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What degree of anaesthesia is necessary for intraocular surgery? It depends on whether surgery is “open” or “closed”
  1. J S Schutz,
  2. N A Mavrakanas
  1. Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland
  1. Correspondence toJames S Schutz, Department of Ophthalmology, Geneva University Hospitals, Rue Alcide-Jentzer 22, Geneva 1205, Switzerland; js485squid{at}yahoo.com

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“Closed” intraocular surgery is characterised by some degree of pressurisation of the globe, positive intraocular pressure, during almost all of the procedure so the eye is not markedly hypotenous more than momentarily. In closed surgery characteristically, the incisions are self sealing or small and easily closed with suturing, and second, the eye is pressurised by an infusion line.1 Phacoemulsification2 and trans pars plana vitrectomy3 are typical forms of closed intraocular surgery.

“Open” intraocular surgery4 is characterised by globe decompression to or close to atmospheric pressure for significant periods of time, typically with an incision which is not self sealing, such as nuclear expression extracapsular cataract surgery, penetrating keratoplasty and trabeculectomy.

Questions

  1. What is positive vitreous pressure?

  2. How is the choice of anaesthetic technique affected by whether intraocular surgery is closed or open?

  3. What are the consequences of converting from closed to open surgery, specifically from phacoemulsification to nuclear expression?

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Answers

From questions above

  1. “Positive vitreous pressure” (PVP)4 5 is apparent pressure forward against the lens-iris diaphragm from the vitreous, movement of the vitreous body anteriorly during intraocular surgery. PVP does not arise from any inherent expansile force generated within the vitreous body nor from elastic forces of the sclera …

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