Eyeworld

EW SECONDARY FEATURE 68 by Matt Young EyeWorld Contributing Editor Posterior capsule opacification: Rare but still noteworthy Surgeons may need to be prepared for PCO when considering telescope prosthesis transplantation A telescope prosthesis can be a boon for patients with bilateral end-stage age-related macular de- generation, improving vi- sion by as many as three or more lines of BCVA. Those improvements can be severely diminished in the event of posterior capsule opacification (PCO). PCO is a rare occurrence after implantation of such a device. The first case was reported in an issue of Archives of Ophthalmology. Lessons learned from that report should be taken into account since many more of these visual aids likely will be implanted in the future. "Although PCO is a rare occur- rence with the use of the telescope prosthesis, it is very likely that more of these devices will be implanted in the near future with the increasingly aging population and limited treat- ment efficacy or options for ad- vanced forms of age-related macular degeneration," according to lead study author Michael A. Singer, M.D., Medical Center Ophthalmol- ogy Associates, San Antonio, Texas. A different PCO cure An end-stage AMD patient with 20/640 vision opted to receive a ×2.2 model telescope prosthesis (Vision- Care Ophthalmic Technologies, Saratoga, Calif.). Initially, the patient improved about four lines to 20/250 after the procedure, but experienced decreased vision (20/500) at 15 months post-op. The cause was dis- covered to be PCO. Experimentally, Nd:YAG laser capsulotomy had been performed on rabbits implanted with telescopes, but 1 in 8 had multiple breaks in the carrier plates due to the laser, Dr. Singer noted. "Given the risk of damage to the telescope's micro-optics by Nd:YAG capsulotomy, the surgeon elected to use a vitrector for surgical capsulo- tomy," Dr. Singer reported. Although there is still risk to the quartz glass cylinder, the capsulotomy can be ap- proached in a better fashion. "The device can be approached with the 25-gauge vitrector from the posterior pole toward the anterior segment as this avoids mechanical trauma to the side of the posterior window where it joins the cylinder," Dr. Singer noted. In this case, a 2 mm pars plana posterior capsulotomy was per- formed using the 25-gauge vitrector. "To accomplish this, first a 25- gauge bent microvitreoretinal blade was used to create a small opening in the posterior capsule, then a 25- gauge vitrector was used to engage and enlarge the opening," Dr. Singer noted. Proper illumination also was im- portant, and physicians used a com- bination of coaxial illumination and retroillumination. "The end of the light source should be kept out of the surgeon's field of view to avoid reflections," Dr. Singer reported. Using these techniques, the sur- geon reported success and the pa- tient's vision improved to BCVA 20/250 after the capsulotomy. In his analysis of the case, Dr. Singer suggested using a 25-gauge vitrector was the right choice rather than a 20-gauge vitrector. "A 25-gauge vitrector would be beneficial due to its smaller outer di- ameter than a 20-gauge vitrector as it covers less of the telescope's 2-mm posterior window optical zone for visualization of the opacification during capsulotomy," Dr. Singer re- ported. "Visualization was a signifi- cant challenge owing to issues of retroillumination of the posterior February 2011 RETINA October 2011 T T I I I T d d F F F PCO (pictured here) can occur after the implantation of a telescope prosthesis Source: Mostafa A. Elgohary, M.D. Implantable miniature telescope for AMD granted pass-through code T he Centers for Medicare and Medicaid Services (CMS) has granted transitional pass-through payment status and has established a billing code for the Implantable Miniature Telescope (IMT by Dr. Isaac Lipshitz), VisionCare Ophthalmic Technologies (Saratoga, Calif.) said in a press release. The new pass-through code, C1840, established under the Hospital Outpatient Prospective Payment System, took effect on October 1, 2011. It will allow outpatient facilities to be re- imbursed for the telescope implant for covered procedures. The U.S. Food and Drug Administration approved the telescope im- plant for improvement of vision in patients with end-stage age-related macular degeneration (AMD). Eligible patients must have associated cen- tral vision blindness and have either stopped responding to AMD medica- tions or have a form of the disease for which there is no available treatment. VisionCare added a recent study published in the peer-review literature found the IMT "to be cost-effective and improve quality of life." 68-75 Feature 2 AMD_EW October 2011-DL2_Layout 1 9/29/11 3:48 PM Page 68

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