Everything about Eye Surgery totally explained
Eye surgery, also known as
ophthalmic surgery or
ocular surgery, is
surgery performed on the
eye or its
adnexa, typically by an
ophthalmologist. Although most eye surgery can be performed by an experienced general ophthalmologist, more complex procedures are usually done by one who is fellowship trained.
Preparation and precautions
The eye is a delicate organ, requiring extreme care before, during and after a surgical procedure. An expert ophthalmologist must identify the need for specific procedure and be responsible for conducting the procedure safely. Many university programs allow patients to specify if they want to be operated upon by the consultant or the resident / fellow.
Proper anesthesia is a must for any eye surgery. Local anesthesia is most commonly used.
Retrobulbar and
peribulbar techniques for infiltrating the local area surrounding the eye muscle cone are used to immobilize the extraocular muscles and eliminate pain sensation. Topical
anesthesia using lidocaine topical gel is preferred for quick procedures. In topical anesthesia, patient cooperation is a must for a smooth procedure.
General anesthesia is recommended for children, traumatic eye injuries, major orbitotomies and for apprehensive patients. Cardiovascular monitoring is preferable in
local anesthesia and is mandatory in general anesthesia. Proper sterile precautions are taken to prepare the area for surgery, including use of antiseptics like
povidone-iodine. Sterile drapes, gowns and gloves are a must. A plastic sheet with a receptacle helps collect the fluids during phacoemulsification. An eye speculum is inserted to keep the eyes wide open. For anxious patients, supplementation with a facial nerve block using
lidocaine and
bupivacaine is recommended.
Laser eye surgery
Although the terms Laser Eye Surgery and
Refractive surgery are commonly used as if they were interchangeable, this isn't the case. Lasers may be used to treat nonrefractive conditions (for example to seal a retinal tear), while radial keratotomy is an example of refractive surgery without the use of a laser.
Cataract surgery
A
cataract is an opacification or cloudiness of the eye's
crystalline lens due to aging, disease, or trauma that typically prevents light from forming a clear image on the
retina. If
visual loss is significant, surgical removal of the lens may be warranted, with lost
optical power usually replaced with a plastic
intraocular lens (IOL). Due to the high prevalence of cataracts, cataract extraction is the most common eye surgery.
Glaucoma surgery
Glaucoma is a group of diseases affecting the
optic nerve that results in
vision loss and is frequently characterized by raised
intraocular pressure (IOP). There are many types of glaucoma surgery, and variations or combinations of those types, that facilitate the escape of excess
aqueous humor from the eye to lower intraocular pressure, and a few that lower IOP by decreasing the production of aqueous humor.
Canaloplasty
Canaloplasty is an advanced, nonpenetrating procedure designed to enhance drainage through the eye’s natural drainage system to provide sustained reduction of IOP. Canaloplasty utilizes microcatheter technology in a simple and minimally invasive procedure.
To perform a canaloplasty, an Ophthalmologist creates a tiny incision to gain access to a canal in the eye. A microcatheter circumnavigates the canal around the iris, enlarging the main drainage channel and its smaller collector channels through the injection of a sterile, gel-like material called viscoelastic. The catheter is then removed and a suture is placed within the canal and tightened. By opening up the canal, the pressure inside the eye can be reduced.
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Refractive surgery
- Refractive surgery aims to correct errors of refraction in the eye, reducing or eliminating the need for corrective lenses
- Presbyopia reversal
- Anterior ciliary sclerotomy (ACS)
- Laser reversal of presbyopia (LRP)
- Scleral expansion bands
Corneal surgery
Corneal surgery includes most refractive surgery as well as the following:
- Corneal transplant surgery, is used to remove a cloudy/diseased cornea and replace it with a clear donor cornea.
- Pterygium excision
- Corneal tattooing
- Osteo-Odonto-Keratoprosthesis (OOKP), in which support for an artificial cornea is created from a tooth and its surrounding jawbone. This is a still-experimental procedure used for patients with severely damaged eyes, generally from burns.
Vitreo-retinal surgery
Vitreo-retinal surgery includes the following
- Vitrectomy
- Anterior vitrectomy is the removal of the front portion of vitreous tissue. It is used for preventing or treating vitreous loss during cataract or corneal surgery, or to remove misplaced vitreous in conditions such as aphakia pupillary block glaucoma.
- Pars plana vitrectomy (PPV), or trans pars plana vitrectomy (TPPV), is a procedure to remove vitreous opacities and membranes through a pars plana incision. It is frequently combined with other intraocular procedures for the treatment of giant retinal tears, tractional retinal detachments, and posterior vitreous detachments (External Link).
- Pan retinal photocoagulation (PRP) is a type of photocoagulation therapy used in the treatment of diabetic retinopathy.
- Retinal detachment repair
- Ignipuncture is an obsolete procedure that involves cauterization of the retina with a very hot pointed instrument.
- A scleral buckle is used in the repair of a retinal detachment to indent or "buckle" the sclera inward, usually by sewing a piece of preserved sclera or silicone rubber to its surface.
- Laser photocoagulation, or photocoagulation therapy, is the use of a laser to seal a retinal tear.
- Macular hole repair
- Partial lamellar sclerouvectomy
- Partial lamellar sclerocyclochoroidectomy
- Partial lamellar sclerochoroidectomy
- Posterior sclerotomy is an opening made into the vitreous through the sclera, as for detached retina or the removal of a foreign body (External Link).
- Radial optic neurotomy
- macular translocation surgery
- through 360 degree retinotomy
- through scleral imbrication technique
Eye muscle surgery
With approximately 1.2 million procedures each year, extraocular muscle surgery is the third most common eye surgery in the United States
(External Link).
Eye muscle surgery typically corrects strabismus and includes the following (External Link):
- Loosening / weakening procedures
- Recession involves moving the insertion of a muscle posteriorly towards its origin.
- Myectomy
- Myotomy
- Tenectomy
- Tenotomy
- Tightening / strengthening procedures
- Resection
- Tucking
- Advancement is the movement of an eye muscle from its original place of attachment on the eyeball to a more forward position.
- Transposition / repositioning procedures
- Adjustable suture surgery is a method of reattaching an extraocular muscle by means of a stitch that can be shortened or lengthened within the first post-operative day, to obtain better ocular alignment (External Link).
Oculoplastic surgery
Oculoplastic surgery, or oculoplastics, is the subspecialty of ophthalmology that deals with the reconstruction of the eye and associated structures. Oculoplastic surgeons perform procedures such as the repair of droopy eyelids (blepharoplasty)(External Link), repair of tear duct obstructions, orbital fracture repairs, removal of tumors in and around the eyes, and facial rejuvenation procedures including laser skin resurfacing, eye lifts, brow lifts, and even facelifts. Common procedures are:
Orbital surgery
Orbital reconstruction / Ocular prosthetics (False Eyes)
Orbital decompression for Grave's Disease
Other oculoplastic surgery
Botox injections
Ultrapeel Microdermabrasion
Endoscopic forehead and browlift
Face lift (Rhytidectomy)
Liposuction of the face and neck
Browplasty (External Link)
Other surgery
Many of these described procedures are historical and are not recommended due to a risk of complications. Particularly, these include operations done on ciliary body in an attempt to control glaucoma, since highly safer surgeries for glaucoma, including lasers, non-penetrating surgery, guarded filtration surgery and seton valve implants have been invented.
A ciliarotomy is a surgical division of the ciliary zone in the treatment of glaucoma.)
An iridesis is a surgical procedure in which a portion of the iris is brought through and incarcerated in a corneal incision in order to reposition the pupil.
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