BASIC OCULAR SURGERIES

Fatima Medical Center

Dr. Vicente O. Santos Jr., MD
Operations on the Lens

Cataracts causing visual impairment

Severe errors of refraction
Patients with severe diabetic retinopathy
Congenital cataract
Artificial intraocular lens
ECCE w/ PCIOL- Extra
Capsular Cataract Extraction w/
Posterior Chamber Intraocular
Lens Implantation
Description of Procedure
Anesthesia- either topical,retrobulbar, peribulbar, gen.
Anes etc
Conjunctival incision, sclera cauterized
Partial thickness limbal incision
Anterior capsulotomy
Full thickness limbal incision
Lens nucleus delivery
Anterior chamber is maintained with sutures
Cortical material is removed
IOL is implanted
Final sutures
phacoemulsification
ecce
POSSIBLE COMPLICATIONS

UGH- Uvietis, Glaucoma, Hemorrhage

Vitreous loss
Infection
Retinal detachment
Decentration of IOL
Induced astigmatism
Corneal edema
endophthalmitis
Phacoemulsification W/ PCIOL
Description of Procedure
•Pre-set corneal stab incision is made
•Continuous curvilinear capsulorrhexis
•Hydro dissection of the lens
•Phacoemulsification is carried out
•Cortical material is removed
•A smaller IOL placed
 Complications

All of the things that can happen in

ECCE can happen to Phaco
 Advantage

Less induced astigmatism with

better uncorrected visual acuity
OPRERATIONS ON EXTRA
OCULAR MUSCLES
Squint surgery

Indications are- 1. Cosmetic

considerations, 2. Diplopia
3.prevention of amblyopia in
strabismic patients
Prerequisites for surgery

Correction of refractive error

Must rule out organic causes of strabismus,
ROP, retinoblastoma, etc.
Measure deviations by loose prisms and
compared with a normogarm based on
surgeons experience
Description of Procedure

Conjunctival incision
EOMs are isolated
Strengthened(resection) or
weakened(recessed)
EOMs are reattached w/ absorbable sutures
Conjunctiva is sutured
Squint Surgery
Resection
Recession
Complications

Overcorrection/undercorrection
Ocular perforation
Retinal detachment
Glaucoma Surgical Procedures

A. TRABECULECTOMY
Indications

Uncontrolled with medical therapy

Acute angle closure glaucoma
Deteriorating visual fields
Description of Procedure

Conjunctiva is incised
Scleral flap is fashioned
Trabecular tissue flap is excised
Peripheral iridectomy is done
Scleral flap is loosely sutured
Conjunctiva is sutured
Complications

Hypotension
Hemorrhage
Endophthalmitis
failure
B. Cryotherapy
Indications
Failure of surgery
Pain from increased IOP
Description of Procedures

Area of the ciliary body is frozen by a

cryoprobe
Circular or semi circular fashion depending
on the goals of the surgeon
Complications

Failure
Pthisis bulbi
DESTRUCTIVE PROCEDURES
Enucleation- Indications:

Severely destroyed, perforated eyeball, w/ loss of

structural integrity
Prevention of sympathetic ophthalmia
Retinoblastoma
Malignant melanoma
Cosmetic removal of pthisical eyeball
Blind painful eye
Description of Procedures
Conjunctiva is incised
EOMs are isolated and suture tagged
Optic nerve is cut
Tamponade
Placement of prosthetic eyeball
EOMs sutured together
Tenon’s capsule is sutured
Conformer is placed in the fornices
Prosthetic conformer is placed after several weeks
Complications

Protrusion of prosthetic ball

Wound dehiscence
Orbital infection
B. EVISCERATION-removal of
intraocular contents, maintaining the
sclera, EOMs and Periorbita
Indication- endophthalmitis
Severe perforation of the eyeball
Blind painful eye
Description of the procedure

Cornea is excised
Lens, uvea, and retina is removed w/ an
evisceration spoon
Prosthetic ball is placed in the Scleral shell
Sclera is sutured
Conjunctiva is closed
Conformer is placed
Prosthetic eyeball is placed after several wks.
C. Exenteration-removal of the eyeball,
EOMs, periorbita ,leaving only the bony orbit

Indications- devastating malignant tumors

Description of procedure-
lower eyelid incision is made
Incision is carried down to the bony orbit
Orbital contents are de-gloved
Tamponade is achieved through sponges
Post-op bandages are applied
Cosmetic prosthesis may be used after several
weeks
OPERATIONS ON THE LACRIMAL
APPARATUS(DCR)

Indications:
Epiphora
Secondary infection
Description of Procedure

Paranasal skin incision below the lower

punctum is made
Dissection until the nasal bone
Removal of portion of nasal bone
Connection between the nasal mucosa and
lacrimal sac is made
Temporary silicone stent is placed
Skin is closed
Dacryocystorhinostomy
DCR with stent
complications

Infection
Failure
Hemorrhage

Procedure now is being replaced by

LASER DCR
Operations on the Retina
A. Scleral Buckling

Indications- retinal detachment w/o

proliferative vitreoretinopathy
Description of the procedure

Conjunctiva is incised
EOM’s are isolated
Retinal hole is located
External drainage of fluid is done
Cryotreatment of hole is done
Buckle is placed where the hole is ; supported by an
encircling band
Closure of the conjunctiva
expansile gas is placed (optional)
Complications

Hemorrhage
Glaucoma
Induced myopia/hyperopia & astigmatism
Retinal incarceration
Vitrectomy

Indications:

Retinal detachment/Retinal redetachment

Vitreous hemorrhage/Vitritis
Endophthalmitis
Dislocated lens/IOL’s
Perforating ocular injuries
Intraocular foreign bodies
Description of procedure

Conjunctival incision
Isolation of EOM’s
Creation of pars plana ports
Placement of special operating lens
Removal of vitreous using a probe, infusion
cannula,light pipe
Special procedures may be done w/in the
procedure (GFX, Retinotomies, Endolaser,
Perflourocarbon injection)
cont

Optional cryotreatment
Optional scleral buckling
Optional expansile gas
OptionaL silicone oil placement
Closure of the conjunctiva
complications

Glaucoma
Iatrogenic retinal breaks
Cataracts(most common)
Induced EOR
Pthisis bulbi
Endophthalmitis
Uveitis
Ptosis
Ptosis Surgery
Ptosis surgery
Entropion Surgery
Entropion Surgery
THANK YOU!