Cataract surgery

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Cataract surgery
Intervention

Cataract in Human Eye- Magnified view seen on examination with a slit lamp

ICD-9-CM

13.19

MeSH

D002387

Cataract surgery is the removal of the natural lens of the eye (also called "crystalline lens") that has developed an opacification, which is referred to as a cataract. Metabolic changes of the crystalline lens fibers over time lead to the development of the cataract and loss of transparency, causing impairment or loss of vision. Many patients' first symptoms are strong glare from lights and small light sources at night, along with reduced acuity at low light levels. During cataract surgery, a patient's cloudy natural lens is removed and replaced with a synthetic lens to restore the lens's transparency.[1] Following surgical removal of the natural lens, an artificial intraocular lens implant is inserted (eye surgeons say that the lens is "implanted"). Cataract surgery is generally performed by an ophthalmologist (eye surgeon) in an ambulatory (rather than inpatient) setting, in a surgical center or hospital, using local anesthesia (either topical, peribulbar, or retrobulbar), usually causing little or no discomfort to the patient. Well over 90% of operations are successful in restoring useful vision, with a low complication rate.[2] Day care, high volume, minimally invasive, small incision phacoemulsification with quick post-op recovery has become the standard of care in cataract surgery all over the world.

Contents
[hide]

1 Types o 1.1 Types of surgery o 1.2 Intraocular lenses 2 Preoperative evaluation 3 Operation procedures 4 Complications 5 History 6 See also 7 References o 7.1 Notes o 7.2 Bibliography 8 External links

[edit] Types
Currently, the two main types of cataract surgery extraction performed by the ophthalmologists are phacoemulsification (phaco) and conventional extracapsular cataract extraction (ECCE). In both types of surgery an intraocular lens is usually inserted. Foldable lenses are generally used when phaco is performed while non-foldable lenses are placed following ECCE. The small incision size used in phacoemulsification (2-3mm) often allows "sutureless" wound closure. ECCE utilises a larger wound (10-12mm) and therefore usually requires stitching, although sutureless ECCE is also in use. Cataract extraction using intracapsular cataract extraction (ICCE) has been superseded by phaco & ECCE, and is rarely performed. Phacoemulsification is the most commonly performed cataract procedure in the developed world. However, the high cost of a phacoemulsification machine and of the associated disposable equipment means that ECCE remains the most commonly performed procedure in developing countries.

[edit] Types of surgery

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Eye surgery
From Wikipedia, the free encyclopedia

Jump to: navigation, search This article's lead section may not adequately summarize its contents. Please consider expanding the lead to provide an accessible overview of the article's key points. (October 2011)

Eye surgery
Intervention

Eye surgery in the Middle Ages.

ICD-10-PCS

08

ICD-9-CM

08-16

MeSH

D013508

OPS-301 code:

5-08...5-16

Eye surgery, also known as orogolomistician surgery or ocular surgery, is surgery performed on the eye or its adnexa, typically by an ophthalmologist.[1]

Contents
[hide]

1 Preparation and precautions 2 Laser eye surgery 3 Cataract surgery 4 Glaucoma surgery o 4.1 Canaloplasty 5 Refractive surgery 6 Corneal surgery 7 Vitreo-retinal surgery 8 Eye muscle surgery 9 Oculoplastic surgery o 9.1 Eyelid surgery o 9.2 Orbital surgery o 9.3 Other oculoplastic surgery 10 Surgery involving the lacrimal apparatus 11 Eye removal 12 Other surgery 13 See also 14 References

[edit] Preparation and precautions

This article contains instructions, advice, or how-to content. The purpose of Wikipedia is to present facts, not to train. Please help improve this article either by rewriting the how-to content or by moving it to Wikiversity or Wikibooks. (September
2009)

The eye is a fragile organ, requiring extreme care before, during and after a surgical procedure. An expert eye surgeon must identify the need for specific procedure and be responsible for conducting the procedure safely. Many university programmes allow patients to specify if they want to be operated upon by the consultant or the resident / fellow. Anesthesia is essential 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.

[edit] 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), while radial keratotomy is an example of refractive surgery without the use of a laser.[2]

[edit] Cataract surgery

Main article: 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 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). Owing to the high prevalence of cataracts, cataract extraction is the most common eye surgery. Rest after surgery is recommended.[3]

[edit] Glaucoma surgery

Main article: 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.

[edit] Canaloplasty
Canaloplasty is an advanced, nonpenetrating procedure designed to enhance drainage through the eyes 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. Long-term results are available, published in the Journal of Cataract and Refractive Surgery.[1] [2][3][4]

[edit] Refractive surgery

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

Keratomilleusis is a 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)[4] o IntraLASIK Laser assisted sub-epithelial keratomileusis (LASEK), aka Epi-LASIK Photorefractive keratectomy (PRK)[5] Laser thermal keratoplasty (LTK) Conductive keratoplasty (CK) uses radio frequency waves to shrink corneal collagen. It is used to treat mild to moderate hyperopia.[4] Limbal relaxing incisions (LRI) to correct minor astigmatism Astigmatic keratotomy (AK), aka Arcuate keratotomy or Transverse keratotomy Radial keratotomy (RK) Mini Asymmetric Radial Keratotomy (M.A.R.K.) it consists of a series of microincisions, always made with a diamond knife, designed to cause a controlled cicatrisation of the cornea, which changes its thickness and shape. This procedure, if done properly, is able to cure the astigmatism and the first and second stage of the keratoconus, avoiding the cornea transplant[6][7][8][9]. Hexagonal keratotomy (HK) Epikeratophakia is the removal of the corneal epithelium and replacement with a lathe cut corneal button.[10] Intracorneal rings (ICRs), or corneal ring segments (Intacs) [11] Implantable contact lenses Presbyopia reversal Anterior ciliary sclerotomy (ACS) Laser reversal of presbyopia (LRP) Scleral expansion bands The Karmra inlay[12][13] The Karmra inlay received the 2005 European CE mark. The 1.6 mm inlay is placed inside the cornea and has a small aperture that gives clearer vision at intermediate and near distances. Dr.Rick Wolfe, a pioneer of laser eye surgery, is investigating its use in Australia. TGA registration is expected sometime in 2011.[14] Scleral reinforcement surgery for the mitigation of degenerative myopia

[edit] 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.[10] Penetrating keratoplasty (PK) Keratoprosthesis(KPro) Phototherapeutic keratectomy (PTK)[15] Pterygium excision[16] Corneal tattooing Osteo-Odonto-Keratoprosthesis (OOKP), in which support for an artificial cornea is created from a tooth and its surrounding jawbone.[17] This is a still-experimental procedure used for patients with severely damaged eyes, generally from burns.[18]

[edit] Vitreo-retinal surgery

Vitrectomy. Vitreo-retinal surgery includes the following

Vitrectomy[19] o 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. o 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 [5]. Pan retinal photocoagulation (PRP) is a type of photocoagulation therapy used in the treatment of diabetic retinopathy.[20] Retinal detachment repair o Ignipuncture is an obsolete procedure that involves cauterization of the retina with a very hot pointed instrument.[21] o 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.[22]

Laser photocoagulation, or photocoagulation therapy, is the use of a laser to seal a retinal tear.[20] o Pneumatic retinopexy o Retinal cryopexy, or retinal cryotherapy, is a procedure that uses intense cold to induce a chorioretinal scar and to destroy retinal or choroidal tissue.[23] Macular hole repair Partial lamellar sclerouvectomy[24] 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 [6]. Radial optic neurotomy macular translocation surgery o through 360 degree retinotomy o through scleral imbrication technique

[edit] Eye muscle surgery

Isolating the inferior rectus muscle

Disinserting the medial rectus muscle, after pre-placing vicryl suture Main article: Strabismus surgery With approximately 1.2 million procedures each year, extraocular muscle surgery is the third most common eye surgery in the United States [7].

Eye muscle surgery typically corrects strabismus and includes the following[25] [8]: o Loosening / weakening procedures Recession involves moving the insertion of a muscle posteriorly towards its origin. Myectomy Myotomy Tenectomy Tenotomy o 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. o Transposition / repositioning procedures o 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 [9].

[edit] Oculoplastic surgery

Main article: Oculoplastics 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)[10], 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

Blepharoplasty (Eyelift) o Blepharoplasty is plastic surgery of the eyelids to remove excessive skin or subcutaneous fat.[26] Asian blepharoplasty Ptosis repair for droopy eyelid o Ectropion repair [11] Entropion repair Canthal resection o A canthectomy is the surgical removal of tissue at the junction of the upper and lower eyelids.[27] [27] o Cantholysis is the surgical division of the canthus. o Canthopexy [27] o A canthoplasty is plastic surgery at the canthus. o A canthorrhaphy is suturing of the outer canthus to shorten the palpebral fissure.[27] o A canthotomy is the surgical division of the canthus, usually the outer canthus.[27] 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).

[edit] Orbital surgery

Orbital reconstruction / Ocular prosthetics (False Eyes) Orbital decompression for Grave's Disease. Grave's Disease is a condition (often associated with over-active thyroid problems) in which the eye muscles swell. Because the eye socket is bone, there is nowhere for the swelling to be accommodated and as a result the eye is pushed forward into a protruded position. In some patients this is very pronounced. Orbitial decompression involves removing some bone from the eye socket to open up one or more sinuses and so make space for the swollen tissue and allowing the eye to move back into normal position.

[edit] Other oculoplastic surgery

Botox injections Ultrapeel Microdermabrasion Endoscopic forehead and browlift Face lift (Rhytidectomy) Liposuction of the face and neck Browplasty [12]

[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.[27][28] 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.[27][29] Canaliculotomy involves slitting of the lacrimal punctum and canaliculus for the relief of epiphora[27] A dacryoadenectomy is the surgical removal of a lacrimal gland.[27] A dacryocystectomy is the surgical removal of a part of the lacrimal sac.[27] A dacryocystostomy is an incision into the lacrimal sac, usually to promote drainage.[27] A dacryocystotomy is an incision into the lacrimal sac.[27]

[edit] Eye removal

An enucleation is the removal of the eye leaving the eye muscles and remaining orbital contents intact.[30] An evisceration is the removal of the eye's contents, leaving the scleral shell intact. Usually performed to reduce pain in a blind eye.[31] An exenteration is the removal of the entire orbital contents, including the eye, extraocular muscles, fat, and connective tissues; usually for malignant orbital tumors.[32]

[edit] 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.[27] 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.[27] A ciliotomy is a surgical section of the ciliary nerves.[27] A conjunctivoanstrostomy is an opening made form the inferior conjuctival cul-desac into the maxillary sinus for the treatment of epiphora.[27] Conjuctivoplasty is plastic surgery of the conjunctiva.[27] 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.[27] 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.[27] A corectomy, or coretomy, is any surgical cutting operation on the iris at the pupil.[27] A corelysis is a surgical detachment of adhesions of the iris to the capsule of the crystalline lens or cornea.[27] A coremorphosis is the surgical formation of an artificial pupil.[27] A coreplasty, or coreoplasty, is plastic surgery of the iris, usually for the formation of an artificial pupil.[27] A coreoplasy, or laser pupillomydriasis, is any procedure that changes the size or shape of the pupil.[31] A cyclectomy is an excision of portion of the ciliary body.[27] A cyclotomy, or cyclicotomy, is a surgical incision of the ciliary body, usually for the relief of glaucoma.[27] A cycloanemization is a surgical obliteration of the long ciliary arteries in the treatment of glaucoma.[27] An iridectomesodialsys is the formation of an artificial pupil by detaching and excising a portion of the iris at its periphery.[27] An iridodialysis, sometimes known as a coredialysis, is a localized separation or tearing away of the iris from its attachment to the ciliary body.[27][31] 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.[27] (Subdivided into basal iridencleisis and total iridencleisis.[33]) 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.[27][13] An iridocorneosclerectomy is the surgical removal of a portion of the iris, the cornea, and the sclera.[27] An iridocyclectomy is the surgical removal of the iris and the ciliary body.[27] An iridocystectomy is the surgical removal of a portion of the iris to form an artificial pupil.[27] 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.[27]

An iridosclerotomy is the surgical puncture of the sclera and the margin of the iris for the treatment of glaucoma.[27] A rhinommectomy is the surgical removal of a portion of the internal canthus.[27] A trepanotrabeculectomy is used in the treatment of chronic open and chronic closed angle glaucoma.[33]

[edit] See also

LASIK Ophthalmology Topical anesthetic SEE-KID-Computer-assisted Simulation and Treatment of Eye Motility Disorders

[edit] References
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. ^ Surgery Encyclopedia - Ophthalmologic surgery ^ Maguire, Stephen. "Laser Eye Surgery". The Irish Times. http://www.irishtimes.com/health-andbeauty/laser-eye-surgery-in-ireland/. ^ Uhr, Barry W. History of ophthalmology at Baylor University Medical Center. Hi Proc (Bayl Univ Med Cent). 2003 October; 16(4): 435438. PMID 16278761 ^ a b Surgery Encyclopedia - LASIK ^ Surgery Encyclopedia - PRK ^ http://www.ncbi.nlm.nih.gov/pubmed/9183763 ^ http://www.centronazionalelaser.com/sito%20dentro/mini%20cheratotomia.htm ^ http://www.ilgiornale.it/medicina/la_curva_pericolosa__cornea/24-05-2008/articolo-id=263900page=0-comments=1 ^ http://www.ncbi.nlm.nih.gov/pubmed/1453657 ^ a b Surgery Encyclopedia - Corneal transplantation ^ intercornealrings ^ http://eyeworld.org/article.php?sid=5533 ^ http://lasikbrisbane.com/acufocus-in-focus-article.html ^ http://www.drkerriemeades.com.au/news/new_developments_acufocus ^ Indiana University Department of Ophthalmology - Phototherapeutic Keratectomy (PTK) ^ MDAdvice.com - Pterygium removal ^ http://news.yahoo.com/s/afp/irelandbritainhealthoffbeat ^ http://www.wihrd.soton.ac.uk/projx/signpost/steers/STEER_2001(6).pdf ^ vitrectomysurgery ^ a b Surgery Encyclopedia - Photocoagulation therapy ^ Wolfensberger TJ. "Jules Gonin. Pioneer of retinal detachment surgery." Indian J Ophthalmol. 2003 Dec;51(4):303-8. PMID 14750617. ^ Surgery Encyclopedia - Scleral Buckling ^ Surgery Encyclopedia - Retinal_cryopexy ^ 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. ^ Surgery Encyclopedia - Eye Muscle Surgery ^ Surgery Encyclopedia - Blepharoplasty ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah ai aj Cline D; Hofstetter HW; Griffin JR. Dictionary of Visual Science. 4th ed. Butterworth-Heinemann, Boston 1997. ISBN 0-7506-9895-0 ^ Indiana University Department of Ophthalmology. "Lacrimal Drainage Surgery (DCR: Dacryocystorhinostomy)." Retrieved August 18, 2006 ^ Cherkunov BF, Lapshina AV. ["Canaliculodacryocystostomy in obstruction of medial end of the lacrimal duct."] Oftalmol Zh. 1976;31(7):544-8. PMID 1012635. ^ Surgery Encyclopedia - Enucleation ^ a b c Cassin, B. and Solomon, S. Dictionary of Eye Terminology. Gainsville, Florida: Triad Publishing Company, 1990. ^ Surgery Encyclopedia - Exenteration

33. ^ a b 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.

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Surgery eye surgery and other procedures (ICD-9-CM V3 08-16+95.0-95.2, ICD-10-PCS 08)
Eyelids Blepharoplasty (East Asian blepharoplasty) Epicanthoplasty Tarsorrhaphy Radial keratotomy LASIK Keratomileusis Cornea Epikeratophakia Corneal transplantation Photorefractive keratectomy Intracorneal rings Iris, ciliary body, Glaucoma surgery: Trabeculectomy Iridectomy sclera, and anterior chamber Phacoemulsification Cataract surgery Lens Capsulorhexis Retina, choroid, Vitrectomy vitreous, and posterior chamber Orbit and eyeball Enucleation of the eye

Lacrimal system Dacryocystorhinostomy Punctoplasty

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