescribed to reduce inflammation and prevent infection. The expected recovery time can vary, but patients should be informed about the importance of adhering to follow-up appointments to monitor the success of the procedure and the stability of the artificial iris implant.