Ophthalmologic Surgery Health Article

Definition

Ophthalmologic surgery is a surgical procedure performed on the eye or any part of the eye.

Purpose

Surgery on the eye is routinely performed to repair retinal defects, remove cataracts or cancer, or to repair eye muscles. The most common purpose of ophthalmologic surgery is to restore or improve vision.

Demographics

Patients from the very young to very old have ocular conditions that warrant eye surgery. Two of the most common procedures are phacoemulsification for cataracts and elective refractive surgeries.

Cataract surgery is the most common ophthalmic procedure. More than 1.5 million cataract surgeries are performed in the United States each year. The National Eye Institute (NEI) recently reported that more than half of all United States residents age 65 and older have a cataract.

Elective refractive surgeries, especially laser in-situ keratomileusis (LASIK), attract younger patients in their thirties and forties. Recently, the American Academy of Ophthalmology (AAO) estimated that 95% of the 1.8 million refractive surgery procedures performed in a year were LASIK.

Description

The surgeon, operating room nurses, and an anesthesiologist are present for ophthalmologic surgery. For many eye surgeries, only a local anesthetic is used, and the patient is awake but relaxed. The patient's eye area is scrubbed prior to surgery, and sterile drapes are placed over the shoulders and head. Heart rate and blood pressure are monitored throughout the procedure. The patient is required to lie still and for some surgery, especially refractive surgery, he or she is asked to focus on the light of the operating microscope. A speculum is placed in the eye to hold it open throughout surgery.

Common ophthalmologic surgery tools include scalpels, blades, forceps, speculums, and scissors. Many ophthalmologic surgeries now use lasers, which decrease the operating time as well as recovery time.

Surgeries requiring suturing can take as long as two to three hours. These intricate surgeries sometimes require the skill of a corneal or vitreo-retinal specialist, and require the patient to be put under general anesthesia.

Refractive surgeries

Refractive surgeries use an excimer laser to reshape the cornea. The surgeon creates a flap of tissue across the cornea with an instrument called a microkeratome, ablates the cornea for about 30 seconds, and then replaces the flap. The laser allows this surgery to take only minutes, without the use of stitches.

Trabeculectomy

Trabeculectomy surgery uses a laser to open the drainage canals or make an opening in the iris to increase outflow of aqueous humor. The purpose is to lower intraocular pressure in the treatment of glaucoma.

Laser photocoagulation

Laser photocoagulation is used to treat some forms of wet age-related macular degeneration. The procedure stops leakage of abnormal blood vessels by burning them to slow the progress of the disease.

Diagnosis/Preparation

Patients complaining of any ocular problem that requires surgery will receive a similar initial examination. A complete patient history is taken, including the chief complaint. The patient needs to disclose any allergies, medication usage, family eye and medical histories, and vocational and recreational vision requirements.

The diagnostic exam should include measurement of visual acuity under both low and high illumination, biomicroscopy with pupillary dilation, stereoscopic fundus examination with pupillary dilation, assessment of ocular motility and binocularity, visual fields, evaluation of pupillary responses to rule out afferent pupillary defects, refraction, and measurement of intraocular pressure (IOP).

Other examination procedures include corneal mapping, a keratometer reading to determine the curvature of the central part of the cornea, and a slit lamp exam to determine any damage to the cornea and evidence of glaucoma and cataracts. A fundus exam also will be performed to check for retinal holes, and macular degeneration and disease.

The patient's overall health must also be considered. Poor general health will affect the ophthalmologic surgery outcome. Surgeons may request a complete physical examination, in addition to the eye examination, prior to surgery.