Transciliary Fistulization for the Treatment of Glaucoma
DESCRIPTION
Transciliary fistulization is being investigated for the treatment of glaucoma (e.g., primary open-angle glaucoma) when conventional management by drug therapy fails to control elevated intraocular pressures. Transciliary fistulization, also known as transciliary filtration or Singh filtration, is a recent approach to filtering surgery. This procedure uses a thermocauterization device called the Fugo Blade to create a plasma-ablated pore or filter track from the sclera through the ciliary body. This is done to allow aqueous fluid to ooze into the subconjunctival lymphatics from the posterior chamber (behind the iris) of the eye. Transciliary fistulization rarely requires an iridectomy.
This technique differs from conventional filtering surgeries in which aqueous fluid is filtered from the anterior chamber of the eye. Transciliary fistulization allows aqueous fluid to drain from the posterior chamber of the eye.
POLICY
Transciliary fistulization for the treatment of glaucoma is considered investigational.
IMPORTANT REMINDER
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ADDITIONAL INFORMATION
Well-designed studies in peer-reviewed journals regarding this technology are lacking. There is insufficient data to determine the long-term health outcomes of transciliary fistulization for the treatment of glaucoma.
SOURCES
American Academy of Ophthalmology. (2005). Preferred practice patterns in primary open-angle glaucoma. Retrieved June 15, 2006 from http://www.aao.org/education/library/ppp/upload/Primary_Open-Angle_Glaucoma.pdf.
BlueCross BlueShield Association. Medical Policy Reference Manual. (2:2011). Transciliary fistulization for the treatment of glaucoma (9.03.17). Retrieved August 30, 2011 from BlueWeb. (2 articles and/or guideline reviewed)
U. S. Food and Drug Administration. (2004, October). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K041019. Retrieved April 1, 2008 from http://www.fda.gov/cdrh/pdf4/k041019.pdf.
ORIGINAL EFFECTIVE DATE: 11/11/2006
MOST RECENT REVIEW DATE: 11/10/2011
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