CPT® Code 0730T

1. Indications

The laser trabeculotomy procedure is indicated for patients with glaucoma when the intraocular pressure (IOP) is not adequately controlled through medication alone. This condition may manifest in various forms, including open-angle glaucoma, where the drainage system of the eye becomes less effective over time, leading to increased pressure. The procedure is particularly beneficial for patients who may not be suitable candidates for traditional surgical interventions or those who prefer a less invasive option to manage their glaucoma effectively.

• Uncontrolled Intraocular Pressure Patients experiencing elevated IOP that remains high despite the use of glaucoma medications.
• Open-Angle Glaucoma Individuals diagnosed with open-angle glaucoma, where the drainage angle remains open but the outflow of aqueous humor is insufficient.
• Minimally Invasive Treatment Preference Patients seeking a less invasive alternative to traditional surgical options for glaucoma management.

2. Procedure

The laser trabeculotomy procedure involves several critical steps to ensure effective treatment of glaucoma. Initially, the patient receives anesthetic and pressure-lowering drops to prepare the eye for the procedure. This is followed by the placement of an optical interface device on the eye, which allows the physician to conduct a thorough inspection of the iridocorneal angle. During this inspection, the physician identifies the most suitable area for treatment, ensuring optimal results.

• Initial Inspection The physician uses an integrated camera mounted on the optical interface device to visualize the iridocorneal angle, assessing the anatomy and determining the best site for laser application.
• OCT Guidance The camera is replaced with a laser system, and the selected area is scanned using optical coherence tomography (OCT) to accurately locate the trabecular meshwork for the creation of a drainage channel.
• Laser Application The femtosecond laser beam is directed at the identified target area in the trabecular meshwork, following a preprogrammed pattern to create precise incisions that facilitate drainage.
• Monitoring and Confirmation Throughout the procedure, the treatment is monitored on screen, and OCT imaging is performed again to confirm that a new drainage channel has been successfully established.
• Completion of Procedure After confirming the successful creation of the drainage channel, the laser system is removed from the interface device, which is then taken off the eye. The eye is subsequently irrigated, and anti-inflammatory drops are instilled to aid in recovery.

3. Post-Procedure

After the laser trabeculotomy procedure, patients are typically monitored for any immediate complications. The eye is irrigated to clear any residual material, and anti-inflammatory drops are instilled to reduce inflammation and promote healing. Following the procedure, the intraocular pressure (IOP) is measured to assess the effectiveness of the treatment. If necessary, additional pressure-lowering drops may be administered, or the patient may be prescribed oral anti-glaucoma medication to further manage IOP. Patients are advised on post-procedure care, including follow-up appointments to monitor their recovery and the long-term effectiveness of the treatment.