Z96.1 Presence of Intraocular Lens

Pseudophakia

ICD-10 Diagnosis Code:

Z96.1 — Presence of intraocular lens

Title
Lens Replaced by Other Means

Category
Organ Or Tissue Replaced By Other Means (1)

Description
Pseudophakia is the term used to describe the replacement of a partial or complete opacity on or in the lens or capsule of one or both eyes with an artificial one.

DEFINITION

Pseudophakia is the term used to describe the replacement of a partial or complete opacity on or in the lens or capsule of one or both eyes with an artificial one.

NATURAL HISTORY

Structural Damage to the Eye

Acquired loss of endothelial cells secondary to intraocular lens implant surgery
Cystoid macular edema can result from intraocular lens implant surgery

Functional Damage to the Eye

Secondary cataracts can form on the intraocular lens
Blurred vision due to secondary cataracts on the intraocular lens
Corneal edema secondary to loss of endothelial cells after intraocular lens implant surgery

DIAGNOSTIC EVALUATION

The main goal of the diagnostic evaluation in a patient with pseudophakia is to accomplish the following:

Determine if the intraocular lens is centered
Assess if secondary opacities are present
Determine if iatrogenic endotheliopathy has occurred
Evaluate the macula with OCT technology to determine if postoperative vitreoretinal pathology is present
Determine a treatment plan

Patient History

Patients will present with any of the following signs and symptoms:

No visual complaints
Blurred and/or distorted vision
Difficulty seeing in bright light

External Ocular Examination with Biomicroscopy

		Clinical Appearance of the Posterior Chamber Pseudophakia Posterior chamber intraocular lens Clear posterior capsule Centered introcular lens

		Clinical Appearance of the Posterior Chamber Pseudophakia Posterior chamber intraocular lens Mild posterior capsule opacity Slightly decenteredintraocular lens (superotemporally)

		Clinical Appearance of the Posterior Chamber Pseudophakia Posterior chamber intraocular lens Mild posterior capsule opacity Slightly decenteredintraocular lens (superotemporally)

		Clinical Appearance of the Anterior Chamber Pseudophakia Anterior chamber intraocular lens Sectoral iris atrophy secondary to intraocular lens

DIAGNOSTIC TESTS

External Ocular Photography

Document the severity of any secondary opacities
Document the progress or lack of progress of the opacities
Help determine a treatment plan

Pseudophakia

Posterior chamber intraocular lens
Severe clouding of the posterior capsule
Clear cornea
Normal corneal endothelium

Specular Endothelial Microscopy

Earlier and more accurate diagnosis of iatrogenic endotheliopathy
To evaluate unexplained loss of visual acuity after surgery
Document the progress or lack of progress of a corneal endotheliopathy
To help plan a treatment program
To document the delivery of medical treatment
To document the response to treatment

		Konan Specular Microscope Visualize and analyze the corneal endothelium Specular microscope captures the image reflected from the optical interface between the corneal endothelium and the acqeous humor Instrument uses computer-assisted morphometry to analyze the size, shape and population of endothelial cells

Specular Microscopy — Three weeks Pre-OP Normal rate of polymegethism in both eyes No pleomorphism in both eyes Normal thickness in both eyes No corneal guttata in both eyes Normal cell density in both eyes Visual acuity = 20/50 in the right eye

Pseudophakia — Two weeks Post-OP in the right eye Posterior chamber IOL Clear posteror capsule Centered IOL Cloudy cornea indicates postoperative corneal edema Cataract surgery generally results in a 4-10% loss of endothelial cells Probable iatrogenic corneal endotheliopathy Visual acuity = 20/40 in the right eye

Specular Microscopy — Two weeks Post-OP Iatrogenic corneal endotheliopathy in the right eye Abnormal rate of polymegethism in the right eye Presence of pleomorphism in the right eye Corneal guttata in the right eye Decrease endothelial cell density in the right eye Visual acuity = 20/40 in the right eye

Retinal Laser Scan

Earlier and more acurate diagnosis of retinal disease
To evaluate unexplained loss of visual acuity after surgery
Document the progress or lack of progress of vitreomacular traction syndrome
Help plan a treatment program
To document the delivery of medical treatment
Document the response to treatment
Measure the effectiveness of therapy
Determine the need for ongoing therapy

Optical Coherence Technology — Three weeks Post-OP

Normal foveal architecture
Incomplete posterior vitreous detachment
Vitreous mebrane adhesion is present at the macula
No vitreomacular traction

Optical Coherence Technology — Four months Post-OP

Normal foveal architecture
Incomplete posterior vitreous detachment
Vitreous membrane adhesions present at the macula
Vitreomacular traction is present
Chronic cystoid macular edema secondary to vitreomacular traction
Visual acuity = 20/50 right eye

CLASSIFICATION

There is no classification system in place for pseudophakia.

TREATMENT OPTIONS

Optical Treatment

Prescription eyeglasses
Prescription contacts

Surgical Treatment

YAG laser capsulotomy
Refractice surgery for uncorrected postoperative refractive error

1. Graham R. Aphakic and Pseudophakic Glaucoma. 2 Sept 2014. http://emedicine.medscape.com/article/1207170-overview. Last accessed November 16, 2014.
2. Prevalence of Cataract and Pseudophakia/Aphakia Among Adults in the United States. Arch Ophthalmol. 2004;122(4):487-494. http://archopht.jamanetwork.com/article.aspx?articleid=416230. Last accessed November 16, 2014.

ICD-9 DIAGNOSIS CODE

V43.1
Lens replaced by other means

ASSOCIATED CPT CODES

92025
Corneal topography

92015
Refraction

92136
Ophthalmic biometry by A-scan with intraocular lens power calculation

92286
Specular endothelial microscopy

ASSOCIATED CASE REPORTS

Iatrogenic endotheliopathy after cataract surgery

Preopertive evaluation for cataract surgery

DISEASE INDEX

Occurrence

The prevalence of pseudophakia is linked to the number of senile cataracts.

Senile cataracts are found in almost 66% of the population over 75 years old
The prevalence is also linked to the number of congenial disorders that require cataract extraction

Distribution

No preference for males or females

Risk Factors

Age
Trauma
Congenital factors causing lens to be remove at a young age