opothalamic surgery and Ophthalmic instrument

Ophthalmic instrument

1. د/شيعي لآ شيعي ضئاع
O.T- LEC 4

2. ANATOMY OF EYE

3. OPHTHALMIC SURGERY
The patient under going ophthalmic surgery faces impairment of vision,
or loss of vision if the outcome of the surgical intervention is un favorable.
Surgical procedures on the eye are extremely delicate surgery and needs
delicate instruments.
It needs steady hands.
Quiet surrounding.
The operating microscope, all accessory equipments should be set up and
checked before the surgical procedure.
Instruments should be protected and handled with extreme care before,
during and after use.

4. OPHTHALMIC SURGERY
Ophthalmic drugs:

Mydriatic and miotic drugs are medications may be given to alter the size
of the pupil.
 Mydriatic drugs used to dilate the pupil.
Miotic drugs used to constrict the pupil.
Local and topical anesthesia can be done in all patients except in
children.

Anesthesia can be by topical instillation or local infiltration by injection of the
lid

5. Ocular surgical procedures:
Extra ocular procedures are conditions
affecting the exterior surface of the eye.
Intra ocular procedures are conditions
pertaining to the interior contents of the
eye.

6. Extra ocular procedures:

Eyelid:
Excision of neoplasm of the eyelid: tissue may be excised with a knife or electro
surgical unit.
Chalazion: an extremely common but benign tumor of the lid, it can be
malignant.
Correction of pitosis: is a drooping of the upper lid, may be acquired in
adulthood but is more commonly congenital.
Acquired malformations of the eyelid are conditions such as senile ectropin or
entropin, most commonly affect the lower lid.
Ectropin: is a condition in which either the upper or the lower lid is everted (
turned out).
Entropin: is a condition in which either the upper or the lower lid is enverted
(turned in).

7. LACRIMAL APPARATUS:
Lacrimal duct dilation: done for excessive tearing. A seies of
probes graduated in size are introduced by one into the duct
system to permit drainage of tears.
Dacryocystectomy: removal of the lacrimal sac due to chronic
inflammation.
 Dacryocystorhinostomy (DCR): construction of a new opening into
the nasal cavity from the lacrimal sac is performed to correct
congenital malformation or trauma to the nasolacrimal duct. A
new tear drainage system is constructed

8. EXTRA OCULAR MUSCLE:
Procedures on the oculomotor muscles
which control eye movement, are done to
correct misalignment (squint) that
interferes with the ability of the two eyes
to remain in simultaneous focus on a
viewed object.
The surgical procedures are to correct
muscle imbalance by strengthen a weak
muscle or weakening an over active one.

9. INTRA OCULAR PROCEDURES:

Cornea:
Cauterization of cornea: can be done with chemicals or heat for the ulceration
of cornea that does not respond to antibiotics.
Pterygium: it is benign growth of the conjunctival tissue over the corneal
surface.
Corneal transplantation (Keratoplasty): damaged cornea is removed and
replaced with a healthy cornea from a human donor. Because the cornea is
a vascular keratoplasty is the most successful transplantation procedure
and has less rejection phenomena than all other tissues except bone.
Suture 10/o or 11/o nylon is used.
Types of corneal graft:
Full thickness- the common type. The entire diameter of the corneal graft is
replaced.
 Partial thickness- the top layer of the cornea, not its entire depth.

10. INTRA OCULAR PROCEDURES:

Glaucoma:
Is a disease characterized by abnormally increased intraocular pressure (IOP).
It often involves the iris.
Uncontrolled glaucoma progress to:
Atrophy of the optic nerve.
Hardening of the eyeball.
Blindness.
The incidence of glaucoma in persons older than 40 years old increases.
There is a familial predisposition to the disease.
IOP is estimated by Tonometer or Slit lamp.

11. INTRA OCULAR PROCEDURES:

Surgical procedures for glaucoma:
1.Iridectomy: Excising a sector of the iris.
Iridotomy: Cutting a small opening in the iris.
They are done to deflate mechanical obstruction, thus increasing drainage by permitting the normal
outflow of aqueous from the posterior to the anterior chamber.
2.Filtering type procedures: such as trephining and
trabeculectomy. It is done by creating an artificial
fistula between the angle of the anterior chamber
and the subconjunctival space to bypass the usual
blocked outflow channels.
3.Cyclodialysis, cyclodiathermy, and
Cyclocryotherapy are performed to diminish
aqueous secretion by the ciliary body.
Cyclodialysis- involves severing the blood supply of the ciliray body.
Cyclodiathermy- application of heat.
Cyclocryotherpy- application of cold.

12. INTRA OCULAR PROCEDURES:

:Cataract
Is an opacification of the crystalline lens, its capsule or both.
The more or less opaque lens does not transmit clear images to the retina.
Causes for cataract:
Metabolic or systemic disease.
Toxic material.
Radiation.
Trauma.
Genetic factors.
Can be done as a day care procedure.
It is classified as one of the following:
Congenital.
Senile or primary.
Secondary resulting from local or systemic disease or eye injury.

13. INTRA OCULAR PROCEDURES:

Surgery is the only treatment for cataract.
Extra capsular Extraction (ECCE):
The lens is delivered through a small incision in the region of the limbus (the
junction of the cornea and sclera).
The anterior capsule is incised with a cystotome.
The nucleus is delivered by manual expression or by phacoemulsification.
The remaining cortex is extracted by irrigation aspiration devices, sparing the
posterior capsule which is left in place.
The wound is closed with a few sutures.
Implantation of intraocular lens (IOL):
It is a microsurgical procedure in which an IOL is implanted in almost the identical
position of the original lens and there for does not change the size of retinal
image.
IOL can be:
Anterior chamber- angle fixation.
Posterior chamber- Capsular or ciliary body fixation.

14. Ophthalmic
instrument

15. NTRODUCTION
Ophthalmology deals with precision surgery of a relatively small
and highly delicate and specialized structure. The instruments used
in ophthalmic surgeries hence, need to be precise, efficient, light
weight and well controlled for a given surgical task. Ophthalmology
instruments underwent a big change with the advent of the operating
microscope, with the need for lighter instruments with non reflective
surfaces becoming the norm. Ophthalmic instruments hence came
to be made of titanium alloys, which is lighter than steel, corrosion
resistant and has a matte finish. However, a major drawback is that
titanium alloys cannot maintain sharp edges
Following is a brief description of the common and basic instruments used in
majority
of ophthalmological surgeries

16. LID SPECULUMS

Speculums are essential for exposure and visualization, in both
intraocular and extraocular surgeries. A variety of speculums are
available, however, the most commonly used are Barraquer Wire
Speculum and the self-retaining speculum with screw .
Speculums with solid blades are heavier and are mainly used in
extraocular
surgeries like strabismus
Wire speculum is most commonly used speculum for adequate
exposure of eye during any ocular surgery and retrieval of globe/

17. LID SPECULUMS

18. LID SPECULUMS

Uses
Eye speculums are used to keep the lids apart during:

Any intraocular operation such as cataract, vitreoretinal
and glaucoma surgery
Any extraocular surgery, e.g. squint surgery, pterygium
surgery

19. KELMAN-MCPHERSON FORCEPS

20. KELMAN-MCPHERSON FORCEPS


Uses
• To hold and insert polymethyl methacrylate (PMMA) intraocular
lens (IOL)
• For loading foldable IOLs in the cartridge
• It is used for tying 0-8 to 0-11 sutures
• It is also useful for holding /tearing the lens capsule tags

21. SUTURE TYING FORCEPS

These are fine and delicate, nontooth catch less forceps, used to hold
and tie the fine sutures used in ophthalmic surgeries

22. LIM’S CORNEOSCLERAL FORCEPS
Uses
These are used to hold the cornea or scleral edge (of incision) for
suturing during cataract surgery, glaucoma surgery, repair of
corneal
and/or scleral tears and penetrating or lamellar keratoplasty

These are toothed forceps with very fine teeth (1 × 2) at the tip and
has a tying platform

23. SUPERIOR RECTUS HOLDING FORCEPS

It is toothed forceps (1 ×2 teeth)
Uses
It is used to hold the superior rectus muscle in order to pass the
bridle
suture for fixing the eyeball during surgery .
The eyeball is rotated downwards which is useful in intracapsular
cataract extraction, extracapsular cataract extraction, corneal
surgeries and glaucoma surgeries

24. UTRATA CAPSULORHEXIS FORCEPS
Uses
It can be used to pick up the anterior capsular flap created by the
cystotome needle to complete the capsulorhexis
It can be used instead of cystotome needle for capsulorhexis .

25. EYE SCISSORS

Straight Scissors
It is a fine pointed scissors with straight sharp cutting
bladesIt is used to cut conjunctival sutures, eyelashes and
muscles .

26. VANNAS SCISSORS
Uses
Cutting anterior capsule of the lens in extracapsular surgery and
for cutting 0-10 nylon sutures
For doing pupillary sphincterotomy
For performing iridectomy

27. CORNEAL SCISSORS OR SECTION ENLARGING SCISSORS
Uses
These are used to enlarge corneal or corneoscleral incision for
conventional intracapsular and extracapsular cataract extraction
cataract surgery
To enlarge corneal incision in keratoplasty operation
To cut the scleral and trabecular tissue in trabeculectomy.

28. CONJUNCTIVAL SPRING SCISSORS (WESTCOTT’S)

Uses
They are used as a handy alternative to plain straight and plain
curved ringed scissors for cutting and undermining conjunctiva
in
various operations and to cut sutures

29. CASTROVIEJO-KALT NEEDLE HOLDER
Kalt needle holder is a commonly
used tool in postoperative management of ophthalmologic
procedures. The instrument is used to grip the needle in
strabismu
lid, or lacrimal operations.

NEEDLE HOLDER

30. ARRUGA NEEDLE HOLDER

It has a locking mechanism to better stabilize the needle
It is used for extraocular procedures such as lid surgery and passing
the bridle sutures under rectus muscles, etc

31. Barraquer Needle Holder
It is used as needle holders especially in retina surgery
(posterior compartment).
They are a type of straight needle holders
The jaws of the needle holder are finely serrated to
hold the fine needles firmly. Spring type needle
holders are for passing sutures in the
conjunctiva, cornea, sclera and extraocular muscles

32. CASTROVIEJO CALIPERS
CALLIPERS

33. CASTROVIEJO CALIPERS

34. INSTRUMENT BOX