CPT® Code 0622T

1. Indications

The trabeculostomy ab interno by laser procedure is indicated for patients diagnosed with glaucoma, particularly when there is a need to reduce intraocular pressure (IOP) to prevent the progression of the disease towards blindness. The following conditions may warrant this procedure:

• Glaucoma Diagnosis Patients with open-angle glaucoma or other forms of glaucoma that require intervention to manage IOP effectively.
• Elevated Intraocular Pressure Individuals exhibiting elevated IOP that cannot be adequately controlled with medication alone.
• Need for Minimally Invasive Surgery Patients who are candidates for micro-invasive glaucoma surgery (MIGS) due to the desire for a procedure with lower risk and quicker recovery times.

2. Procedure

The trabeculostomy ab interno by laser procedure involves several critical steps to ensure its effectiveness and safety. The following outlines the procedural steps:

• Step 1: Preparation The procedure begins with the patient being positioned appropriately, and a clear corneal incision of at least 0.8 mm is made to access the anterior chamber. A viscoelastic substance is then introduced into the anterior chamber to maintain its structure and prevent collapse during the procedure.
• Step 2: Insertion of the Probe A goniolens is placed on the cornea, or an ophthalmic endoscope is utilized to visualize the trabecular meshwork. A 500 μm diameter probe is advanced through the anterior chamber, ensuring that the bevel of the probe is oriented upwards as it makes contact with the trabecular meshwork.
• Step 3: Laser Application The physician employs a foot pedal system to activate the laser, which is used to create approximately 10 microchannels in the trabecular meshwork. These channels are spaced about 500 μm apart and cover an arc of approximately 90 degrees.
• Step 4: Observation of Reflux During the procedure, blood and microbubbles may be observed as reflux from Schlemm’s canal, indicating the successful creation of the microchannels.
• Step 5: Pneumatic Canaloplasty The procedure is theorized to produce an additional beneficial effect known as pneumatic canaloplasty, where the microbubbles formed from the photoablated tissue push against the outer wall of Schlemm’s canal and adjacent collector channels, further dilating the outflow tract.

3. Post-Procedure

After the trabeculostomy ab interno by laser procedure, patients are typically monitored for any immediate complications. Post-procedure care may include the use of anti-inflammatory or antibiotic eye drops to prevent infection and manage inflammation. Patients are advised to follow up with their ophthalmologist to assess the effectiveness of the procedure in lowering IOP and to monitor for any potential side effects. Recovery times can vary, but many patients experience a quick return to normal activities, with a significant reduction in IOP often observed shortly after the procedure.