Ophthalmology Procedures

BAND KERATOPATHY 

Is the result of precipitation of calcium salts on the corneal surface (directly under the epithelium). Serum and normal body fluids (eg, tears, aqueous humor) contain calcium and phosphate in concentrations that approach their solubility product. Evaporation of tears tends to concentrate solutes and to increase the tonicity of tears; it is especially true in the intrapalpebral area where the greatest exposure of the corneal surface to ambient air occurs. Elevated serum calcium or serum phosphate can tip the balance in favor of precipitation. Topical medications that contain phosphates also may contribute to this problem. Finally, elevation of the surface pH out of the physiologic range changes the solubility product and favors precipitation. This type of tissue pH change can be seen in chronically inflamed eyes and may explain, in part, why patients with uveitis are at risk for the development of this problem

BLEPHAROPLASTY 

Can be both a functional or cosmetic surgical procedure intended to reshape the upper eyelid or lower eyelid by the removal and/or repositioning of excess tissue as well as by reinforcement of surrounding muscles and tendons. When an advanced amount of upper eyelid skin is present, the skin may hang over the eyelashes and cause a loss of peripheral vision. The outer and upper parts of the visual field are most commonly affected and the condition may cause difficulty with activities such as driving or reading. In this circumstance, upper eyelid blepharoplasty is performed to improve peripheral vision. Patients with a less severe amount of excess skin may have a similar procedure performed for cosmetic reasons. Lower eyelid blepharoplasty is almost always done for cosmetic reasons, to improve puffy lower eyelid "bags" and reduce the wrinkling of skin.

BROW LIFT 

Also known as a forehead lift, minimizes the creases that develop across the forehead, or those that occur high on the bridge of the nose; improves what are commonly referred to as frown lines; and repositions a low or sagging brow.

CANTHOPLASTY 

Refers to a procedure designed to reinforce lower eyelid support by detaching the lateral canthal tendon from the orbital bone and constructing a replacement.

CATARACT 

Is a clouding that develops in the crystalline lens of the eye or in its envelope, varying in degree from slight to complete opacity and obstructing the passage of light. Early in the development of age-related cataract the power of the lens may be increased, causing near-sightedness (myopia), and the gradual yellowing and opacification of the lens may reduce the perception of blue colours. Cataracts typically progress slowly to cause vision loss and are potentially blinding if untreated. 

LASER CATARACT SURGERY

With the laser approach to cataract surgery, the surgeon creates a precise surgical plan with a sophisticated 3-D image of the eye called an OCT (optical coherence tomography). The goal is to create an incision with a specific location, depth and length in all planes, and with the OCT image and a femtosecond laser, it can be performed exactly without the variable of surgeon experience.

CHALAZION

Is a cyst in the eyelid that is caused by inflammation of a blocked meibomian gland, usually on the upper eyelid. Chalazions differ from styes (hordeolums) in that they are usually painless apart from the tenderness caused when they swell up, and in size (chalazia tend to be larger than styes). A chalazion may eventually disappear on its own after a few months, though more often than not, some treatment is necessary.

CORNEAL DYSTROPHY

Is an eye condition in which the cornea thickness increases due to elevated pressure within the cornea. Normally corneal dystrophy is a slowly progressing disease.

CORNEAL DYSTROPHIES

Are inherited traits where 1 or more parts of the cornea lose clarity due to buildup of cloudy material. Ex; Fuch’s Dystrophy, Keratoconus, Lattice Dystrophy, Map-Dot Fingerprint Dystrophy.

CORNEAL TRANSPLANTATION

Also known as corneal grafting or penetrating keratoplasty, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue which has been removed from a recently deceased individual having no known diseases which might affect the viability of the donated tissue. The cornea is the clear part of eye in front of the iris and pupil. 

DACRYOCYSTORHINOSTOMY

Is a surgical procedure to restore the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct does not function.

DSEK/DSAEK/DMEK 

Endothelial keratoplasty (EK) has been introduced by Melles et al in 1998. Today there are three forms of EK. Deep Lamellar Endothelial Keratoplasty (DLEK) in which the posterior part of the recipient cornea is replaced by donor tissue. The corneal endothelium is a monolayer of cells attached to the basement membrane called Descemet Membrane. Descemet's  Stripping (Automated) Endothelial Keratoplasty (DSEK/DSAEK) in which the diseased Descemet's membrane is removed and replaced by a healthy donor posterior transplant. DSEK/DSAEK uses only a small incision that is either self-sealing or may be closed with a few sutures. The small incision offers several benefits over traditional methods of corneal transplant such as Penetrating Keratoplasty. Because the procedure is less invasive, DSAEK leaves the eye much stronger and less prone to injury than full-thickness transplants. Additionally, DSAEK has a more rapid rate of visual recovery. Vision is typically restored in three to six months rather than one to two years. Descemet Membrane Endothelial Keratoplasty (DMEK) is the most recent EK technique in which an isolated Descemet membrane is transplanted. The DMEK procedure combines the anatomical benefits of DSEK/DSAEK with visual rehabilitation to 20/40 or better within the first month in approximately 90% of cases. 

ECTROPION

Is a medical condition in which the lower eyelid turns outwards. It is one of the notable aspects of newborns exhibiting Harlequin ichthyosis. The condition can be repaired surgically. 

EDTA CHELATION

Edta Chelation (ethylenediaminetetraacetic acid) is a technique for correcting Calcium Band Keratopathy in conjunction with Laser Assisted Subepithelial Keratecomy (LASIK)

ENTROPION

Is a medical condition in which the eyelids fold inward. It is very uncomfortable, as the eyelashes rub against the cornea constantly. Entropion is usually caused by genetic factors and may be congenital. Trachoma infection may cause scarring of the inner eyelid, which may cause entropion.

GLAUCOMA 

Is a group of diseases of the optic nerve involving loss of retinal ganglion cells in a characteristic pattern of optic neuropathy. Although raised intraocular pressure is a significant risk factor for developing glaucoma, there is no set threshold for intraocular pressure that causes glaucoma. One person may develop nerve damage at a relatively low pressure, while another person may have high eye pressure for years and yet never develop damage. Untreated glaucoma leads to permanent damage of the optic nerve and resultant visual field loss, which can progress to blindness.

LIMBAL RELAXING INCISION  (LRI)

Patients with astigmatism who are undergoing cataract surgery can choose to have limbal-relaxing incisions made to reduce their dependence on glasses for clear vision. Limbal-relaxing incisions are tiny incisions made around the edge of the cornea, called the limbus. These incisions "relax" the cornea's steep curvature and improve the way the eye focuses light.  Limbal-relaxing incisions have been shown to heal faster and cause fewer side effects than other astigmatic keratotomy (AK) procedures.

ORBITOTOMY 

An incision into the orbit.

PENETRATING KERATOPLASTY (PKP) 

Is a full thickness corneal button transplant. Most common indications for surgery are: Keratoconus, Bullous Keratopathy, and Viral Keratitis. Fuch’s Dystrophy is also an indication, but not as much recently with the DSEK/DSAEK procedure introduced.

PTERYGIUM

Usually refers to a benign growth of the conjunctiva. A pterygium commonly grows from the nasal side of the sclera. It is associated with, and thought to be caused by ultraviolet-light exposure (e.g. sunlight), low humidity, and dust. The predominance of pterygia on the nasal side is possibly a result of the sun's rays passing laterally through the cornea where it undergoes refraction and becomes focused on the limbic area. Sunlight passes unobstructed from the lateral side of the eye, focusing on the medial limbus after passing through the cornea. On the contralateral side, however, the shadow of the nose medially reduces the intensity of sunlight focused on the lateral/temporal limbus. Pterygia usually appear as a raised wedge shape growth.

PTOSIS 

Is an abnormally low position (drooping) of the upper eyelid. The drooping may be worse after being awake longer, when the individual's muscles are tired. This condition is sometimes incorrectly referred to as a "lazy eye", a separate condition known as Amblyopia. If severe enough and left untreated, the drooping eyelid can cause other conditions, like Amblyopia or Astigmatism. This is why it is especially important for this disorder to be treated in children at a young age, before it can interfere with vision development.

SELECTIVE LASER TRABECULOPLASTY  (SLT)

As its name suggests, argon laser trabeculoplasty uses an argon laser to create tiny burns on the trabecular meshwork. Selective laser  trabeculoplasty is newer technology that uses a Nd:YAG laser to target specific cells within the trabecular meshwork and create less thermal damage than ALT. SLT shows promise as a long term treatment. In SLT a laser is used to selectively target the melanocytes in the trabecular meshwork. Though the mechanism by which SLT functions is not well understood, it has been shown in trials to be as effective as the older Argon Laser Trabeculoplasty. However, because SLT is performed using a much lower power laser, it does not appear to affect the structure of the trabecular meshwork (based on electron microscopy) to the same extent, so retreatment may be possible if the effects from the original treatment should begin wear off.

SYMBLEPHARON 

Adhesion of the eyelids to the eyeball.

TARSORRHAPHY 

Is a surgical procedure in which the eyelids are partially sewn together to narrow the opening (i.e. palpebral fissure).

YAG LASER CAPSULOTOMY

During cataract surgery, the clouded lens in the eye is removed from the lens capsule and replaced with a clear, artificial lens called an IOL. Weeks, months or years after the surgery, some patients experience a decrease to their vision. This sometimes happens because the lens capsule becomes cloudy or wrinkled, blurring the patient's vision once again. This affects about 1 in 3 people within 5 years of having cataract surgery. It is sometimes called an "after cataract" or secondary membrane. If an examination confirms that this is the case, and if the clouded capsule prevents the patient from doing what he or she wants or needs to do, then a YAG capsulotomy may be recommended. This simple procedure uses a YAG laser to open a window in the back of the lens capsule and restore clear vision. YAG capsulotomy is a painless outpatient procedure that takes less than 10 minutes. Vision improvement is quick, and the patient can resume normal activities immediately.

YAG LASER IRIDOTOMY 

In acute angle closure glaucoma cases, surgical iridectomy has been superseded by Nd:YAG laser iridotomy, because the laser procedure is much safer. Opening the globe for a surgical iridectomy in a patient with high intraocular pressure greatly increases the risk of suprachoroidal hemorrhage, with  potential for associated expulsive hemorrhage. Nd:YAG laser iridotomy avoids such a catastrophe by laser created hole in the iris, which facilitates flow of aqueous humor from the posterior to the anterior chamber of the eye.