ICD-10: H35.173

Retrolental fibroplasia (RLF), particularly in its bilateral form, is a condition primarily associated with premature infants and is characterized by abnormal blood vessel growth in the retina. The ICD-10 code for this condition is H35.173. Below are alternative names and related terms that are commonly associated with this diagnosis.

Alternative Names for Retrolental Fibroplasia

1. Retinopathy of Prematurity (ROP): This is the most widely used term for retrolental fibroplasia, especially in contemporary medical literature. ROP refers to the abnormal development of retinal blood vessels in premature infants, which can lead to vision impairment or blindness.

2. Fibroplasia Retrolentalis: This is a Latin term that directly translates to retrolental fibroplasia and is sometimes used in medical contexts.

3. Retrolental Fibrosis: This term emphasizes the fibrous tissue formation behind the lens, which is a hallmark of the condition.

4. Bilateral Retrolental Fibroplasia: This term specifies that the condition affects both eyes, which is relevant for clinical documentation and coding.

Related Terms

1. Premature Retinopathy: This term highlights the association of the condition with premature birth, which is a significant risk factor for developing ROP.

2. Vascular Retinopathy: This broader term encompasses various retinal conditions characterized by abnormal blood vessel growth, including ROP.

3. Ocular Complications of Prematurity: This phrase refers to a range of eye-related issues that can arise in premature infants, including retrolental fibroplasia.

4. Neovascularization: This term describes the process of new blood vessel formation, which is a critical aspect of retrolental fibroplasia and ROP.

5. Retinal Detachment: While not synonymous, this term is related as ROP can lead to retinal detachment, a serious complication that can result from the abnormal vascular changes associated with retrolental fibroplasia.

Conclusion

Understanding the alternative names and related terms for ICD-10 code H35.173 is essential for accurate diagnosis, coding, and communication among healthcare professionals. The most prevalent term today is "Retinopathy of Prematurity," which reflects the condition's association with premature infants and its implications for vision health.

Retrolental fibroplasia (RLF), classified under ICD-10 code H35.173, is a condition primarily affecting premature infants, characterized by abnormal blood vessel growth in the retina. This condition can lead to severe visual impairment or blindness if not properly managed. Below is a detailed clinical description and relevant information regarding this diagnosis.

Clinical Description of Retrolental Fibroplasia

Definition

Retrolental fibroplasia is a retinal disorder that occurs due to the abnormal proliferation of fibrovascular tissue behind the lens (retrolental area) in the eye. It is most commonly associated with premature birth and low birth weight, particularly in infants who are exposed to high levels of oxygen therapy.

Pathophysiology

The pathogenesis of RLF involves a disruption in the normal development of retinal blood vessels. In premature infants, the retina is not fully vascularized at birth. When these infants are exposed to supplemental oxygen, it can lead to a phase of hyperoxia, which inhibits normal vascular growth. Following this, a phase of hypoxia may occur, triggering the overproduction of vascular endothelial growth factor (VEGF), leading to abnormal neovascularization and scarring in the retina[1][2].

Symptoms

Infants with retrolental fibroplasia may not exhibit symptoms until later in life, as the condition can progress silently. However, potential symptoms include:
- Poor visual acuity
- Strabismus (crossed eyes)
- Nystagmus (involuntary eye movement)
- Amblyopia (lazy eye)

Diagnosis

Diagnosis of RLF typically involves:
- Fundoscopic Examination: An eye care professional examines the retina for signs of abnormal blood vessel growth and scarring.
- Imaging: In some cases, advanced imaging techniques may be used to assess the extent of retinal damage.

Classification

Retrolental fibroplasia is classified into different stages based on the severity of the condition, ranging from mild (stage 1) to severe (stage 5), with stage 5 indicating total retinal detachment[3].

Treatment Options

Management of retrolental fibroplasia may include:
- Laser Therapy: To ablate abnormal blood vessels and prevent further complications.
- Cryotherapy: In some cases, freezing treatment may be used to address abnormal growth.
- Surgical Intervention: For advanced cases, surgical options may be necessary to repair retinal detachment or other complications.

Prognosis

The prognosis for infants diagnosed with RLF varies significantly based on the stage of the disease at diagnosis and the timeliness of intervention. Early detection and treatment can improve visual outcomes, but severe cases may lead to permanent vision loss.

Conclusion

ICD-10 code H35.173 is designated for retrolental fibroplasia, bilateral, highlighting the importance of early diagnosis and management in at-risk populations, particularly premature infants. Continuous monitoring and appropriate interventions are crucial to mitigate the risk of severe visual impairment associated with this condition. For healthcare providers, understanding the clinical implications and treatment options for RLF is essential in providing optimal care for affected infants[4][5].

References

1. Clinical Policy: Extended Ophthalmoscopy.
2. Billing and Coding: Ophthalmology: Posterior Segment.
3. Clinical Policy: Extended Ophthalmoscopy.
4. ICD-10-CM Code for Retrolental fibroplasia, bilateral H35.173 - AAPC.
5. ICD-10-CM Diagnosis Code H35.173 - Retrolental fibroplasia, bilateral.

Retrolental fibroplasia (RLF), now more commonly referred to as retinopathy of prematurity (ROP), is a condition primarily affecting premature infants. It is characterized by abnormal blood vessel development in the retina, which can lead to vision impairment or blindness. The ICD-10 code H35.173 specifically denotes bilateral retrolental fibroplasia, indicating that both eyes are affected. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with this condition.

Clinical Presentation

Patient Characteristics

• Prematurity: RLF predominantly occurs in infants born before 28 weeks of gestation, although it can affect those born up to 34 weeks. The risk increases with decreasing gestational age and low birth weight.
• Oxygen Therapy: Infants who receive supplemental oxygen, particularly in high concentrations, are at a higher risk for developing RLF. This is due to the potential for oxygen-induced retinal damage.
• Low Birth Weight: Infants weighing less than 1500 grams (approximately 3.3 pounds) are particularly susceptible to RLF.

Signs and Symptoms

• Visual Impairment: The most significant symptom of bilateral retrolental fibroplasia is impaired vision, which may range from mild to severe. In some cases, it can lead to complete blindness.
• Strabismus: Misalignment of the eyes may be observed, which can be a result of abnormal retinal development.
• Nystagmus: Involuntary eye movements may occur, affecting visual stability and clarity.
• Abnormal Eye Movements: Infants may exhibit unusual eye movements or difficulty tracking objects, which can indicate underlying retinal issues.

Additional Clinical Features

• Retinal Detachment: In severe cases, the abnormal blood vessels can lead to retinal detachment, which is a critical condition requiring immediate medical intervention.
• Scarring: The presence of fibrous tissue behind the lens (retrolental) can be observed during ophthalmic examinations, indicating the progression of the disease.

Diagnosis

Diagnosis of bilateral retrolental fibroplasia typically involves a comprehensive eye examination, often using indirect ophthalmoscopy to assess the retina's condition. The examination may reveal the characteristic findings associated with RLF, such as abnormal vascularization and scarring.

Conclusion

Retrolental fibroplasia, particularly in its bilateral form (ICD-10 code H35.173), is a serious condition primarily affecting premature infants. The clinical presentation includes a range of visual impairments and associated ocular abnormalities. Early detection and intervention are crucial to managing the condition and preventing severe visual impairment or blindness. Regular screening of at-risk infants is essential to identify RLF early and initiate appropriate treatment strategies.

Retrolental fibroplasia (RLF), now more commonly referred to as retinopathy of prematurity (ROP), is a condition that primarily affects premature infants and can lead to vision impairment or blindness. The ICD-10 code H35.173 specifically denotes "Retrolental fibroplasia, bilateral." To diagnose this condition, several criteria and clinical assessments are typically employed.

Diagnostic Criteria for Retrolental Fibroplasia (H35.173)

1. Clinical History

• Prematurity: The infant must be born prematurely, typically before 32 weeks of gestation, as the risk of ROP increases significantly with lower gestational age.
• Birth Weight: Infants with a birth weight of less than 1500 grams are at a higher risk for developing ROP.

2. Ophthalmic Examination

• Fundoscopic Examination: A thorough examination of the retina using an ophthalmoscope is crucial. This examination helps identify the presence of abnormal blood vessel growth (neovascularization) and other retinal changes characteristic of ROP.
• Staging of ROP: ROP is classified into five stages based on the severity of the disease:
  • Stage 1: Mildly abnormal blood vessel growth.
  • Stage 2: Moderately abnormal blood vessel growth.
  • Stage 3: Severely abnormal blood vessel growth, which may be associated with the formation of new blood vessels.
  • Stage 4: Partial retinal detachment.
  • Stage 5: Total retinal detachment.
• Zone Classification: The retina is divided into three zones based on the distance from the optic nerve, with Zone I being the most posterior and Zone III being the most anterior. The location of the abnormality is also considered in the diagnosis.

3. Additional Diagnostic Tools

• Retinal Imaging: Advanced imaging techniques, such as optical coherence tomography (OCT), may be used to assess the retinal structure and detect any abnormalities.
• Visual Acuity Testing: Although challenging in very young infants, assessing visual acuity can provide insights into the functional impact of ROP.

4. Follow-Up and Monitoring

• Regular Screening: Infants at risk for ROP should undergo regular eye examinations, typically starting at 4-6 weeks of age or at the time of discharge from the neonatal intensive care unit (NICU).
• Monitoring Progression: The progression of ROP can vary, and continuous monitoring is essential to determine if treatment is necessary.

Conclusion

The diagnosis of retrolental fibroplasia (ICD-10 code H35.173) involves a combination of clinical history, detailed ophthalmic examinations, and possibly advanced imaging techniques. Early detection and intervention are critical in managing this condition to prevent severe visual impairment. Regular follow-up is essential for infants at risk, ensuring timely treatment if the disease progresses.

Retrolental fibroplasia (RLF), also known as retinopathy of prematurity (ROP), is a condition primarily affecting premature infants, characterized by abnormal blood vessel development in the retina. The ICD-10 code H35.173 specifically refers to bilateral retrolental fibroplasia. Treatment approaches for this condition vary based on the severity of the disease and the age of the infant at diagnosis. Below is a detailed overview of standard treatment approaches for bilateral retrolental fibroplasia.

Understanding Retrolental Fibroplasia

Pathophysiology

Retrolental fibroplasia occurs when there is an interruption in the normal development of retinal blood vessels, often due to factors such as oxygen therapy in premature infants. This can lead to scarring and retinal detachment if not managed appropriately[1].

Risk Factors

• Prematurity (especially infants born before 28 weeks of gestation)
• Low birth weight
• Oxygen therapy
• Other neonatal complications

Standard Treatment Approaches

1. Monitoring and Screening

Early detection is crucial in managing RLF. Infants at risk should undergo regular eye examinations, typically starting at 4-6 weeks of age or at 30-32 weeks postmenstrual age. The frequency of screening depends on the infant's risk factors and the findings of previous examinations[2].

2. Laser Therapy

For infants diagnosed with severe RLF, laser photocoagulation is a common treatment. This procedure involves using a laser to destroy the abnormal blood vessels in the retina, thereby preventing further complications such as retinal detachment. Laser therapy is most effective when performed early in the disease process[3].

3. Cryotherapy

Cryotherapy, which involves freezing the abnormal blood vessels, is another treatment option. However, it has become less common with the advent of laser therapy, which is generally preferred due to its precision and effectiveness[4].

4. Anti-VEGF Therapy

In some cases, intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents may be used. These medications help inhibit the growth of abnormal blood vessels and can be particularly useful in cases where laser therapy is not feasible or has failed[5].

5. Surgical Intervention

In advanced cases where retinal detachment has occurred, surgical intervention may be necessary. This can include vitrectomy, which involves removing the vitreous gel from the eye to address complications related to RLF[6].

6. Supportive Care

Supportive care is essential for infants with RLF. This includes managing overall health, ensuring proper nutrition, and monitoring for other complications associated with prematurity. Multidisciplinary care involving neonatologists, ophthalmologists, and pediatricians is often required[7].

Conclusion

The management of bilateral retrolental fibroplasia involves a combination of monitoring, laser therapy, and potentially surgical interventions, depending on the severity of the condition. Early detection and treatment are critical to preventing vision loss and ensuring the best possible outcomes for affected infants. Continuous research and advancements in treatment modalities are essential to improve the prognosis for those at risk of RLF.

For further information or specific case management, consulting with a pediatric ophthalmologist is recommended, as they can provide tailored guidance based on the individual needs of the infant.