The chamber was entered with a sharp keratome. Healon was used to deepen the chamber. A capsulotomy was performed with the can-opener technique and the lens nucleus rocked loose. A phacoemulsification tip was introduced and a large bowl sculpted. The remaining nucleus was brought into the anterior chamber, and with the pulse mode and phacoemulsification with high vacuum, the remaining nucleus was removed without complication. With the irrigation and aspiration, the cortical material was removed. The posterior capsule was polished.
The chamber was deepened with viscoelastic and a posterior chamber lens implant of the appropriate power was placed in the capsular bag. The lens was centered with a Sinskey hook. The Healon was removed and Miochol injected. The pupil was noted to be round and small. A single 10-0 nylon suture was used to close the wound. The wound was checked for leakage and found to be secure. The conjunctiva was closed with wet-field cautery and antibiotic and steroid combination injected sub-Tenon. The superior rectus suture was removed and the lid speculum was removed. A patch and shield were placed over the eye and the patient returned to the recovery room in good condition.
INDICATIONS FOR SURGERY:
Slow, painless decreased vision, right eye, secondary to cataract formation, interfering with the patient's ability to perform daily activities.
Cataract, right eye, with impaired function.
Cataract, right eye, with impaired function.
Local with intravenous sedation.
DESCRIPTION: Following instillation of dilating and antibiotic eye drops, the patient was brought to the operating room where anesthesia was induced through neuroleptic along with peribulbar injection. Following onset of anesthesia and akin esia, the patient was prepared and draped for ophthalmic surgery. A wire lid speculum was placed in the right eye and a 5-0 black silk stay suture was placed beneath the superior rectus muscle.
A fornix-based conjunctival flap was formed with Westcott s cissors and hemostasis was achieved with electrocautery. Clear-cornea paracentesis wound was made with a Supersharp blade. A #7 blade was used to make a superior scleral incision 2 mm posterior to the surgical limbus. From this point, the crescent blade was used to fashion a scleral tunnel through which the anterior chamber was entered with a 3.2-mm keratome. Viscoelastic was injected into the anterior chamber to deepen it, and an anterior capsulotomy performed with a capsulorrhexis technique. The nu cleus was hydrodissected with balanced salt solution and emulsified with the phacoemulsification device. The remaining cortex was removed using irrigation and aspiration. Additional viscoelastic was reintroduced into the anterior chamber to deepen it.
The scleral tunnel was enlarged with a 5.2-mm keratome. The posterior chamber intraocular lens was inspected and irrigated with balanced salt solution. Using a smooth lens forceps, we introduced the lens into the eye and placed it in the appropriate pos ition. Following rotation, it was noted to be well centered and well positioned with the loop in the horizontal position. The viscoelastic was removed using irrigation and aspiration, and Miochol was injected into the anterior chamber, producing a small round pupil. The scleral wound was closed with an interrupted 10-0 nylon suture. The wound was found to be watertight, as was the paracentesis wound. The anterior chamber was deep and well formed with a well-centered intraocular lens. The conjunctiva was closed with electrocautery. The wire lid speculum and stay suture were removed from the eye which was then dressed with topical antibiotic and steroid drops followed by a patch and shield. The patient tolerated the procedure well and was taken to the recovery room in alert and stable condition.
PREPARATION: Both eyes were prepared with Ioprep and draped in the usual sterile manner.
DESCRIPTION: After appropriate draping, a lid speculum was placed between the lids of the right eye. An incision was made supertemporally to expose the right medial rectus muscle. This was hooked with a muscle hook and secured with 6-0 Vicryl sutures and disinserted from the globe. It was reattached to the globe in hang-back, adjustable suture fashion, recessing it 6 mm from the original insertion. A 5-0 Mersilene suture was placed for traction purposes during the adjustment process.
The right superior rectus muscle was then approached through the same supranasal incision, hooked to the muscle hook and cleared of surrounding tissue far backwards over the top surface of the muscle, and was disinserted from the globe after being secured with a double-armed 6-0 Vicryl suture. It was reattached to the globe in hang-back adjustable suture fashion, recessing it 4 mm from the insertion site, and 5-0 mersilene traction suture was placed.
The left medial rectus muscle was then recessed in a similar manner, 5.5 mm on an adjustable suture. Both eyes were dressed with Pred-G ointment. The patient was returned to her room in good condition, having tolerated the procedure well.
The patient was brought to the operating room and placed in the supine position. Local anesthesia was induced with a retrobulbar injection of 2% Xylocaine mixed 1:1 with 0.75% Marcaine with Wydase. The eye was prepared and draped in the usual sterile fashion. A lid speculum was placed between the lids. Conjunctival incisions were made nasally and temporally, and a 4-mm infusion cannula was sutured into the inferotemporal quadrant 4 mm posterior to the limbus using a 4-0 Vicryl suture. After cannula tip placement in the vitreous cavity had been verified, infusion was begun. Supranasal and superotemporal sclerotomies were performed, and the trocar and cannula system was introduced. The vitrectomy was performed. The posterior vitreous was not detached. It was elevated from the posterior pole and trimmed back into the far periphery.
We then selected a biopsy site inferiorly and cut out a 2 x 2-mm piece of retina at 6 o'clock at the border of infected and noninfected retina. There was no significant bleeding. We then performed a fluid-gas exchange, flatting the retina through the biopsy site. Laser was placed around the biopsy for 360 degrees to demarcate the peripheral retinitis. We then filled the eye with silicone oil. The sclerotomies were sutured shut with 7-0 Vicryl, and the conjunctiva was closed with 6-0 plain. Sub-Tenon's Ancef and Decadron were injected. The patient tolerated the procedure well and was returned to the recovery room in stable condition.
Description of Procedure: The patient was brought to the operating room where the anesthesiologist established I.V. lines and cardiac monitoring leads. Mild intravenous sedation was administered. Using a solution containing 0.75% Marcaine and 2% lidocaine with Wydase, a peribulbar block was administered to the right eye. Gentle digital pressure was applied to the eye for approximately 2 minutes to help diffuse the anesthetic. The patient was then prepared with a 5% solution of povidone-iodine to the conjunctival ornix and lashes, and a 10% solution of povidone-iodine to the lids and periorbital skin. The patient was then draped in the usual sterile fashion. A lid speculum and 4-0 silk superior rectus bridle suture were then placed in the operative eye. A keratome blade was then used to create a biplanar incision into the anterior chamber. Healon was then instilled into the anterior chamber.
A capsulorrhexis was then fashioned with a cystotome blade. BSS and a cannula were then used to hydrodissect and hydrodelineate the lens. Aparacentesis incision was made at 3 o'clock with a Supersharp blade. The phacoemulsification unit, after being properly tuned and tested, was then used to emulsify the nucleus. Residual cortical material was aspirated from the capsular bag with the irrigation and aspiration unit. Healon was then instilled into the anterior chamber, severing the anterior and posterior sections of the capsular bag. The corneal wound was then enlarged to the size of the optic with the keratome blade. The intraocular lens was then inspected and thought to be satisfactory. Then the lens was gently placed in the capsular bag. Positioning within the capsular bag was confirmed by direct visualization. Optic centration was accomplished with a Sinskey hook.
Residual Healon was removed from the anterior chamber using the irrigation and aspiration unit. Miostat was then instilled into the anterior chamber, producing myosis without optic capture. The corneal wound was then tested for leaks and none were found. The conjunctiva was closed using bipolar cautery. Subconjunctival injections of Ancef and dexamethasone were then given inferiorly with the needle tip visible at all times. The bridle suture and lid speculum were then removed. Betoptic-S and Pred-G ointment was then placed in the conjunctival fornix. Sponge and needle counts were correct. An eye patch and shield were placed over the operative eye. The patient was taken to the recovery room in stable condition. There were no complications. The patient tolerated the procedure well. Dr. X performed the entire procedure.
Cataract, right eye.
Cataract, right eye.
Local with sedation.
PREPARATION: Soap and Ioprep.
DESCRIPTION: The patient was placed on the operating room table in the supine position. After adequate local anesthesia was achieved, the right face was prepared and draped in the usual fashion. A lid speculum was placed between the right lids. A stay suture of 4-0 black silk was placed beneath the insertion of the superior rectus muscle and the eye retracted downward. A peritomy was then performed from the 9 o'clock to the 3 o'clock position at the limbus. Hemostasis was achieved using biopolar cautery. A groove was then made from the 10 o'clock to the 2 o'clock position using a Beaver blade. A suture of 8-0 black silk was then preplaced in a mattress fashion at 10 o'clock and 2 o'clock. The sutures were removed from the groove. The anterior chamber was entered at the 12 o'clock position using a Supersharp blade. The anterior chamber was reformed using Healon.
An anterior capsulotomy was then performed using a bent 30-gauge needle. The wound was then opened to its entire extent using straight corneoscleral scissors. Lens nucleus was expressed without complication. Previously placed 8-0 black silk sutures were temporarily tightened and tied. Irrigation and aspiration tip was entered into the anterior chamber and the cortical remnants were removed. The lens was then inserted without complication. The previously placed 8-0 black silk sutures were permanently tightened, tied and cut. Miochol was introduced into the anterior chamber in such a fashion that the Healon was irrigated free. The pupil came down nicely and was round.
The wound was secured using multiple simple placed 10-0 nylon stitches at 11 o'clock, 1 o'clock. These sutures were tightened, tied and cut. The patient received subconjunctival injection of Decadron and Ancef. The stay suture and the lid speculum was removed. The eye was dressed and patched. The patient was returned to the recovery room, having tolerated the procedure well without complication.
Cataract, right eye.
Cataract, right eye.
Local with standby.
DESCRIPTION: After the patient was given a peribulbar block consisting of 0.75% Marcaine with 2% Xylocaine and Wydase, she was routinely prepared and draped for right cataract surgery. A lid speculum was placed in the eye and a superior rectus suture on the superior rectus muscle. A fornix-based flap was raised and any bleeding vessels were cauterized. A sharp knife was used to make a side port and partial-scleral-thickness incision which was dissected anteriorly. A 3-Mm keratome was used to enter the anterior cha mber. Under Provisc, an anterior capsulotomy was performed and hydrodissection occurred.
Phacoemulsification was performed, and irrigation and aspiration of any remaining cortical material. The wound was enlarged under Provisc to 5.5 mm so that a #8191 IOLab lens could be placed in the bag and switched to the 3 and 9 o'clock position with a Sinskey hook. The remaining Healon was removed. Miochol was placed in the eye. The wound was found to be watertight. The fornix-based flap was closed with cautery. Ancef and Decadron solution was injected subconjunctivally. Pred-G ointment was place in the eye. The eye was patched and shielded, and the patient was taken to the recovery room in excellent condition.
Visually significant immature cataract, right eye.
Visually significant immature cataract, right eye.
Neuroleptic with I.V. sedation combined with local consisting of 2% Xylocaine mixed half-and-half with 0.75% Marcaine by retrobulbar and Nadbath.
Posterior chamber intraocular lens.
DESCRIPTION: After satisfactory local and neuroleptic anesthesia, the right eyelids and face were prepped and draped in the usual fashion for sterile ophthalmic surgery. A lid speculum was placed between the lids of the right eye and traction suture of 4-0 black silk was placed superiorly and attached to the drape. A coelastic material, a capsulotomy of 360 degrees was performed using the can-opener technique. The capsular material was then removed from the center and the lens was gently freed. The corneoscleral wound was then extended to 10 mm and the lens nucleus was expressed intact without difficulty. The cortical material was then removed with aspiration. Following this, additional viscoelastic material was placed and a posterior chamber intraocular lens implant, 15 diopters, #MC60, was inserted. This was centered. Each of the haptics was checked for positioning and appeared to be tight.
The wound was closed with multiple interrupted 10-0 nylon sutures. Each of the sutures was buried. The viscoelastic material was removed with aspiration. Following this, the traction suture was removed and the conjunctiva was closed with subconjunctival gentamicin and Decadron. Maxitrol ointment and Betoptic drops were placed and a pad and shield were placed. The patient tolerated the procedure well and was sent to the recovery room in satisfactory condition.
A caliper was used to measure 3 mm inferior to the limbus in the inferotemporal quadrant, and the globe was penetrated with a 19-blade MVR blade. An infusion was placed. After visualizing deep in the vitreous cavity, it was turned on. Sclerotomies were then made superonasally and superotemporally 3 mm posterior from the limbus. The MVR blade was then used to penetrate the equator of the lens. Fragmentation of the lens was performed, keeping the anterior capsule of the lens intact. Following this, the trocar and cannula system was introduced and the vitrectomy was performed, letting the previous silicone oil out of the eye. The posterior pole was visualized using the flat lens followed by the quartz prism lens followed by the AVI lens. Because of extensive anterior Postvoiding residual, membrane peeling was performed anteriorly followed by retinotomy for 360 degrees. Perfluorocarbon was used to flatten the retina which flattened nicely. The endolaser was applied in 360 degrees around the retinotomy. Following this, a fluid-air exchange was performed and 5000 centistokes of silicone oil was injected. It should be noted that during the procedure there was leakage of fluid from the superonasal sclerotomy which was lacerated. It was then sutured with 8-0 nylon sutures and an additional sclerotomy was performed more superiorly. Further sclerotomies in these areas should be avoided.
Following the silicone oil injection, the sclerotomies were closed with 7-0 Vicryl sutures. The conjunctiva was closed with 6-0 plain gut. Subconjunctival dexamethasone and Ancef were injected. The eye was patched and shielded and the patient was returned to the floor in good condition.
Local/MAC. PROSTHETIC DEVICE:
Intraocular lens, Alcon model #MA60BA, 22 diopters, serial #427252.090.
DESCRIPTION: After informed consent was obtained and all questions were answered, the patient was brought to the operating room and placed in the supine position. After adequate I.V. sedation, a retrobulbar block of 5 cc of a 50:50 mixture of 2% lidocaine with Wydase and 0.75% Marcaine was given. The Honan balloon was then applied to the left eye at 40 mmHg for 5 minutes. The left eye was prepped and draped in the usual sterile fashion. A lid speculum was placed between the lids of the left eye. A clear-corneal incision was made at the temporal limbus. Healon was used to reform the anterior chamber.
A continuous-tear capsulorrhexis was performed. Hydrodissection of the lens nucleus was performed. The lens nucleus was then removed using the phacoemulsification handpiece. The I/A handpiece was used to remove the residual cortex. The capsular bag was reinflated with Healon. The intraocular lens was folded and placed into the capsular bag under direct inspection. The I/A hand piece was used to remove residual Healon. Miochol was injected. The wound was closed with a single 10-0 Vicryl suture. Ancef and Decadron were injected beneath the conjunctiva. The lid speculum was removed and Pred-G ointment applied. A patch and shield were applied. The patient left the operating room in stable condition and there were no complications. Dr. X was present and assisted for the entire procedure.
A distance of 3 mm was marked along the superonasal limbal zone. Using a diamond blade, an initial perpendicular groove of approximately 500-micron depth was created. The diamond blade was then used to create a corneal tunnel perpendicular to the initial groove, extending approximately 1.5 mm into clear cornea. The diamond keratome was then directed perpendicular to the plane of the iris in order to enter the anterior chamber and create a self-sealing corneal-valve incision. The anterior chamber was then reformed with Healon GV. The operating microscope was brought in; the light was initially on low power and then gradually intensified. A 27-gauge needle was entered through the corneal valve incision and a nick created in the anterior capsule.
A continuous 360-degree curvilinear capsulorrhexis was then carried out without difficulty. Balanced salt solution was injected beneath the capsule to achieve both hydrodissection and hydrodelineation. The lens nucleus was then emulsified without difficulty using the Alcon Masters Series 10,000 unit. Any remaining cortical debris was removed with the automated irrigation/aspiration unit. The posterior capsule was then vacuum polished clean. The anterior chamber and capsular bag were reinflated with Healon GV. The AcrySof +19.5-diopter PC IOL was then carefully folded using the folding forceps and grasped with the direct-action forceps. The PC IOL was then introduced through the corneal-valve incision and delivered into the anterior chamber and capsular bag. The lens was centered into position within the capsular bag using the Sinskey hook. Any remaining Healon GV was then removed with the automated irrigation/aspiration unit.
Miochol was instilled to achieve pupillary myosis. The corneal valve incision was then closed with a single interrupted 10-0 Vicryl suture. The suture was cut and the knot buried in the wound. The wound was tested and found to be free of any leaks. Subconjunctival cefazolin, gentamicin, and dexamethasone were then injected superonasally. The left eye was then dressed with Pred-G ophthalmic ointment and Pilopin gel. A sterile eye patch and fox metallic shield were placed over her left eye. Ms. X tolerated the procedure extremely well and the operation went without difficulty. She was transported to her room in stable condition.