नेत्रशल्यचिकित्सा

नेपाली विकिपीडियाबाट
यसमा जानुहोस्: परिचालन, खोज्नुहोस्
मध्य युगमा नेत्र शल्य चिकित्सा।

नेत्र शल्यचिकित्सा वा अप्थाल्मोलोजिक सर्जरी वा अकुलर सर्जरी आँखा वा आँखाको वरिपरि गरिने शल्यचिकित्सा हो। यस प्रकारका शल्यचिकित्सा नेत्र शल्यचिकित्सकहरुले गर्दछन्। [१]

Laser surgery र incisional surgery[सम्पादन गर्ने]

Although the terms "laser eye surgery" र "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), while radial keratotomy is an example of refractive surgery without the use of a laser.

Types of eye surgeries[सम्पादन गर्ने]

Cataract surgery[सम्पादन गर्ने]

A cataract is an opacification or cloudiness of the eye's crystalline lens due to aging, 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 usually replaced with a plastic intraocular lens (IOL). Due to the high prevalence of cataracts, cataract extraction is the most common eye surgery.[२]

Glaucoma surgery[सम्पादन गर्ने]

Glaucoma is a group of diseases affecting the optic nerve that results in vision loss र is frequently characterized by raised intraocular pressure (IOP). There are many glaucoma surgeries, र variations or combinations of those surgeries, that facilitate the escape of excess aqueous humor from the eye to lower intraocular pressure, र a few that lower IOP by decreasing the production of aqueous.

Procedures that facilitate outflow of aqueous humor[सम्पादन गर्ने]

Laser trabeculoplasty

A trabeculoplasty is a modification of the trabecular meshwork. Laser trabeculoplasty (LTP) is the application of a laser beam to burn areas of the trabecular meshwork, located near the base of the iris, to increase fluid outflow. LTP is used in the treatment of various open-angle glaucomas.[३] The two types of laser trabeculoplasty are argon laser trabeculoplasty (ALT) र selective laser trabeculoplasty (SLT). As its name suggests, argon laser trabeculoplasty uses an argon laser to create tiny burns on the trabecular meshwork.[४] Selective laser trabeculoplasty is newer technology that uses a Nd:YAG laser to target specific cells within the trabecular meshwork र create less thermal damage than ALT.[५][६]

Iridotomy

An iridotomy involves making puncture-like openings through the iris without the removal of iris tissue. Performed either with standard surgical instruments or a laser, it is typically used to decrease intraocular pressure in patients with angle-closure glaucoma. A laser peripheral iridotomy (LPI) is the application of a laser beam to selectively burn a hole through the iris near its base. LPI may be performed with either an argon laser or Nd:YAG laser.[७][८]

Iridectomy

An iridectomy, also known as a corectomy or surgical iridectomy, involves the removal of a portion of iris tissue.[९][१०] A basal iridectomy is the removal of iris tissue from the far periphery, near the iris root; a peripheral iridectomy is the removal of iris tissue at the periphery; र a sector iridectomy is the removal of a wedge-shaped section of iris that extends from the pupil margin to the iris root, leaving a keyhole-shaped pupil.

Filtering procedures: penetrating vs. non-penetrating

Filtering surgeries are the mainstay of surgical treatment to control intraocular pressure.[११] An anterior sclerotomy or sclerostomy is used to gain access to the inner layers of the eye [१] [२] [३] in order to create a drainage channel from the anterior chamber to the external surface of the eye under the conjunctiva, allowing aqueous to seep into a bleb from which it is slowly absorbed. Filtering procedures are typically divided into either penetrating or non-penetrating types depending upon whether an intraoperative entry into the anterior chamber occurs [४] [५].

Penetrating filtering surgeries are further subdivided into guarded filtering procedures, also known as protected, subscleral, or partial thickness filtering procedures (in which the surgeon sutures a scleral flap over the sclerostomy site [६]), र full thickness procedures [७]. Trabeculectomy is a guarded filtering procedure that removes of part of the trabecular meshwork[१२][८]. Full thickness procedures include sclerectomy, posterior lip sclerectomy (in which the surgeon completely excises the sclera on the area of the sclerostomy [९]), trephination, thermal sclerostomy (Scheie procedure), iridenclesis, र sclerostomy (including conventional sclerostomy र enzymatic sclerostomy) [१०] [११].

Non-penetrating filtering surgeries do not penetrate or enter the eye's anterior chamber [१२] [१३]. There are two types of non-penetrating surgeris: Bleb-forming र viscocanalostomy [१४] [१५]. Bleb forming procedures include ab externo trabeculectomy र deep sclerectomy [१६]. Ab externo trabeculectomy (AET) involves cutting from वाहिर the eye inward to reach Schlemm's canal, the trabecular meshwork, र the anterior chamber. Also known as non-penetrating trabeculectomy (NPT), it is an ab externo (from the outside), major ocular procedure in which Schlemm's canal is surgically exposed by making a large र very deep scleral flap. The inner wall of Schlemm's canal is stripped off after surgically exposing the canal [१७]. Deep sclerectomy, also known as nonpenetrating deep sclerectomy (PDS) or nonpenetrating trabeculectomy is a filtering surgery where the internal wall of Schlemm's canal is excised, allowing subconjunctival filtration without actually entering the anterior chamber [१८]; it is commonly performed with the Aquaflow® collagen wick [१९]. Viscocanalostomy is also an ab externo, major ocular procedure in which Schlemm's canal is surgically exposed by making a large र very deep scleral flap. In the VC procedure, Schlemm's canal is cannulated र viscoelastic substance injected (which dilates Schlemm's canal र the aqueous collector channels)[२०].

Other surgical procedures

Goniotomytrabeculotomy are similar simple र directed techniques of microsurgical dissection with mechanical disruption of the trabecular meshwork [२१] [२२] [२३]. Gonotomy procedures include surgical goniotomy र laser goniotomy. A surgical goniotomy involves cutting the fibers of the trabecular meshwork to allow aqueous fluid to flow more freely from the eye [२४][२५].[१३] Laser goniotomy is also known as goniophotoablation र laser trabecular ablation [२६]. In many patients suffering from congenital glaucoma, the cornea is not clear enough to visualize the anterior chamber angle. Although an endoscopic goniotomy, which employs an endoscope to view the anterior chamber angle, may be performed [२७], a trabeculotomy which accesses the angle from the exterior surface of the eye, thereby eliminating the need for a clear cornea, is usually preferred in these instances. A specially designed probe is used to tear through the trabecular meshwork to open it र allow fluid flow [२८].Video

Tube-shunt surgery or drainage implant surgery involves the placement of a tube or glaucoma valve to facilitate aqueous outflow from the anterior chamber[१४] [२९][३०]. Trabeculopuncture uses a Q switched Nd:YAG laser to punch small holes in the trabecular meshwork with [३१][३२] [३३]. Goniocurretage is an "ab interno" (from the inside) procedure that used an instrument "to scrape pathologically altered trabecular meshwork off the scleral sulcus" [३४][३५] [३६]. A surgical cyclodialysis is a rarely used procedure that aims to separate the ciliary body from the sclera to form a communication between the suprachoroidal space र the anterior chamber.[१०] A cyclogoniotomy is a surgical procedure for producing a cyclodialysis, in which the ciliary body is cut from its attachment at the scleral spur under gonioscopic control.[१०]

Procedures that decrease production of aqueous humor[सम्पादन गर्ने]

Certain cells within the eye's ciliary body produce aqueous humor. A ciliary destructive or cyclodestructive procedure is one that aims to destroy those cells in order to reduce intraocular pressure [३७]. Cyclocryotherapy, or cyclocryopexy, uses a freezing probe [३८]. Cyclophotocoagulation, also known as transscleral cyclophotocoagulation, ciliary body ablation,[३९], cyclophotoablation [४०], र cyclophototherapy [४१], uses a laser[१५][४२]. Cyclodiathermy uses heat generated from a high frequency alternating electric current passed through the tissue,[१०] while cycloelectrolysis uses the chemical action caused by a low frequency direct current.[१०]

Refractive surgery[सम्पादन गर्ने]

  • Refractive surgery aims to correct errors of refraction in the eye, reducing or eliminating the need for corrective lenses
    • Keratomilleusis is method of reshaping the cornea surface to change its optical power. A disc of cornea is shaved off, quickly frozen, lathe-ground, then returned to its original power.
    • Automated lamellar keratoplasty (ALK)
    • Laser assisted in-situ keratomileusis (LASIK)[१६]
    • Laser assisted sub-epithelial keratomileusis (LASEK), aka Epi-LASIK
    • Photorefractive keratectomy (PRK)[१७]
    • Laser thermal keratoplasty (LTK)
    • Conductive keratoplasty (CK) uses radio frequency waves to shrink corneal collagen. It is used to treat mild to moderate hyperopia.[१६]
    • Limbal relaxing incisions (LRI)
    • Astigmatic keratotomy (AK), aka Arcuate keratotomy or Transverse keratotomy
    • Radial keratotomy (RK)
    • Hexagonal keratotomy (HK)
    • Epikeratophakia is the removal of the corneal epithelium र replacement with a lathe cut corneal button.[१८]
    • Intracorneal rings (ICRs), or corneal ring segments (Intacs) [४३]
    • Implantable contact lenses
  • Presbyopia reversal
    • Anterior ciliary sclerotomy (ACS)
      • Laser reversal of presbyopia (LRP)
    • Scleral expansion bands

Corneal surgery[सम्पादन गर्ने]

Vitreo-retinal surgery[सम्पादन गर्ने]

Vitrectomy.
  • Vitreo-retinal surgery includes the following
    • Vitrectomy [४४]
      • Anterior vitrectomy is the removal of the front portio of vitreous tissue. It is used for preventing or treating vitreous loss during cataract or corneal surgery, or to remove misplaced vitreous in conditions such as aphakia pupillary block glaucoma.
      • Pars plana vitrectomy (PPV), or trans pars plana vitrectomy (TPPV), is a procedure to remove vitreous opacities र membranes through a pars plana incision. It is frequently combined with other intraocular procedures for the treatment of giant retinal tears, tractional retinal detachments, र posterior vitreous detachments [४५].
    • Pan retinal photocoagulation (PRP) is a type of photocoagulation therapy used in the treatment of diabetic retinopathy.[२१]
    • Retinal detachment repair
      • Ignipuncture is an obsolete procedure that involves cauterization of the retina with a very hot pointed instrument.[२२]
      • A scleral buckle is used in the repair of a retinal detachment to indent or "buckle" the sclera inward, usually by sewing a piece of preserved sclera or silicone rubber to its surface.[२३]
      • Laser photocoagulation, or photocoagulation therapy, is the use of a laser to seal a retinal tear.[२१]
      • Pneumatic retinopexy
      • Retinal cryopexy, or retinal cryotherapy, is a procedure that uses intense cold to induce a chorioretinal scar र to destroy retinal or choroidal tissue.[२४]
    • Macular hole repair
    • Partial lamellar sclerouvectomy[२५]
      • Partial lamellar sclerocyclochoroidectomy
      • Partial lamellar sclerochoroidectomy
    • Posterior sclerotomy is an opening made into the vitreous through the sclera, as for detached retina or the removal of a foreign body [४६].
  • Radial optic neurotomy

macular translocation surgery

 through 360 degree retinotomy
 through scleral imbrication technique

Eye muscle surgery[सम्पादन गर्ने]

With approximately 1.2 million procedures each year, extraocular muscle surgery is the third most common eye surgery in the United States [४७].

Extraocular muscle surgery in progress
  • Eye muscle surgeries typically correct strabismus र include the following[२६] [४८]:
    • Loosening / weakening procedures
      • Recession involves moving the insertion of a muscle posteriorly towards its origin.
      • Myectomy
      • Myotomy
      • Tenectomy
      • Tenotomy
    • Tightening / strengthening procedures
      • Resection
      • Tucking
      • Advancement is the movement of an eye muscle from its original place of attachment on the eyeball to a more forward position.
    • Transposition / repositioning procedures
    • Adjustable suture surgery is a method of reattaching an extraocular muscle by means of a stitch that can be shortened or lengthened within the first post-operative day, to obtain better ocular alignment [४९].

Oculoplastic surgery[सम्पादन गर्ने]

Other[सम्पादन गर्ने]

References[सम्पादन गर्ने]

  1. Surgery Encyclopedia - Ophthalmologic surgery
  2. Uhr, Barry W. History of ophthalmology at Baylor University Medical Center. Proc (Bayl Univ Med Cent). 2003 October; 16(4): 435–438. PMID 16278761
  3. University of Michigan Health System - Surgery for Glaucoma
  4. EyeMDLink.com - Argon Laser Trabeculoplasty (ALT)
  5. Review of Optometry - SLT: The Laser Picks Up Where Medications Leave Off
  6. Glaucoma Research Foundation - SLT: A New Type of Glaucoma Surgery
  7. Surgery Encyclopedia - Laser iridotomy
  8. EyeMDLink.com - Laser Peripheral Iridotomy (PI)
  9. Surgery Encyclopedia - Iridectomy
  10. १०.०० १०.०१ १०.०२ १०.०३ १०.०४ १०.०५ १०.०६ १०.०७ १०.०८ १०.०९ १०.१० १०.११ १०.१२ १०.१३ १०.१४ १०.१५ १०.१६ १०.१७ १०.१८ १०.१९ १०.२० १०.२१ १०.२२ १०.२३ १०.२४ १०.२५ १०.२६ १०.२७ १०.२८ १०.२९ १०.३० १०.३१ १०.३२ १०.३३ १०.३४ १०.३५ १०.३६ Cline D; Hofstetter HW; Griffin JR. Dictionary of Visual Science. 4th ed. Butterworth-Heinemann, Boston 1997. ISBN 0-7506-9895-0
  11. Jacobi PC, Dietlein TS, Krieglstein GK. "Technique of goniocurettage: a potential treatment for advanced chronic open angle glaucoma." Br J Ophthalmol. 1997 Apr;81(4):302-7. PMID 9215060.
  12. Surgery Encyclopedia - Trabeculectomy
  13. Surgery Encyclopedia - Goniotomy
  14. Surgery Encyclopedia - Tube-shunt surgery
  15. EyeMDLink.com - Cyclophotocoagulation
  16. १६.० १६.१ Surgery Encyclopedia - LASIK
  17. Surgery Encyclopedia - PRK
  18. १८.० १८.१ Surgery Encyclopedia - Corneal transplantation
  19. Indiana University Department of Ophthalmology - Phototherapeutic Keratectomy (PTK)
  20. MDAdvice.com - Pterygium removal
  21. २१.० २१.१ Surgery Encyclopedia - Photocoagulation therapy
  22. Wolfensberger TJ. "Jules Gonin. Pioneer of retinal detachment surgery." Indian J Ophthalmol. 2003 Dec;51(4):303-8. PMID 14750617.
  23. Surgery Encyclopedia - Scleral Buckling
  24. Surgery Encyclopedia - Retinal_cryopexy
  25. Shields JA, Shields CL. Surgical approach to lamellar sclerouvectomy for posterior uveal melanomas: the 1986 Schoenberg lecture. Ophthalmic Surg. 1988 Nov;19(11):774-80. PMID 3222038.
  26. Surgery Encyclopedia - Eye Muscle Surgery
  27. Surgery Encyclopedia - Blepharoplasty
  28. Cherkunov BF, Lapshina AV. ["Canaliculodacryocystostomy in obstruction of medial end of the lacrimal duct."] Oftalmol Zh. 1976;31(7):544-8. PMID 1012635.
  29. Indiana University Department of Ophthalmology. "Lacrimal Drainage Surgery (DCR: Dacryocystorhinostomy)." Retrieved August 18, 2006
  30. Surgery Encyclopedia - Enucleation
  31. Surgery Encyclopedia - Exenteration
  32. ३२.० ३२.१ Cassin, B. र Solomon, S. Dictionary of Eye Terminology. Gainsville, Florida: Triad Publishing Company, 1990.
  33. ३३.० ३३.१ Cvetkovic D, Blagojevic M, Dodic V. ["Comparative results of trepanotrabeculectomy र iridencleisis in primary glaucoma."] J Fr Ophtalmol. 1979 Feb;2(2):103-7. PMID 444110.

See also[सम्पादन गर्ने]

External links[सम्पादन गर्ने]


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