You're in objectively the best field of medicine :) and congrats to getting started on your training. Ophthalmology has a steep learning curve starting out because the field is not something that is emphasized during medical school. At the start it often feels like a foreign language. Thankfully, the clinical training at UCI is excellent and you will catch on quickly and soon be able to handle even the most complex eye pathologies in clinic as a PGY-2. This is not a comprehensive guide on everything you need to know. The purpose is to help you focus on high yield topics so you don't get lost in the sea of information.
Retina
Procedure:
1) Laser Settings: Power 1.0-2.0 mJ generally with posterior offset
2) Usually RTC 1-2 weeks for DFE
3) Start PF QID x 4 days if more than 100 mJ
*helpful laser site https://eyeguru.org/blog/ophthalmic-lasers/
AC Tap
Various methods. Typically we do the slit lamp approach. Check IOP afterwards
Supplies:
-Proparacaine
§ Subconj lidocaine optional if they're not in much pain
- 1 mL syringe
- 30 G needle
- Sterile black caps for aqueous cultures
- Speculum
- Iodine
- Ofloxacin (1 drop after and QID x4 days for infection ppx)
Procedure:
**Make sure there's no vitreous floating in the AC beforehand**
1) Numb+place speculum
2) Drop of betadine on temporal cornea
3) Bring patient to slit lamp, position and put patient in focus, 10x mag setting better
4) Unplug plunger from syringe, have hand with needle positioned temporal to operative eye and have other hand with plunger ready to apply pressure on eye opposite the needle
5) Enter cornea around 9oc at plane parallel to iris, prefer bevel up--if bevel down and IOP is very high, the iris can get sucked into the bevel and get tracked out
§ Beware: try not to nick the iris and DEFINITELY try not to nick the lens
6) Gentle pressure with plunger on opposite side of eye, should see the eye start to get softer
7) When eye feels soft or sufficient aqueous is in the needle/syringe, remove needle
8) Check IOP
§ If you need to do an intravitreal injection, clean the eye again and do an intravitreal injection like you usually would, then recheck IOP
9) Check Seidel, if positive can place BCL (although some people don't)
10) Give oflox and remember to order it for patient
11) RTC next day for IOP check