Eye surgery

Last updated
Eye surgery
Augenoperation 1195.jpg
Eye surgery in the Middle Ages
ICD-10-PCS 08
ICD-9-CM 08-16
MeSH D013508
OPS-301 code 5-08...5-16
Ophthalmologic Surgeon, Ophthalmologist, Eye Surgeon
Occupation
Names
  • Physician
  • Surgeon
Occupation type
Specialty
Activity sectors
Medicine, Surgery
Description
Education required
Fields of
employment
Hospitals, Clinics

Eye surgery, also known as ophthalmic surgery or ocular surgery, is surgery performed on the eye or its adnexa. [1] Eye surgery is part of ophthalmology and is performed by an ophthalmologist or eye surgeon. The eye is a fragile organ, and requires due care before, during, and after a surgical procedure to minimize or prevent further damage. An eye surgeon is responsible for selecting the appropriate surgical procedure for the patient, and for taking the necessary safety precautions. Mentions of eye surgery can be found in several ancient texts dating back as early as 1800 BC, with cataract treatment starting in the fifth century BC. [2] It continues to be a widely practiced class of surgery, with various techniques having been developed for treating eye problems.

Contents

Preparation and precautions

Since the eye is heavily supplied by nerves, anesthesia is essential. Local anesthesia is most commonly used. Topical anesthesia using lidocaine topical gel is often used for quick procedures. Since topical anesthesia requires cooperation from the patient, general anesthesia is often used for children, traumatic eye injuries, or major orbitotomies, and for apprehensive patients. The physician administering anesthesia, or a nurse anesthetist or anesthetist assistant with expertise in anesthesia of the eye, monitors the patient's cardiovascular status. Sterile precautions are taken to prepare the area for surgery and lower the risk of infection. These precautions include the use of antiseptics, such as povidone-iodine, and sterile drapes, gowns, and gloves.

Laser eye 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). [3] Laser eye surgery or laser corneal surgery is a medical procedure that uses a laser to reshape the surface of the eye to correct myopia (short-sightedness), hypermetropia (long-sightedness), and astigmatism (uneven curvature of the eye's surface). Importantly, refractive surgery is not compatible with everyone, and people may find on occasion that eyewear is still needed after surgery. [4]

Recent developments also include procedures that can change eye color from brown to blue. [5] [6] Before proceeding with laser surgery, the eye specialist needs to certify that the patient is a suitable candidate for the surgery and there are several factors to be considered before doing laser surgery. [7]

Cataract surgery

Cataract surgery, using a temporal approach phacoemulsification probe (in right hand) and "chopper" (in left hand) being done under operating microscope at a Navy medical center Cataract surgery.jpg
Cataract surgery, using a temporal approach phacoemulsification probe (in right hand) and "chopper" (in left hand) being done under operating microscope at a Navy medical center

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. Owing to the high prevalence of cataracts, cataract extraction is the most common eye surgery. Rest after surgery is recommended. [8]

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. Many types of glaucoma surgery exist, and variations or combinations of those types can facilitate the escape of excess aqueous humor from the eye to lower intraocular pressure, and a few that lower it 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 intraocular pressure. Canaloplasty uses 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.[ clarification needed ] The catheter is then removed and a suture is placed within the canal and tightened.[ clarification needed ] By opening up the canal, the pressure inside the eye can be reduced.[ clarification needed ] [9] [10] [11] [12]

Refractive surgery

Refractive surgery aims to correct errors of refraction in the eye, reducing or eliminating the need for corrective lenses.

Corneal surgery

Corneal surgery includes most refractive surgery, as well as:

Vitreoretinal surgery

Vitrectomy Vitrectomy3727-PH.jpg
Vitrectomy

Vitreoretinal surgery includes:

Eye muscle surgery

Isolating the inferior rectus muscle Eye surgery.jpg
Isolating the inferior rectus muscle
Disinserting the medial rectus muscle, after placing vicryl suture Desinsertion du muscle CO.jpg
Disinserting the medial rectus muscle, after placing vicryl suture

With about 1.2 million procedures each year, extraocular muscle surgery is the third-most common eye surgery in the United States. Archived 2016-08-18 at the Wayback Machine

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), [30] 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:

Eyelid surgery

Orbital surgery

Other oculoplastic surgery

Surgery involving the lacrimal apparatus

Eye removal

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, nonpenetrating surgery, guarded filtration surgery, and seton valve implants have been invented.

Related Research Articles

<span class="mw-page-title-main">Ophthalmology</span> Field of medicine treating eye disorders

Ophthalmology is a surgical subspecialty within medicine that deals with the diagnosis and treatment of eye disorders. A former term is oculism.

<span class="mw-page-title-main">Vitrectomy</span> Surgery to remove vitreous humor from the eye

Vitrectomy is a surgery to remove some or all of the vitreous humor from the eye.

<span class="mw-page-title-main">LASIK</span> Corrective ophthalmological surgery

LASIK or Lasik, commonly referred to as laser eye surgery or laser vision correction, is a type of refractive surgery for the correction of myopia, hyperopia, and an actual cure for astigmatism, since it is in the cornea. LASIK surgery is performed by an ophthalmologist who uses a laser or microkeratome to reshape the eye's cornea in order to improve visual acuity.

<span class="mw-page-title-main">Radial keratotomy</span> Refractive surgical procedure to correct myopia (nearsightedness

Radial keratotomy (RK) is a refractive surgical procedure to correct myopia (nearsightedness). It was developed in 1974 by Svyatoslav Fyodorov, a Russian ophthalmologist. It has been largely supplanted by newer, more accurate operations, such as photorefractive keratectomy, LASIK, Epi-LASIK and the phakic intraocular lens.

<span class="mw-page-title-main">Refractive surgery</span> Surgery to treat common vision disorders

Refractive surgery is optional eye surgery used to improve the refractive state of the eye and decrease or eliminate dependency on glasses or contact lenses. This can include various methods of surgical remodeling of the cornea (keratomileusis), lens implantation or lens replacement. The most common methods today use excimer lasers to reshape the curvature of the cornea. Refractive eye surgeries are used to treat common vision disorders such as myopia, hyperopia, presbyopia and astigmatism.

<span class="mw-page-title-main">Phacoemulsification</span> Method of cataract surgery

Phacoemulsification is a cataract surgery method in which the internal lens of the eye which has developed a cataract is emulsified with the tip of an ultrasonic handpiece and aspirated from the eye. Aspirated fluids are replaced with irrigation of balanced salt solution to maintain the volume of the anterior chamber during the procedure. This procedure minimises the incision size and reduces the recovery time and risk of surgery induced astigmatism.

<span class="mw-page-title-main">Intraocular lens</span> Lens implanted in the eye to treat cataracts or myopia

An Intraocular lens (IOL) is a lens implanted in the eye usually as part of a treatment for cataracts or for correcting other vision problems such as short sightedness and long sightedness, a form of refractive surgery. If the natural lens is left in the eye, the IOL is known as phakic, otherwise it is a pseudophakic lens. Both kinds of IOLs are designed to provide the same light-focusing function as the natural crystalline lens. This can be an alternative to LASIK, but LASIK is not an alternative to an IOL for treatment of cataracts.

<span class="mw-page-title-main">Retinal detachment</span> Medical condition of the eye

Retinal detachment is a disorder of the eye in which the retina peels away from its underlying layer of support tissue. Initial detachment may be localized, but without rapid treatment the entire retina may detach, leading to vision loss and blindness. It is a surgical emergency.

<span class="mw-page-title-main">Phakic intraocular lens</span> Lens implanted in eye in addition to the natural lens

A phakic intraocular lens (PIOL) is a special kind of intraocular lens that is implanted surgically into the eye to correct myopia (nearsightedness). It is called "phakic" because the eye's natural lens is left untouched. Intraocular lenses that are implanted into eyes after the eye's natural lens has been removed during cataract surgery are known as pseudophakic.

<span class="mw-page-title-main">Cataract surgery</span> Removal of opacified lens from the eye

Cataract surgery, also called lens replacement surgery, is the removal of the natural lens of the eye that has developed a cataract, an opaque or cloudy area. The eye's natural lens is usually replaced with an artificial intraocular lens (IOL) implant.

Aphakia is the absence of the lens of the eye, due to surgical removal, such as in cataract surgery, a perforating wound or ulcer, or congenital anomaly. It causes a loss of ability to maintain focus (accommodation), high degree of farsightedness (hyperopia), and a deep anterior chamber. Complications include detachment of the vitreous or retina, and glaucoma.

<span class="mw-page-title-main">Glaucoma surgery</span> Type of eye 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 humor.

Howard V. Gimbel FRCSC, AOE, FACS, CABES, is a Canadian ophthalmologist, university professor, senior editor, and amateur musician. He is better known for his invention, along with Thomas Neuhann, of the continuous curvilinear capsulorhexis (CCC), a technique employed in modern cataract surgery.

The Trabectome is a surgical device that can be used for ab interno trabeculotomy, a minimally invasive glaucoma surgery for the surgical management of adult, juvenile, and infantile glaucoma. The trabecular meshwork is a major site of resistance to aqueous humor outflow. As angle surgeries such as Trabectome follow the physiologic outflow pathway, the risk of complications is significantly lower than filtering surgeries. Hypotony with damage to the macula, can occur with pressures below 5 mmHg, for instance, after traditional trabeculectomy, because of the episcleral venous pressure limit. The Trabectome handpiece is inserted into the anterior chamber, its tip positioned into Schlemm's canal, and advanced to the left and to the right. Different from cautery, the tip generates plasma to molecularize the trabecular meshwork and remove it drag-free and with minimal thermal effect. Active irrigation of the trabectome surgery system helps to keep the anterior chamber formed during the procedure and precludes the need for ophthalmic viscoelastic devices. Viscoelastic devices tend to trap debris or gas bubbles and diminish visualization. The Trabectome decreases the intra-ocular pressure typically to a mid-teen range and reduces the patient's requirement to take glaucoma eye drops and glaucoma medications. The theoretically lowest pressure that can be achieved is equal to 8 mmHg in the episcleral veins. This procedure is performed through a small incision and can be done on an outpatient basis.

Micro-invasive glaucoma surgery (MIGS) is the latest advance in surgical treatment for glaucoma, which aims to reduce intraocular pressure by either increasing outflow of aqueous humor or reducing its production. MIGS comprises a group of surgical procedures which share common features. MIGS procedures involve a minimally invasive approach, often with small cuts or micro-incisions through the cornea that causes the least amount of trauma to surrounding scleral and conjunctival tissues. The techniques minimize tissue scarring, allowing for the possibility of traditional glaucoma procedures such as trabeculectomy or glaucoma valve implantation to be performed in the future if needed.

<span class="mw-page-title-main">John Marshall (eye laser scientist)</span> British medical scientist and inventor

John Marshall MBE, FMedSci, PhD, DSc, FRCPath, FRSB, FRCOphth(Hon), FRCOptom (Hon), FARVO is a British medical scientist and inventor. Currently he is the Frost Professor of Ophthalmology at the Institute of Ophthalmology UCL and Emeritus Professor King's College London. He is a pioneer of laser eye surgery.

An artificial iris is an intraocular implant that is used as both a cosmetic and to treat those with aniridia or other eye trauma. People with this condition experience photophobia, or increased sensitivity to light. The artificial iris, made from silicone, acts as a replacement iris. The artificial iris is implanted in the eye using different surgery techniques depending on the patient's eye trauma. Most of the major artificial iris manufacturers are European and the treatment is used sparingly in the United States because of limited FDA approval, in part due to possibility of vision loss and other risks.

<span class="mw-page-title-main">Phacolytic glaucoma</span> Medical condition

Phacolytic glaucoma (PG) is a form of glaucoma which is caused due to a leaking mature or immature cataract. Inflammatory glaucoma which occurs in phacolysis is a condition which is a result of the leakage of protein within the lens into the capsule of a mature or hyper mature cataract and involves a simple procedure to be cured that is referred to as cataract extraction.

Manual small incision cataract surgery (MSICS) is an evolution of extracapsular cataract extraction (ECCE); the lens is removed from the eye through a self-sealing scleral tunnel wound. A well-constructed scleral tunnel is held closed by internal pressure, is watertight, and does not require suturing. The wound is relatively smaller than that in ECCE but is still markedly larger than a phacoemulsification wound. Comparative trials of MSICS against phaco in dense cataracts have found no difference in outcomes but MSICS had shorter operating times and significantly lower costs. MSICS has become the method of choice in the developing world because it provides high-quality outcomes with less surgically induced astigmatism than ECCE, no suture-related problems, quick rehabilitation, and fewer post-operative visits. MSICS is easy and fast to learn for the surgeon, cost effective, simple, and applicable to almost all types of cataract.

Clear lens extraction (CLE), also known as refractive lensectomy or refractive lens exchange (RLE) is a surgical procedure in which clear lens of the human eye is removed. Unlike cataract surgery, where cloudy lens is removed to treat cataract, clear lens extraction is done to surgically correct refractive errors such as high myopia. It can also be done in hyperopic or presbyopic patients who wish to have a multifocal IOL implanted to avoid wearing glasses. It is also used as a treatment for diseases such as angle closure glaucoma.

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