ICD-10: H35.142

Retinopathy of prematurity (ROP) is a significant condition affecting premature infants, characterized by abnormal blood vessel development in the retina. The ICD-10 code H35.142 specifically refers to ROP at stage 3 in the left eye. Below is a detailed clinical description and relevant information regarding this diagnosis.

Clinical Description of Retinopathy of Prematurity

Overview of Retinopathy of Prematurity

Retinopathy of prematurity occurs primarily in infants born before 31 weeks of gestation or weighing less than 1500 grams. The condition arises when the retinal blood vessels do not develop normally, leading to potential vision impairment or blindness. ROP is classified into five stages, with stage 3 indicating the presence of significant pathological changes.

Stage 3 ROP

Stage 3 ROP is characterized by the presence of abnormal blood vessels that grow into the vitreous gel of the eye. This stage can be further divided into two subcategories:
- Stage 3A: Mildly aggressive disease with some abnormal vessel growth.
- Stage 3B: More aggressive disease with extensive abnormal vessel growth and potential for retinal detachment.

In the case of H35.142, the diagnosis specifically pertains to stage 3 ROP in the left eye, indicating that the condition is localized and may require targeted intervention.

Clinical Features

• Symptoms: Infants with ROP may not exhibit noticeable symptoms until the condition progresses. However, signs can include:
• Poor visual tracking
• Abnormal eye movements

• Strabismus (crossed eyes)

• Diagnosis: Diagnosis typically involves a comprehensive eye examination, often performed by a pediatric ophthalmologist. The examination may include:

• Fundus examination to assess the retina and blood vessel development.
• Use of indirect ophthalmoscopy to visualize the peripheral retina.

Treatment Options

Treatment for stage 3 ROP may include:
- Laser Therapy: This is the most common treatment, where laser photocoagulation is used to destroy the peripheral retina, reducing the stimulus for abnormal blood vessel growth.
- Cryotherapy: In some cases, freezing treatment may be applied to the peripheral retina.
- Anti-VEGF Injections: Medications that inhibit vascular endothelial growth factor (VEGF) may be used to reduce abnormal blood vessel growth.

Prognosis

The prognosis for infants diagnosed with stage 3 ROP varies. Early detection and treatment can significantly improve outcomes, reducing the risk of severe vision loss. Regular follow-up examinations are crucial to monitor the progression of the disease and the effectiveness of treatment.

Conclusion

ICD-10 code H35.142 denotes a critical stage of retinopathy of prematurity in the left eye, highlighting the need for careful monitoring and intervention. Understanding the clinical implications and treatment options for this condition is essential for healthcare providers involved in the care of premature infants. Early diagnosis and appropriate management can lead to better visual outcomes and quality of life for affected individuals.

Retinopathy of prematurity (ROP) is a significant condition affecting premature infants, characterized by abnormal blood vessel growth in the retina. The ICD-10 code H35.142 specifically refers to ROP at stage 3 in the left eye. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this condition is crucial for timely diagnosis and management.

Clinical Presentation

Definition and Staging

Retinopathy of prematurity is classified into five stages, with stage 3 indicating the presence of abnormal blood vessels that can lead to retinal detachment. In stage 3, there is significant neovascularization, which can be either aggressive or non-aggressive. The condition is typically diagnosed through a comprehensive eye examination, often performed by a pediatric ophthalmologist.

Signs and Symptoms

The signs and symptoms of ROP, particularly at stage 3, may include:

• Visual Impairment: Infants may exhibit signs of visual impairment, which can range from mild to severe. This may manifest as a lack of visual fixation or tracking.
• Abnormal Eye Movements: Infants may show unusual eye movements, such as strabismus (crossed eyes) or nystagmus (involuntary eye movement).
• Retinal Changes: Upon examination, the retina may show signs of neovascularization, which can be observed as abnormal blood vessels in the peripheral retina.
• Potential Symptoms of Retinal Detachment: In advanced cases, symptoms may include sudden changes in vision or signs of retinal detachment, although these are less common in infants.

Patient Characteristics

Retinopathy of prematurity primarily affects premature infants, particularly those with the following characteristics:

• Gestational Age: Infants born before 28 weeks of gestation are at the highest risk, although ROP can occur in infants born up to 34 weeks.
• Birth Weight: Low birth weight (typically less than 1500 grams) is a significant risk factor for developing ROP.
• Oxygen Therapy: Infants who receive supplemental oxygen, especially in high concentrations, are at increased risk for ROP.
• Other Health Conditions: Conditions such as respiratory distress syndrome, sepsis, and other complications of prematurity can contribute to the risk of developing ROP.

Conclusion

Retinopathy of prematurity, particularly at stage 3 in the left eye (ICD-10 code H35.142), presents with specific clinical signs and symptoms that necessitate careful monitoring and intervention. Early detection through regular eye examinations in at-risk infants is essential to prevent progression to more severe stages, which can lead to significant visual impairment or blindness. Understanding the characteristics of affected patients helps healthcare providers implement appropriate screening and treatment protocols to manage this condition effectively.

ICD-10 code H35.142 specifically refers to "Retinopathy of prematurity, stage 3, left eye." This condition is a significant concern in neonatology and ophthalmology, particularly affecting premature infants. Below are alternative names and related terms associated with this diagnosis.

Alternative Names

1. Stage 3 Retinopathy of Prematurity (ROP): This is the most common alternative name used in clinical settings to describe the condition without specifying the eye involved.
2. ROP Stage 3, Left Eye: A more specific term that indicates the stage and the affected eye.
3. Severe Retinopathy of Prematurity: This term may be used to describe the severity of the condition, particularly in discussions about treatment options.

Related Terms

1. Retinopathy of Prematurity (ROP): A broader term that encompasses all stages of the disease, not limited to stage 3.
2. Neonatal Retinopathy: A general term that may refer to various retinal conditions affecting newborns, including ROP.
3. Premature Retinopathy: This term emphasizes the association of the condition with premature birth.
4. Vascular Retinopathy: While not specific to ROP, this term can relate to the underlying vascular issues present in retinopathy cases.
5. Ophthalmic Complications of Prematurity: A broader category that includes ROP and other eye conditions that can affect premature infants.

Clinical Context

Retinopathy of prematurity is characterized by abnormal blood vessel development in the retina of premature infants, which can lead to vision impairment or blindness if not treated appropriately. Stage 3 indicates a more severe form of the disease, where there is significant abnormality in the retinal blood vessels, and intervention may be necessary to prevent progression to more severe stages.

Understanding these alternative names and related terms is crucial for healthcare professionals involved in the diagnosis, treatment, and coding of this condition, ensuring accurate communication and documentation in clinical practice[7][8][11].

The diagnosis of Retinopathy of Prematurity (ROP), particularly for ICD-10 code H35.142, which specifies stage 3 ROP in the left eye, involves several clinical criteria and assessments. Here’s a detailed overview of the diagnostic criteria and considerations for this condition.

Understanding Retinopathy of Prematurity (ROP)

Retinopathy of Prematurity is a potentially blinding eye disorder that primarily affects premature infants. It occurs when abnormal blood vessels grow in the retina, which can lead to retinal detachment and vision loss. The condition is classified into different stages, with stage 3 indicating the presence of abnormal blood vessel growth that can lead to more severe complications.

Diagnostic Criteria for ROP

1. Gestational Age and Birth Weight

• ROP is most commonly seen in infants born before 28 weeks of gestation or those weighing less than 1500 grams at birth. Infants with lower gestational ages and birth weights are at a higher risk for developing ROP[1].

2. Fundoscopic Examination

• A comprehensive eye examination using indirect ophthalmoscopy is essential. This examination allows the clinician to visualize the retina and assess the presence and severity of ROP. The examination should be performed by a qualified ophthalmologist trained in pediatric eye care[2].

3. Classification of ROP Stages

• ROP is classified into five stages, with stage 3 characterized by the presence of neovascularization (abnormal blood vessel growth) in the retina. The specific criteria for stage 3 include:
  • Presence of new blood vessels: These vessels grow from the retina into the vitreous gel.
  • Extent of involvement: The extent of the disease is classified based on the area of the retina affected, which can be divided into zones (Zone I being the most severe) and the number of quadrants involved[3].

4. Additional Risk Factors

• Other factors that may influence the diagnosis include:
  • Oxygen therapy: High levels of oxygen exposure can increase the risk of ROP.
  • Intraventricular hemorrhage: This condition is common in premature infants and can be associated with ROP.
  • Systemic health issues: Conditions such as sepsis or respiratory distress syndrome can also contribute to the risk of developing ROP[4].

5. Follow-Up and Monitoring

• Infants at risk for ROP should be monitored regularly, with follow-up examinations scheduled based on the initial findings. The timing of these examinations is crucial, as early detection and treatment can significantly improve outcomes[5].

Conclusion

The diagnosis of Retinopathy of Prematurity, particularly for stage 3 in the left eye (ICD-10 code H35.142), relies on a combination of gestational age, clinical examination findings, and the classification of the disease's severity. Early detection through regular screening in at-risk infants is vital for preventing vision loss. If you have further questions or need more specific information regarding treatment options or management strategies, feel free to ask!

Retinopathy of prematurity (ROP) is a significant concern in neonatal care, particularly for premature infants. The condition can lead to severe visual impairment or blindness if not treated appropriately. The ICD-10 code H35.142 specifically refers to ROP at stage 3 in the left eye, indicating a critical phase of the disease that requires timely intervention.

Understanding Retinopathy of Prematurity

ROP occurs when abnormal blood vessels grow in the retina of premature infants, potentially leading to retinal detachment. The stages of ROP range from mild (stage 1) to severe (stage 5), with stage 3 characterized by the presence of abnormal blood vessels and the potential for significant vision loss. Early detection and treatment are crucial to prevent progression to more severe stages.

Standard Treatment Approaches

1. Laser Therapy

One of the most common treatments for stage 3 ROP is laser photocoagulation. This procedure involves using a laser to destroy the peripheral retina, which helps to reduce the production of vascular endothelial growth factor (VEGF), a protein that promotes the growth of abnormal blood vessels. By targeting the areas of the retina that are not receiving adequate blood supply, laser therapy can help stabilize the condition and prevent further progression[1].

2. Cryotherapy

Cryotherapy, or cryoablation, is another treatment option that involves applying extreme cold to the peripheral retina. This method is less commonly used today due to the effectiveness of laser therapy but may still be considered in certain cases. Cryotherapy aims to induce scarring in the retina, which can help to halt the progression of ROP[2].

3. Anti-VEGF Injections

In recent years, the use of anti-VEGF agents, such as aflibercept (Eylea®), has emerged as a promising treatment for ROP. These medications are injected into the eye to inhibit the action of VEGF, thereby reducing the growth of abnormal blood vessels. Anti-VEGF therapy may be particularly beneficial for infants with severe ROP who are at high risk of vision loss[3].

4. Surgical Intervention

In cases where ROP progresses to stage 4 (partial retinal detachment) or stage 5 (total retinal detachment), surgical intervention may be necessary. Procedures such as vitrectomy can be performed to remove the vitreous gel and repair the retina. However, these surgeries are typically considered only after other treatment options have been exhausted[4].

5. Monitoring and Follow-Up Care

Regular monitoring is essential for infants diagnosed with ROP. Follow-up examinations by a pediatric ophthalmologist are crucial to assess the progression of the disease and the effectiveness of treatments. Infants at risk for ROP should be screened according to established guidelines, which recommend examinations starting at 4-6 weeks of age for those born before 28 weeks of gestation or with a birth weight of less than 1500 grams[5].

Conclusion

The management of retinopathy of prematurity, particularly at stage 3, requires a multifaceted approach that includes laser therapy, cryotherapy, anti-VEGF injections, and possibly surgical intervention. Early detection and timely treatment are vital to preserving vision in affected infants. Ongoing research continues to refine these treatment strategies, aiming to improve outcomes for the most vulnerable patients. Regular follow-up care remains essential to monitor the condition and adjust treatment as necessary.

References

1. Billing and Coding: Ophthalmology: Posterior Segment.
2. Clinical Policy: Fundus Photography.
3. Eylea® HD - Aflibercept.
4. Vascular Endothelial Growth Factor (VEGF) Inhibitors.
5. Understanding ICD-10 Code for H35 - Eye Surgery Guide.