Eye Surgery Article Index for
Eye
Website Links For
Eye
 

Information About

Eye Surgery





LASER SURGERY AND INCISIONAL 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.


TYPES OF EYE SURGERIES


Cataract surgery

See Also: Cataract surgery


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). Due to the high prevalence of cataracts, cataract extraction is the most common eye surgeryUhr, Barry W. ''History of ophthalmology at Baylor University Medical Center''. Proc (Bayl Univ Med Cent). 2003 October; 16(4): 435–438. PMID 16278761. The two main types of cataract extraction are intracapsular cataract extraction (ICCE) and extracapsular cataract extraction (ECCE).

is a form of ICCE that freezes the lens with a cryogenic substance such as Liquid Nitrogen Surgery Encyclopedia - Cryotherapy for cataracts . Although it is now used primarily for the removal of subluxated lenses, it was the favored form of cataract extraction from the late 1960s to the early 1980sMeadow, Norman B. '' Cryotherapy: A fall from grace, but not a crash ''. Ophthalmology Times. October, 15, 2005..

. Conventional extracapsular cataract extraction involves manual expression of the lens through an incision made in the Cornea or Sclera . Although it requires a larger incision and the use of stitches, the conventional method is indicated for patients with very hard cataracts or weak corneal epithelial tissue. Phacoemulsification involves the use of an ultrasonic vibrating handpiece to shatter and break up a cataract, thus making it easier to remove. Because a smaller incision is required, few or no stitches are needed and the patient's recovery time is usually shorter Surgery Encyclopedia - Phacoemulsification for cataracts .

A Capsulotomy is a procedure to open a portion of the lens capsule. An anterior capsulotomy refers to the opening of the front portion of the lens capsule, whereas a posterior capsulotomy refers to the opening of the back portion of the lens capsule. In an extracapsular surgery, the surgeon performs an anterior capsulotomy, or Capsulorhexis , to create an opening through which the lens nucleus can be removed and the intraocular lens implant inserted. An opacification or clouding of the posterior lens capsule frequently occurs in those who have had an extracapsular cataract extraction procedure, therefore, a laser posterior capsulotomy, or YAG Laser capsulotomy, is used to clear the back implant surface Surgery Encyclopedia - Laser posterior capsulotomy . (Whereas a capsulotomy is the creation of an opening in the lens capsule, a capsulectomy is the acutal removal of lens capsule tissue.)


Glaucoma surgery

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 glaucoma surgeries, and variations or combinations of those surgeries, 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.


Procedures that facilitate outflow of aqueous humor


''Laser trabeculoplasty''

A trabeculoplasty is a modification of the to target specific cells within the trabecular meshwork and create less thermal damage than ALT Review of Optometry - SLT: The Laser Picks Up Where Medications Leave Off
Glaucoma Research Foundation - SLT: A New Type of Glaucoma Surgery .

''Iridotomy''

An iridotomy involves making puncture-like openings through the Iris without the removal of iris tissue. Performed either with standard surgical instruments or a laser, it is typically used to decrease intraocular pressure in patients with angle-closure glaucoma. A '''laser peripheral iridotomy''' (LPI) is the application of a laser beam to selectively burn a hold through the iris near its base. LPI may be performed with either an argon laser or Nd:YAG laser Surgery Encyclopedia - Laser iridotomy
EyeMDLink.com - Laser Peripheral Iridotomy (PI) .

''Iridectomy''

An iridectomy, also known as a corectomy or surgical iridectomy, involves the removal of a portion of iris tissue Surgery Encyclopedia - Iridectomy . A basal iridectomy is the removal of iris tissue from the far periphery, near the iris root; a peripheral iridectomy is the removal of iris tissue at the periphery; and a sector iridectomy is the removal of a wedge-shaped section of iris that extends from the pupil margin to the iris root, leaving a keyhole-shaped pupil.

''Filtering procedures: penetrating vs. non-penetrating''

Filtering surgeries are the mainstay of surgical treatment to control intraocular pressureJacobi PC, Dietlein TS, Krieglstein GK. "Technique of goniocurettage: a potential treatment for advanced chronic open angle glaucoma." ''Br J Ophthalmol''. 1997 Apr;81(4):302-7. PMID 9215060.. An anterior sclerotomy or '''sclerostomy''' is used to gain access to the inner layers of the eye {Link without Title}
[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=10150851&dopt=Abstract in order to create a drainage channel from the anterior chamber to the external surface of the eye under the conjunctiva, allowing aqueous to seep into a bleb from which it is slowly absorbed. Filtering procedures are typically divided into either penetrating or non-penetrating types depending upon whether an intraoperative entry into the anterior chamber occurs [http://www.jdosmp.org/glaucoma_filtering_surgeries.html .

Penetrating filtering surgeries are further subdivided into guarded filtering procedures, also known as protected, subscleral, or partial thickness filtering procedures (in which the surgeon sutures a scleral flap over the sclerostomy site and full thickness procedures [http://adam.about.com/reports/000025_8.htm . Trabeculectomy is a guarded filtering procedure that removes of part of the trabecular meshwork Surgery Encyclopedia - Trabeculectomy Full thickness procedures include sclerectomy, posterior lip sclerectomy (in which the surgeon completely excises the sclera on the area of the sclerostomy [http://www.revoptom.com/index.asp?ArticleType=SiteSpec&page=body/articles/10_2001/ro259.htm ), trephination, thermal sclerostomy (Scheie procedure), iridenclesis, and sclerostomy (including conventional sclerostomy and enzymatic sclerostomy) [http://www.jdosmp.org/glaucoma_filtering_surgeries.html .

Non-penetrating filtering surgeries do not penetrate or enter the eye's , the trabecular meshwork, and the anterior chamber. Also known as non-penetrating trabeculectomy (NPT), it is an ab externo (from the outside), major ocular procedure in which Schlemm's canal is surgically exposed by making a large and very deep scleral flap. The inner wall of Schlemm's canal is stripped off after surgically exposing the canal Deep sclerectomy, also known as nonpenetrating deep sclerectomy (PDS) or nonpenetrating trabeculectomy is a filtering surgery where the internal wall of Schlemm's canal is excised, allowing subconjunctival filtration without actually entering the anterior chamber [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15005582&query_hl=2 ; it is commonly performed with the Aquaflow® collagen wick Viscocanalostomy is also an ab externo, major ocular procedure in which Schlemm's canal is surgically exposed by making a large and very deep scleral flap. In the VC procedure, Schlemm's canal is cannulated and viscoelastic substance injected (which dilates Schlemm's canal and the aqueous collector channels)[http://appft1.uspto.gov/netacgi/nph-Parser?Sect1=PTO2&Sect2=HITOFF&u=%2Fnetahtml%2FPTO%2Fsearch-adv.html&r=69&f=G&l=50&d=PG01&s1=penis&p=2&OS=toilet&RS=toilet .

''Other surgical procedures''

Goniotomy and '''trabeculotomy''' are similar simple and directed techniques of microsurgical dissection with mechanical disruption of the trabecular meshwork [http://www.emedicine.com/oph/topic138.htm Gonotomy procedures include surgical goniotomy and laser goniotomy. A surgical goniotomy involves cutting the fibers of the trabecular meshwork to allow aqueous fluid to flow more freely from the eye [http://www.emedicinehealth.com/articles/38365-6.asp Surgery Encyclopedia - Goniotomy . Laser goniotomy is also known as goniophotoablation and laser trabecular ablation In many patients suffering from congenital glaucoma, the cornea is not clear enough to visualize the anterior chamber angle. Although an endoscopic goniotomy, which employs an endoscope to view the anterior chamber angle, may be performed [http://spiedl.aip.org/getabs/servlet/GetabsServlet?prog=normal&id=PSISDG002126000001000259000001&idtype=cvips&gifs=yes , a trabeculotomy which accesses the angle from the exterior surface of the eye, thereby eliminating the need for a clear cornea, is usually preferred in these instances. A specially designed probe is used to tear through the trabecular meshwork to open it and allow fluid flow Video

Tube-shunt surgery or '''drainage implant surgery''' involves the placement of a tube to facilitate aqueous outflow from the anterior chamber Surgery Encyclopedia - Tube-shunt surgery Trabeculopuncture uses a Q switched Nd:YAG laser to punch small holes in the trabecular meshwork with [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=4022580&dopt=Abstract [http://appft1.uspto.gov/netacgi/nph-Parser?Sect1=PTO2&Sect2=HITOFF&u=%2Fnetahtml%2FPTO%2Fsearch-adv.html&r=69&f=G&l=50&d=PG01&s1=penis&p=2&OS=toilet&RS=toilet . '''Goniocurretage''' is an "ab interno" (from the inside) procedure that used an instrument "to scrape pathologically altered trabecular meshwork off the scleral sulcus" [http://appft1.uspto.gov/netacgi/nph-Parser?Sect1=PTO2&Sect2=HITOFF&u=%2Fnetahtml%2FPTO%2Fsearch-adv.html&r=69&f=G&l=50&d=PG01&s1=penis&p=2&OS=toilet&RS=toilet . A surgical '''cyclodialysis''' is a rarely used procedure that aims to separate the ciliary body from the sclera.


Procedures that decrease production of aqueous humor

Certain cells within the eye's Ciliary Body produce aqueous humor. A ciliary destructive or cyclodestructive procedure is one that aims to destroy those cells in order to reduce intraocular pressure Cyclocryotherapy, or cyclocryopexy, uses a freezing probe [http://www.wills-glaucoma.org/cyclotherapy.htm . Cyclophotocoagulation, also known as transscleral cyclophotocoagulation, ciliary body ablation, cyclophotoablation [http://www.techniques-in-ophthalmology.com/pt/re/techophth/abstract.00145756-200312000-00007.htm;jsessionid=DmVgzeMPoLTnzNMAeXm4awgZWBAbDuLph511nCc1h8wF1uy4vC1l!-85436088!-949856145!9001!-1 , and cyclophototherapy uses a laser[http://www.eyemdlink.com/EyeProcedure.asp?EyeProcedureID=48 EyeMDLink.com - Cyclophotocoagulation .


Refractive surgery

See Also: Refractive surgery


  • 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 power.

  • ---Automated lamellar keratoplasty (ALK)

  • ---Laser assisted in-situ keratomileusis ( LASIK ) Surgery Encyclopedia - LASIK


  • -- IntraLASIK

  • ---Laser assisted sub-epithelial keratomileusis ( LASEK ), aka Epi-LASIK

  • --- Photorefractive Keratectomy (PRK) Surgery Encyclopedia - 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)

  • ---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 Surgery Encyclopedia - Corneal transplantation .

  • --- Intracorneal Rings (ICRs), or corneal ring segments (''Intacs'') {Link without Title}

  • ---Implantable contact lenses

  • Presbyopia reversal

  • ---Anterior ciliary sclerotomy (ACS)


  • --Laser reversal of presbyopia (LRP)

  • ---Scleral expansion bands



Corneal surgery



Vitreo-retinal surgery

  • Vitreo-retinal surgery includes the following

  • ---Vitrectomy {Link without Title}


  • --Anterior vitrectomy is the removal of the front portio of vitreous tissue. It is used for preventing or treating vitreous loss during cataract or corneal surgery, or to remove misplaced vitreous in conditions such as aphakia pupillary block glaucoma.


  • --Pars plana vitrectomy (PPV), or trans pars plana vitrectomy (TPPV), is a procedure to remove vitreous opacities and membranes through a pars plana incision. It is frequently combined with other intraocular procedures for the treatment of giant retinal tears, tractional retinal detachments, and posterior vitreous detachments {Link without Title} .

  • ---Pan retinal photocoagulation (PRP) is a type of photocoagulation therapy used in the treatment of Diabetic Retinopathy Surgery Encyclopedia - Photocoagulation therapy .

  • --- Retinal Detachment repair


  • --A Scleral Buckle is used in the repair of a retinal detachment to indent or "buckle" the sclera inward, usually by sewing a piece of preserved sclera or silicone rubber to its surface Surgery Encyclopedia - Scleral Buckling .


  • --Laser photocoagulation, or photocoagulation therapy, is the use of a laser to seal a retinal tear .


  • --Pneumatic retinopexy


  • --Retinal cryopexy, or retinal cryotherapy, is a procedure that uses intense cold to induce a chorioretinal scar and to destroy retinal or choroidal tissue Surgery Encyclopedia - Retinal_cryopexy .

  • ---Macular hole repair

  • ---Partial lamellar sclerouvectomyShields JA, Shields CL. ''Surgical approach to lamellar sclerouvectomy for posterior uveal melanomas: the 1986 Schoenberg lecture.'' Ophthalmic Surg. 1988 Nov;19(11):774-80. PMID 3222038.


  • --Partial lamellar sclerocyclochoroidectomy


  • --Partial lamellar sclerochoroidectomy

  • ---Posterior sclerotomy is an opening made into the vitreous through the sclera, as for detached retina or the removal of a foreign body {Link without Title} .

  • Radial optic neurotomy

  • macular translocation surgery

through 360 degree retinotomy
through scleral imbrication technique


Eye muscle surgery

With approximately 1.2 million procedures each year, Extraocular Muscle surgery is the third most common eye surgery in the United States {Link without Title} .
  • Eye Muscle surgeries typically correct Strabismus and include the following Surgery Encyclopedia - Eye Muscle Surgery [http://webeye.ophth.uiowa.edu/asorn/CE/2002-09Strabismus.pdf]:

  • ---Loosening / weakening procedures


  • --Recession involves moving the insertion of a muscle posteriorly towards its origin.


  • --Myectomy


  • --Myotomy


  • --Tenectomy


  • --Tenotomy

  • ---Tightening / strengthening procedures


  • --Resection


  • --Tucking


  • --Advancement is the movement of an eye muscle from its original place of attachment on the eyeball to a more forward position.

  • ---Transposition / repositioning procedures

  • ---Adjustable suture surgery is a method of reattaching an extraocular muscle by means of a stitch that can be shortened or lengthened within the first post-operative day, to obtain better ocular alignment {Link without Title} .



Oculoplastic surgery



Other

  • A coreoplasy, or '''laser pupillomydriasis''', is any procedure that changes the size or shape of the pupil. Cassin, B. and Solomon, S. ''Dictionary of Eye Terminology''. Gainsville, Florida: Triad Publishing Company, 1990.

  • An iridodialysis is a tear in the iris made intentionally or unintentionally with surgical instruments. Sometimes known as a '''coredialysis'''.



REFERENCES






SEE ALSO



EXTERNAL LINKS