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CHAPTER 16. Ophthalmic Surgery. Objectives. After studying this chapter, you will be able to: Recognize the anatomy of the eye Summarize the pathology that prompts surgical intervention of the eye and related terminology Determine any special preoperative preparation procedures.

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Chapter 16

CHAPTER 16

Ophthalmic Surgery


Objectives
Objectives

  • After studying this chapter, you will be able to:

    • Recognize the anatomy of the eye

    • Summarize the pathology that prompts surgical intervention of the eye and related terminology

    • Determine any special preoperative preparation procedures


Objectives cont d
Objectives (cont’d.)

  • Indicate the names and uses of ophthalmic instruments, supplies, and drugs

  • Indicate the names and uses of special equipment

  • Determine the intraoperative preparation of the patient undergoing an ophthalmic procedure

  • Summarize the surgical steps of ophthalmic procedures


Objectives cont d1
Objectives (cont’d.)

  • Interpret the purpose and expected outcomes of the ophthalmic procedure

  • Recognize the immediate postoperative care and possible complications of the ophthalmic procedure

  • Assess any specific variations related to the preoperative, intraoperative, and postoperative care of the ophthalmic patient


Introduction to ophthalmic surgery
Introduction to Ophthalmic Surgery

  • Ophthalmic surgery

    • Specialty of microsurgery since

    • Involves use of the microscope on the majority of procedures and microinstruments

  • Surgical technologist

    • Must have knowledge of how to set up and run the microscope, and be familiar with other specialty equipment (e.g., phaco machine)


Introduction to ophthalmic surgery cont d
Introduction to Ophthalmic Surgery (cont’d.)

  • Surgical technologist must also have fine motor skills

    • Properly handle small instruments without damaging them

    • Properly pass small instruments to the surgeon in position of use so he/she does not have to look up from the microscope


Introduction to ophthalmic surgery cont d1
Introduction to Ophthalmic Surgery (cont’d.)

  • Surgical technologist must become used to looking through the microscope

    • Assist the surgeon during procedure (e.g., irrigating the eye, cutting a small-diameter suture, etc.)

  • Purpose of this chapter

    • Familiarize the student with the ophthalmic procedures commonly performed as preparation for surgical rotation


Instruments routine equipment and supplies
Instruments, Routine Equipment, and Supplies

  • Forceps

    • Colibri forceps

    • Nontoothed forceps

    • Bishop-Harmon iris forceps

      • Refer to Figure 16-1

    • Desmarres chalazion forceps

      • Refer to Figure 16-2


Instruments routine equipment and supplies cont d
Instruments, Routine Equipment, and Supplies (cont’d.)

  • Needle holders

    • Castroviejo: locking or nonlocking

      • Refer to Figure 16-3

    • Microsurgical needle holder


Instruments routine equipment and supplies cont d1
Instruments, Routine Equipment, and Supplies (cont’d.)

  • Scalpels

    • Graefe cataract knife

    • Keratomes

    • Razor fragments

    • Diamond knife

    • Oscillating knife

    • Beaver blades

    • No. 15 knife blade


Instruments routine equipment and supplies cont d2
Instruments, Routine Equipment, and Supplies (cont’d.)

  • Hooks and retractors

    • Scleral hooks: scleral retraction

    • Kilner hook: reconstructive surgery

    • Desmarres lid retractors

      • Refer to Figure 16-4

    • Iris retractor

    • Eye speculum


Instruments routine equipment and supplies cont d3
Instruments, Routine Equipment, and Supplies (cont’d.)

  • Scissors

    • Westcott scissors; spring action microscissors

    • Small spring scissors

    • McPherson-Vannas iris scissors

      • Refer to Figure 16-5

  • Miscellaneous

    • Bowman probe

      • Refer to Figure 16-6


Instruments routine equipment and supplies cont d4
Instruments, Routine Equipment, and Supplies (cont’d.)

  • Routine equipment

    • Ophthalmic stretcher with attachable wrist rest for the surgeon

    • Donut for positioning the head

    • Electrosurgical unit (ESU)


Instruments routine equipment and supplies cont d5
Instruments, Routine Equipment, and Supplies (cont’d.)

  • Special equipment

    • Phacoemulsifier: uses ultrasonic energy to fragment the hard lens material, which then can be aspirated from the eye

    • Operating microscope: magnifies surgical site through use of lenses

    • Vitreoretinal system: provides light, suction, diathermy, and intraoperative access to the surgeon


Instruments routine equipment and supplies cont d6
Instruments, Routine Equipment, and Supplies (cont’d.)

  • Argon OR Nd:YAG laser: used for photocoagulation or photodynamic therapy

  • Cryotherapy unit: uses localized cold temperature to seal tears and holes much as a diathermy unit; CO2 gas passed is under pressure through flexible tubes to the tip of a probe


Instruments routine equipment and supplies cont d7
Instruments, Routine Equipment, and Supplies (cont’d.)

  • Routine supplies

    • Prep set

    • Eye or head and neck back table pack (depending on procedure)

    • Wexcel sponges

    • Sterile gloves

    • Sterile cotton swabs

    • Suture material (surgeon’s preference)


Instruments routine equipment and supplies cont d8
Instruments, Routine Equipment, and Supplies (cont’d.)

  • BSS

  • 27- and 30-gauge disposable needles, straight and angled

  • Needles and sutures

    • Refer to Tables 16-1 and 16-2


Surgical intervention
Surgical Intervention

  • A variety of surgical procedures and approaches are available

    • There are elements of consistency in every ophthalmic procedure

      • Practical considerations

      • Procedural considerations


Surgical intervention cont d
Surgical Intervention (cont’d.)

  • Procedures

    • Laparotomy 

    • Surgical repair of chalzion

    • Transconjunctival approach

    • Surgical repair of entropion

    • Iridectomy

    • Strabismus correction: recession/resection

    • Adjustable suture surgery


Surgical intervention cont d1
Surgical Intervention (cont’d.)

  • Scleral buckle

  • Dacryocystorhinostomy

  • Enucleation

  • Keratoplasty (corneal transplant)

  • Cataract extraction

    • Extracapsular

    • Intracapsular

  • Vitrectomy

  • Repair of traumatic eyelid laceration


Summary
Summary

  • This chapter reviewed:

    • The pathology that prompts surgical intervention of the eye

    • Ophthalmic instruments

    • Special equipment

    • Surgical steps of ophthalmic procedures

    • Preoperative, intraoperative, and postoperative preparation and care


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