The Ophthalmic Office Procedures Handbook

CHAPTER 25

465

Corneal Debridement

The patient was fully numbed with topical ophthalmic anesthetic drops, lids and lashes cleaned with standard povidone–iodine 10% swab stick (Betadine), and draped for a sterile environment. Topical ophthalmic antibiotic drops were instilled prior to starting the procedure. A lid speculum is shown being inserted onto the eye. The corneal debridement begins with loose epithelium overlying the gelatinous nodules being easily removed by a foreign body golf spud. Inter estingly, sheet-like layers of tissue are observed and are seen being peeled away in large sections at a time. Circular motions are made to guide the debridement, being careful to leave 1 to 1 ½ mm of tissue from the limbus intact. Forceps are used to guide this process along, with a technique similar to Salzmann nodule removal. After the initial epithelial layer and nodules are removed, any areas of redundant basement mem brane are further removed by using a foreign body golf spud to debride any residual islands. Nodular material near the limbus is also smoothed out or removed to reduce recurrence as much as possible. After a few drops of buffer saline solution is instilled to keep the ocular tissue moisturized, diamond burr polishing is shown, with the rotation of the diamond burr rotating away from the limbus, or rather, toward the center of the cornea. EFFICACY For EBMD and RCE , corneal debridement with diamond burr polishing has recurrence rates of 0% to 11.1%. Corneal debridement alone resulted in 24% recurrence rates, whereas pho totherapeutic keratectomy (PTK) resulted in 27% recurrence rates with significant changes in refractive error. 2,13,14 In a small study, corneal debridement with diamond burr polish fol lowed by cryopreserved AM application resulted in 67% of corneas healed without any stain ing, with 100% of patients treated having no residual symptoms at the 1-month follow-up. 3 Other studies have reported a statistically significant improvement in corneal and refractive astigmatism. No statistical difference has been reported for techniques with or without alcohol delamination. 2,4,13 For Salzmann nodular degeneration , 90% to 100% of patients treated reported subjective im provement and 78% to 100% of patients had decreased corneal astigmatism. Recurrence rates of 22% have been reported, with some requiring repeat debridement over 5 years of follow-up. 1,2,14 In band keratopathy , corneal debridement with EDTA chelation resulted in significant im provement in clinical signs and symptoms in 72% to 100%, according to multiple studies. Visual acuity improvement of two or more lines was reported in 35%, whereas 8% lost two lines of visual acuity. Recurrence rates were reported in several studies to be 0% to 17% for corneal debridement with EDTA chelation, and 12.5% to 28% without EDTA chelation. 1,2,16 CODING AND BILLING ● 65435 —Removal of corneal epithelium with or without chemocauterization, 0 day global period. Corneal debridement is considered a minor procedure. A minor surgical procedure already includes the office visit, meaning that it should not be billed in conjunction with a same-day office visit (unless the office visit was unrelated to the decision to perform the minor surgery). Corneal procedures cannot be billed on the same day as 92071 (fitting of a contact lens for ocular surface disease) or 65778 (placement of AM; without sutures). 17,18

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