Most Aetna benefit plans exclude coverage of refractive surgery. Note: Aetna does not cover corneal topography if it is performed pre- or post-operatively in relation to a non-covered procedure (i.e., refractive eye surgery). Repeat testing to monitor disease progression in keratoconus or Terrien's marginal degenerationВ may be necessary over time. Pre- and post-penetrating keratoplasty and post kerato-refractive surgery for irregular astigmatism (subject to medical necessity criteria for these procedures - see CPB 0023 - Corneal Remodeling) orДЇootnote1* Generally,В 1 testing for each eye is sufficient for fitting, unless there is some reason for repeat testing conducted in the medical record, such as a change in the member's condition from the prior examination.Difficult fitting of contact lens (see CPB 0126 - Contact Lenses and Eyeglasses) Footnote1* or.Diagnosing and monitoring disease progression in keratoconusВ or Terrien's marginal degeneration or.Corneal dystrophy, bullous keratopathy and complications of transplanted cornea or.Combined treatments and improved screening could eliminate the need for surgical management in most cases of PMD.Aetna considers computerized corneal topography medically necessary for any of the following conditions: Corneal collagen cross-linking is especially exciting because it halts disease progression. Combining treatments such as ICRS, CXL, toric PIOL implantation, and refractive surgery is promising, but additional studies are needed to investigate their efficacy and safety.ДЄlthough little is understood about the etiology, pathophysiology, epidemiology, and genetics of PMD, new treatments are improving visual outcomes and reducing complications. CXL demonstrates effectiveness without complications, although data are limited and long-term results are needed. ICRS implantation can delay penetrating keratoplasty and improve contact lens tolerance, but does not treat the underlying process. Toric PIOL implantation is effective, but ectasia progression is a concern. Crescentic lamellar keratoplasty and TILK are effective, but technically difficult and without long-term results. CLWR is effective, but lacks long-term results. FTCWR has good visual outcomes, but with significant astigmatic drift. DALK provides visual outcomes similar to penetrating keratoplasty without the risk of immune-mediated graft rejection, but its complexity and relative novelty limit its acceptance. Penetrating keratoplasty is the treatment of last resort in PMD and is effective, but with considerable complications. Reported data for each treatment is presented. This is the first review article looking at the literature specific to PMD. To review and evaluate current and future directions in the diagnosis and surgical management of pellucid marginal degeneration (PMD), including penetrating keratoplasty, full-thickness crescentic wedge resection (FTCWR), deep anterior lamellar keratoplasty (DALK), crescentic lamellar wedge resection (CLWR), crescentic lamellar keratoplasty, tuck-in lamellar keratoplasty (TILK), toric phakic intraocular lens (PIOL) implantation, intrastromal corneal ring segment implantation (ICRS), corneal collagen cross-linking (CXL), and combined therapies.

Pellucid marginal degernation icd 10