Eye surgery
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Eye surgery, also known as ophthalmic surgery or ocular surgery, is surgery performed on the eye or its adnexa, typically by an ophthalmologist.<ref>Surgery Encyclopedia - Ophthalmologic surgery</ref> Although most eye surgeries can be performed by an experienced general ophthalmologist, more complex procedures are usually done by one who is fellowship trained.
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[edit] 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 anaethesia 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 immobilze 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.
[edit] Laser surgery and incisional surgery
Although the terms "laser eye surgery" and "refractive surgery" are commonly used as if they were interchangeable, this is not the case. Lasers may be used to treat nonrefractive conditions (e.g. to seal a retinal tear), while radial keratotomy is an example of refractive surgery without the use of a laser.
[edit] 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.<ref>Uhr, Barry W. History of ophthalmology at Baylor University Medical Center. Proc (Bayl Univ Med Cent). 2003 October; 16(4): 435–438. PMID 16278761</ref>
[edit] 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 glaucoma surgeries, and variations or combinations of those surgeries, 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.
[edit] Refractive surgery
- Refractive surgery aims to correct errors of refraction in the eye, reducing or eliminating the need for corrective lenses
- Keratomilleusis is method of reshaping the cornea surface to change its optical power. A disc of cornea is shaved off, quickly frozen, lathe-ground, then returned to its original power.
- Automated lamellar keratoplasty (ALK)
- Laser assisted in-situ keratomileusis (LASIK)<ref name="LASIK">Surgery Encyclopedia - LASIK</ref>
- Laser assisted sub-epithelial keratomileusis (LASEK), aka Epi-LASIK
- Photorefractive keratectomy (PRK)<ref>Surgery Encyclopedia - PRK</ref>
- Laser thermal keratoplasty (LTK)
- Conductive keratoplasty (CK) uses radio frequency waves to shrink corneal collagen. It is used to treat mild to moderate hyperopia.<ref name="LASIK"/>
- Limbal relaxing incisions (LRI)
- Astigmatic keratotomy (AK), aka Arcuate keratotomy or Transverse keratotomy
- Radial keratotomy (RK)
- Hexagonal keratotomy (HK)
- Epikeratophakia is the removal of the corneal epithelium and replacement with a lathe cut corneal button.<ref name="cornealtransplant">Surgery Encyclopedia - Corneal transplantation</ref>
- Intracorneal rings (ICRs), or corneal ring segments (Intacs) <ref>http://www.iupui.edu/~ophthal/html/eyes_intercornealrings.html</ref>
- Implantable contact lenses
- Presbyopia reversal
- Anterior ciliary sclerotomy (ACS)
- Laser reversal of presbyopia (LRP)
- Scleral expansion bands
- Anterior ciliary sclerotomy (ACS)
[edit] Corneal surgery
- Corneal surgery includes most of the refractive surgeries as well as the following:
- Corneal transplant surgery, is used to remove a cloudy/diseased cornea and replace it with a clear donor cornea.<ref name="cornealtransplant"/>
- Phototherapeutic keratectomy (PTK)<ref>Indiana University Department of Ophthalmology - Phototherapeutic Keratectomy (PTK)</ref>
- Pterygium excision<ref>MDAdvice.com - Pterygium removal</ref>
[edit] Vitreo-retinal surgery
- Vitreo-retinal surgery includes the following
- Vitrectomy<ref>http://www.iupui.edu/~ophthal/html/eyes_vitrectomysurgery.html</ref>
- Anterior vitrectomy is the removal of the front portio 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 [1].
- Pan retinal photocoagulation (PRP) is a type of photocoagulation therapy used in the treatment of diabetic retinopathy.<ref name="photocoagulation">Surgery Encyclopedia - Photocoagulation therapy</ref>
- Retinal detachment repair
- Ignipuncture is an obsolete procedure that involves cauterization of the retina with a very hot pointed instrument.<ref name="Wolfensberger">Wolfensberger TJ. "Jules Gonin. Pioneer of retinal detachment surgery." Indian J Ophthalmol. 2003 Dec;51(4):303-8. PMID 14750617.</ref>
- 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.<ref>Surgery Encyclopedia - Scleral Buckling</ref>
- Laser photocoagulation, or photocoagulation therapy, is the use of a laser to seal a retinal tear.<ref name="photocoagulation"/>
- Pneumatic retinopexy
- Retinal cryopexy, or retinal cryotherapy, is a procedure that uses intense cold to induce a chorioretinal scar and to destroy retinal or choroidal tissue.<ref>Surgery Encyclopedia - Retinal_cryopexy</ref>
- Macular hole repair
- Partial lamellar sclerouvectomy<ref>Shields JA, Shields CL. Surgical approach to lamellar sclerouvectomy for posterior uveal melanomas: the 1986 Schoenberg lecture. Ophthalmic Surg. 1988 Nov;19(11):774-80. PMID 3222038.</ref>
- 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 [2].
- Radial optic neurotomy
- macular translocation surgery
- through 360 degree retinotomy
- through scleral imbrication technique
- Vitrectomy<ref>http://www.iupui.edu/~ophthal/html/eyes_vitrectomysurgery.html</ref>
[edit] 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 [3].
- Eye muscle surgeries typically correct strabismus and include the following<ref>Surgery Encyclopedia - Eye Muscle Surgery</ref> [4]:
- 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 [5].
- Loosening / weakening procedures
[edit] 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)[6], 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:
[edit] Eyelid surgery [7]
- Blepharoplasty (Eyelift)
- Blepharoplasty is plastic surgery of the eyelids to remove excessive skin or subcutaneous fat.<ref>Surgery Encyclopedia - Blepharoplasty</ref>
- Ptosis pepair for droopy eyelid
- Ectropion repair[8]
- Entropion repair
- Canthal resection
- A canthectomy is the surgical removal of tissue at the junction of the upper and lower eyelids.<ref name="Cline">Cline D; Hofstetter HW; Griffin JR. Dictionary of Visual Science. 4th ed. Butterworth-Heinemann, Boston 1997. ISBN 0-7506-9895-0</ref>
- Cantholysis is the surgical division of the canthus.<ref name="Cline"/>
- Canthopexy
- A canthoplasty is plastic surgery at the canthus.<ref name="Cline"/>
- A canthorrhaphy is suturing of the outer canthus to shorten the palpebral fissure.<ref name="Cline"/>
- A canthotomy is the surgical division of the canthus, usually the outer canthus.<ref name="Cline"/>
- A lateral canthotomy is the surgical division of the outer canthus.
- Epicanthoplasty
- Tarsorrhaphy is a procedure in which the eyelids are partially sewn together to narrow the opening (i.e. palpebral fissure).
- Blepharoplasty (Eyelift)
[edit] Surgery involving the lacrimal apparatus
- A dacryocystorhinostomy (DCR) or dacryocystorhinotomy is a procedure to restore the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct does not function.<ref name="Cline"/><ref>Indiana University Department of Ophthalmology. "Lacrimal Drainage Surgery (DCR: Dacryocystorhinostomy)." Retrieved August 18, 2006</ref>
- Canaliculodacryocystostomy is a surgical correction for a congenitally blocked tear duct in which the closed segment is excised and the open end is joined to the lacrimal sac.<ref name="Cline"/><ref>Cherkunov BF, Lapshina AV. ["Canaliculodacryocystostomy in obstruction of medial end of the lacrimal duct."] Oftalmol Zh. 1976;31(7):544-8. PMID 1012635.</ref>
- Canaliculotomy involves slitting of the lacrimal punctum and canaliculus for the relief of epiphora<ref name="Cline"/>
- A dacryoadenectomy is the surgical removal of a lacrimal gland.<ref name="Cline"/>
- A dacryocystectomy is the surgical removal of a part of the lacrimal sac.<ref name="Cline"/>
- A dacryocystostomy is an incision into the lacrimal sac, usually to promote drainage.<ref name="Cline"/>
- A dacryocystotomy is an incision into the lacrimal sac.<ref name="Cline"/>
[edit] Eye removal
- An enucleation is the removal of the eye leaving the eye muscles and remaining orbital contents intact.<ref>Surgery Encyclopedia - Enucleation</ref>
- An evisceration is the removal of the eye's contents, leaving the scleral shell intact. Usually performed to reduce pain in a blind eye.<ref name="Cassin">Cassin, B. and Solomon, S. Dictionary of Eye Terminology. Gainsville, Florida: Triad Publishing Company, 1990.</ref>
- An exenteration is the removal of the entire orbital contents, including the eye, extraocular muscles, fat, and connective tissues; usually for malignant orbital tumors.<ref>Surgery Encyclopedia - Exenteration</ref>
[edit] Orbital surgeries
- Orbital reconstruction / Ocular prosthetics (False Eyes)
- Orbital decompression for Grave's Disease
[edit] Other oculoplastic surgeries
- Botox injections
- Ultrapeel Microdermabrasion
- Endoscopic forehead and browlift
- Face lift (Rhytidectomy)
- Liposuction of the face and neck
- Browplasty [9]
[edit] Other surgeries
- A ciliarotomy is a surgical division of the ciliary zone in the treatment of glaucoma.<ref name="Cline"/>
- A ciliectomy is 1) the surgical removal of part of the ciliary body, or 2) the surgical removal of part of a margin of an eyelid containing the roots of the eyelashes.<ref name="Cline"/>
- A ciliotomy is a surgical section of the ciliary nerves.<ref name="Cline"/>
- A conjunctivoanstrostomy is an opening made form the inferior conjuctival cul-de-sac into the maxillary sinus for the treatment of epiphora.<ref name="Cline"/>
- Conjuctivoplasty is plastic surgery of the conjunctiva.<ref name="Cline"/>
- A conjunctivorhinostomy is a surgical correction of the total obstruction of a lacrimal canaliculus by which the conjuctiva is anastomosed with the nasal cavity to improve tear flow.<ref name="Cline"/>
- A corectomedialysis, or coretomedialysis, is an excision of a small portion of the iris at its junction with the ciliary body to form an artificial pupil.<ref name="Cline"/>
- A corectomy, or coretomy, is any surgical cutting operation on the iris at the pupil.<ref name="Cline"/>
- A corelysis is a surgical detachment of adhesions of the iris to the capsule of the crystalline lens or cornea.<ref name="Cline"/>
- A coremorphosis is the surgical formation of an artificial pupil.<ref name="Cline"/>
- A coreplasty, or coreoplasty, is plastic surgery of the iris, usually for the formation of an artificial pupil.<ref name="Cline"/>
- A coreoplasy, or laser pupillomydriasis, is any procedure that changes the size or shape of the pupil.<ref name="Cassin"/>
- A cyclectomy is an excision of portion of the ciliary body.<ref name="Cline"/>
- A cyclotomy, or cyclicotomy, is a surgical incision of the ciliary body, usually for the relief of glaucoma.<ref name="Cline"/>
- A cycloanemization is a surgical obliteration of the long ciliary arteries in the treatment of glaucoma.<ref name="Cline"/>
- An iridectomesodialsys is the formation of an artificial pupil by detaching and excising a portion of the iris at its periphery.<ref name="Cline"/>
- An iridodialysis, sometimes known as a coredialysis, is a localized separation or tearing away of the iris from its attachment to the ciliary body.<ref name="Cline"/><ref name="Cassin"/>
- An iridencleisis, or corenclisis, is a surgical procedure for glaucoma in which a portion of the iris is incised and incarcerated in a limbal incision.<ref name="Cline"/> (Subdivided into basal iridencleisis and total iridencleisis.<ref name="Cvetkovic">Cvetkovic D, Blagojevic M, Dodic V. ["Comparative results of trepanotrabeculectomy and iridencleisis in primary glaucoma."] J Fr Ophtalmol. 1979 Feb;2(2):103-7. PMID 444110.</ref>)
- 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.<ref name="Cline"/>[10]
- An iridocorneosclerectomy is the surgical removal of a portion of the iris, the cornea, and the sclera.<ref name="Cline"/>
- An iridocyclectomy is the surgical removal of the iris and the ciliary body.<ref name="Cline"/>
- An iridocystectomy is the surgical removal of a portion of the iris to form an artificial pupil.<ref name="Cline"/>
- An iridosclerectomy is the surgical removal of a portion of the sclera and a portion of the iris in the region of the limbus for the treatment of glaucoma.<ref name="Cline"/>
- An iridosclerotomy is the surgical puncture of the sclera and the margin of the iris for the treatment of glaucoma.<ref name="Cline"/>
- A rhinommectomy is the surgical removal of a portion of the internal canthus.<ref name="Cline"/>
- A trepanotrabeculectomy is used in the treatment of chronic open and chronic closed angle glaucoma.<ref name="Cvetkovic"/>
[edit] References
<references/>
[edit] See also
[edit] External links
- Video of LASIK procedure
- Operations on the Eye - 2006 ICD-9-CM OFFICIAL CODES
- Operations (Word doc)
- EyeMDLink.com - Cataract Surgery
- eMedicine.com - Glaucoma, Complications and Management of Glaucoma Filtering
- American Board of Eye Surgeons
