Uuuuuugh.... i couldnt even be in the room when my husband was getting lasik eye surgery -shudders-
My eye is twitching just thinking about it.
Best thing about sci fi, is you can yadda yadda it.Does it serve the plot to go in depth?
Luckily, the
National Library of Medicine wrote a paper on the whole procedure (sans pictures), known as a "
Enucleation"
Surgical Technique
- Once a sterile field is achieved, the eyelids are retracted with the lid speculum or a traction suture.
- A retrobulbar anesthetic injection is administered with a mixture of 2% lidocaine and 0.5% marcaine with epinephrine.
- A 360-degree conjunctival peritomy is performed, and Tenon fascia is carefully removed from the globe with blunt dissection between the rectus muscles.
- Each rectus muscle is isolated with a squint hook, and the Tenon capsule is detached from the muscles.
- The muscle is secured by a locking double-armed 6-0 suture posterior to the insertions. Displacement of the muscle is prevented by clamping the suture to the surgical drape. The muscle is then transected anterior to the suture.
- The superior and inferior oblique muscles are disinserted without using tacking sutures.
- Vertical traction on the globe is created by grasping the rectus muscle insertions. The optic nerve is clamped, and enucleation scissors or snares are introduced to the posterior orbit, and the nerve is transacted. A useful technique to provide anterior traction is to use the stump of the inferior oblique.
- The optic nerve is cut using enucleation scissors.
- Careful dissection of residual fibrous attachments is undertaken with Wescott scissors.
- Minimize any orbital fat manipulation to reduce the risk of atrophy.
- Soak neurosurgical paddies/swabs in local anesthetic with epinephrine and temporarily pack these into the orbit with pressure for a few minutes. Bipolar cautery can be used to assist in hemostasis but should be used judiciously.
- In cases of intraocular tumors, at least 7-10 mm of the optic nerve is removed during the enucleation. It is wise to photograph the globe and the length of the optic nerve after the enucleation.
- Send the globe for pathologic investigation.
- If planning to insert the orbital implant, choose the correct size and with or without wrapping, introduce with the Carter introducer inside the muscle cone, posterior to the Tenon capsule.
- The rectus muscles are secured to the implant, and the Tenon capsule is closed with buried and interrupted 5-0 absorbable sutures.
- The conjunctiva is closed with a running 6-0 or 7-0 absorbable suture, avoiding invagination of the epithelium, which can lead to cyst formation.
- Finally, a conformer is placed to maintain the fornices and prevent symblepharon formation. Topical antibiotic ointment is applied to the fornices and lids.
- Retro-orbital injection with liposomal bupivacaine gives good postoperative pain control.[21]
- A temporary tarsorrhaphy suture is frequently inserted between the lateral, upper, and lower eyelids with a 5-0 vicryl or 6-0 vicryl suture to reduce chemosis and prevent the conformer from falling out. These sutures are removed in one to four weeks after surgery.
- The orbit is covered with a gentle pressure patch for 24 hours to reduce postoperative edema.
Equipment
The equipment can vary depending on the surgical technique used for enucleation. An enucleation set should include the following surgical instruments:
- Eye speculum
- Straight dressings forceps
- Hemostatic forceps
- Straight and curved tenotomy scissors
- Enucleation scissors
- Enucleation snare
- Retractors
- Carter sphere introducer and holder
- Conformer
- Suturing set for wound closure
