Friday, August 5, 2011

Optho : Operation Theatre Day

Friday is an OT day.

But,i didn't bring my OT slippers.
Its okay, they didn't bother at all. Hoyeah!

It was an awesome OT because the case is related to our theory class we just had that morning.
It was wonderful because i still have the Wow! moment in there. I need it badly. 
It is awesome how the eyes are numbed,cut,poked and rolled on the surgery table,while the patient still conscious and he/she could actually see the whole procedure!!! 

These are the highlights during OT.
Might be viva question too.

The screen. Thanks to it, i can see what is going on under the microscope.

~Do you know what is biometry? Biometry is for intraocular lense power calculation. 
  Answer : P=A-2.5L - 0.9K.
  Where P is the power of IOL,A is a constant for lens type, L is the axial length of eyeball in mm determined by A-scan ultrasonography, K is average corneal curvature determined by keratometry.

~Traumatic induced cataract in a teenage girl following needle break in sewing lesson. The needle penetrated the cornea all the way through the vitreous and posterior capsule. Removal of the lense or lensectomy with anterior and posterior capsule removal  is done. Vitrectomy is completed using cutting ,irrigation and aspiration mechanism and implantation of IOL of 22D slightly higher than normal lense. He said even with loss of vitreous there will be no associated diminished vision or  post operative complications. Although, the damaged done is irreversible,they tried to save what they can since the patient is still young and they do not want to disfigure her.

~Pilocarpine injection into anterior chamber to asses pupillary reflex.

~Peribulbar anesthatic injection. I say you, it is painful and scary to us! Imagine a needle being poked straight  into the eye.!!! Gosh, i had anesthesia before, it was painful and i shed a tear. Well, a bit. But this is so scary and painful, even to those watching from bedside!

~Superior rectus muscle fixation. It is also know as bridle suture is passed to fix the eye in downward gaze manner.Sir said it was the most painful stage of cataract removal surgery.

~Tryphan blue dye to stain anterior capsule. A bubble is introduced between capsule and cornea. The bluish 
   tinged capsule is then teared with help of a knife to expose the pearly white cataractous lense.


  • It has three significant stage. Irrigation, aspiration and ultrasound.
  • Something about needle. Fact: Nucleus of the cataract is emulsified using a needle that vibrates at ultrasonic speed of 40000 times a second. One of great WOW! moments is OT, i must say.

~What type of cataract could develop after ECCE ? Answer: it is also known as after cataract. It has two types, Soemmering's ring and Elschnig's pearls.

~What is IOL related complications? Answer: CMO, corneal endothelial damage,uveitis and secondary which is frequently seen with anterior chamber IOLs. UGH syndrome refers to occurence of uveitis, glaucoma, and hyphema. 

~Students, where do we put the incision for lens delivery in intracapsular cataract extraction ? Is it from 6 o'clock or 12 o'clock?  With pure curiosity and without further thinking i asked " Sir, which clock sir? Your clock or our clock? " while standing on the bedside with surgeon sitting behind patient head. They burst into laughter. Pfft! What a bummer! I cracked a joke when the patient is STILL lying there.I didn't mean to. But, still it is a fair question! Answer: Indian smith method, fix the eye at 6 o'clock and by using another hand put counter pressure at 12 o'clock to deliver the lens out of the capsule through the pupil and anterior chamber.


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