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  Iris withdrawn through opening and cut.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).

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OPHTHALMIC OPERATION 2 correction ectropian

Ectropian Correction

Objective

The correction of an eyelid deformity (causing permanent exposure of the conjunctiva).

Position

Supine.

Anesthesia

Local.

Procedure

There are several operations for this condition, including skin grafting procedures. Basically:

1.  The V-Y procedure to suture the skin.

2.  A mapping pen, dipped in gentian violet may be used to mark the redundant fold.

3.  An incision is made along the marked line and an arrow headed area excised.

4.  Kilners hooks are used to bring together the eyelid skin to a point where the ectropion is corrected.

Instruments

•   As for Chalazion, plus

•   Eyelid retractors, left and right (Clark or Lang), 2 (Fig. 14.42)

•   Eyelid retractors Desmarre’s (Fig. 14.29)

•   Fine skin hooks (Kilner), 2

•   Mapping pen and gentian violet

•   6/0 Synthetic absorbable on small cutting needle for orbicularis suture

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OPHTHALMIC OPERATIONS 1 removal chalazion

Excision of Chalazion

Objective

The removal of a cystic enlargement of the Meibomian gland in the eyelid.

Position

Supine with head elevated.

Anesthesia

The skin or conjunctiva overlying the lesion is infiltrated with local anesthesia.

Procedure

1.  The cyst is usually removed via the conjunctiva but occasionally through the skin.

2.  A chalazion clamp is applied with the cyst projecting into the ring of the forceps.

3.  Approach to the cyst through the conjunctiva vertical incision is made to the lid margin, for this type of wound closes readily without sutures.

4.  The cyst is curetted.

5.  Or a recurred cyst is dissected out with sharp scissors or a scalpel.

6.  The cyst can be approached through the skin.

7.  The incision is made parallel with the lid margin.

8.  And closed afterwards with a few interrupted synthetic non-absorbable or silk sutures.

Instruments

•   Sponge holding forceps (Rampley), 2

•   Scalpel handle, and No. 15 blade (Bard Parker)

•   Tarsal cyst forceps (Greene) (Fig. 14.40)

•   Meibomian cyst curettes, 3 sizes (Fig. 14.41)

•   Fine needle holder (Barraquer) (Fig. 14.4)

•   Towel clips (Backhaus), 4

•   Hand cautery and points

•   6/0 synthetic non-absorbable or black silk

•   Small cutting needle for skin closure.

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UROLOGIC OPERATION 18 vasovasostomy

Vasovasostomy

Objective

In case of:

•   Demand for reversal

•   Anastomosis of the severed ends of the vas deferens.

Position

Supine.

Anesthesia

Local, spinal or general.

Procedure

1.  A scrotal incision exposes the vas deferens above and below site of the previous ligation.

2.  Scar tissue is excised from both ends of the vas.

3.  Under magnification sutures are placed in the mucosal lining of the lumen.

4.  Muscularis is approximated separately.

5.  Wound is closed.

Instruments

•   Vasectomy set

•   Vasovasostomy microscopic instruments, for example,

     1 tissue forceps,

     2 curved smooth forceps,

     1 curved tying forceps,

     1 castroviejo needle holder,

     1 vas holder

•   Electrosurgical pencil with needle tip

•   Scrotal support

•           Microscope or magnifying loop.

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UROLOGIC OPERATION 17 Vasectomy

Vasectomy

Objective

•   To achieve permanent male contraception

•   Excision of a segment of the vas deferens

•   Ligation of the distal and proximal ends.

Position

Supine (legs apart).

Anesthesia

Local.

Procedure

1.  The vas is palpated through the scrotum.

2.  Anesthetic is administered.

3.  A scrotal incision is made.

4.  Vas is seized and is freed of surrounding tissue.

5.  Segment of vas is excised and the ends ligated.

6.  Severed ends may be cauterized or crushed with a clamp prior to ligation.

7.  The wound is closed.

8.  The procedure is repeated on the other side.

Instruments + Supply

•   Vasectomy set

•   Scrotal support

•   Small specimen container.

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