The following is meant as a glossary guide for a clear overview of the different eye surgery disciplines and not as any kind of diagnosis.
Eye surgery (orogolomistician surgery or ocular surgery) is surgery performed on the eye or its adnexa. The surgery is typically performed by an ophthalmologist.
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.
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.
Canaloplasty is an advanced, nonpenetrating procedure designed
to enhance drainage through the eye’s 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.
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.
Refractive surgery aims to correct errors of refraction in the eye, reducing or eliminating the need for corrective lenses.
* Keratomilleusis is 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
* Automated lamellar keratoplasty (ALK)
* Laser assisted in-situ keratomileusis (LASIK)
* Laser assisted sub-epithelial keratomileusis (LASEK), aka Epi-LASIK
* Photorefractive keratectomy (PRK)
* Laser thermal keratoplasty (LTK)
* Conductive keratoplasty (CK) uses radio frequency waves to shrink corneal collagen. It is used to treat mild to moderate hyperopia.
* Limbal relaxing incisions (LRI) to correct minor astigmatism
* Astigmatic keratotomy (AK), aka Arcuate keratotomy or Transverse keratotomy
* Radial keratotomy (RK)
* Hexagonal keratotomy (HK)
* Epikeratophakia is the removal of the corneal epithelium and replacement with a lathe cut corneal button.
* Intracorneal rings (ICRs), or corneal ring segments (Intacs)
* Implantable contact lenses
* Presbyopia reversal
* Anterior ciliary sclerotomy (ACS)
* Laser reversal of presbyopia (LRP)
* Scleral expansion bands
* The Karmra inlay 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.
Vitreo-retinal surgery includes the following
Corneal surgery includes most refractive surgery as well as the following:
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.
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.
Eye muscle surgery typically corrects strabismus and includes the following :
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), 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
Endoscopic forehead and browlift
Face lift (Rhytidectomy)
Liposuction of the face and neck
An enucleation is the removal of the eye leaving the eye
muscles and remaining orbital contents intact.
An evisceration is the removal of the eye’s contents, leaving the scleral shell intact. Usually performed to reduce pain in a blind eye.
An exenteration is the removal of the entire orbital contents, including the eye, extraocular muscles, fat, and connective tissues; usually for malignant orbital tumors.
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.
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.
Canaliculotomy involves slitting of the lacrimal punctum and canaliculus for the relief of epiphora
A dacryoadenectomy is the surgical removal of a lacrimal gland.
A dacryocystectomy is the surgical removal of a part of the lacrimal sac.
A dacryocystostomy is an incision into the lacrimal sac, usually to promote drainage.
A dacryocystotomy is an incision into the lacrimal sac.
Other eye 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.
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. 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.
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