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Ophthalmology

PROCEDURE: Extracapsular Cataract Extraction

The patient is given intravenous analgesia and cardiovascular monitoring by the anesthesiologist. I administer a Nadbath and retrobulbar block to the left eye, using 2% Xylocaine containing Wydase and epinephrine. The patient is then prepped and draped so as to expose the left eye in a sterile field.

A Barraquer lid speculum is inserted. Intraocular pressure is normal to palpation. The globe is in good position for surgery, so no superior rectus bridle suture is needed.

A corneal stab incision is made through peripheral cornea at the 3 o'clock meridian into the anterior chamber with a 15-degree razor blade. The anterior chamber is filled with Vitrax. A peripheral corneal incision, self-sealing of a shelving nature is made superiorly, using a 2.8-mm phacoemulsification blade. Following this, an anterior capsulorrhexis, 5.5 mm in diameter, is performed using Stolte forceps and cystotome.

The nucleus is hydrodelineated from cortex by injection of balanced salt solution and the nucleus is phacoemulsified by dividing it into quadrants and phacoemulsifying each quadrant separately in the posterior chamber. Cortex is aspirated and irrigated and removed. It is noticed that there is a slit in the anterior portion of the capsule, extending toward the zonules at the 5:30 meridian. Posterior capsule is entirely intact. The capsular bag is inflated with Vitrax.

The incision is now enlarged from 2.8 to 5.5 mm. The intraocular lens is examined, irrigated and slid through the incision, and haptics are placed in the capsular bag. The lens is rotated slightly so that the haptics end up in the 9 and 3 o'clock meridian. The lens centers well.

Vitrax is removed by irrigation-aspiration. The incision is examined and found to be watertight and self-sealing. The lens is perfectly centered. At the end of the procedure, the cornea is clear. The anterior chamber is deep and clear. The lens is in a good position in the capsular bag. The incision site is watertight and self-sealing and a good result is anticipated.

The patient has been given Ancef 1 g intravenously prior to the onset of surgery. At this point, Tobradex ophthalmic ointment and a sterile patch and shield are applied.

Other terms: wet-field cautery, Tenon's, sub-Tenon's, Viscoat, Miochol Van Lint block, Healon *See Vitrax.

PROCEDURE: Pars Plana Vitrectomy/Inspection of Retina With Scleral Depression Right Eye

The patient was taken to the operating room and administered a 6 mL Nadbath block and 4 mL peribulbar block. Anesthetic mixture consisted of equal parts of 2% lidocaine without epinephrine, 0.75% Marcaine, 150 units of Wydase. The eye was prepped and draped in the usual sterile fashion.

A wire lid speculum was placed. Limbal peritomy was made temporally and superiorly. The areas peritomized were then cauterized lightly. Three sclerotomies were made in a standard fashion, 3.5 mm posterior to the limbus. In the inferior sclerotomy, a 4-mm infusion cannula was secured. The tip of the cannula was visualized in the midvitreous cavity and infusion of balanced salt solution plus was turned on. In the 2 additional sclerotomies at 10 and 2 o'clock, a light pipe and vitrector were placed.

Using the vitrector under high suction, but low cutting, cortical material, which was blocking the visual access, was first removed from the eye. Care was taken not to disturb the placement of the intraocular lens implant. A 4-mm central opening in the retrolental space was made in this fashion. The vitrectomy was then extended posteriorly until the retina could be visualized. The vitrectomy was extended peripherally as far as visualization could allow.

Cortical fragments were present on the retinal surface, and these removed with aspiration using the ocutome. After this was done, the superior sclerotomies were plugged and the retina was inspected with indirect ophthalmoscopy and scleral depression. No retinal tears, subretinal fluid nor hemorrhages were found. The peripheral retina was attached. The 3 sclerotomies were then closed with 7-0 Vicryl suture. At the conclusion of the procedure, 20 mg of gentamicin, 20 mg of Solu-Medrol were injected in the subconjunctival space. One drop each of 1% Atropine and Tobradex were placed on the cornea. The eye was patched and shielded.

PROCEDURE: Scleral Buckle Left Eye for Retinal Detachment

The patient was placed supine on the operating table in the usual fashion. A retrobulbar injection of Xylocaine and Marcaine was given on the left side. The patient was prepped and draped in the usual sterile manner.

Peritomy was performed to the limbus. The rectus muscles were isolated, and 4-0 silk sutures placed beneath. The eye was examined with the indirect ophthalmoscope.

There was a retinal detachment present temporally involving the macula. Cryocoagulation was performed to areas superior temporally and inferior temporally which were suspicious for retinal tears. A #41 band was placed around the eye and fastened in all 4 quadrants. The band was tied together superior temporally and pulled to give a buckle effect. Paracentesis was performed to normalize the intraocular pressure.

The eye was examined with the ophthalmoscope. There was a good buckle effect present for 360 degrees. There was residual subretinal fluid present and there was good perfusion of the optic nerve.

At this point, the sutures were removed from the rectus muscles. The conjunctivae closed with 6-0 plain suture. Subconjunctival gentamicin and Solu-Medrol were given. Atropine drops and Tobradex drops were placed in the eye. A patch and shield were placed over the eye.