Eye surgery

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Eye surgery
Eye surgery in the Middle Ages.
ICD-10-PCS08
ICD-9-CM08-16
MeSHD013508
OPS-301 code5-08...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

Main article: Anaesthesia for ocular surgery

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 monitors the patient's cardiovascular status. Sterile precautions are taken to prepare the area for surgery and lower the risk of infection. Sterile precautions include the use of antiseptics like povidone-iodine, 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. Long-term results are available, published in the Journal of Cataract and Refractive Surgery.[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

  • Vitrectomy[22]
    • Anterior vitrectomy is the removal of the front portion 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.[23]
  • Pan retinal photocoagulation (PRP) is a type of photocoagulation therapy used in the treatment of diabetic retinopathy.[24]
  • Retinal detachment repair
    • Ignipuncture is an obsolete procedure that involves cauterization of the retina with a very hot pointed instrument.[25]
    • A scleral buckle is used in the repair of a retinal detachment to indent or "buckle" the sclera inward, usually by sewing a piece of preserved sclera or silicone rubber to its surface.[26]
    • Laser photocoagulation, or photocoagulation therapy, is the use of a laser to seal a retinal tear.[24]
    • Pneumatic retinopexy
    • Retinal cryopexy, or retinal cryotherapy, is a procedure that uses intense cold to induce a chorioretinal scar and to destroy retinal or choroidal tissue.[27]
  • Macular hole repair
  • Partial lamellar sclerouvectomy[28]
  • 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 [1].
  • Radial optic neurotomy
  • macular translocation surgery
    • through 360 degree retinotomy
    • through scleral imbrication technique
  • Dexmedetomidine Versus Propofol in Vitreoretinal Surgery Alpha2 adrenergic receptor agonist have been used increasingly as a new armamentarium to provide sedative/hypnotic, analgesic, anxiolytic and sympatholytic effects in the perioperative settings. Dexmedetomidine, a selective and specific alpha2- adrenoceptor agonist has unique properties that makes it an almost ideal sedative drug for monitored anesthesia care in procedures under local or regional block. Unlike other drugs use for sedation, dexmedetomidine induces sedation that is similar to natural sleep (readily arousable) without causing respiratory depression. It attenuates the stress-induced sympathoadrenal response seen with laryngoscopy and intubation. It has anesthetic and opioid sparing effects, hence it may be a useful adjunct to general anesthesia and monitored anesthesia care in patients susceptible to narcotic induced respiratory depression. Another unique property of dexmedetomidine is that its sedative effect is reversible with Atipamezole. A previous study wherein dexmedetomidine has been used in procedures under local and regional block had shown that it provides effective sedation and better operating condition without significant respiratory depression. As a supplement to general anesthesia, it has been shown to provide stable hemodynamics. However, it is associated with some adverse events such as hypertension, hypotension and bradycardia, these commonly occur during bolus administration of the recommended dose of 1 ug/kg. Post-operatively it can cause nausea and vomiting. Vitreoretinal surgery requires either an injection of local anesthetic within the muscle cone (retrobulbar block),or into the periorbital space (peribulbar block). This can be done individually or in combination. This surgery can also be done under a safer technique of retrobulbar block that is given using a sub-tenon's approach through a snip peritomy; a blunt cannula can be used with this technique mitigating the complications of retrobulbar hemorrhage or inadvertent injection into the optic nerve sheath or perforation of the globe using a sharp needle. The anesthetic goal is to provide an immobile and uncongested operative field. Hemodynamic stability of the patient is also important since some patients that require this procedure are elderly with co-morbid conditions such as hypertension, diabetes mellitus and CAD. In our study we would like to investigate if Dexmedetomidine alone and in a reduced dose can prevent or reduce the incidence of adverse effects, provide hemodynamic and respiratory stability, provide adequate sedation with patient and surgeon satisfaction and compare it with Propofol.[29]

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 [2].

  • Eye muscle surgery typically corrects strabismus and includes the following[30] [3]:
    • Loosening / weakening procedures
      • Recession involves moving the insertion of a muscle posteriorly towards its origin.
      • Myectomy
      • Myotomy
      • Tenectomy
      • Tenotomy
    • Tightening / strengthening procedures
      • Resection
      • Tucking
      • 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 [4].

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)[5], 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

  • Orbital reconstruction / Ocular prosthetics (False Eyes)
  • Orbital decompression for Grave's Disease. Grave's Disease is a condition (often associated with over-active thyroid problems) in which the eye muscles swell. Because the eye socket is bone, there is nowhere for the swelling to be accommodated and as a result the eye is pushed forward into a protruded position. In some patients this is very pronounced. Orbitial decompression involves removing some bone from the eye socket to open up one or more sinuses and so make space for the swollen tissue and allowing the eye to move back into normal position.

Other oculoplastic surgery

Surgery involving the lacrimal apparatus

Eye removal

  • An enucleation is the removal of the eye leaving the eye muscles and remaining orbital contents intact.[36]
  • An evisceration is the removal of the eye's contents, leaving the scleral shell intact. Usually performed to reduce pain in a blind eye.[37]
  • An exenteration is the removal of the entire orbital contents, including the eye, extraocular muscles, fat, and connective tissues; usually for malignant orbital tumors.[38]

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.

See also

References

  1. ^ Surgery Encyclopedia - Ophthalmologic surgery
  2. ^ Maguire, Stephen. "Laser Eye Surgery". The Irish Times.
  3. ^ "Laser Eye Surgery Eligibility". 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. ^ a b Surgery Encyclopedia - LASIK
  10. ^ Surgery Encyclopedia - PRK
  11. ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 9183763, please use {{cite journal}} with |pmid=9183763 instead.
  12. ^ http://www.centronazionalelaser.com/sito%20dentro/mini%20cheratotomia.htm
  13. ^ http://www.ilgiornale.it/medicina/la_curva_pericolosa__cornea/24-05-2008/articolo-id=263900-page=0-comments=1
  14. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1055/s-2008-1045898, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1055/s-2008-1045898 instead.
  15. ^ a b Surgery Encyclopedia - Corneal transplantation
  16. ^ intercornealrings
  17. ^ http://eyeworld.org/article.php?sid=5533
  18. ^ Indiana University Department of Ophthalmology - Phototherapeutic Keratectomy (PTK)
  19. ^ MDAdvice.com - Pterygium removal
  20. ^ http://news.yahoo.com/s/afp/irelandbritainhealthoffbeat
  21. ^ http://www.wihrd.soton.ac.uk/projx/signpost/steers/STEER_2001(6).pdf
  22. ^ vitrectomysurgery
  23. ^ http://www.vrmny.com/vitrectomy.htm
  24. ^ a b Surgery Encyclopedia - Photocoagulation therapy
  25. ^ Wolfensberger TJ. "Jules Gonin. Pioneer of retinal detachment surgery." Indian J Ophthalmol. 2003 Dec;51(4):303-8. PMID 14750617.
  26. ^ Surgery Encyclopedia - Scleral Buckling
  27. ^ Surgery Encyclopedia - Retinal_cryopexy
  28. ^ 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.
  29. ^ http://clinicaltrials.gov/show
  30. ^ Surgery Encyclopedia - Eye Muscle Surgery
  31. ^ Surgery Encyclopedia - Blepharoplasty
  32. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah ai aj Cline D; Hofstetter HW; Griffin JR. Dictionary of Visual Science. 4th ed. Butterworth-Heinemann, Boston 1997. ISBN 0-7506-9895-0
  33. ^ http://www.emedicine.com/ent/topic100.htm
  34. ^ Indiana University Department of Ophthalmology. "Lacrimal Drainage Surgery (DCR: Dacryocystorhinostomy)." Retrieved August 18, 2006
  35. ^ Cherkunov BF, Lapshina AV. ["Canaliculodacryocystostomy in obstruction of medial end of the lacrimal duct."] Oftalmol Zh. 1976;31(7):544-8. PMID 1012635.
  36. ^ Surgery Encyclopedia - Enucleation
  37. ^ a b c Cassin, B. and Solomon, S. Dictionary of Eye Terminology. Gainesville, Florida: Triad Publishing Company, 1990.
  38. ^ Surgery Encyclopedia - Exenteration
  39. ^ a b 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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