©2014 delmar, cengage learning. all rights reserved. may not be scanned, copied, duplicated, or...

©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 1©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,

duplicated, or posted to a publicly accessible website, in whole or in part.

©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 2©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.

CHAPTER 16

Ophthalmic Surgery

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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.)

– 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’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

• 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.)

• 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’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

• Forceps– Colibri forceps– Nontoothed forceps– Bishop-Harmon iris forceps

• Refer to Figure 16-1 (p.596)

– Desmarres chalazion forceps• Refer to Figure 16-2 (p. 597)


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

• Needle holders– Castroviejo: locking or nonlocking

• Refer to Figure 16-3 (p. 597)

– Microsurgical needle holder



• Scalpels– Graefe cataract knife– Keratomes – Razor fragments– Diamond knife– Oscillating knife– Beaver blades– No. 15 knife blade


Graefe cataract knife

Diamond knife


Oscillating kni

Beaver blades



• Hooks and retractors– Scleral hooks: scleral retraction– Kilner hook: reconstructive surgery– Desmarres lid retractors


– Iris retractor – Eye speculum

• Refer to Figure 16-9 (p. 605)



• Scissors– Westcott scissors; spring action microscissors– Small spring scissors– McPherson-Vannas iris scissors


• Miscellaneous – Bowman probe




• Routine equipment – Ophthalmic stretcher with attachable wrist rest

for the surgeon– Donut for positioning the head– Electrosurgical unit (ESU)



• 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


Vitreoretinal system

Operating microscope

Phacoemulsifier & Handpiece



– 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



• 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)



– BSS– 27- and 30-gauge disposable needles,

straight and angled– Needles and sutures

• Refer to Tables 16-1 and 16-2


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.)

• Procedures– Laparotomy – Surgical repair of chalzion– Transconjunctival approach– Surgical repair of entropion– Iridectomy – Strabismus correction: recession/resection– Adjustable suture surgery


Surgical Intervention (cont’d.)

– Scleral buckle– Dacryocystorhinostomy– Enucleation – Keratoplasty (corneal transplant)– Cataract extraction

• Extracapsular • Intracapsular

– Vitrectomy– Repair of traumatic eyelid laceration


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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Documents

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