These are preliminary notes from limited observation, updates will come as time goes on.
[[Ophthalmic Procedures]]
====By no means does this mean I am an expert====
INTRODUCTION: Purpose: removing cataracts Types of Extraction: *[http://www.visionrx.com/library/enc/enc_icextraction.asp Intracapsular] – entire lens is removed via suction and cryosurgical probe **[http://www.medrounds.org/bookstore/ProductDetail.php?product_id=76] ICCE **-less common form of cataract extraction *[http://www.surgeryencyclopedia.com/Ce-Fi/Extracapsular-Cataract-Extraction.html Extracapsular] – phacoemulsifier: fragmentation via ultrasonic vibration and suctioned with aspirating system **-most common form of cataract extraction Types of IOLs: [http://en.wikipedia.org/wiki/Intraocular_lens IOL Description] *[http://www.docshop.com/education/vision/refractive/iol/types/ Multifocal IOLs] **Multifocal Refractive IOLs **Apodized Diffractive Multifocal IOLs **Accommodatie IOLs
==MATERIALS:== [[image:Phaco1.jpg|.4x]] – One Type(mentioned in materials – keep in mind other available machines): *Phaco Machine *-#1[http://www.infinitivision.com/ INFINITI Vision System by Alcon] *-#2[http://www.joneseyecenters.com/index.cfm/technology/infiniti INFINITI Vision System by Alcon as well as other machines] *-#3[http://www.medrounds.org/cataract-surgery-greenhorns/2005/10/chapter-3-phaco-machine-settings.html Introduction To Phaco Machine and One Doc's Preference of Alcon's LEGACY and INFINITI as well as Bausch and Lomb's MILLENNIUM Machines] **500 ml glass bottle of BSS for Phaco Machine **Phaco Steps (use the arrows buttons () built in the phaco machine mayo stand to change settings **Phaco Settings: Quad, Sculpt, Cortex, Visco, Polish **-Quad Vac100 Asp23 **-Cortex Vac550 Asp35 **-Epi **-Sculpt **-Polish *-Phaco Drape *-Phaco tubing that connects the Machine Handle to machine for Irrigation **Phaco is a modified dentists drill *20 ml Ocucoat by Baush & Lomb – Assembled syringe of Viscous fluid **[http://www.bausch.com/en_US/ecp/surgical/ocucoat_statement.aspx Description1] **[http://www.bausch.com/en_US/ecp/age/ocucoat.aspx Description2] *-Requires some time to allow the air bubble to travel due to viscocity *20 ml syringe of H2O to rinse machine handle *Mayo Drape *Machine Handle *-flush with water utilizing 20 ml syringe of H2O *-#1use torsion bit in Microinstrument pan to install Metal Tip *-#2use yellow torsion bit in the kit to install the Metal Tip *-apply the plastic over the Metal Tip *3 ml syringe for medication (1:1 miostat and BSS) *3 ml syringe for BSS *18 ml bottle of [http://walcottrx.com/shop/scripts/prodView.asp?idproduct=99 BSS] *2X gray 27g straight needle **[http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=6827 Miostat] by Alcon Labs *Stab (spear shapped) Knife *Spatula (diamond shapped) Knife *Plastic Cup for betadine and cotton swabs *[http://cataractsurgeryforgreenhorns.blogspot.com/2009/04/pearls-for-small-pupils.html Malyugin Ring] *Seprate mayo stand and drape *-Betadine and Cotton Swabs *Eye Rectractor (amber plastic casing – looks like a plastic spatula housing a retractor inside) *Intraocular Lens (IOL) **#1[http://www.staar.com/html/toric-iol.html Staar Toric] IOL – looks like a blue tampon applicator **-reduces astigmatism **#2[http://www.tecnisiol.com/physician.htm TECNIS] injected foldable IOL **requies [http://www.duckworth-and-kent.com/resources/PDF/DK7791%20Injector%20and%20DK7726%20Forceps%20AMO%20Ultra%20Cartridge.pdf AMO TECNIS IOL] applicator **requires [http://www.duckworth-and-kent.com/resources/PDF/DK7791%20Injector%20and%20DK7726%20Forceps%20AMO%20Ultra%20Cartridge.pdf AMO TECNIS IOL] loading forceps *Pink bent needle *Peach bent needle – Irrigating Anstotome 25 g X 16mm formed needle *1/2 sheet *eye sheet *-reuquires cotton swat to maintain eye position while draping *4X4 Pre-cut Sponge – Soak with saline to clean instruments *Microinstruments **Probe **Forceps (preference dictated) **Eye Specula (preference dicated) **[http://www.medetzsurgical.com/224.html Stevens Tenotomy] Scissors *2X small basin **one for H2O to soak 4X4 pre-cut sponge **one for betadine solution *[http://www.operatingmicroscopes.com/ Operating Microscope] **Microscope handles that are sterilizable or disposalbe like light handles *Sterile cotton swabs
==STEPS:==
*Pt is evaluated by Doc and selects the best IOL for the case
*Surg Tech is scrubbed and prepares the Phaco machine, instruments, back table and 2X mayo stand *Patient is brought in and depending on the hospital policy a time-out maybe done BEFORE the preping *Pateint is anesthesized as ordered by doc
*Doc comes in to adjust Operating Microscope
*Doc inspects the eye to be repaired
*Doc leaves to scrub Draping/Prep:
*Surg Tech drapes pt with 1/2 sheet
**Circulator begins to concertedly prep pt
*Circulator preps the face with betadine using sterile cotton swabs
*Microscope handles are placed
*Prep dries and Surg Tech uses a sterile cotton swab to maintain an open eye position while using an eye drape to drape the face and eye
*Doc comes in from scrub and is gowned by tech
*Doc positions self and is handed BSS and [http://www.medetzsurgical.com/224.html Stevens Tenotomy] Scissors while the surg tech draws the back table, phaco machine and mayo stand
*Doc utilizes [http://www.medetzsurgical.com/224.html Stevens Tenotomy] Scissors to expose surgical area Surgery:
*1)Utilize 18 ml bottle of BSS
*2)Utilize 3 ml of local
*3)Utilize stab knife followed by diamond knife
*4)Emulsify cataract w/ ocucoat (utilizing the peach bent needle)
*5)Quad setting of Phaco Machine using the first bit (modified dentist’s drill)
**this setting divides the emulsified cataract into quarters
*6)As ordered by the doc, the Cortex setting of Phaco Machine is then used
**this setting picks up the majority of the emulsified cataract
*7)As ordered by the doc, the Sculpt setting of Phaco Machine is then used
**this setting picks up the rest of the emulsified cataract
*8)IOL is prepared and administered
**Surg Tech prepares IOL
**Doc applies the IOL
*8)a – Suture maybe utilized (optional and based on case by case basis preference dictated)
*Betadine is utulized
*Surgery is finalized
*Patient wakes up
*Eye is better – FINI :0
*Surg Tech breaks down sterile field
==INQUIRY:== What are the differences with the applications of different types of IOLs – cost, astigmatism, effectiveness and etc?
