ICD-10: H35.46

ICD-10 code H35.46 refers to Secondary vitreoretinal degeneration, a condition characterized by the deterioration of the vitreous body and retina due to underlying systemic or ocular diseases. This degeneration can lead to various visual impairments and is often associated with other ocular conditions.

Clinical Description

Definition

Secondary vitreoretinal degeneration occurs when the vitreous and retinal structures are affected by other diseases, such as diabetes, hypertension, or inflammatory conditions. Unlike primary vitreoretinal degeneration, which arises independently, secondary degeneration is a consequence of another pathological process.

Etiology

The causes of secondary vitreoretinal degeneration can include:
- Diabetic Retinopathy: High blood sugar levels can lead to changes in the retinal blood vessels, causing leakage and subsequent degeneration.
- Hypertensive Retinopathy: Elevated blood pressure can damage retinal blood vessels, leading to ischemia and degeneration.
- Inflammatory Diseases: Conditions such as uveitis can cause inflammation that affects the retina and vitreous.
- Trauma: Physical injury to the eye can result in secondary degeneration of the vitreous and retina.

Symptoms

Patients with secondary vitreoretinal degeneration may experience:
- Blurred or distorted vision
- Floaters or flashes of light
- Dark spots in the visual field
- Progressive vision loss

Diagnosis

Diagnosis typically involves a comprehensive eye examination, including:
- Fundoscopy: To visualize the retina and vitreous for signs of degeneration.
- Optical Coherence Tomography (OCT): To obtain cross-sectional images of the retina and assess structural changes.
- Fluorescein Angiography: To evaluate blood flow in the retina and identify areas of leakage or ischemia.

Treatment

Management of secondary vitreoretinal degeneration focuses on treating the underlying condition and may include:
- Control of systemic diseases: Such as managing diabetes or hypertension.
- Laser therapy: To address retinal damage or leakage.
- Surgical intervention: In cases of severe degeneration, procedures like vitrectomy may be necessary to remove the vitreous gel and repair the retina.

Conclusion

ICD-10 code H35.46 encapsulates a significant clinical condition that underscores the importance of managing systemic diseases to prevent secondary ocular complications. Early diagnosis and intervention are crucial in preserving vision and improving patient outcomes. Regular eye examinations are recommended for individuals at risk of developing secondary vitreoretinal degeneration due to underlying health issues.

Secondary vitreoretinal degeneration, classified under ICD-10 code H35.46, is a condition that can arise from various underlying diseases or injuries affecting the retina and vitreous body. Understanding its clinical presentation, signs, symptoms, and patient characteristics is crucial for accurate diagnosis and management.

Clinical Presentation

Overview

Secondary vitreoretinal degeneration typically occurs as a result of other ocular conditions, such as retinal detachment, diabetic retinopathy, or inflammatory diseases. The degeneration can lead to significant visual impairment and may present with a range of symptoms depending on the severity and underlying cause.

Signs and Symptoms

Patients with secondary vitreoretinal degeneration may exhibit the following signs and symptoms:

• Visual Disturbances: Patients often report blurred vision, decreased visual acuity, or sudden vision loss. These symptoms can vary in intensity and may be progressive or sudden, depending on the underlying cause[1].

• Floaters and Flashes: Many patients experience the perception of floaters (small spots or lines that drift across the field of vision) and flashes of light, which are indicative of vitreous traction on the retina[1][2].

• Metamorphopsia: This is a visual distortion where straight lines appear wavy or bent, often associated with retinal changes[2].

• Peripheral Vision Loss: Patients may notice a decrease in peripheral vision, which can be a sign of retinal involvement[1].

• Fundoscopic Findings: Upon examination, clinicians may observe retinal changes such as atrophy, pigmentary changes, or signs of retinal detachment. The presence of exudates or hemorrhages may also be noted, depending on the underlying pathology[2][3].

Patient Characteristics

Demographics

• Age: Secondary vitreoretinal degeneration can occur in individuals of any age but is more commonly seen in older adults, particularly those with chronic conditions like diabetes or hypertension[3].

• Underlying Conditions: Patients with a history of systemic diseases (e.g., diabetes mellitus, hypertension) or ocular conditions (e.g., retinal detachment, uveitis) are at higher risk for developing secondary vitreoretinal degeneration[1][2].

• Gender: There may be a slight male predominance in certain underlying conditions that lead to vitreoretinal degeneration, although this can vary based on specific diseases[3].

Risk Factors

• Diabetes: Diabetic retinopathy is a significant risk factor, as it can lead to secondary changes in the vitreous and retina[1].

• Trauma: Ocular trauma can precipitate vitreoretinal degeneration, particularly if it results in retinal tears or detachments[2].

• Genetic Factors: Certain hereditary conditions, such as familial exudative vitreoretinopathy (FEVR), can predispose individuals to secondary degeneration[3].

Conclusion

Secondary vitreoretinal degeneration (ICD-10 code H35.46) presents with a variety of visual symptoms and signs that can significantly impact a patient's quality of life. Understanding the clinical presentation and patient characteristics is essential for timely diagnosis and intervention. Clinicians should consider the underlying causes and associated risk factors when evaluating patients with suspected vitreoretinal degeneration to provide appropriate management and care. Regular monitoring and comprehensive eye examinations are crucial for patients at risk, particularly those with pre-existing ocular or systemic conditions.

ICD-10 code H35.46 refers specifically to "Secondary vitreoretinal degeneration." This condition is characterized by the degeneration of the vitreous and retina due to secondary causes, often related to other underlying ocular diseases or systemic conditions. Understanding alternative names and related terms can enhance clarity in medical documentation and communication. Below are some alternative names and related terms associated with H35.46.

Alternative Names

1. Secondary Retinal Degeneration: This term emphasizes the retinal aspect of the degeneration, indicating that the retina is affected as a result of another condition.
2. Vitreoretinal Degeneration: A broader term that encompasses degeneration affecting both the vitreous body and the retina, which may be secondary to various factors.
3. Vitreous Degeneration: While this term focuses more on the vitreous body, it is often used in conjunction with retinal conditions, especially when discussing secondary effects.
4. Retinal Atrophy: This term can be used to describe the loss of retinal cells, which may occur as a secondary effect of other diseases.

Related Terms

1. H35.461: This is the specific code for "Secondary vitreoretinal degeneration, right eye," indicating the laterality of the condition.
2. H35.462: This code refers to "Secondary vitreoretinal degeneration, left eye," providing a similar indication for the left eye.
3. Peripheral Retinal Degeneration (H35.4): While not identical, this term relates to degeneration occurring in the peripheral regions of the retina, which may also be secondary in nature.
4. Retinal Detachment: Although distinct, this condition can be a consequence of vitreoretinal degeneration and is often discussed in the same clinical context.
5. Diabetic Retinopathy: A common cause of secondary vitreoretinal degeneration, this term refers to retinal damage due to diabetes, which can lead to degeneration.

Conclusion

Understanding the alternative names and related terms for ICD-10 code H35.46 is crucial for accurate medical coding, documentation, and communication among healthcare professionals. These terms help in identifying the condition's nature and its implications in clinical practice, particularly in the context of secondary causes affecting the vitreous and retina.

The ICD-10 code H35.46 refers to "Secondary vitreoretinal degeneration," which is a condition characterized by degeneration of the vitreous and retina due to underlying systemic or ocular diseases. Diagnosing this condition involves a combination of clinical evaluation, patient history, and specific diagnostic criteria. Below is a detailed overview of the criteria and considerations used in the diagnosis of H35.46.

Clinical Evaluation

Patient History

• Medical History: A thorough medical history is essential, focusing on any systemic diseases (e.g., diabetes, hypertension) or previous ocular conditions that may contribute to vitreoretinal degeneration.
• Symptoms: Patients may report symptoms such as blurred vision, floaters, flashes of light, or visual field loss, which can indicate retinal involvement.

Physical Examination

• Ophthalmic Examination: A comprehensive eye examination is crucial. This includes:
• Visual Acuity Testing: Assessing the clarity of vision.
• Fundoscopy: Direct examination of the retina and vitreous using an ophthalmoscope to identify any degenerative changes, such as retinal thinning, detachment, or other abnormalities.

Diagnostic Imaging

Advanced Imaging Techniques

• Optical Coherence Tomography (OCT): This non-invasive imaging technique provides cross-sectional images of the retina, allowing for detailed assessment of retinal layers and the vitreous.
• Fluorescein Angiography: This test involves injecting a fluorescent dye into the bloodstream to visualize blood flow in the retina and identify any vascular abnormalities associated with degeneration.
• Ultrasound: B-scan ultrasonography can be used to evaluate the vitreous and retina, especially in cases where the view is obscured due to cataracts or other opacities.

Differential Diagnosis

• It is important to differentiate secondary vitreoretinal degeneration from other retinal conditions, such as:
• Primary vitreoretinal degeneration: Conditions that arise without systemic disease.
• Retinal detachment: A more acute condition that may present similarly.
• Diabetic retinopathy: Common in diabetic patients and can lead to secondary degeneration.

Laboratory Tests

• While not always necessary, laboratory tests may be conducted to rule out systemic conditions contributing to retinal degeneration, such as blood glucose levels for diabetes or inflammatory markers for autoimmune diseases.

Conclusion

The diagnosis of secondary vitreoretinal degeneration (ICD-10 code H35.46) is multifaceted, relying on a combination of patient history, clinical examination, advanced imaging techniques, and differential diagnosis. Proper identification of the underlying causes is crucial for effective management and treatment of the condition. If you suspect this diagnosis, it is advisable to consult with an ophthalmologist who can perform the necessary evaluations and tests to confirm the diagnosis and recommend appropriate interventions.

Secondary vitreoretinal degeneration, classified under ICD-10 code H35.46, refers to retinal degeneration that occurs as a consequence of other ocular conditions or systemic diseases. This condition can lead to significant visual impairment, and its management typically involves a combination of medical and surgical approaches tailored to the underlying cause.

Understanding Secondary Vitreoretinal Degeneration

Secondary vitreoretinal degeneration can arise from various etiologies, including:

• Diabetic Retinopathy: Damage to the retina due to diabetes, leading to changes in the vitreous and retina.
• Age-Related Macular Degeneration (AMD): A progressive condition affecting the macula, which can lead to secondary changes in the vitreous.
• Retinal Vascular Occlusions: Blockages in the retinal blood vessels can cause ischemia and subsequent degeneration.
• Inflammatory Diseases: Conditions such as uveitis can lead to secondary changes in the vitreous and retina.

Standard Treatment Approaches

1. Medical Management

• Anti-VEGF Therapy: For conditions like neovascular AMD or diabetic retinopathy, anti-vascular endothelial growth factor (anti-VEGF) injections (e.g., ranibizumab, aflibercept) are commonly used to reduce retinal edema and prevent further degeneration[1][2].
• Corticosteroids: In cases of inflammatory vitreoretinal degeneration, corticosteroids may be administered to reduce inflammation and prevent further damage[3].
• Systemic Treatments: For underlying systemic conditions (e.g., diabetes), managing the primary disease through systemic medications and lifestyle changes is crucial[4].

2. Surgical Interventions

• Vitrectomy: This surgical procedure involves the removal of the vitreous gel, which can be indicated in cases of significant vitreous hemorrhage or tractional retinal detachment associated with secondary degeneration[5].
• Retinal Laser Therapy: Laser photocoagulation can be used to treat areas of ischemia or to create scars that stabilize the retina in conditions like diabetic retinopathy[6].
• Scleral Buckling: In cases of retinal detachment, this procedure can help reattach the retina and prevent further degeneration[7].

3. Supportive Therapies

• Vision Rehabilitation: Patients may benefit from low vision aids and rehabilitation services to maximize their remaining vision and improve quality of life[8].
• Regular Monitoring: Ongoing follow-up with an ophthalmologist is essential to monitor the progression of the disease and adjust treatment as necessary[9].

Conclusion

The management of secondary vitreoretinal degeneration is multifaceted, focusing on treating the underlying causes while addressing the degeneration itself. A combination of medical therapies, surgical interventions, and supportive care can help preserve vision and improve patient outcomes. Regular monitoring and a tailored approach based on individual patient needs are critical for effective management of this condition. For optimal results, collaboration among healthcare providers, including ophthalmologists and primary care physicians, is essential to ensure comprehensive care for patients with secondary vitreoretinal degeneration.

References

1. Billing and Coding: Ophthalmology: Posterior Segment.
2. Real-life management of neovascular age-related macular degeneration.
3. Vision protection therapy for prevention of neovascular age-related macular degeneration.
4. Variations in Using Diagnosis Codes for Defining Age-Related Macular Degeneration.
5. Local Coverage Determination (LCD).
6. Geographic atrophy: Mechanism of disease.
7. Age-Related Macular Degeneration - Medical Clinical Guidelines.
8. Local Coverage Determination (LCD).
9. Billing and Coding: Ophthalmology: Posterior Segment.