Eye Surgery

Because of the internal rotation I have right now, we were allowed to take the day yesterday to go up to a Surgical Opthalmology center to observe some ocular surgeries. Su went with me (my clinic-mate) and we saw 5 different surgeries. Most were muscle ressessions or resections, where the detach one of the eye muscles and move it forward or back, to make it weaker or stronger, depending on if the patient's eye likes to turn in or out. The surgery for the muscles wasn't that bad, and just looked like this with minimal blood and stuff.

Another surgery was for a 3 year old who had a cataract removed as a baby. This kid has no lens, which leave him a +19 hyperope (far sighted). He was going uncorrected for a year because of lack of health care/money, and now he is finally getting a fake lens put in. In order to figure out exactly what power he needs, they did a sonogram of his eye to find the eyeball length, found the refractive power of his cornea with a hand held keratometer, and then someone left to go calculate the lens power he would need... (this is all while the kid is under anesthesia). So that is all fine and good, but what frustrated me is they left this kid as as a +2 hyperope, which means he will NOT be able to see distance OR near, since he does not have the ability to focus (accommodate) with a fake (phakic) lens in place. The surgeon was just trying to give him the 'normal' refractive error for a kid his age, but really he was not giving that eye a chance to see clearly at all. But what do i konw, i'm just an optometry student.

The last surgery was the most interesting. And the scariest. It was on a little 5 mo old baby, who had a membrane covering his pupil, like a spiderweb over the hole. It's called a pupillary membrane, and the surgery was meant to remove the membrane. This is kind of what it looked like, except the eye was blue and the membrane covering the eye was white. The surgeon (who admitted that he had never seen anything like this before, which means he had never done this kind of surgery before) took a peek while the baby was under anesthesia and saw that the lens and fundus were healthy, so he said (with all the cockiness of a surgeon), "oh, this will be a quick one, 30 minutes at the most". Well, it turned out to be much more complicated. After two corneal incisions and trying a number of different instruments, the iris was trying to come out the corneal incisions. In the end he got most of hte membrane out but also some of the iris, and had trouble stuffing it back in through the cornea. It was still attached to the cornea when he closed the incisions. He had to cut some of the iris away, and ended up making a mess of the anterior chamber. The pupil will never be round again and i don't know if it will function correctly. It took over an hour and i don't know if i would call it a success. I doubt he researched the condition before hand, but i just did a quick web search and found a successful report on using a YAG laser to get rid of this membrane. Oh, the audacity and ego of surgeons! I hope I never have to get surgery anytime soon...

Well, that's it for now... nothing much else exciting to report after that little craziness.

PS we are now climbing at stoneworks every Wednesday at 7.