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Is Diode Laser Cyclophotocoagulation included under Surgery Class 2 along with other laser procedures for the treatment of glaucoma?

Although several laser procedures used in the treatment of glaucoma, such as iridotomy, iridectomy, iridoplasty, and trabeculoplasty, are permitted under the Surgery Class 2 rating classification, diode laser cyclophotocoagulation, including procedures utilizing micropulse delivery (MP3/MP-TSCPC/MPCP), is not eligible for coverage under this rate class. Diode laser cyclophotocoagulation is generally considered a treatment reserved for severe cases of glaucoma that have not responded to more conventional treatments. Due to this procedure’s level of risk, Surgery Class 3 rates are required.

Although MPCP may pose less risk of heat damage to surrounding tissues because it uses short pulses of wave energy rather than a continuous wave beam, severe complications including loss of light perception, a significant reduction in visual acuity, choroidal effusion, and phthisis, while rare, can occur. Persistent complications such as mydriasis and SPK have proven to be quite bothersome to some patients. Furthermore, the success in lowering IOP may be short-term. Studies show that nearly half of the patients treated with MPCP require additional IOP-lowering intervention. Candidates for MPCP should be appropriately counseled regarding the potential for persistent complications that impact visual acuity as well as rare but severe complications.

 

Updated 12/21/2021

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