CPT® Code 66989

Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more

Extracapsular cataract removal with insertion of intraocular lens prosthesis is a specialized surgical procedure designed to address complex cataract cases. This one-stage procedure employs either manual or mechanical techniques, such as irrigation and aspiration or phacoemulsification, to effectively remove the cataract. The complexity of this procedure arises from the use of advanced devices or techniques that are not typically utilized in standard cataract surgeries. For instance, it may involve the use of an iris expansion device, suture support for the intraocular lens, or primary posterior capsulorrhexis, particularly in patients who are in the amblyogenic developmental stage, such as children. The procedure is particularly critical for pediatric patients, as the anatomical and developmental characteristics of their eyes present unique challenges. In children, the anterior capsule is more difficult to open, and the cortex is more challenging to remove due to lens adhesion. Additionally, certain ocular conditions, including uveitis, glaucoma, pseudoexfoliation syndrome, or Marfan syndrome, can further complicate the surgery, necessitating a more intricate approach. Patients with a history of prior intraocular surgery, trauma to the eye, or those presenting with dense, hard, white cataracts may also require this complex surgical intervention. During the procedure, an incision is made at the corneoscleral junction to facilitate the insertion of the phacoemulsification device, followed by a series of steps that ensure the successful removal of the cataract and the insertion of an intraocular lens (IOL) prosthesis. The procedure also includes the placement of an anterior segment aqueous drainage device, which is essential for managing chronic or progressive open-angle glaucoma, thereby reducing intraocular pressure and improving patient outcomes.