CPT® Code 0253T

1. Indications

The insertion of an anterior segment aqueous drainage device, as described by CPT® Code 0253T, is indicated for the treatment of specific conditions related to intraocular pressure management. The primary indications include:

• Chronic Open-Angle Glaucoma - This condition is characterized by a gradual increase in intraocular pressure due to the impaired drainage of aqueous humor, leading to potential optic nerve damage.
• Progressive Open-Angle Glaucoma - This refers to a worsening form of open-angle glaucoma where the disease progresses despite treatment, necessitating more invasive interventions to control intraocular pressure.

2. Procedure

The procedure for the insertion of the anterior segment aqueous drainage device involves several critical steps, each designed to ensure the effective placement of the device for optimal drainage of aqueous humor. The steps are as follows:

• Step 1: Preparation and Anesthesia - The patient is prepared for the procedure, which includes administering local anesthesia to ensure comfort during the surgery. The eye is then cleaned and draped to maintain a sterile environment.
• Step 2: Incision Creation - A small, self-sealing incision is made in the cornea to access the anterior chamber. This incision is designed to minimize trauma and promote quick healing.
• Step 3: Scleral Flap Creation - A deep posterior scleral flap is created to access the suprachoroidal space. This flap allows the surgeon to reach the area where the drainage device will be placed.
• Step 4: Device Placement - Using a gonioscope, the surgeon carefully positions the drainage device at the angle of the anterior chamber. The gonioscope provides the necessary magnification and visualization to ensure accurate placement.
• Step 5: Device Insertion - The drainage device is then inserted through the sclera, with its terminal end positioned in the suprachoroidal space. This placement is crucial for effective drainage of aqueous humor.
• Step 6: Closure - After the device is securely in place, the scleral flap is closed, and the corneal incision is allowed to self-seal. The surgeon ensures that there is no leakage and that the device is functioning as intended.

3. Post-Procedure

Post-procedure care following the insertion of the anterior segment aqueous drainage device is essential for ensuring proper healing and device function. Patients are typically monitored for any immediate complications, such as bleeding or infection. It is common for patients to experience some discomfort or mild pain, which can be managed with prescribed analgesics. Follow-up appointments are crucial to assess intraocular pressure and the overall success of the drainage device. Patients may also be advised on the use of topical medications, such as antibiotics or anti-inflammatory drops, to prevent infection and reduce inflammation. Regular monitoring will help determine if further interventions are necessary to optimize intraocular pressure control.