Eye surgery, also known as ophthalmic surgery or ocular surgery, is surgery performed on the eye or its adnexa, typically by an ophthalmologist. Although most eye surgeries can be performed by an experienced general ophthalmologist, more complex procedures are usually done by one who is fellowship trained.

 Preparation and precautions

The eye is a delicate organ, requiring extreme care before, during and after a surgical procedure. An expert ophthalmologist must identify the need for specific procedure and be responsible for conducting the procedure safely. Many university programs allow patients to specify if they want to be operated upon by the consultant or the resident / fellow.

Proper anaethesia is a must for any eye surgery. Local anesthesia is most commonly used. Retrobulbar and peribulbar techniques for infiltrating the local area surrounding the eye muscle cone are used to immobilze the extraocular muscles and eliminate pain sensation. Topical anesthesia using lidocaine topical gel is preferred for quick procedures. In topical anesthesia, patient cooperation is a must for a smooth procedure. General anesthesia is recommended for children, traumatic eye injuries, major orbitotomies and for apprehensive patients. Cardiovascular monitoring is preferable in local anesthesia and is mandatory in general anesthesia. Proper sterile precautions are taken to prepare the area for surgery, including use of antiseptics like povidone-iodine. Sterile drapes, gowns and gloves are a must. A plastic sheet with a receptacle helps collect the fluids during phacoemulsification. An eye speculum is inserted to keep the eyes wide open. For anxious patients, supplementation with a facial nerve block using lidocaine and bupivacaine is recommended.

 

Laser eye 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.

 

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 surgery. 

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.

 

 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)
    • IntraLASIK
  • Laser assisted sub-epithelial keratomileusis (LASEK), aka Epi-LASIK
  • Photorefractive keratectomy (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.
  • Intracorneal rings (ICRs), or corneal ring segments (Intacs)
  • Implantable contact lenses
• Presbyopia reversal
  • Anterior ciliary sclerotomy (ACS)
    • Laser reversal of presbyopia (LRP)
  • Scleral expansion bands

 

 Corneal surgery

• Corneal surgery includes most of the refractive surgeries as well as the following:
  • Corneal transplant surgery, is used to remove a cloudy/diseased cornea and replace it with a clear donor cornea.
    • Penetrating keratoplasty (PK)
  • Phototherapeutic keratectomy (PTK)
  • Pterygium excision

 

Vitreo-retinal surgery

• Vitreo-retinal surgery includes the following
  • Vitrectomy
    • 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
  • Pan retinal photocoagulation (PRP) is a type of photocoagulation therapy used in the treatment of diabetic retinopathy.
  • Retinal detachment repair
    • Ignipuncture is an obsolete procedure that involves cauterization of the retina with a very hot pointed instrument.
    • 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.
    • 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.
  • Macular hole repair
  • Partial lamellar sclerouvectomy^[14]
    • 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  .
  • 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.

• Eye muscle surgeries typically correct strabismus and include the following^[15]:
  • 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

 

Oculoplastic surger

• Oculoplastic surgery, or oculoplastics, is the subspecialty of ophthalmology that deals with the reconstruction of the eye and associated structures. Oculoplastic surgeons perform procedures such as the repair of droopy eyelids (blepharoplasty), repair of tear duct obstructions, orbital fracture repairs, removal of tumors in and around the eyes, and facial rejuvenation procedures including laser skin resurfacing, eye lifts, brow lifts, and even facelift

Eye surgery is very sensitive treatment. Spectacles are rapidly replacing cheap contact lenses. Most eye sight cases are now contact lens cases. Beauty conscious people us color contact lenses. Unifocal and multifocal ophthalmic lenses meet visual needs of the patients. But a patient need to be in contact with eye care professional for regular check up and care of his eyes.