chapter 16

©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

©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. 3

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– Desmarres chalazion forceps

• Refer to Figure 16-2


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

• Needle holders– Castroviejo: locking or nonlocking

• Refer to Figure 16-3– Microsurgical needle holder



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



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

• Refer to Figure 16-4– Iris retractor– Eye speculum



• 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



– 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

chapter 16

Documents

cengage learning

accessible website

ophthalmic instruments

ophthalmic surgery2014

ophthalmic patient

ophthalmic procedurerecognize

ophthalmic proceduresummarize

ophthalmic procedureassess