Ophthalmic Surgery Flashcards
Vitrectomy, Cataract Surgery, Enucleation
What is a Vitrectomy?
Surgical removal of the Vitreous Humor
Why is a Vitrectomy needed?
Vitreous Humor has opacified reducing vision
- Hemorrhage - Retinal detachment - Diabetic retinopathy
What special equipment is needed for Vitrectomy?
- Wescott Scissors
- Microscope
- Biom
- Vitrectomy machine
What is the purpose of the Biom?
Increases magnification and allows a 360 degree view of the Retina
What is Patient Positioning for a Vitrectomy?
- Supine
- Bed turned 90 degrees away from anesthesia
- Specialized bed with wrist rest frame
What type of anesthesia is used for a Vitrectomy?
- General
- Retrobulbar
- Localized injection behind eye to stop movement
What is the Prep for a Vitrectomy?
- 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
What instrument is used to hold open the eye during a Vitrectomy?
Eyelid speculum
Where is the incision made during a Vitrectomy?
Trocars are placed Perpendicular to Sclera and aimed toward the center of the Vitreous cavity to avoid damage to Lens and Retina
How many Cannulas (Trocars) are placed in the eye during a Vitrectomy?
3
What are the sizes of Cannulas used in Vitrectomies?
- 20g
- 23g
- 25g
- 27g
Higher the gauge, the smaller diameter
What are the three types of Cannulas used during a Vitrectomy?
- Infusion
- Illumination
- Vitreous cutter
What is the purpose of an Infusion Cannula?
Delivers Basic Sterile Saline (BSS) to replace Vitreous Humor
What is the purpose of the Illumination Cannula?
Light probe for visualization
What is the purpose of the Vitreous Cutter?
High-speed cutting and low suction
What is the function of the Vitrectomy Machine?
Central hub that controls the three Cannulas
What must the SA do with the Vitrectomy Machine during the case?
- Prime the Infusion line prior to case
- Make sure BSS comes out of tube, no air bubbles
- Cord management
- Control flow of Infusion line
How is hemostasis achieved in the event of a bleed during a Vitrectomy?
Photocoagulation using an Nd-YAG laser
What is Direct Laser Treatment?
An endolaser (probe) is passed through the Cannula and cauterizes bleeders from the inside of the eye
What is Indirect Laser Treatment?
Laser aimed from outside of the eye through a magnifier to cauterize bleeders in the Retina
True or False: Eye protection must be worn when using Direct/Indirect Laser Treatment.
True
-You must protect your own eyes from the laser
What is a Scleral Depression?
Applying external pressure to the Sclera to expose more of the Retina internally
What is the purpose of a Scleral Depression?
Allows surgeon to trim and shave the Vitreous Base (Retina)
When must a Cannula port be closed with suture?
- 20g Cannula was used
- Leaking ports
What type of suture is used in a Vitrectomy (if needed)?
- 7-0 Vicryl
- 7-0 Nylon
When is a Tamponade placed during a Vitrectomy?
Before removing the final Cannula
What is Intraocular Gas Infusion Tamponade?
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
What kind of gas is used for Intraocular Gas Infusions?
Perfluorocarbon gas
True or False: Intraocular Gas Infusion Tamponades can be used for Retinal hemostasis?
True
What is a Scleral Buckle?
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
When is the Scleral Buckle technique used?
- Extensive Retinal detachment
- Degenerated Retina
What are the steps of a Scleral Buckle?
- 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
What is Cataract Surgery?
The removal of the natural lens and replacement with an intraocular lens
What is Patient Positioning for Cataract Surgery?
- Supine
- Bed turned 90 degrees away from anesthesia
- Specialized bed with wrist rest frame
What anesthesia is used for Cataract Surgery?
MAC sedation with a Retrobulbar block
What are the steps to Cataract Surgery?
- Phacoemulsification
- Intraocular Lens (IOL) Placement
- Eye Patch Placement
What is Phacoemulsification?
Specialized machine uses ultrasonic frequency to break the lens and suction it out
What happens during IOL Placement?
- Incision made at border of the Iris and Pupil
- Probe enters incision
- Intraocular Lens is deployed
- Incision closes itself
What is Enucleation?
Surgical removal of the eye including Optic Nerve transection
What are the causes of Enucleation?
- Trauma
- Cancer
What anesthesia is used for Enucleation?
- General
- MAC with Retrobulbar block
What is Patient Positioning for an Enucleation?
- Supine
- Normal OR bed
- Head in jelly ring
What are the steps for an Enucleation?
- 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
What suture is used to close the Conjunctiva?
7-0 Vicryl
-Running stitch
