Ophthalmic Procedures Research Articles

Glove Perforations in Ophthalmic Surgery

To determine the potential rate of intraoperative parenteral exposure of physicians and patients caused by glove perforation during ophthalmic surgery, gloves were analyzed after 125 procedures. Gloves were collected from all surgical team members (surgeon, assistants, scrub nurse, and circulating nurse). The rate of glove perforation was significantly lower for the surgeon, 0.3% (one of 303 gloves) than for the assistants, 5% (ten of 202 gloves [P = .001]), scrub nurses, 16% (52 of 326 gloves [P = .0001]), and circulating nurses, 15% (43 of 293 gloves [P = .0001]); similarly, assistants had a significantly lower rate than did scrub nurses (P = .0001) and circulating nurses (P = .001). There was no statistically significant difference in number of perforations on the basis of surgery duration or type of ophthalmic procedure. These findings suggest that the risk of parenteral exposure during ophthalmic surgery is low for the surgeon, and higher for other surgical personnel. We also analyzed additional safety precautions. Further study is warranted to determine the effectiveness of precautions and to guide policy formulation.

KNOWLEDGE DEFICIT IN THE OPHTHALMIC SURGICAL PATIENT

This case history illustrates some important aspects of the informational needs of ophthalmic surgery patients. As is true with many ophthalmic patients, this patient had a relatively high level of anxiety regarding his potential loss of vision postoperatively. This concern is magnified in a monocular patient. The nurse must help these patients put this concern in the proper perspective by providing accurate information. The nurse who performs such extensive preoperative teaching takes on a role that entails a great deal of responsibility. A planned program of information with written objectives and an outline of the important information to include will help the nurse provide a high level of care in meeting the knowledge needs of the patient. It is not necessary, or even desirable, to develop a plan for each individual patient. A written outline of important and necessary information for each type of ophthalmic surgical procedure provides a means of assuring that the teaching plan is complete and accurate. The information in the teaching plan should be validated by other physician and nurse colleagues. A written plan can save time once it is developed, because the nurse can follow the standard plan, modifying the presentation to meet each patient's specific needs as necessary. The patient indicated feeling somewhat overwhelmed with information when faced with his ophthalmic surgery. It is very important to ensure that the patient and appropriate significant others get both verbal and written information in these situations. The written information gives the patient and his or her family a reference to use when they return home and begin to assimilate more of the information given to them by the nurse. The patient in this case history and his wife both referred to the written instructions several times before and after the operation to verify certain information. The written materials presented information at an appropriate reading level and had large well-spaced print. Repetition (whether verbal or in written format) is important because it reinforces important aspects of the necessary information. The nurse at the surgical facility repeated the postoperative requirements to the patient and his wife before they left the center and made sure that they had the written instructions as well. The nurse demonstrated the necessary motor skills and gave the patient and his wife the opportunity to return the demonstration.

Ophthalmic Desk Reference

Part 1 Synopsis of clinical ophthalmology: ocular trauma and emergency care orbital disease ocular motility neuro-ophthalmology external eye disease uveitis the glaucomas retinal and choroidal vascular disease hereditary chorioretinal dystrophies intraocular tumors systemic disease nonstrabismic pediatric ophthalmology clinical refraction contact lenses. Part 2 Surgical topics: ophthalmic anesthesia common ophthalmic plastic procedures orbital surgery corneal surgery management of cataracts surgical management of the glaucomas retinal and vitreous surgery ophthalmic laser surgery refractive surgery miscellaneous ophthalmic surgical procedures. Part 3 Differential diagnosis. Appendices: glossary of ophthalmic terminology, eponyms and syndromes therapeutics genetics, embryology and anatomic drawings ocular dimensions and basic optical data intraocular lenses, sutures and needles selected diagnostic modalities laboratory norms and conversion tables.

Keratophakia and Keratomileusis: Safety, and Effectiveness

The purpose of the Committee on Ophthalmic Procedures Assessment is to evaluate on a scientific basis new and existing ophthalmic tests, devices, and procedures for their safety, efficacy, clinical effectiveness and appropriate uses. Evaluations include examination of available literature, epidemiological analyses when appropriate, and compilation of opinions from recognized experts and other interested parties. After appropriate review by all contributors, including legal counsel, assessments are submitted to the Academy's Board of Directors for consideration as official Academy policy.

Surgical Procedures Performed After Refractive Surgery

Refractive surgical procedures have been performed for over one decade. The complications that cause visual disability are abnormalities in wound healing, residual ametropia, and/or severe irregular astigmatism. Many of these complications can be manifested clinically in terms of visually disabling problems (loss of best-corrected vision, glare, monocular diplopia, etc). Some of these complications require additional standard ophthalmic or refractive surgical procedures to restore vision. However, since these secondary procedures have been performed in only a few cases, we known little about their outcome. We report the histopathologic analysis of 132 cases that have undergone a secondary surgical procedure following a primary keratorefractive procedure. We attempt to correlate the problems encountered with such secondary intervention with histopathologic information obtained from specimens that have been submitted to our pathology laboratory and that had undergone secondary surgical procedures. Many specimens displayed abnormalities in wound healing associated with visual difficulties such as loss of best corrected acuity, glare, and under- and overcorrection. A short time from the initial procedure to the time of secondary intervention was common. The combination of a secondary surgical or keratorefractive procedure can produce unpredictable refractive results. Judicious application of a refractive procedure and an appropriate time period before a second procedure is performed may reduce unexpected refractive complications.

Reactive Oxygen Species in The Photosensitization of Retinal Pigment Epithelial Cells by Rose Bengal

AbstractRose bengal (RB) is a fluorescein derivative used as a vital stain in certain ophthalmic diagnostic procedures. RB is a potent photo-sensitizer and has been used as a model for photosensitized reactions involving singlet oxygen. Ultraviolet (UV)-visible (UV-VIS) irradiation of RB with nitroblue tetrazolium (NBT) in the absence of glutathione (GSH) induced the reduction of NBT. However since superoxide dismutase (SOD) did not inhibit this NBT reduction it seems to be not mediated by superoxide, but due to the direct reduction of NBT by the excited state of RB. UV-VIS irradiation of RB, NBT, and 1-5 mM GSH reduced larger amounts of NBT. Moreover, SOD partially inhibited the NBT reduction under these conditions, indicating the formation of superoxide. The optimal pH for the formation of superoxide was 7-9. The superoxide formation during UV-VIS irradiation of RB and GSH was not inhibited by the singlet oxygen scavengers β-carotene, sodium azide, or 1,4-diaza-bicyclo[2.2.2]octane (DABCO), indicating t...

Ophthalmic Procedures and Surgery in the Standing Horse

Although many ophthalmic procedures can be performed on the standing horse, the decision to perform a procedure under sedation rather than general anesthesia must be made on the basis of the temperament of the horse, severity of the injury, and skill of the veterinarian. For example, veterinarians who are not comfortable with small suture material may find accurate repair of an eyelid laceration easier after general anesthesia rather than attempting to handle this suture in a moving patient. Correct use of nerve blocks and topical anesthesia will greatly facilitate examination, diagnosis, and treatment, and, in addition, will serve to prevent further damage to the eye during these procedures.

Functional Indications for Upper and Lower Eyelid Blepharoplasty

The purpose of the Committee on Ophthalmic Procedures Assessment is to evaluate on a scientific basis new and existing ophthalmic tests, devices, and procedures for their safety, efficacy, clinical effectiveness and appropriate uses. Evaluations include examination of available literature, epidemiological analyses when appropriate, and compilation of opinions from recognized experts and other interested parties. After appropriate review by all contributors, including legal counsel, assessments are submitted to the Academy's Board of Directors for consideration as official Academy policy.

Corneal Endothelial Photography

The purpose of the Committee on Ophthalmic Procedures Assessment is to evaluate on a scientific basis new and existing ophthalmic tests, devices, and procedures for their safety, efficacy, clinical effectiveness and appropriate uses. Evaluations include examination of available literature, epidemiological analyses when appropriate, and compilation of opinions from recognized experts and other interested parties. After appropriate review by all contributors, including legal counsel, assessments are submitted to the Academy's Board of Directors for consideration as official Academy policy.

Sodium Bicarbonate Reduces Pain Associated With Ophthalmic Nerve Blocks

Administration of local nerve blocks for ophthalmic surgical procedures causes pain resulting in an unpleasant and stressful experience for the patient. A prospective, randomized, double-masked study compared injection pain of anesthetic solutions used for facial and retrobulbar nerve blocks. Anesthetic solutions to which sodium bicarbonate had been added were compared with anesthetic solutions without added sodium bicarbonate. Pain on injection of both facial and retrobulbar nerve blocks was significantly less (P = .0009 and P less than .0001 respectively), without diminution of effectiveness of either type of nerve block, in the group using anesthetic solutions to which sodium bicarbonate had been added.

The Repair of Rhegmatogenous Retinal Detachments

Current techniques of rhegmatogenous retinal detachment repair allow most retinal detachments to be repaired successfully. The success of repair depends on a careful preoperative examination and choice of an appropriate surgical procedure. The surgical procedure must be tailored to the individual eye based on a detailed preoperative examination of the retina and vitreous. Postoperative complications are not infrequent compared to many other ophthalmic surgical procedures such as cataract extraction and strabismus repair. The surgeon must observe the eye carefully in the postoperative period to monitor and treat any complications as they arise. Improvements in surgical techniques coupled with a better understanding of the pathophysiology of rhegmatogenous retinal detachment continue to improve the anatomic and functional success of retinal detachment repair.

A New Ophthalmic Microtrephine

We present a new instrument designed to facilitate the microtrephination of tissues required in various ophthalmic procedures. This microtrephine is a 21-gauge stainless steel tube, 0.81 mm in diameter and 16 mm long, with a sharpened cutting end and a plastic finger-grip area to facilitate micro-rotation. A standard plastic luer hub allows the trephine to be used with a syringe, either a standard type or one with a spring-assisted plunger. Scar tissue, biopsy specimens, or abnormal inflammatory fluids can be suctioned into the syringe for subsequent pathologic examination.

Small-Incision Techniques in Ophthalmic Plastic Surgery

A stepped surgical incision, in which an initial small cutaneous incision is followed by progressively longer incisions in the subcutaneous tissues, limits postoperative scar formation in the skin. Placement of incisions parallel to relaxed skin-tension lines further reduces the size of the scar. We describe how these principles may be applied to ophthalmic plastic surgical procedures to improve cosmesis. Autogenous fascia lata can be harvested with scissors through a 15-mm incision parallel to relaxed skin-tension lines, placed over the middle of the iliotibial tract. Lacrimal bypass operations can be performed well and with good cosmesis through a 12 to 15-mm skin wound if the above principles are followed.

The Value of Strabismus Surgery

Strabismus surgery is indicated for a variety of conditions stemming from misalignment of the eyes, abnormal head posture, and nystagmus. Although part of the value of such surgery lies in the fact that it improves appearance, it differs from cosmetic surgery, because, unlike the latter, it is designed to restore only normal configuration for ocular alignment--straight and/or aligned with the object of regard. A wide array of diagnostic tests are used to determine the precise treatment required, the goal of which is to provide comfortable vision, normal head position, and normal human appearance. In some cases nonsurgical techniques can be used to treat strabismus, but there is no evidence that visual training is an effective means of straightening eyes in those cases where surgery is considered the treatment of choice. For the most common strabismus, essential infantile or "congenital" esotropia, 80+% of infants have "straight" eyes after the initial operation, and 90% after a second operation, most of these with "straight eyes" have residual deviation of 5 prism diopters of esotropia or less. More than 50% of surgically treated patients have stable, long-term satisfactory results. Considering the effort required on the part of the ophthalmologist, together with the physical and psychological benefit to the patient, the cost of strabismus surgery should be equal to that of any major ophthalmic surgical procedure. That strabismus surgery is compensated at a lower rate, than for example, cataract surgery, suggests that strabismus surgery is an excellent value.

Ophthalmic Surgical Procedures

Ophthalmic Surgical Procedures , by Peter S. Hersh, MD, is an easy-to-read and well-illustrated textbook on the commonly performed ophthalmic surgical procedures. It has a very complete bibliography and index, and it appears to be nicely suited for the medical student rotating through ophthalmology as well as for the ophthalmology resident in training. There are general chapters that discuss surgical instrumentation, sutures, anesthesia, and preoperative and postoperative surgical care, and chapters that review the commonly performed ophthalmic surgical procedures with comments on the indications for the procedure, the preoperative preparation, instrumentation, postoperative care, and potential complications. The reader should realize that the procedures described and illustrated may not be the ones that might be encountered in his or her own particular hospital or training program. The reader of this text should also recognize that what is presented is not the only way that a

A New Classification of Ophthalmic Disorders with Standardized Ophthalmic Abbreviations

A classification of ocular disorders has been developed that is both comprehensive and easy to use. Each disorder was assigned a unique abbreviation and cross referenced to the International Classification of Diseases, 9th edition (ICD-9). Ophthalmic procedures, medications, and other terms were similarly standardized and abbreviated. The result is a system of ophthalmic terminology that improves the quality of the medical record, facilitates ICD-9 coding, and makes computer data entry faster and more accurate. The system is published as a standard text with companion handbook. A computer program that uses the system also has been developed.

Principles of ophthalmic anesthesia

Ophthalmic surgery presents the anesthesiologist with many unique challenges. The exigencies of this subspecialty include a comprehensive knowledge of ocular physiology and pharmacology and an understanding of the anesthetic implications intrinsic to a wide variety of ophthalmic procedures.

Significance of the oculocardiac reflex during ophthalmic surgery in the dog

ABSTRACTAntimuscarinic drugs were intentionally excluded from the anaesthetic protocol used in 72 dogs undergoing a variety of ophthalmic surgical procedures. Following premedication with acepromazine and morphine, anaesthesia was induced with thiopentone and maintained with halothane vaporised in oxygen and nitrous oxide. Muscle relaxation was achieved in all dogs using either vecuronium or atracurium and ventilation was controlled to produce mild hypocapnia. Only one patient showed electrocardiographic and arterial blood pressure changes that could be attributed to the oculocardiac reflex. This indicates that the reflex is of minor clinical importance when anaesthesia results in good muscle relaxation, mild hypocapnia and adequate unconsciousness. When these conditions are present the routine use of atropine or glycopyrrolate is unwarranted during ocular surgery in the dog.

Retinal Phototoxicity from the Operating Microscope: The Role of Inspired Oxygen

The effect of the inspired oxygen concentration (FI02) on the production of retinal phototoxicity by the operating microscope was studied in phakic rhesus monkeys. One eye of each monkey was exposed to light under conditions of 99% FIO2, and the other eye was exposed under 21 % oxygen (O2)Three of four locations on each retina were exposed to light for durations varying from 1 1/2 to 20 minutes per exposure. Fundus photographs and fluorescein angiograms were obtained 24 to 72 hours after exposure. Animals were euthanatized for analysis of retinal histopathology at intervals from 2 weeks to 8 months after light exposure. Retinal phototoxic lesions were produced after an average of 5 minutes of light exposure under both 21 and 99% O2. O2 potentiated the light damage both clinically and histologically. Under both conditions, lesion size was directly related to the duration of light exposure (P < 0.005). Lesions near threshold produced with 99% FIO2 were 1.6 to 6.9 (mean, 2.9) times larger than the corresponding lesions formed with 21 % FIO2. Histologic damage was likewise more severe in lesions produced under high O2 conditions. Retinal repair occurred in lesions produced under high and low O2 conditions. Photoreceptor regeneration was nearly complete by 18 weeks, whereas retinal pigment epithelial (RPE) recovery lagged up to 11/2 months. The results of this study have important implications for clinical practice: the operating microscope can produce retinal phototoxicity rapidly, and O2 administered during ophthalmic procedures may potentiate the damage if appropriate precautions are not taken.

Peribulbar anesthesia for ophthalmic procedures

A modified version of peribulbar anesthesia is described. An analysis of 230 consecutive ophthalmic procedures including cataract surgery, penetrating keratoplasty, and scleral buckling demonstrates the safety and effectiveness of this modified peribulbar anesthesia technique.