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. 1

2. 2 CHAPTER 16 Ophthalmic Surgery

3. ©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

4. ©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. 4 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

5. ©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. 5 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

6. ©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. 6 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)

7. ©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. 7 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

8. ©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. 8 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

9. ©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. 9 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)

10. ©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. 10 Instruments, Routine Equipment, and Supplies (cont’d.) Needle holders –Castroviejo: locking or nonlocking Refer to Figure 16-3 (p. 597) –Microsurgical needle holder

11. ©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. 11

12. ©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. 12 Instruments, Routine Equipment, and Supplies (cont’d.) Scalpels –Graefe cataract knife –Keratomes –Razor fragments –Diamond knife –Oscillating knife –Beaver blades –No. 15 knife blade

13. ©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. 13 Graefe cataract knife Diamond knife

14. ©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. 14 Oscillating kni Beaver blades

15. ©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. 15 Instruments, Routine Equipment, and Supplies (cont’d.) Hooks and retractors –Scleral hooks: scleral retraction –Kilner hook: reconstructive surgery –Desmarres lid retractors Refer to Figure 16-4 (p.597) –Iris retractor –Eye speculum Refer to Figure 16-9 (p. 605)

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. 16 Instruments, Routine Equipment, and Supplies (cont’d.) Scissors –Westcott scissors; spring action microscissors –Small spring scissors –McPherson-Vannas iris scissors Refer to Figure 16-5 (p.598) Miscellaneous –Bowman probe Refer to Figure 16-6 (p.598)

17. ©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. 17 Instruments, Routine Equipment, and Supplies (cont’d.) Routine equipment –Ophthalmic stretcher with attachable wrist rest for the surgeon –Donut for positioning the head –Electrosurgical unit (ESU)

18. ©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. 18

19. ©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. 19 Instruments, Routine Equipment, and Supplies (cont’d.) 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

20. ©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. 20 Vitreoretinal system Operating microscope Phacoemulsifier & Handpiece

21. ©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. 21 Instruments, Routine Equipment, and Supplies (cont’d.) –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; CO 2 gas passed is under pressure through flexible tubes to the tip of a probe

22. ©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. 22

23. ©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. 23 Instruments, Routine Equipment, and Supplies (cont’d.) 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)

24. ©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. 24 Instruments, Routine Equipment, and Supplies (cont’d.) –BSS –27- and 30-gauge disposable needles, straight and angled –Needles and sutures Refer to Tables 16-1 and 16-2

25. ©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. 25 Surgical Intervention A variety of surgical procedures and approaches are available –There are elements of consistency in every ophthalmic procedure Practical considerations Procedural considerations

26. ©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. 26 Surgical Intervention (cont’d.) Procedures –Laparotomy –Surgical repair of chalzion –Transconjunctival approach –Surgical repair of entropion –Iridectomy –Strabismus correction: recession/resection –Adjustable suture surgery

27. ©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. 27 Surgical Intervention (cont’d.) –Scleral buckle –Dacryocystorhinostomy –Enucleation –Keratoplasty (corneal transplant) –Cataract extraction Extracapsular Intracapsular –Vitrectomy –Repair of traumatic eyelid laceration

28. ©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. 28 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