You are here

Article Text

Article menu
Download PDFPDF
Education
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 to James S Schutz, Department of Ophthalmology, Geneva University Hospitals, Rue Alcide-Jentzer 22, Geneva 1205, Switzerland; js485squid{at}yahoo.com

https://doi.org/10.1136/bjo.2008.152660

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    “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?

    See page 1413 for answers

    Answers

    From questions on page 1400

    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 …

    View Full Text

    Footnotes

    • Competing interests None.

    • Provenance and peer review Not commissioned; externally peer reviewed.