Ophthalmic Surgery

Question 1

What is a Vitrectomy?

Answer 1

Surgical removal of the Vitreous Humor

Question 2

Why is a Vitrectomy needed?

Answer 2

Vitreous Humor has opacified reducing vision

 - Hemorrhage
 - Retinal detachment
 - Diabetic retinopathy

Question 3

What special equipment is needed for Vitrectomy?

Answer 3

• Wescott Scissors
• Microscope
• Biom
• Vitrectomy machine

Question 4

What is the purpose of the Biom?

Answer 4

Increases magnification and allows a 360 degree view of the Retina

Question 5

What is Patient Positioning for a Vitrectomy?

Answer 5

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

Question 6

What type of anesthesia is used for a Vitrectomy?

Answer 6

• General
• Retrobulbar
  
  • Localized injection behind eye to stop movement

Question 7

What is the Prep for a Vitrectomy?

Answer 7

• 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

Question 8

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

Answer 8

Eyelid speculum

Question 9

Where is the incision made during a Vitrectomy?

Answer 9

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

Question 10

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

Answer 10

3

Question 11

What are the sizes of Cannulas used in Vitrectomies?

Answer 11

• 20g
• 23g
• 25g
• 27g

Higher the gauge, the smaller diameter

Question 12

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

Answer 12

• Infusion
• Illumination
• Vitreous cutter

Question 13

What is the purpose of an Infusion Cannula?

Answer 13

Delivers Basic Sterile Saline (BSS) to replace Vitreous Humor

Question 14

What is the purpose of the Illumination Cannula?

Answer 14

Light probe for visualization

Question 15

What is the purpose of the Vitreous Cutter?

Answer 15

High-speed cutting and low suction

Question 16

What is the function of the Vitrectomy Machine?

Answer 16

Central hub that controls the three Cannulas

Question 17

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

Answer 17

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

Question 18

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

Answer 18

Photocoagulation using an Nd-YAG laser

Question 19

What is Direct Laser Treatment?

Answer 19

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

Question 20

What is Indirect Laser Treatment?

Answer 20

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

Question 21

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

Answer 21

True

-You must protect your own eyes from the laser

Question 22

What is a Scleral Depression?

Answer 22

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

Question 23

What is the purpose of a Scleral Depression?

Answer 23

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

Question 24

When must a Cannula port be closed with suture?

Answer 24

• 20g Cannula was used

- Leaking ports

Question 25

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

Answer 25

- 7-0 Vicryl | - 7-0 Nylon

Question 26

When is a Tamponade placed during a Vitrectomy?

Answer 26

Before removing the final Cannula

Question 27

What is Intraocular Gas Infusion Tamponade?

Answer 27

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

Question 28

What kind of gas is used for Intraocular Gas Infusions?

Answer 28

Perfluorocarbon gas

Question 29

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

Answer 29

True

Question 30

What is a Scleral Buckle?

Answer 30

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

Question 31

When is the Scleral Buckle technique used?

Answer 31

- Extensive Retinal detachment | - Degenerated Retina

Question 32

What are the steps of a Scleral Buckle?

Answer 32

- 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

Question 33

What is Cataract Surgery?

Answer 33

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

Question 34

What is Patient Positioning for Cataract Surgery?

Answer 34

- Supine - Bed turned 90 degrees away from anesthesia - Specialized bed with wrist rest frame

Question 35

What anesthesia is used for Cataract Surgery?

Answer 35

MAC sedation with a Retrobulbar block

Question 36

What are the steps to Cataract Surgery?

Answer 36

- Phacoemulsification - Intraocular Lens (IOL) Placement - Eye Patch Placement

Question 37

What is Phacoemulsification?

Answer 37

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

Question 38

What happens during IOL Placement?

Answer 38

- Incision made at border of the Iris and Pupil - Probe enters incision - Intraocular Lens is deployed - Incision closes itself

Question 39

What is Enucleation?

Answer 39

Surgical removal of the eye including Optic Nerve transection

Question 40

What are the causes of Enucleation?

Answer 40

- Trauma | - Cancer

Question 41

What anesthesia is used for Enucleation?

Answer 41

- General | - MAC with Retrobulbar block

Question 42

What is Patient Positioning for an Enucleation?

Answer 42

- Supine - Normal OR bed - Head in jelly ring

Question 43

What are the steps for an Enucleation?

Answer 43

- 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

Question 44

What suture is used to close the Conjunctiva?

Answer 44

7-0 Vicryl | -Running stitch