Eye surgery, also known as ophthalmic surgery or ocular surgery, is surgery performed on the eye or its adnexa. Eye surgery is part of ophthalmology and is performed by an ophthalmologist or eye surgeon. The eye is a fragile organ, and requires due care before, during, and after a surgical procedure to minimize or prevent further damage. An eye surgeon is responsible for selecting the appropriate surgical procedure for the patient, and for taking the necessary safety precautions. Mentions of eye surgery can be found in several ancient texts dating back as early as 1800 BC, with cataract treatment starting in the fifth century BC. It continues to be a widely practiced class of surgery, with various techniques having been developed for treating eye problems.
Preparation and precautions
Since the eye is heavily supplied by nerves, anesthesia is essential. Local anesthesia is most commonly used. Topical anesthesia using lidocaine topical gel is often used for quick procedures. Since topical anesthesia requires cooperation from the patient, general anesthesia is often used for children, traumatic eye injuries, or major orbitotomies, and for apprehensive patients. The physician administering anesthesia, or a nurse anesthetist or anesthetist assistant with expertise in anesthesia of the eye, monitors the patient's cardiovascular status. Sterile precautions are taken to prepare the area for surgery and lower the risk of infection. These precautions include the use of antiseptics, such as povidone-iodine, and sterile drapes, gowns, and gloves.
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). Laser eye surgery or laser corneal surgery is a medical procedure that uses a laser to reshape the surface of the eye to correct myopia (short-sightedness), hypermetropia (long-sightedness), and astigmatism (uneven curvature of the eye's surface). Importantly, refractive surgery is not compatible with everyone, and people may find on occasion that eyewear is still needed after surgery. Recent developments also include procedures that can change eye color from brown to blue. Before proceeding with laser surgery, the eye specialist needs to certify that the patient is a suitable candidate for the surgery and there are several factors to be considered before doing laser surgery.
Cataract surgery
A cataract is an opacification or cloudiness of the eye's crystalline lens due to aging, radiation, 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 and preoperative refractive power usually replaced with an implantable intraocular lens. Owing to the high prevalence of cataracts, cataract extraction is the most common eye surgery. Rest after surgery is recommended.
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. Many types of glaucoma surgery exist, and variations or combinations of those types can facilitate the escape of excess aqueous humor from the eye to lower intraocular pressure, and a few that lower it by decreasing the production of aqueous humor.
Refractive surgery
Refractive surgery aims to correct errors of refraction in the eye, reducing or eliminating the need for corrective lenses.
Keratomileusis is a method of reshaping the corneal surface to change its optical power. A disc of the cornea is shaved off, quickly frozen, lathe-ground, then returned to its original power. Automated lamellar keratoplasty Laser-assisted in situ keratomileusis (LASIK) Laser assisted subepithelial keratomileusis (LASEK), a.k.a. Epi-LASIK Photorefractive keratectomy Laser thermal keratoplasty Conductive keratoplasty uses radio-frequency waves to shrink corneal collagen. It is used to treat mild to moderate hyperopia. Limbal relaxing incisions can correct minor astigmatism Astigmatic keratotomy, arcuate keratotomy, or transverse keratotomy Radial keratotomy Hexagonal keratotomy Epikeratophakia is the removal of the corneal epithelium and replacement with a lathe-cut corneal button. Intracorneal rings or corneal ring segments Implantable contact lenses Presbyopia reversal Anterior ciliary sclerotomy Scleral reinforcement surgery for the mitigation of degenerative myopia Small incision lenticule extraction
Corneal surgery Corneal surgery includes most refractive surgery, as well as:
Corneal transplant surgery is used to remove a cloudy/diseased cornea and replace it with a clear donor cornea. Penetrating keratoplasty Keratoprosthesis Phototherapeutic keratectomy Pterygium excision Corneal tattooing Osteo-odonto-keratoprosthesis is surgery in which support for an artificial cornea is created from a tooth and its surrounding jawbone. This is a still-experimental procedure used for patients with severely damaged eyes, generally from burns. Eye color-change surgery through an iris implant, known as Brightocular, or the stripping away the top layer of eye pigment, known as the stroma procedure
Vitreoretinal surgery
Vitreoretinal surgery includes:
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