CPT® Code 0100T

1. Indications

The placement of a subconjunctival retinal prosthesis receiver and pulse generator, along with the implantation of an intraocular retinal electrode array, is indicated for patients experiencing blindness due to specific retinal diseases. These conditions include:

• Retinitis Pigmentosa A genetic disorder that leads to the degeneration of photoreceptor cells in the retina, resulting in progressive vision loss.
• Hereditary Retinal Degeneration A group of inherited conditions that cause the gradual deterioration of the retina, leading to vision impairment or blindness.
• Macular Degeneration Certain forms of this condition, which affect the central portion of the retina (the macula), can lead to significant vision loss, particularly in older adults.

2. Procedure

The procedure for the placement of a subconjunctival retinal prosthesis receiver and pulse generator, along with the implantation of an intraocular retinal electrode array, involves several critical steps:

• Step 1: Incision and Exposure The conjunctiva and tenon layers are incised to expose the sclera, allowing access to the underlying structures of the eye.
• Step 2: Vitrectomy Vitrectomy is performed by creating three small incisions, known as sclerotomies, in the pars plana, which is located just behind the iris and in front of the retina. This step is crucial for removing the vitreous humor, a gel-like substance that fills the eye.
• Step 3: Insertion of Instruments A light pipe is inserted through one of the incisions to illuminate the surgical field, while a fluid infusion port is established in a second incision to maintain intraocular pressure. A vitrector is then inserted through the third incision to cut and suction the vitreous humor.
• Step 4: Removal of Vitreous Humor The vitreous humor is carefully cut and removed using suction, ensuring that the retina is protected during this process. A saline solution is infused to maintain pressure within the eye and safeguard the retinal tissue.
• Step 5: Insertion of the Prosthesis After the vitrector is removed, the subconjunctival receiver and the retinal electrode array are inserted. The electrode array is centered on the central macula and tacked securely to the retina to ensure proper placement.
• Step 6: Closure of Incisions The fluid infusion line is removed after confirming that adequate fluid pressure has been established in the eye. The light pipe is then taken out, and the sclerotomies are closed. Finally, the tenon layers and conjunctiva are sutured to complete the procedure.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications and ensuring that the implanted devices are functioning correctly. Patients may experience some discomfort and will require follow-up visits to assess the healing process and the effectiveness of the retinal prosthesis. Instructions regarding activity restrictions, medication use, and signs of potential complications will be provided to ensure optimal recovery and device performance.