CPT® Code 65900

1. Indications

The procedure for the removal of epithelial downgrowth is indicated in the following situations:

• Complications from Eye Surgery Epithelial downgrowth may occur as a complication following various ocular surgical procedures, necessitating intervention.
• Trauma to the Eye Nonsurgical trauma to the eye can lead to the development of epithelial downgrowth, requiring surgical removal to alleviate symptoms and prevent further complications.
• Symptoms of Pain Patients experiencing significant ocular pain due to the presence of epithelial downgrowth may require this procedure for relief.
• Increased Intraocular Pressure The presence of epithelial downgrowth can lead to elevated intraocular pressure, which may necessitate surgical intervention to prevent glaucoma.
• Signs of Inflammation Inflammatory responses in the eye associated with epithelial downgrowth may indicate the need for removal to restore ocular health.

2. Procedure

The procedure for the removal of epithelial downgrowth involves several critical steps to ensure effective treatment and patient safety.

• Anesthesia Administration The eye is first anesthetized using a topical ophthalmic anesthetic to minimize discomfort during the procedure.
• Identification of the Downgrowth Using an operative microscope or slit lamp, the surgeon locates the flap edge from the previous incision or traumatic wound. This step is crucial for accessing the area of downgrowth.
• Opening the Flap The flap is carefully opened using a Sinskey hook or a similar instrument to expose the downgrowth for removal.
• Elevation of the Flap If the area of downgrowth is extensive, a cyclodialysis spatula may be employed to further elevate the flap, providing better access to the affected tissue.
• Scraping the Stromal Bed The stromal bed is then scraped with a blade or knife to remove any adherent epithelial cells, ensuring complete excision of the downgrowth.
• Replacement of the Flap After the downgrowth has been adequately addressed, the flap is replaced to restore the anatomical integrity of the eye.
• Surgical Removal of Epithelial Tissue Alternatively, if necessary, the epithelial tissue can be removed using direct electrocautery or photocoagulation techniques to ensure thorough excision.
• Cystic Lesion Management In cases where the downgrowth presents as a cystic lesion, the surgeon may perform cyst aspiration followed by cauterization, diathermy, or injection of sclerosing agents or alcohol to eliminate the lesion.
• Irrigation of the Eye Following the removal of the downgrowth, the eye is irrigated to clear any debris and ensure a clean surgical field.
• Application of Bandage A corneal contact lens bandage may be placed to protect the eye postoperatively, followed by the instillation of antibiotic and/or steroid eye drops to prevent infection and reduce inflammation.
• Patching the Eye Finally, the eye is patched to provide additional protection during the initial recovery phase.

3. Post-Procedure

After the removal of epithelial downgrowth, patients can expect a recovery period that may involve monitoring for any signs of complications such as infection or increased intraocular pressure. The application of a corneal contact lens bandage helps to protect the eye during healing. Patients are typically instructed to use prescribed antibiotic and/or steroid eye drops to aid in recovery and reduce inflammation. Follow-up appointments are essential to assess the healing process and ensure that the downgrowth has been completely removed, as well as to monitor for any recurrence of symptoms. It is important for patients to adhere to post-operative care instructions and report any unusual symptoms to their healthcare provider promptly.