OPHTHALMIC OPERATIONS 7 Retinal detachment

Retinal Detachment

Objective

In cases of detachment of the retina from the choroid. The detachment is corrected:

•   By cryotherapy

•   By indenting sclera

•   By encircling the sclera.

Position

Supine.

Anesthesia

Local, retrobulbar and facial nerve injection.

Procedure

1.  It may be necessary to divide a rectus muscle to gain access to a retinal break.

2.  By indirect ophthalmoscope the operator visualizes the site of the retinal break.

3.  A cryoprobe is applied until the tissues around the retinal break are treated.

4.  Explant is fixed to the sclera over the site of the retinal break.

5.  To create an indent and achieve mechanical block of retinal breaks.

6.  A silicone strap is passed under the four recti muscles.

7.  The strap is overlapped and secured in the silicone sleeve. Usually done with cryotherapy.

Instruments

•   General ophthalmoplasty set

•   Retinal set

•   Eye speculae (Clark and Lang), 2

•   Fine artery forceps, curved on flat, mosquito, 10

•   Fine dissecting forceps, 2/3 teeth, fixation (St. Martins)

•   Fine dissecting forceps, 1/2 teeth, fixation (Jayles), 2

•   Fine dissecting forceps, non-toothed, fixation (Moorfields), 2

•   Fine scissors, straight, blunt points (Strabismus)

•   Iris scissors, straight, sharp points

•   Bulldog clips, 4

•   Towel clips (Backhaus), 4

•   Cryotherapy, retinal cryoprobe

•   Gass indentor, appropriate explant

•   Fine pen and methylene blue (Optional)

•   4 (1) and 2 (4/0) Synthetic nonabsorbable or black silk on small half-circle round bodied needle for traction sutures

•   1.5 (5/0) Synthetic nonabsorbable on small curved cutting needle

•   0.5 (8/0) Synthetic nonabsorbable or silk on small cutting needle for conjunctiva

•   0.7 (6/0) Synthetic nonabsorbable or silk on small curved cutting needle for marker suture.

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OPHTHALMIC OPERATION 6 Cataract extraction

Cataract Extraction

Objective

In cases of impaired vision due to opaque lens:

•   The removal of an ‘opaque’ crystalline lens.

•   To replace it with an intraocular lens. To restore vision

Position

Supine.

Anesthesia

Local retrobulbar and facial nerve injection.

Procedure

   1.  Insertion of an eye speculum.

   2.  Traction suture is inserted through the belly of the superior rectus muscle.

   3.  The conjunctiva is incised above the limbus.

   4.  A flap of conjunctiva is reflected over the limbus.

   5.  Incisions are made in the limbus.

   6.  Synthetic absorbable stay-stutures are inserted to facilitate closure of the corneal flap.

   7.  The anterior chamber is then irrigated with saline to remove traces of enzymes.

   8.  Extraction of the lens.

   9.  After cataract operations the surgeon may insert a plastic lens implant.

10.  The corneoscleral incision is closed with synthetic absorbable sutures.

11.  The conjunctival incision is closed.

Instruments

•   Anterior segment set

•   Cataract set

•   Diamond knife or razor fragment in holder

•   Eyelid retractors (Desmarre), 2

•   Capsule forceps (Arruga or McPherson)

•   Iris repositor (Bowman)

•   Razor fragment in holder

•   Angled corneal splitter (Tooke)

•   Corneal scissors (Troutmans)

•   Anterior chamber cannula (Ryecroft) with irrigator (Southamptom) for Chymar, Trypsin, Zonulysin (to digest suspensory ligaments)

•   Cryoprobe and cryomachine

•   1 (4) Synthetic nonabsorbable or white silk on small half-circle cutting needle for traction sutures

•   0.5 (8/0) Synthetic nonabsorbable or virgin silk on small curved cutting needle for corneoscleral and conjunctival sutures

•   0.2 (10/0) Synthetic nonabsorbable on small micro point needle for implant fixation

•   Corneal splitter (Tooke)

•   Veetis (Knolle)

•   Fine needle holder (Castroviejo) (Fig. 14.48).

Any questions be sent to drmmkapur@gmail.copm

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OPHTHALMIC OPERATION 5 corneal transplant

Transplantation of a corneal graft from stored eye of another human being.

Position

Supine.

Anesthesia

General.

Procedure

1.  The donor eye is held in a suitable stand.

2.  And a graft cut from the cornea using a trephine of appropriate size.

3.  An eye speculum inserted.

4.  Traction sutures of synthetic non-absorbable or white silk passed transversely through the insertions of the superior and inferior rectus muscles.

5.  A fine needle knife is passed into the anterior chamber at the limbus in the upper temporal quadrant.

6.  Sterile air injected into the anterior chamber.

7.  The surface of the graft is flush with the surrounding cornea.

8.  Interrupted or continuous 0. 2 (10/0) synthetic non-absorb­able sutures are inserted to unite the corneal graft to the host.

Instruments

•   Anterior segment set

•   Keratoplasty set

•   Scalpel handle with No. 15 blade

•   Support for donor eye (Tudor Thomas)

•   Scissors, right and left (Troutman)

•   Towel clips (Backhaus), 4

•   1 (4) Synthetic non-absorbable or silk on small half circle, reverse cutting needle for traction sutures of rectus muscles

•   0.7 (7/0) Synthetic non-absorbable or silk on small curved needle with cutting edge on concavity of needle point, for cross-over suture to hold graft in place whilst final sutures are being inserted

•   0.2 (10/0) Synthetic non-absorbable on small curved needle with cutting edge on convexity of needle point for sutures to secure graft in position.

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OPHTHALMIC OPERATION 4 Iredectomy

Iridectomy

Objective

Excision of a segment of iris for:

•   Cysts removal

•   Tumors

•   Glaucoma

•   Iris prolapse.

Position

Supine.

Anesthesia

Local and retrobulbar injection.

Procedure

   1.  Insertion of an eye speculum.

   2.  Traction sutures of synthetic non-absorbable or white silk.

   3.  A conjunctival flap is made to protect the incision.

   4.  Fixation forceps on opposite site of incision.

   5.  Incision at limbus.

   6.  Closed iris forceps inserted.

   7.  Iris grasped.

   8.  Iris withdrawn through opening and cut.

   9.  Return iris.

10.  Incision closed with suture.

Instruments

•   Anterior segment set 1

•   Iris hook

•   Iris repositor (Bowman)

•   Lacrimal cannula with 2 ml syringe for irrigation (balanced sodium chloride solution)

•   Towel clips (Backhaus), 4

•   1 (4) Synthetic non-absorbable or silk on small half circle round bodied needle for traction sutures

•   0.5 (8/0) Synthetic nonabsorbable or silk on small curved cutting needle for conjunctival sutures

•   Eye specula

•   Razor blade fragment holder

•   Micro forceps (Fig. 14.46)

•   Eye scissors (De Wecker) (Fig. 14.47).

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OPHTHALMIC OPERATION 3 stabismus correction

Strabismus Operations

Objective

Shortening or lengthening of the ocular muscles to correct squint.

Position

Supine.

Anesthesia

General.

Procedure

1.  An eye speculum is inserted.

2.  Traction sutures are placed into the sclera.

3.  And a curved incision made in the conjunctiva.

4.  The conjunctiva is freed from the underlying fascia.

5.  Insertion of the ocular muscle on the sclera isolated.

6.  Sutures inserted at the point chosen for division of the muscle to replace it into the new insertion.

7.  For resection the amount of muscle selected for resection is removed and shortened stump of muscle sutured to the sclera at the muscle insertion.

8.  The conjunctiva is closed with continuous synthetic non-absorbable or silk sutures.

Instruments

•   General ophthalmoplasty set

•   Strabismus set

•   Rule, stainless steel 15 cm (6 in)

•   Diathermy forceps, electrodes, cable and cable forceps

•   Towel clips (Backhaus), 4 

•   2 (4/0) Synthetic non-absorbable or silk on small curved cutting needle for traction suture

•   1.5 (5/0) Synthetic absorbable or 0.5 (8/0) synthetic non-absorbable or silk on small curved cutting needle for conjunc­tiva

•   Eyelid speculum guarded (Lang)

•   Graefe strabismus hooks (Fig. 14.34)

•   Fine dissecting forceps (Fig. 14.43)

•   Scissors (Westcott) (Fig. 14.44)

•   Muscle forceps (Fig. 14.45)

•   Needle holder (Barraquer) (Fig. 14.4).

Any questions be sent to drmmkapur@gmal.com

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