Eye surgery

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Cataract surgery, using a temporal approach phacoemulsification probe (in right hand) and "chopper"(in left hand) being done under operating microscope at a Navy medical center
Isolating the inferior rectus muscle

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Overview

Eye surgery, also known as ophthalmic surgery or ocular surgery, is surgery performed on the eye or its adnexa, typically by an ophthalmologist.[1] Although most eye surgery can be performed by an experienced general ophthalmologist, more complex procedures are usually done by one who is fellowship trained.

Preparation and precautions

The eye is a delicate organ, requiring extreme care before, during and after a surgical procedure. An expert ophthalmologist must identify the need for specific procedure and be responsible for conducting the procedure safely. Many university programs allow patients to specify if they want to be operated upon by the consultant or the resident / fellow.

Proper anesthesia is a must for any eye surgery. Local anesthesia is most commonly used. Retrobulbar and peribulbar techniques for infiltrating the local area surrounding the eye muscle cone are used to immobilize the extraocular muscles and eliminate pain sensation. Topical anesthesia using lidocaine topical gel is preferred for quick procedures. In topical anesthesia, patient cooperation is a must for a smooth procedure. General anesthesia is recommended for children, traumatic eye injuries, major orbitotomies and for apprehensive patients. Cardiovascular monitoring is preferable in local anesthesia and is mandatory in general anesthesia. Proper sterile precautions are taken to prepare the area for surgery, including use of antiseptics like povidone-iodine. Sterile drapes, gowns and gloves are a must. A plastic sheet with a receptacle helps collect the fluids during phacoemulsification. An eye speculum is inserted to keep the eyes wide open. For anxious patients, supplementation with a facial nerve block using lidocaine and bupivacaine is recommended.

Laser eye surgery

Although the terms Laser Eye Surgery and Refractive surgery are commonly used as if they were interchangeable, this is not the case. Lasers may be used to treat nonrefractive conditions (e.g. to seal a retinal tear), while radial keratotomy is an example of refractive surgery without the use of a laser.

Cataract surgery

Main article: Cataract surgery

A cataract is an opacification or cloudiness of the eye's crystalline lens due to aging, disease, or trauma that typically prevents light from forming a clear image on the retina. If visual loss is significant, surgical removal of the lens may be warranted, with lost optical power usually replaced with a plastic intraocular lens (IOL). Due to the high prevalence of cataracts, cataract extraction is the most common eye surgery.[2]

Glaucoma surgery

Main article: Glaucoma surgery

Glaucoma is a group of diseases affecting the optic nerve that results in vision loss and is frequently characterized by raised intraocular pressure (IOP). There are many types of glaucoma surgery, and variations or combinations of those types, that facilitate the escape of excess aqueous humor from the eye to lower intraocular pressure, and a few that lower IOP by decreasing the production of aqueous.

Canaloplasty

Canaloplasty is an advanced, nonpenetrating procedure designed to enhance drainage through the eye’s natural drainage system to provide sustained reduction of IOP. Canaloplasty utilizes microcatheter technology in a simple and minimally invasive procedure. To perform a canaloplasty, an Ophthalmologist creates a tiny incision to gain access to a canal in the eye. A microcatheter circumnavigates the canal around the iris, enlarging the main drainage channel and its smaller collector channels through the injection of a sterile, gel-like material called viscoelastic. The catheter is then removed and a suture is placed within the canal and tightened. By opening up the canal, the pressure inside the eye can be reduced.

Refractive surgery

Main article: Refractive surgery
  • Refractive surgery aims to correct errors of refraction in the eye, reducing or eliminating the need for corrective lenses
  • Presbyopia reversal
    • Anterior ciliary sclerotomy (ACS)
      • Laser reversal of presbyopia (LRP)
    • Scleral expansion bands

Corneal surgery

Vitreo-retinal surgery

  • Vitreo-retinal surgery includes the following
    • Vitrectomy[9]
      • Anterior vitrectomy is the removal of the front portion of vitreous tissue. It is used for preventing or treating vitreous loss during cataract or corneal surgery, or to remove misplaced vitreous in conditions such as aphakia pupillary block glaucoma.
      • Pars plana vitrectomy (PPV), or trans pars plana vitrectomy (TPPV), is a procedure to remove vitreous opacities and membranes through a pars plana incision. It is frequently combined with other intraocular procedures for the treatment of giant retinal tears, tractional retinal detachments, and posterior vitreous detachments [1].
    • Pan retinal photocoagulation (PRP) is a type of photocoagulation therapy used in the treatment of diabetic retinopathy.[10]
    • Retinal detachment repair
      • Ignipuncture is an obsolete procedure that involves cauterization of the retina with a very hot pointed instrument.[11]
      • A scleral buckle is used in the repair of a retinal detachment to indent or "buckle" the sclera inward, usually by sewing a piece of preserved sclera or silicone rubber to its surface.[12]
      • Laser photocoagulation, or photocoagulation therapy, is the use of a laser to seal a retinal tear.[10]
      • Pneumatic retinopexy
      • Retinal cryopexy, or retinal cryotherapy, is a procedure that uses intense cold to induce a chorioretinal scar and to destroy retinal or choroidal tissue.[13]
    • Macular hole repair
    • Partial lamellar sclerouvectomy[14]
      • Partial lamellar sclerocyclochoroidectomy
      • Partial lamellar sclerochoroidectomy
    • Posterior sclerotomy is an opening made into the vitreous through the sclera, as for detached retina or the removal of a foreign body [2].
    • Radial optic neurotomy
    • macular translocation surgery
      • through 360 degree retinotomy
      • through scleral imbrication technique

Eye muscle surgery

Main article: Strabismus surgery

With approximately 1.2 million procedures each year, extraocular muscle surgery is the third most common eye surgery in the United States [3].

  • Eye muscle surgery typically corrects strabismus and includes the following[15] [4]:
    • Loosening / weakening procedures
      • Recession involves moving the insertion of a muscle posteriorly towards its origin.
      • Myectomy
      • Myotomy
      • Tenectomy
      • Tenotomy
    • Tightening / strengthening procedures
      • Resection
      • Tucking
      • Advancement is the movement of an eye muscle from its original place of attachment on the eyeball to a more forward position.
    • Transposition / repositioning procedures
    • Adjustable suture surgery is a method of reattaching an extraocular muscle by means of a stitch that can be shortened or lengthened within the first post-operative day, to obtain better ocular alignment [5].

Oculoplastic surgery

Main article: Oculoplastics
  • Oculoplastic surgery, or oculoplastics, is the subspecialty of ophthalmology that deals with the reconstruction of the eye and associated structures. Oculoplastic surgeons perform procedures such as the repair of droopy eyelids (blepharoplasty)[6], repair of tear duct obstructions, orbital fracture repairs, removal of tumors in and around the eyes, and facial rejuvenation procedures including laser skin resurfacing, eye lifts, brow lifts, and even facelifts. Common procedures are:

Eyelid surgery [7]

Surgery involving the lacrimal apparatus

    • A dacryocystorhinostomy (DCR) or dacryocystorhinotomy is a procedure to restore the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct does not function.[17][18]
    • Canaliculodacryocystostomy is a surgical correction for a congenitally blocked tear duct in which the closed segment is excised and the open end is joined to the lacrimal sac.[17][19]
    • Canaliculotomy involves slitting of the lacrimal punctum and canaliculus for the relief of epiphora[17]
    • A dacryoadenectomy is the surgical removal of a lacrimal gland.[17]
    • A dacryocystectomy is the surgical removal of a part of the lacrimal sac.[17]
    • A dacryocystostomy is an incision into the lacrimal sac, usually to promote drainage.[17]
    • A dacryocystotomy is an incision into the lacrimal sac.[17]

Eye removal

    • An enucleation is the removal of the eye leaving the eye muscles and remaining orbital contents intact.[20]
    • An evisceration is the removal of the eye's contents, leaving the scleral shell intact. Usually performed to reduce pain in a blind eye.[21]
    • An exenteration is the removal of the entire orbital contents, including the eye, extraocular muscles, fat, and connective tissues; usually for malignant orbital tumors.[22]

Orbital surgery

  • Orbital reconstruction / Ocular prosthetics (False Eyes)
  • Orbital decompression for Grave's Disease

Other oculoplastic surgery

Other surgery

Many of these described procedures are historical and are not recommended due to a risk of complications. Particularly, these include operations done on ciliary body in an attempt to control glaucoma, since highly safer surgeries for glaucoma, including lasers, non-penetrating surgery, guarded filtration surgery and seton valve implants have been invented.

  • A ciliarotomy is a surgical division of the ciliary zone in the treatment of glaucoma.[17]
  • A ciliectomy is 1) the surgical removal of part of the ciliary body, or 2) the surgical removal of part of a margin of an eyelid containing the roots of the eyelashes.[17]
  • A ciliotomy is a surgical section of the ciliary nerves.[17]
  • A conjunctivoanstrostomy is an opening made form the inferior conjuctival cul-de-sac into the maxillary sinus for the treatment of epiphora.[17]
  • Conjuctivoplasty is plastic surgery of the conjunctiva.[17]
  • A conjunctivorhinostomy is a surgical correction of the total obstruction of a lacrimal canaliculus by which the conjuctiva is anastomosed with the nasal cavity to improve tear flow.[17]
  • A corectomedialysis, or coretomedialysis, is an excision of a small portion of the iris at its junction with the ciliary body to form an artificial pupil.[17]
  • A corectomy, or coretomy, is any surgical cutting operation on the iris at the pupil.[17]
  • A corelysis is a surgical detachment of adhesions of the iris to the capsule of the crystalline lens or cornea.[17]
  • A coremorphosis is the surgical formation of an artificial pupil.[17]
  • A coreplasty, or coreoplasty, is plastic surgery of the iris, usually for the formation of an artificial pupil.[17]
  • A coreoplasy, or laser pupillomydriasis, is any procedure that changes the size or shape of the pupil.[21]
  • A cyclectomy is an excision of portion of the ciliary body.[17]
  • A cyclotomy, or cyclicotomy, is a surgical incision of the ciliary body, usually for the relief of glaucoma.[17]
  • A cycloanemization is a surgical obliteration of the long ciliary arteries in the treatment of glaucoma.[17]
  • An iridectomesodialsys is the formation of an artificial pupil by detaching and excising a portion of the iris at its periphery.[17]
  • An iridodialysis, sometimes known as a coredialysis, is a localized separation or tearing away of the iris from its attachment to the ciliary body.[17][21]
  • An iridencleisis, or corenclisis, is a surgical procedure for glaucoma in which a portion of the iris is incised and incarcerated in a limbal incision.[17] (Subdivided into basal iridencleisis and total iridencleisis.[23])
  • An iridesis is a surgical procedure in which a portion of the iris is brought through and incarcerated in a corneal incision in order to reposition the pupil.[17][10]
  • An iridocorneosclerectomy is the surgical removal of a portion of the iris, the cornea, and the sclera.[17]
  • An iridocyclectomy is the surgical removal of the iris and the ciliary body.[17]
  • An iridocystectomy is the surgical removal of a portion of the iris to form an artificial pupil.[17]
  • An iridosclerectomy is the surgical removal of a portion of the sclera and a portion of the iris in the region of the limbus for the treatment of glaucoma.[17]
  • An iridosclerotomy is the surgical puncture of the sclera and the margin of the iris for the treatment of glaucoma.[17]
  • A rhinommectomy is the surgical removal of a portion of the internal canthus.[17]
  • A trepanotrabeculectomy is used in the treatment of chronic open and chronic closed angle glaucoma.[23]

See also

References

  1. ↑ Surgery Encyclopedia - Ophthalmologic surgery
  2. ↑ Uhr, Barry W. History of ophthalmology at Baylor University Medical Center. Proc (Bayl Univ Med Cent). 2003 October; 16(4): 435–438. PMID 16278761
  3. ↑ 3.0 3.1 Surgery Encyclopedia - LASIK
  4. ↑ Surgery Encyclopedia - PRK
  5. ↑ 5.0 5.1 Surgery Encyclopedia - Corneal transplantation
  6. ↑ http://www.iupui.edu/~ophthal/html/eyes_intercornealrings.html
  7. ↑ Indiana University Department of Ophthalmology - Phototherapeutic Keratectomy (PTK)
  8. ↑ MDAdvice.com - Pterygium removal
  9. ↑ http://www.iupui.edu/~ophthal/html/eyes_vitrectomysurgery.html
  10. ↑ 10.0 10.1 Surgery Encyclopedia - Photocoagulation therapy
  11. ↑ Wolfensberger TJ. "Jules Gonin. Pioneer of retinal detachment surgery." Indian J Ophthalmol. 2003 Dec;51(4):303-8. PMID 14750617.
  12. ↑ Surgery Encyclopedia - Scleral Buckling
  13. ↑ Surgery Encyclopedia - Retinal_cryopexy
  14. ↑ Shields JA, Shields CL. Surgical approach to lamellar sclerouvectomy for posterior uveal melanomas: the 1986 Schoenberg lecture. Ophthalmic Surg. 1988 Nov;19(11):774-80. PMID 3222038.
  15. ↑ Surgery Encyclopedia - Eye Muscle Surgery
  16. ↑ Surgery Encyclopedia - Blepharoplasty
  17. ↑ 17.00 17.01 17.02 17.03 17.04 17.05 17.06 17.07 17.08 17.09 17.10 17.11 17.12 17.13 17.14 17.15 17.16 17.17 17.18 17.19 17.20 17.21 17.22 17.23 17.24 17.25 17.26 17.27 17.28 17.29 17.30 17.31 17.32 17.33 17.34 17.35 Cline D; Hofstetter HW; Griffin JR. Dictionary of Visual Science. 4th ed. Butterworth-Heinemann, Boston 1997. ISBN 0-7506-9895-0
  18. ↑ Indiana University Department of Ophthalmology. "Lacrimal Drainage Surgery (DCR: Dacryocystorhinostomy)." Retrieved August 18, 2006
  19. ↑ Cherkunov BF, Lapshina AV. ["Canaliculodacryocystostomy in obstruction of medial end of the lacrimal duct."] Oftalmol Zh. 1976;31(7):544-8. PMID 1012635.
  20. ↑ Surgery Encyclopedia - Enucleation
  21. ↑ 21.0 21.1 21.2 Cassin, B. and Solomon, S. Dictionary of Eye Terminology. Gainsville, Florida: Triad Publishing Company, 1990.
  22. ↑ Surgery Encyclopedia - Exenteration
  23. ↑ 23.0 23.1 Cvetkovic D, Blagojevic M, Dodic V. ["Comparative results of trepanotrabeculectomy and iridencleisis in primary glaucoma."] J Fr Ophtalmol. 1979 Feb;2(2):103-7. PMID 444110.

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