Overview of Major Ophthalmic Surgeries
Oculoplastics
Lots of different techniques, but generally can be done by tightening the muscles that lift the eyelid from in front of (levator) or behind (muller) the eyelid
| Procedure Name | Common Indications | How it’s done |
|---|---|---|
| Ptosis repair | Superior visual field loss; cosmetic improvement | Lots of different techniques, but generally can be done by tightening the muscles that lift the eyelid from in front of (levator) or behind (muller) the eyelid |
| Blepharoplasty | Excess eyelid skin (dermatochalasis) causing superior visual field defect; cosmetic improvement | The excess skin is excised from the eyelid |
| Entropion repair | Eyelids turning inwards can worsen dry eye, cause discomfort, or cause scarring of cornea | Sutures are placed to evert the eyelid or skin is removed to cause eversion of the lid |
| Ectropion repair | Eyelids turning outwards can worsen dry eye and cause discomfort | Lid is tightened laterally to prevent outward rotation |
| Canthopexy | Too much ocular surface exposure (can cause dry eye), cosmetic improvement ) | Canthal tendon tightening procedure that is performed with a stitch |
| Canthoplasty | Too much ocular surface exposure (can cause dry eye ), cosmetic improvement | Lateral canthal reconstruction |
| Canthotomy /cantholysis | Orbital compartment syndrome (e.g. retrobulbar hematoma | Cut 1-2 cm skin at the corner of eye, cut the inferior crux of lateral canthal tendon |
| Tarsorrhaphy | Too much ocular surface exposure (can cause dry eye), persistent epithelial defect of the eye | Suture upper and lower lid margins together. Could be partial closure (central aperture for viewing) or complete closure. |
| Evisceration | Severe infection or pain in eye with loss of vision | Removal of inner eye contents, (leaving the sclera / muscles intact) |
| Enucleation | Tumors contained within the eye, trauma | Removal of entire globe (leaving muscles intact) |
| Exenteration | Tumors spreading outside of the eye, trauma | Removal of entire globe, muscles, and contents of orbital cone |
| Nasolacrimal Duct Probing | Nasolacrimal duct obstruction (NLDO) leading to overflow tearing | A probe is passed from the eyelid puncta, through the cannaliculus and lacrimal sac, and ending in the inferior turbinate of the nose to open up any a blockage of tear outflow from the eye. |
Cornea
| Procedure Name | Common Indications | How it’s done |
|---|---|---|
| Deep Anterior Lamellar Keratoplasty (DALK) | Corneal scar, keratoconus | Removal of the anterior cornea, leaving posterior endothelium intact |
| Penetrating Keratoplasty (PK) | Corneal scar, keratoconus, Fuchs corneal dystrophy | Removal of a full thickness circular button of host cornea. Subsequent placement and fixation of donor cornea with sutures |
| Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) | Fuchs corneal dystrophy, pseudophakic bullous keratopathy | Removal of the Descement membrane and endothelium , leaving the anterior cornea intact. Subsequent transplantation of donor Descement membrane and corneal endothelium WITH partial thickness button of donor corneal stroma. |
| Descemet Membrane Endothelial Keratoplasty (DMEK) | Fuchs corneal dystrophy, pseudophakic bullous keratopathy | Removal of the Descement membrane and endothelium, leaving the anterior cornea intact. Subsequent transplantation of donor Descement membrane and corneal endothelium WITHOUT any donor corneal stroma. |
| Keratoprosthesis (KPro) | Failed corneal transplants, corneal conjunctivalization | Removal of a full thickness circular button of host cornea. Artificial cornea fixated onto donor button, and sewn into place on host |
| Corneal Inlays | Keratoconus , corneal weakening (ectasia) | Clear rigid structural supports slid into laser cut grooves in cornea (intrastromal) |
| Photo Therapeutic Keratectomy (PTK) | Superficial corneal opacities / irregularities, some corneal dystrophies | Laser removal of superficial corneal opacities / irregularities |
| Cross- Linking (CxL) | Keratoconus , corneal weakening (ectasia) | Application of riboflavin, followed by laser activation to strengthen cornea |
Refractive Surgery
| Procedure Name | Common Indication | How it’s done |
|---|---|---|
| Astigmatic Keratotomy (AK) / Limbal Relaxing Incision (LRI) | Astigmatism | Blade or laser used to create 80-90% thickness incisions to flatten cornea and reduce astigmatism |
| Laser Assisted in situ Keratomileusis (LASIK) | Refractive error | Hinged corneal flap is cut and lifted. Laser shapes the cornea to reduce refractive error. Corneal flap replaced, faster recovery than PRK but possible flap complications. |
| Photorefractive Keratectomy (PRK) | Refractive error | Corneal epithelium removed , laser shapes the cornea to reduce refractive error. No flap complications, but epithelium must regrow, leading to a more painful, slower recovery than LASIK. |
| Radial Keratotomy (RK) | Refractive error | Grooves cut radially in cornea cause steepening, correcting myopia. This older technique is rarely used today. |
Glaucoma
| Procedure Name | Common Indications | How it’s done |
|---|---|---|
| Trabeculectomy ( trab ) | High intraocular pressure not controlled by other measures (drops, laser, etc.) | A partial thickness flap is created in the sclera and a hole is made into the anterior chamber. The flap is then sutured down to better control the outflow so the eye doesn’t completely depressurize. |
| Ahmed / Baerveldt Valve (tube) | High intraocular pressure not controlled by other measures (drops, laser, etc.) | A tube is inserted into the anterior chamber, fluid drains from this tube into the subconjunctival space |
| Iridotomy / Iridectomy | Narrow angle glaucoma | Removal of part of the iris (by laser or surgery) |
| Trabeculotomy | Pediatric glaucoma when corneal opacity limits view . | Opening of schlemm’s canal via an external approach (cannulation of schlemm’s canal and purse string tearing inwards to open the canal and improve outflow) |
| Goniotomy | Pediatric glaucoma, when cornea is clear | Opening of the schlemm’s canal via an internal approach (direct incision) |
Retina
| Procedure Name | Common Indications | How it’s done |
|---|---|---|
| Pars Plana Vitrectomy (PPV) | The workhorse retinal procedure, used to operate inside the eye (epiretinal membrane, vitreomacular traction, macular hole, vitreous hemorrhage, rhegmatogenous retinal detachment, tractional retinal detachment, endophthalmitis and retained lens fragments) | Instruments inserted into the eye include light pipe, vitreous cutter , and infusion line. Other intraocular instruments can be used to cut, grasp, laser or put gas into the eye. |
| Membrane Peel | Epiretinal membrane | During PPV , instruments are used to remove the preretinal membrane |
| Endolaser | Vitreous hemorrhage | During PPV, a laser is introduced into the eye to photocoagulate the retina |
| Air-fluid Exchange or Silicone Oil | Retinal detachment repair, macular hole repair | During PPV, fluid is exchanged for air, gas or silicone oil to provide tamponade for the retina |
| Scleral Buckle (SB) | Retinal detachment | An encircling band is placed around the eye to bring the walls of the eye inward. Cryotherapy and drainage of subretinal fluid are used in conjunction with scleral buckling. |
| Pneumatic Retinopexy | Retinal detachment | An intraocular gas bubble is injected to seal the retinal break while cryotherapy creates chorioretinal scarring to permanently seal the break. |
Eye Muscles
| Procedure Name | Common Indications | How it’s done |
|---|---|---|
| Strabismus Surgery | Misalignment of the eyes (strabismus) | Eye muscles are detached, cut, and/or reattached to the eye to strengthen or weaken the the muscle to improve eye alignment |
Lasers
| Procedure Name | Common Indications | How it’s done |
|---|---|---|
| Panretinal Photocoagulation (PRP) | Proliferative diabetic retinopathy | Lasering the ischemic retinal periphery to prevent neovascularization |
| Laser Retinopexy | Retinal tears | Lasering around a retinal tear to prevent progression to a detachment |
| YAG Capsulotomy | Posterior capsular opacification (PCO) | Uses YAG laser to clear opacification of the posterior capsule after cataract surgery |
| YAG Iridotomy | Narrow angle glaucoma | Uses YAG laser to create a hole in the iris to prevent pupillary block |
| Selective Laser Trabeculoplasty (SLT) | High pressure in glaucoma | Application of laser to trabecular meshwork to cause remodeling and decrease IOP |
Blog Reference Link :Â https://eyeguru.org/blog/major-ophthalmology-surgeries-explained/
