Procedures

Supplies:

-Proparacaine

-Capsulotomy lens

 Goniosol or genteal gel to fill lens

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/

Supplies:

-Drops: Proparacaine, pilocarpine (1% or 2%), apraclonidine

-LPI lens (iridotomy  lens, different from YAG cap lens--it has a small circle that's more magnified)

-Goniosol or gental gel to fill lens

Procedure:

1)  Pre-treat with pilocarpine and apraclonidine ~15 min before procedure

2) Consider pre-treatment with argon laser (i.e. the PRP slit lamp) with LPI lens

• Power 400, spot size 50, duration 100 then like 10-20 shots

3) After pre-treatment (or directly here if no pre-treatment), bring to YAG slit lamp with LPI lens

• Power 4-8mJ, NO posterior offset, 1-10 shots

• If iris starts to bleed, hold pressure, can keep trying to shoot through but if not working can check IOP 30min after, if elevated start pressure-lowering drops, and bring back soon for repeat

3) Check IOP 30 minutes after

4) Pred QID x4 days

5) 1-2 week followup patency check and do other eye if necessary

*helpful laser site https://eyeguru.org/blog/ophthalmic-lasers/

-Settings: Power 200-400 (start low and adjust as needed for burn marks), duration 80-100, rate 300 

• Tip: take a look at the macula before you start, and foot off the pedal when you're looking at the macula

• Beware: starting on power too high can be painful for the patient, go up instead of starting high and going low

• Can decrease rate as you get more comfortable

** Evaluate for canalicular involvement first, if c/f canalicular lac, probe and irrigate and if it's involved, talk to oculoplastics**

Supplies:

-Deep stitches: 5-0 vicryl

-Superficial brow not near margin: 5-0 chromic 

-Marginal or near brow margin: 6-0 chromic

-One 10 cc syringe with 27 gauge needle for local

-Local anesthesia: can use lido w/epi or

• Plastics prefers 4.5:4.5:1 ratio of lido w/epi : bupivacaine : sodium bicarb because bupivacaine lasts longer

-Wescott Scissors

-Castroviejo needle holder

-Tying Forceps

-Corneal protector

-Betadine swabs

-Sterile towels and gloves

Procedure:

1) 1 vertical mattress thru grey line

2) Simple interrupted:

• 2 tarsal simple interrupted if upper lid

• 3 tarsal simple interrupted if lower lid

Supplies

- Intravitreal antibiotics are  0.1 cc injection; make sure to specify into pharmacy comments on order to overfill to 0.3 cc so that you have enough to prime the needle

- Typically Ceftazadime + Vancomycin +/- Dexamethasone +/- Amphotericin (if concerned for fungal)

- Anesthesia -- prepare first and numb the patient while you collect the next things on this list

- Subconj lidocaine, if eye is really beefy or inflamed consider actin gel or vigorous tetracaine

- One 3 cc syringe with 25g needle for vit tap

- Three 30 gauge needles for injections (depending on how many meds you're injecting) and load onto medications

- One 1 cc syringe + 30 gauge needle in case you need to perform AC tap

- Speculum

- Iodine swab/drops

- Tonopen

- Q-tips

- Black syringe caps for vitreous sample send off

Procedure:

1) Numb, speculum, clean, mark, clean as you would for any intravitreal

2) Where you would usually do the intravitreal injection 3-4mm from limbus on mark,  enter the eye with the  3cc syringe with 25g needle (can hub), draw back. You may need to move the needle around a little to find a pocket of vitreous while drawing back.

3) Aim to remove around the amount of medication you're going to inject; if the IOP is high, remove slightly more

4) Once you get your vitreous sample, do the injections (can do around the same area as the vit tap)

5) Clean up and check IOP

Supplies

- Local anesthesia: Lidocaine 2% or 1% with epi (the same one we use for subconj) drawn into 5-10cc syringe with 27 gauge needle

- Bolster: Butterfly needle tubing (ask nursing or check the bedside supply cabinets in ICU or IV room)

- One or two 5-0 blue prolene sutures (4-0 works too)

- Wescott Scissors

- Castroviejo needle holder

- Tying Forceps

- Corneal protector (make sure you take it out while you still can before sealing the eye shut)

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

Supplies:

-Suture removal kit (if need to trim lashes)

-Desmarres

-Cyanoacrylate glue (cornea glue)

-10x5 AmnioGraft, one per eye if doing both

-Prokera or Butterly tubing (to use a symblepharon ring)

-Two nontooth curved platform tying forceps

Helpful guide:

SS Shanghag et al 

http://sciencedirect.com/science/article/abs/pii/S1542012419300102?via%3Dihub

(trying to figure out how to add a picture here of the procedure)