MY MT Helper.com
Ophthalmology Samples

 

Cataract surgery

PREOPERATIVE DIAGNOSIS:  Cataract, right eye. 

POSTOPERATIVE DIAGNOSIS:  Cataract, right eye. 

PROCEDURE:  Phacoemulsification cataract extraction with posterior chamber intraocular lens, right eye.

COMPLICATIONS: None.  

ANESTHESIA:  Monitored anesthesia care with retrobulbar injection. 

HISTORY:  The patient is a 69-year-old man with a history of a cataract of his right eye.  After thoroughly discussing the potential risks and benefits of having cataract surgery, he made an informed decision to perform with cataract extraction of his right eye. 

PROCEDURE IN DETAIL:  The patient was taken to the Operating Room and placed in the supine position.  Sedation was provided by the Anesthesia Department and retrobulbar injection was performed. 

The patient was then prepped and draped in the normal sterile ophthalmic fashion.  The guarded blade was used to make a clear corneal incision.  The keratome was used to enter the anterior chamber.  Viscoat was instilled in the anterior chamber.  The 75 blade was used to make a paracentesis.  The cystotome was used to initiate the capsulorrhexis and Utrata forceps were used to complete it.  Balanced salt solution was injected in the anterior lip of the capsule.  The nucleus was rotated.  Phacoemulsification utilizing the stop and chop technique was performed to remove the nucleus.  Additional irrigation and aspiration were performed.  A model SA60, 22.5 diopter AcrySof single piece posterior chamber intraocular lens was placed in the capsular bag using the injector (serial number 984731.076).  Additional irrigation and aspiration were performed.  The wound was checked for leak using a Weck-cel sponge.  No leak was present.  Topical dexamethasone and gentamicin were placed on the eye.  Pilopine and Maxitrol drops were placed in the inferior fornix and a patch and shield were put in place.  The patient was specifically directed to avoid any bending, lifting, or straining and will be seen in the afternoon of surgery in the Eye Clinic. 

Exotropia & Alternating Hypertropia

PREOPERATIVE DIAGNOSIS: Exotropia and alternating hypertropia.  

POSTOPERATIVE DIAGNOSIS: Exotropia and alternating hypertropia.

OPERATION: Recession, both lateral rectus muscles, 8.0 mm; and recession, both inferior oblique muscle, 10 mm.

ANESTHESIA: General.

COMPLICATIONS: None.

PROCEDURE: The patient was brought to the operating room and was prepped and draped in the usual sterile fashion, after the induction of suitable general anesthesia in the supine position.

A lid speculum was inserted between the lids of the right eye. Under microscopic control, a conjunctival incision was carried horizontally for a distance of approximately 1 cm in the inferotemporal quadrant ending at a 0.5 mm inferior to the inferior limbus. Through this incision, Tenon’s capsule was opened vertically. Through this opening, the right lateral rectus muscle was hooked using a succession of muscle hooks. The muscle was cleaned of its fascial attachments using a combination of sharp and blunt dissection. A 4-0 black silk traction suture was passed bluntly beneath the muscles insertion and was secured with a hemostat. Under direct visualization, the right inferior oblique muscle was hooked near its insertion using a succession of muscle hooks. This muscle was then cleaned of its fascial attachments using a combination of sharp and blunt dissection. The muscle was disinserted from the globe. A single double-armed 6-0 Vicryl suture was passed across the muscle’s cut end with a lock stitch at each extremity. The traction suture was removed. The inferior rectus muscle was hooked using a succession of muscle hooks. The inferior oblique was attached to sclera using the “crossed-swords” technique at a point 2 mm temporal and 3 mm posterior to the temporal corner of the inferior rectus insertion.

Through the same conjunctival incision, the right lateral rectus again was hooked using a succession of muscle hooks. A single double-armed 6-0 Vicryl suture was passed across the muscle’s tendon at its insertion with a lock stitch at each extremity. The muscle was disinserted from the globe and was reattached to sclera using the “crossed-swords” technique at a point measured 8.0 mm posterior to the original insertion. Excess Tenon’s and insertional tissue were excised. Conjunctiva was reapproximated using 2 interrupted 6-0 plain sutures.

The lid speculum was removed from the right and was reinserted between the lids of the left eye. Again, under microscopic control, a conjunctival incision was carried horizontally for a distance of approximately 1 cm in the inferotemporal quadrant, ending at a 0.5 mm inferior to the inferior limbus. Through this incision, Tenon’s capsule was opened vertically. Through this opening, the left lateral rectus muscle was hooked using a succession of muscle hooks. The muscle was cleaned of its fascial attachments using a combination of sharp and blunt dissection. A 4-0 black silk traction suture was passed bluntly beneath the insertion and was secured with a hemostat.

Under direct visualization, the left inferior oblique muscle was hooked near its insertion using a succession of muscle hooks. The muscle was then cleaned of its fascial attachments using a combination of sharp and blunt dissection. It was disinserted from the globe. A single double-armed 6-0 Vicryl suture was passed across the muscle’s cut end with a lock stitch at each extremity. The traction suture was removed. The inferior rectus muscle was hooked using a succession of muscle hooks. The inferior oblique was attached to sclera using the “crossed-swords” technique at a point 2 mm temporal and 3 mm posterior to the temporal corner of the inferior rectus insertion.

The left lateral rectus muscle, again, was hooked using a succession of muscle hooks. A single double-armed 6-0 Vicryl suture was passed across the muscle’s tendon at its insertion with a lock stitch at each extremity. The muscle was disinserted from the globe and was reattached to sclera using the “crossed-swords” technique at a point measured 8.0 mm posterior to the original insertion. Excess Tenon’s and insertional tissue were excised. Conjunctiva was reapproximated using 2 interrupted 6-0 plain sutures.

At the completion of the surgery, the lid speculum was removed and erythromycin ointment was instilled in each eye.  

 

Exotropia

PREOPERATIVE DIAGNOSIS: Exotropia.

POSTOPERATIVE DIAGNOSIS: Exotropia.  

OPERATION: Recession, both lateral rectus muscles, 5 mm.

ANESTHESIA: General.

COMPLICATIONS: None.

PROCEDURE: The patient was brought to the operating room and was prepped and draped in the usual sterile fashion after the induction of suitable general anesthesia in the supine position. A lid speculum was inserted between the lids of the right eye. Under microscopic control, a conjunctival incision was carried horizontally for a distance of approximately 1 cm in the inferotemporal quadrant, ending at a 0.5 mm inferior to the inferior limbus. Through this incision, Tenon capsule was opened vertically. Through this opening, the right lateral rectus muscle was hooked using a succession of muscle hooks. The muscle was cleaned of its fascial attachments using a combination of sharp and blunt dissection. A single double-armed 6-0 Vicryl suture was passed across the muscle’s tendon at its insertion with a lock stitch at each extremity. The muscle was disinserted from the globe and it was reattached to sclera, using the “crossed sword” technique at a point measured 5 mm posterior to the original insertion. Excess Tenon’s and insertional tissue were excised. Conjunctiva was reapproximated using 2 interrupted 6-0 plain sutures.

The lid speculum was removed from the right eye and was reinserted between the lids of the left eye. Again, under microscopic control, a conjunctival incision was carried horizontally for a distance of approximately 1 cm in the inferotemporal quadrant ending at a 0.5 mm inferior to the inferior limbus. Through this incision, Tenon’s capsule was opened vertically. Through this opening, the left lateral rectus muscle was hooked using a succession of muscle hooks. The muscle was cleaned of its fascial attachments using a combination of sharp and blunt dissection. A single double-armed 6-0 Vicryl suture was passed across the muscle’s tendon at its insertion with a lock stitch at each extremity. The muscle was disinserted from the globe and it was reattached to sclera, using the “crossed sword” technique at a point measured 5 mm posterior to the original insertion. Excess Tenon’s and insertional tissue were excised. Conjunctiva was reapproximated using 2 interrupted 6-0 plain sutures.

At the completion of the surgery, the lid speculum was removed and erythromycin ointment was instilled in both eyes.

Exotropia and Diplopia

PREOPERATIVE DIAGNOSIS: Exotropia (diagnosis code is 378.23) and diplopia (diagnosis code is 368.2)

POSTOPERATIVE DIAGNOSIS: Exotropia (diagnosis code is 378.23) and diplopia (diagnosis code is 368.2)  

OPERATION: Recession bilateral lateral rectus, 6.5 mm.   

ANESTHESIA: General with laryngeal mask airway.

COMPLICATIONS: None.

PROCEDURE: The patient was brought to the OR with an IV line already in place. She was placed on the OR table in a supine position. She was placed under general anesthesia with IV induction followed by LMA placement. She was prepped and draped in the usual sterile fashion for procedure to both eyes.

Under microscopic control, a lid speculum was placed between the lids of the right eye. In the inferotemporal quadrant, a conjunctival incision was made followed by incision of Tenon’s. Through this, the right to lateral rectus was hooked using a succession of muscle hooks. The muscle was cleaned of its fascial attachments using a combination of sharp and blunt dissection. A double-armed 6-0 Vicryl suture was passed across the muscle’s tendon with a locked stitch at each extremity. The muscle was disinserted from the globe and reattached to sclera 6.5 mm posterior to the original insertion. Excess Tenon’s and insertional tissue were excised. Conjunctiva was reapproximated using 5 interrupted 6-0 plain gut sutures.

Continuing under microscopic control, the lid speculum was removed from between the lids of the right eye and placed between the lids of the left eye. In the inferotemporal quadrant, a conjunctival incision was made followed by incision of Tenon’s. Through this the left lateral rectus was hooked with a succession of muscle hooks. The muscle was cleaned of its fascial attachments using a combination of sharp and blunt dissection. A double-armed 6-0 Vicryl suture was passed across the muscle’s tendon with a locked stitch at each extremity. The muscle was disinserted from the globe and reattached to sclera 6.5 mm posterior to the original insertion. Excess Tenon’s and insertional tissue were excised. Conjunctiva was reapproximated using 3 interrupted silk plain gut sutures.

Erythromycin ointment was placed in the conjunctival fornix of each eye.

The patient was awakened from anesthesia having tolerated the procedure well. No complications.

 

Gold Weight Placement Eyelid

PREOPERATIVE DIAGNOSIS:
1. Left facial nerve palsy.
2. Exposure left eye.

POSTOPERATIVE DIAGNOSIS:
1. Left facial nerve palsy.
2. Exposure left eye.

OPERATION: Gold weight placement left upper lid.

ESTIMATED BLOOD LOSS: 3 ml.

COMPLICATIONS: None.

ANESTHESIA: MAC.  

INDICATIONS: The patient is a 33-year-old female who is status post tumor resection which has resulted in facial nerve palsy on the left. The patient had postoperative exposure and had been previously operated on by me. Left lower lid ectropion repair was performed with excellent results in the past. The patient continued to have exposure problems in her left eye with ocular lubrication every 2 hours. The risks of benefits of gold weight placement to the left upper lid were explained to the patient. She elected to have the procedure.

PROCEDURE: The patient was taken to the operating room where she was sedated by the anesthesiology service. The left upper lid crease was marked with a surgical marking pen and local anesthetic consisting of 2% lidocaine with 1:100,000 epinephrine was infiltrated into the left upper eyelid subcutaneously. The skin was prepped with a Betadine prep and the patient was prepped and draped in the usual sterile fashion.

Toothed forceps and Stevens scissors were used to incise the skin in orbicularis on the left upper lid along the left upper lid crease. Dissection was carried posteriorly and inferiorly exposing the anterior tarsal surface. Once this had been adequately exposed and hemostasis had been achieved with Bovie electrocautery, the gold weight was fitted onto the tarsus and found to be of good size then three single interrupted 6-0 Vicryl sutures were used to anchor the gold weight to the tarsus of the left upper lid. The lid was then everted and an 0 Vicryl was found to be exposed through the palpebral conjunctiva. Three single interrupted 6-0 Vicryl sutures were then used to close the orbicularis muscle over the gold weight. The skin was closed using a single running 6-0 fast-absorbing gut suture. The wound was dressed with gentamicin ophthalmic ointment and a patch.

The patient tolerated the procedure well and there were no complications. The patient will continue to use the gentamicin ointment to the wound 4 times daily for the next 6 days. She is to follow up with me in the Eye Clinic on November 3. The patient will use ice packs continuously as tolerated for the first 48 hours and has been encouraged to call with any problems relating to the eye or the wound.