Eye surgery

Eye surgery
Intervention

Eye surgery in the Middle Ages.
ICD-10-PCS 08
ICD-9-CM 08-16
MeSH D013508
OPS-301 code 5-08...5-16

Eye surgery, also known as ocular surgery, is surgery performed on the eye or its adnexa, typically by an ophthalmologist.[1] The eye is a fragile organ, and requires extreme care before, during, and after a surgical procedure. An expert eye surgeon is responsible for selecting the appropriate surgical procedure for the patient, and for taking the necessary safety precautions.

Preparation and precautions

Since the eye is heavily supplied by nerves, anesthesia is essential. Local anesthesia is most commonly used. Topical anesthesia using lidocaine topical gel are often used for quick procedures. Since topical anesthesia requires cooperation from the patient, general anesthesia is often used for children, traumatic eye injuries, major orbitotomies and for apprehensive patients. The physician administering anesthesia, or a nurse anesthetist or anesthetist assistant with expertise in anesthesia of the eye, monitors the patient's cardiovascular status. Sterile precautions are taken to prepare the area for surgery and lower the risk of infection. These precautions include the use of antiseptics, such as povidone-iodine, and sterile drapes, gowns and gloves.

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).[2] Laser eye surgery or laser corneal surgery is a medical procedure that uses a laser to reshape the surface of the eye. This is done to correct myopia (short-sightedness), hypermetropia (long sightedness) and astigmatism (uneven curvature of the eye's surface). It is important to note that refractive surgery is not compatible with everyone, and rarely people may find that eyewear is still needed after surgery.[3]

Cataract surgery

Main article: Cataract surgery
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

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). Owing to the high prevalence of cataracts, cataract extraction is the most common eye surgery. Rest after surgery is recommended.[4]

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 humor.

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.[5][6][7][8]

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

Corneal surgery

Corneal surgery includes most refractive surgery as well as the following:

Vitreo-retinal surgery

Vitrectomy.

Vitreo-retinal surgery includes the following

Eye muscle surgery

Isolating the inferior rectus muscle
Disinserting the medial rectus muscle, after pre-placing vicryl suture
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 .

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), 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

Orbital surgery

Other oculoplastic surgery

Surgery involving the lacrimal apparatus

Eye removal

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.

References

  1. Surgery Encyclopedia - Ophthalmologic surgery
  2. Maguire, Stephen. "Laser Eye Surgery". The Irish Times.
  3. "Laser Eye Surgery Suitability". Optical Express.
  4. Uhr, Barry W. History of ophthalmology at Baylor University Medical Center. Hi Proc (Bayl Univ Med Cent). 2003 October; 16(4): 435–438. PMID 16278761
  5. https://mediamillinc.com/vjo.php?display=video&id=013
  6. http://www.jcrsjournal.org/article/S0886-3350(08)00004-7/abstract,
  7. http://www.jcrsjournal.org/article/S0886-3350(07)00697-9/abstract
  8. http://www.jcrsjournal.org/article/S0886-3350(09)00139-4/abstract
  9. 1 2 Surgery Encyclopedia - LASIK
  10. Surgery Encyclopedia - PRK
  11. 1 2 Surgery Encyclopedia - Corneal transplantation
  12. Indiana University Department of Ophthalmology - Phototherapeutic Keratectomy (PTK)
  13. http://news.yahoo.com/s/afp/irelandbritainhealthoffbeat
  14. http://www.wihrd.soton.ac.uk/projx/signpost/steers/STEER_2001(6).pdf
  15. vitrectomysurgery
  16. 1 2 Surgery Encyclopedia - Photocoagulation therapy
  17. Wolfensberger TJ. "Jules Gonin. Pioneer of retinal detachment surgery." Indian J Ophthalmol. 2003 Dec;51(4):303-8. PMID 14750617.
  18. Surgery Encyclopedia - Scleral Buckling
  19. Surgery Encyclopedia - Retinal_cryopexy
  20. 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.
  21. Surgery Encyclopedia - Eye Muscle Surgery
  22. Surgery Encyclopedia - Blepharoplasty
  23. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 Cline D; Hofstetter HW; Griffin JR. Dictionary of Visual Science. 4th ed. Butterworth-Heinemann, Boston 1997. ISBN 0-7506-9895-0
  24. http://www.emedicine.com/ent/topic100.htm
  25. Indiana University Department of Ophthalmology. "Lacrimal Drainage Surgery (DCR: Dacryocystorhinostomy)." Retrieved August 18, 2006
  26. Cherkunov BF, Lapshina AV. ["Canaliculodacryocystostomy in obstruction of medial end of the lacrimal duct."] Oftalmol Zh. 1976;31(7):544-8. PMID 1012635.
  27. Surgery Encyclopedia - Enucleation
  28. 1 2 3 Cassin, B. and Solomon, S. Dictionary of Eye Terminology. Gainesville, Florida: Triad Publishing Company, 1990.
  29. Surgery Encyclopedia - Exenteration
  30. 1 2 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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