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Eye surgery, also known as ophthalmic surgery or ocular surgery, is surgery performed on the eye or its adnexa, typically by an ophthalmologist. Most of the following eye surgeries can be performed by an experienced general ophthalmologist. However, more complex procedures are usually done by a fellowship trained ophthalmologist.
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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 anaethesia 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 immobilze the extraocular muscles and eliminate pain sensation. Topical anesthesia using lidocaine topical gel is prefered 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.
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Laser surgery and incisional 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.
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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.
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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 glaucoma surgeries, and variations or combinations of those surgeries, 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.
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Refractive surgery
Refractive surgery aims to correct errors of refraction in the eye, reducing or eliminating the need for corrective lenses
Keratomilleusis is method of reshaping the cornea surface to change its optical power. A disc of cornea is shaved off, quickly frozen, lathe-ground, then returned to its original power.
Laser assisted in-situ keratomileusis (LASIK)
Limbal relaxing incisions (LRI)
Epikeratophakia is the removal of the corneal epithelium and replacement with a lathe cut corneal button.
Implantable contact lenses
Anterior ciliary sclerotomy (ACS)
Laser reversal of presbyopia (LRP)
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Corneal surgery
Corneal surgery includes most of the refractive surgeries as well as the following:
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Vitreo-retinal surgery
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Vitreo-retinal surgery includes the following
Anterior vitrectomy is the removal of the front portio 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 *.
Pan retinal photocoagulation (PRP) is a type of photocoagulation therapy used in the treatment of diabetic retinopathy.
Retinal cryopexy, or retinal cryotherapy, is a procedure that uses intense cold to induce a chorioretinal scar and to destroy retinal or choroidal tissue.
Partial lamellar sclerouvectomy
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 *.
macular translocation surgery
through 360 degree retinotomy
through scleral imbrication technique
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Eye muscle surgery
With approximately 1.2 million procedures each year, extraocular muscle surgery is the third most common eye surgery in the United States
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Loosening / weakening procedures
Recession involves moving the insertion of a muscle posteriorly towards its origin.
Tightening / strengthening procedures
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 *.
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Oculoplastic surgery
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:
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Eyelid surgery [http://www.iupui.edu/~ophthal/html/eyes_eyelidesurgery.html]
Ptosis pepair for droopy eyelid
A canthectomy is the surgical removal of tissue at the junction of the upper and lower eyelids.[Cline D; Hofstetter HW; Griffin JR. Dictionary of Visual Science. 4th ed. Butterworth-Heinemann, Boston 1997. ISBN 0-7506-9895-0]
A canthotomy is the surgical division of the canthus, usually the outer canthus.
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Surgery involving the lacrimal apparatus
A dacryocystostomy is an incision into the lacrimal sac, usually to promote drainage.
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Eye removal
An enucleation is the removal of the eye leaving the eye muscles and remaining orbital contents intact.
An evisceration is the removal of the eye's contents, leaving the scleral shell intact. Usually performed to reduce pain in a blind eye.
An exenteration is the removal of the entire orbital contents, including the eye, extraocular muscles, fat, and connective tissues; usually for malignant orbital tumors.
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Orbital surgeries
Orbital decompression for Grave's Disease
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Other oculoplastic surgeries
Endoscopic forehead and browlift
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Other surgeries
A ciliarotomy is a surgical division of the ciliary zone in the treatment of glaucoma.
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.
A ciliotomy is a surgical section of the ciliary nerves.
A conjunctivoanstrostomy is an opening made form the inferior conjuctival cul-de-sac into the maxillary sinus for the treatment of epiphora.
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.
A corectomy, or coretomy, is any surgical cutting operation on the iris at the pupil.
A coremorphosis is the surgical formation of an artificial pupil.
A coreplasty, or coreoplasty, is plastic surgery of the iris, usually for the formation of an artificial pupil.
A cyclectomy is an excision of portion of the ciliary body.
A cyclotomy, or cyclicotomy, is a surgical incision of the ciliary body, usually for the relief of glaucoma.
A cycloanemization is a surgical obliteration of the long ciliary arteries in the treatment of glaucoma.
An iridectomesodialsys is the formation of an artificial pupil by detaching and excising a portion of the iris at its periphery.
An iridodialysis, sometimes known as a coredialysis, is a localized separation or tearing away of the iris from its attachment to the ciliary body.
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.[*]
An iridocyclectomy is the surgical removal of the iris and the ciliary body.
An iridocystectomy is the surgical removal of a portion of the iris to form an artificial pupil.
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.
An iridosclerotomy is the surgical puncture of the sclera and the margin of the iris for the treatment of glaucoma.
A rhinommectomy is the surgical removal of a portion of the internal canthus.
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See also
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