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Principles of SA Lecture 2 > Ophthalmic Surgery > Flashcards

Ophthalmic Surgery Flashcards

Vitrectomy, Cataract Surgery, Enucleation

1
Q

What is a Vitrectomy?

A

Surgical removal of the Vitreous Humor

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2
Q

Why is a Vitrectomy needed?

A

Vitreous Humor has opacified reducing vision

 - Hemorrhage
 - Retinal detachment
 - Diabetic retinopathy
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3
Q

What special equipment is needed for Vitrectomy?

A
  • Wescott Scissors
  • Microscope
  • Biom
  • Vitrectomy machine
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4
Q

What is the purpose of the Biom?

A

Increases magnification and allows a 360 degree view of the Retina

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5
Q

What is Patient Positioning for a Vitrectomy?

A
  • Supine
  • Bed turned 90 degrees away from anesthesia
  • Specialized bed with wrist rest frame
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6
Q

What type of anesthesia is used for a Vitrectomy?

A
  • General
  • Retrobulbar
    • Localized injection behind eye to stop movement
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7
Q

What is the Prep for a Vitrectomy?

A
  • Operative eye prepped with Betadine Paint
    • Saline if Betadine allergy
  • Large drape across patient’s body
  • Blue towels draped over wrist rest
  • Clear sticky drape over face
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8
Q

What instrument is used to hold open the eye during a Vitrectomy?

A

Eyelid speculum

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9
Q

Where is the incision made during a Vitrectomy?

A

Trocars are placed Perpendicular to Sclera and aimed toward the center of the Vitreous cavity to avoid damage to Lens and Retina

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10
Q

How many Cannulas (Trocars) are placed in the eye during a Vitrectomy?

A

3

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11
Q

What are the sizes of Cannulas used in Vitrectomies?

A
  • 20g
  • 23g
  • 25g
  • 27g

Higher the gauge, the smaller diameter

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12
Q

What are the three types of Cannulas used during a Vitrectomy?

A
  • Infusion
  • Illumination
  • Vitreous cutter
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13
Q

What is the purpose of an Infusion Cannula?

A

Delivers Basic Sterile Saline (BSS) to replace Vitreous Humor

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14
Q

What is the purpose of the Illumination Cannula?

A

Light probe for visualization

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15
Q

What is the purpose of the Vitreous Cutter?

A

High-speed cutting and low suction

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16
Q

What is the function of the Vitrectomy Machine?

A

Central hub that controls the three Cannulas

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17
Q

What must the SA do with the Vitrectomy Machine during the case?

A
  • Prime the Infusion line prior to case
    • Make sure BSS comes out of tube, no air bubbles
  • Cord management
  • Control flow of Infusion line
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18
Q

How is hemostasis achieved in the event of a bleed during a Vitrectomy?

A

Photocoagulation using an Nd-YAG laser

19
Q

What is Direct Laser Treatment?

A

An endolaser (probe) is passed through the Cannula and cauterizes bleeders from the inside of the eye

20
Q

What is Indirect Laser Treatment?

A

Laser aimed from outside of the eye through a magnifier to cauterize bleeders in the Retina

21
Q

True or False: Eye protection must be worn when using Direct/Indirect Laser Treatment.

A

True

-You must protect your own eyes from the laser

22
Q

What is a Scleral Depression?

A

Applying external pressure to the Sclera to expose more of the Retina internally

23
Q

What is the purpose of a Scleral Depression?

A

Allows surgeon to trim and shave the Vitreous Base (Retina)

24
Q

When must a Cannula port be closed with suture?

A
  • 20g Cannula was used

- Leaking ports

25
Q

What type of suture is used in a Vitrectomy (if needed)?

A
  • 7-0 Vicryl

- 7-0 Nylon

26
Q

When is a Tamponade placed during a Vitrectomy?

A

Before removing the final Cannula

27
Q

What is Intraocular Gas Infusion Tamponade?

A

Gas bubble injected inside Vitreous Cavity so when patient is in a certain position, the bubble holds the Retinal tear in place while healing to the Choroid

28
Q

What kind of gas is used for Intraocular Gas Infusions?

A

Perfluorocarbon gas

29
Q

True or False: Intraocular Gas Infusion Tamponades can be used for Retinal hemostasis?

A

True

30
Q

What is a Scleral Buckle?

A

Repair of Retinal detachment by supporting Retinal tears from outside of the eye

-Creates external pressure that causes Vitreous Humor to push Retinal tear against the Choroid

31
Q

When is the Scleral Buckle technique used?

A
  • Extensive Retinal detachment

- Degenerated Retina

32
Q

What are the steps of a Scleral Buckle?

A
  • 360 degree incision in Conjunctiva
  • Isolate four rectus muscles using 3-0 Silk
  • Silicone band placed circumferentially around eye
  • Sclera closed over silicone band using 5-0 Prolene
    • Mattress Technique
  • End of band closed with silicone sleeve
33
Q

What is Cataract Surgery?

A

The removal of the natural lens and replacement with an intraocular lens

34
Q

What is Patient Positioning for Cataract Surgery?

A
  • Supine
  • Bed turned 90 degrees away from anesthesia
  • Specialized bed with wrist rest frame
35
Q

What anesthesia is used for Cataract Surgery?

A

MAC sedation with a Retrobulbar block

36
Q

What are the steps to Cataract Surgery?

A
  • Phacoemulsification
  • Intraocular Lens (IOL) Placement
  • Eye Patch Placement
37
Q

What is Phacoemulsification?

A

Specialized machine uses ultrasonic frequency to break the lens and suction it out

38
Q

What happens during IOL Placement?

A
  • Incision made at border of the Iris and Pupil
  • Probe enters incision
  • Intraocular Lens is deployed
  • Incision closes itself
39
Q

What is Enucleation?

A

Surgical removal of the eye including Optic Nerve transection

40
Q

What are the causes of Enucleation?

A
  • Trauma

- Cancer

41
Q

What anesthesia is used for Enucleation?

A
  • General

- MAC with Retrobulbar block

42
Q

What is Patient Positioning for an Enucleation?

A
  • Supine
  • Normal OR bed
  • Head in jelly ring
43
Q

What are the steps for an Enucleation?

A
  • 360 degree incision of the Conjunctiva
  • 4 rectus muscles are transected
  • Optic Nerve is clamped for hemostasis
  • Enucleation scissors transect the Optic Nerve
  • Eye is removed
  • Conjunctiva is closed
44
Q

What suture is used to close the Conjunctiva?

A

7-0 Vicryl

-Running stitch

Principles of SA Lecture 2 (26 decks)

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