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AnswerWhat is the ICD 10 code for Irvine-Gass syndrome?
add. Pseudophakic Cystoid Macular Edema (Irvine-Gass Syndrome) DiseasesDB. 32406. ICD - 10. H 35.3. ICD - 9. 362.53. Pseudophakic cystoid macular edema (CME), also known as Irvine-Gass syndrome, is one of the most common causes of visual loss after cataract surgery.
What is Irvine-Gass syndrome (CME)?
362.53 Pseudophakic cystoid macular edema (CME), also known as Irvine-Gass syndrome, is one of the most common causes of visual loss after cataract surgery.
What is Rodman Irvine Gass syndrome?
Irvine–Gass syndrome, pseudophakic cystoid macular edema or postcataract CME is one of the most common causes of visual loss after cataract surgery. The syndrome is named in honor of S. Rodman Irvine and J. Donald M. Gass.
What is the incidence of Irvine-Gass syndrome?
The syndrome is named in honor of S. Rodman Irvine and J. Donald M. Gass. The incidence is more common in older types of cataract surgery, where postcataract CME could occur in 20–60% of patients, but with modern cataract surgery, incidence of Irvine–Gass syndrome have reduced significantly.
What is Irvine-Gass syndrome?
Irvine–Gass syndrome (IGS), sometimes named pseudophakic cystoid macular edema (PCME), is a cystoid macular edema that develops following uneventful cataract surgery. It was first described in 1953 by Irvine and studied using fluorescein angiography (FA) by Gass and Norton in 1966 [2,3].
What is pseudophakic cystoid macular edema?
Pseudophakic cystoid macular edema (CME), also known as Irvine-Gass syndrome, is one of the most common causes of visual loss after cataract surgery.
Is retinal edema the same as macular edema?
In the retina, blisters of fluid form and swell the retina—this is macular edema. Factors likely to cause macular edema include conditions that: Cause more fluid to leak from blood vessels (diabetes and high blood pressure) Increase inflammation in the eye (surgery, inflammatory diseases)
How common is Irvine-Gass syndrome?
The incidence following cataract surgery (Irvine-Gass syndrome) of clinically significant CME with decreased vision is only 0.2-1.4% after modern phacoemulsification surgery. The frequency was more common in older types of cataract surgery, where CME could occur in 20-60% of patients.
What is pseudophakic eye?
Pseudophakia is a Latin word for false lens. We use this term after placing an artificial lens into the eye. Also known as intraocular IOL, lens implants, or “fake eye lenses,” this procedure can significantly improve vision after removing cataracts and replacing them with a new lens.
What is cystoid macular Oedema?
Sometimes the macula becomes swollen with fluid. When any tissue of the body becomes swollen with fluid, the condition is called edema. When this happens to the macula, the edema fluid typically combines in cyst-like patterns; this condition is called cystoid macular edema.
What is difference between macular edema and macular degeneration?
While both DME and AMD happen in the macula, the location isn't exactly the same. DR/DME is more intraretinal (within the retina and the vessels of the retina), whereas AMD involves choroidal neovascularization, the medical term for blood vessels that are typically under the retina that don't belong there, Dr.
What is macular edema of the eye?
Macular edema is the build-up of fluid in the macula, an area in the center of the retina. The retina is the light-sensitive tissue at the back of the eye and the macula is the part of the retina responsible for sharp, straight-ahead vision. Fluid buildup causes the macula to swell and thicken, which distorts vision.
What is the ICD 10 CM code for retinal edema?
ICD-10 code H35. 81 for Retinal edema is a medical classification as listed by WHO under the range - Diseases of the eye and adnexa .
How do you treat Irvine gas?
Managing the Irvine-Gass syndrome is a true treatment escalation. A treatment combining the off-label use of oral acetazolamide (Diamox®) with topical NSAIDs is generally used as first-line therapy. Acetazolamide increases the retinal pigment epithelium pump function through the inhibition of carbonic anhydrase(21).
How long does macular edema last after cataract surgery?
The procedure is painless, takes less than 5 minutes, and is performed in the office. The major side effect is that some patients actually see the laser spots after the treatment is finished; these usually fade away over the next few weeks. The macular edema may take up to four months to go away.
What causes CME after cataract surgery?
“Risk factors for CME after cataract surgery include diabetic retinopathy; an epiretinal membrane; a history of uveitis; and/or a prior history of macular edema related to something like a retinal vein occlusion,” notes Chirag P.
Prognosis
- Most patients with CME found via angiography or OCT will not have visual changes. Furthermore, most patients with clinical CME will experience spontaneous improvement by 3 to 12 months.[12]
Statistics
- Schmier et al. conducted a study of 139,759 Medicare beneficiaries who underwent modern cataract surgery, and determined that total ophthalmic payments were 47% ($1,092) higher for those who developed pseudophakic CME, compared to those who did not (P < .0001).[13]
Pathophysiology
- The pathogenesis of pseudophakic CME is thought to be multifactorial. However, the major etiology appears to be inflammatory mediators that are upregulated in the aqueous and vitreous humors after surgical manipulation. Inflammation breaks down the blood-aqueous and blood-retinal-barriers, which leads to increased vascular permeability.[14] Eosinophilic transudate accu…
Treatment
- Diabetics confer a unique challenge in cataract surgery. Cataract surgery was historically thought to accelerate progression of diabetic retinopathy (DR), but recent prospective studies may not support this theory.[16][17] However, postoperative macular edema usually develops in those with a prior history of diabetic macular edema (DME).[18] If the patient actively had DME at the time …
Risks
- Cataract surgery was historically considered a very high-risk procedure with many complications for patients with uveitis. However, the advent of modern surgical techniques is allowing patients with uveitis, who often develop cataract prematurely, opportunities for intraocular lens placement. Belair and Kim et al. demonstrated that incidence of pseudophakic CME on OCT at 1 month pos…
Clinical significance
- Pediatric uveitis patients pose unique challenges. Sijssens et al. reported that CME developed in 3 of 19 (16%) of aphakic, and 1 of 29 (3%) pseudophakic eyes at 1 year (P = .286), and 7 of 19 (37%) and 2 of 20 (10%) cumulatively at 2 years (P = .065), of children with juvenile idiopathic arthritis-associated uveitis.[20] Pseudophakic eyes also were not at increased risk of other complication…
Controversy
- Topical glaucoma medications as a risk factor for pseudophakic CME is still controversial. Miyake et al. demonstrated in several clinical trials and cellular studies that preoperative and postoperative topical glaucoma medications, specifically latanoprost and timolol, may increase the incidence of pseudophakic CME[21]. It appears that a commonly used preservative, benzalk…
Signs and symptoms
- The occurrence of pseudophakic CME peaks at approximately 4-6 weeks postoperatively. The most common presentation is blurry vision. Less common presentations include central scotomas, metamorphopsia, and mild photophobia.
Diagnosis
- On biomicroscopy, retinal thickening and loss of the foveal depression is usually appreciated. These findings are best observed using a fundus contact lens, and red-free light may aide in demonstrating cystic changes. In severe or chronic cases, optic disc swelling and/or a lamellar hole may also be seen. Splinter hemorrhages may also be present. However, biomicroscopy ma…
Research
- Recent studies assessing the efficacy of topical NSAIDs in the prophylaxis of pseudophakic CME have compared topical corticosteroid monotherapy to combination therapy with NSAIDs. In a multicenter masked randomized clinical trial (RCT), Wittpenn et al. showed that clinical CME developed in 5 of 278 patients who received perioperative prednisolone, and in 0 of 268 who als…
Results
- SD-OCT of the same patient 1 month after a sub-Tenon's injection of triamcinolone. The retinal thickening, cystic lesions, and subretinal fluid have improved (Images courtesy of Ivana Kim, MD, Massachusetts Eye and Ear Infirmary)
Medical uses
- Topical corticosteroids are commonly used in the treatment of pseudophakic CME. Few studies, however, have examined their efficacy. Furthermore, its effects are often confounded by the concomitantly used and more efficacious topical NSAIDs. Sustained drug delivery systems (DDS) have been developed to address this limitation of intravitreal corticosteroid injections. Ozurdex (…
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