Eye surgery


Eye surgery, also known as ophthalmic surgery or ocular surgery, is surgery performed on the eye or its adnexa. 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. It continues to be a widely practiced class of surgery, with various techniques having been developed for treating eye problems.

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. 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, hypermetropia, and astigmatism. Importantly, refractive surgery is not compatible with everyone, and people may find on occasion that eyewear is still needed after surgery.
Recent developments also include procedures that can change eye color from brown to blue. 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.

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

Glaucoma surgery

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. 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.

Refractive surgery

Refractive surgery aims to correct errors of refraction in the eye, reducing or eliminating the need for corrective lenses.
includes most refractive surgery, as well as:
Vitreoretinal surgery includes:
  • 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 or trans pars plana vitrectomy 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.
  • Pan retinal photocoagulation 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.
  • * 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.
  • 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.
  • Radial optic neurotomy
  • Macular translocation surgery
  • * through 360° retinotomy
  • * through scleral imbrication technique

    Eye muscle surgery

With about 1.2 million procedures each year, extraocular muscle surgery is the third-most common eye surgery in the United States.

  • Eye muscle surgery typically corrects strabismus and includes:
  • * Loosening or weakening procedures
  • ** Recession involves moving the insertion of a muscle posteriorly towards its origin.
  • ** Myectomy
  • ** Myotomy
  • ** Tenectomy
  • ** Tenotomy
  • * Tightening or 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 or 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 postoperative day, to obtain better ocular alignment.

    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, 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