Before reading this section I would recommend at least skimming Review of Ocular Diseases so that you are confident with common pathologies before you read about how those pathologies are treated surgically.

General

What is a minor procedure?

A minor procedure is a simple procedure that can be perfumed with minimal risk. Many of these procedures are performed in the clinic. Examples of minor procedures are chalazion removal, punctal plug insertion, and foreign body removal.

Incision vs Excision

An incision is cutting into tissue. While and excision is cutting tissue out.

Instrument Preparation

The trick to this section is to know what each of the instruments do. In all reality physicians may vary a little in what instruments they like to use. For this reason it is better to memorize what the different instruments do then to memorize an exact set up. This way you will be able to pick out instrument sets that don’t make sense for a certain procedure.

 Refractive Surgery

Refractive surgery is used to change the shape of the cornea so that a patient can see with little or no correction. The types of procedures are the following:

Note: in situ means “in living”.

Sterile Fields

The sterile field is a field that is free of microorganisms. For example, if a surgeon if performing a cataract surgery then the sterile field would be the area immediately around the patient and the physician from the operating area up. If an unsterile object touches a sterile object the sterile object becomes contaminated.

Aseptic Technique

Aseptic means without infection. Sterile techniques are to major surgeries as aseptic techniques are to minor procedures, such as those preformed in a clinical setting. The purposed of aseptic techniques are to reduce the chance of a wound infection. The skin is still disinfected and gloves are still worn. Minor procedures usually don’t require a sterile gown and mask.

Nonrefractive Laser Therapy

Lasers are common in ophthalmology it is important to know what different lasers their are and for what procedures they are used. Laser got its name from the following acronym.

L – Light

A – Amplification (by)

S – Stimulated

E – Emission (of)

R – Radiation

Lasers used in ophthalmology are either thermal lasers or photodisruptive lasers.

There are two thermal lasers

1. Argon – green/blue color
2. Krypton – red/yellow color

Thermal lasers are used for coagulation in surgeries such as

• Diabetic Retinopathy
• Hypertensive retinopathy

There are two photodisruptive lasers

1. Yag (yttrium-aluminum-garnet) say that three times fast, infrared (can’t be seen)
2. Excimer (argon–fluoride) , ultraviolet (can’t be seen)

Photodisruptive lasers are used for tissue damage in surgeries such as

• Clearing an opacified capsule
• Refractive surgeries (PRK, PTK, LASIK, LASEK)

 Intraocular Injections

Intraocular injections are used to treat:

1. Wet macular degeneration
2. Retinal vein occlusions
3. Diabetic retinopathy

Before initiating an intraocular injection Iodide should be put directly on the ocular surface. The physician then injections the medication into the eye within a few seconds. When the physician has finished the injections the sharp must be placed in the sharps container.

Yag Laser

The Yag (yttrium-aluminum-garnet) laser is a infrared photodisruptive laser. It is used in refractive surgeries, iridotomy, and distorting tissue surrounding an opacified capsule.

Sterilization

Please review microbiology.

After an instrument is used it should be cleaned of all debris and placed in an enzymatic solution.

Three effective sterilization procedures are:

1. Boiling
2. Autocluave (a machines that creates really hot steam)
3. Germicides  (disinfectant)

Site Identification

Site identification is a way to make sure the the correct procedure is being performed on the correct eye. Site identification includes the following

1. Performing a surgical time-out – This is a pause before the surgery begins when patient information is reviewed by staff
2. Consulting the patient record- Looking to make sure that the records and the procedure about to be performed are the same.
3. Patient confirmation – This is when the physician asks the patient to confirm the procedure which is about to be performed.

Laser Safety

All people present during a laser treatment must wear eye protection. The laser must be turned off when not in use.

Assist with Procedures

When washing hands before surgery lift hands so that the water drips from the elbows. When wearing sterile gloves don’t touch anything that is not sterile. Many techs clasp their hands together until they need to assist with a procedure.

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