F Intraocular procedures
Intraocular procedures may refer to vitrectomy, glaucoma drainage, corneal transplant, and open eye injury. These procedures involve entry into the vitreous humor. It is crucial to avoid increases in intraocular pressure (IOP) with all intraocular procedures.
The most common of these procedures, vitrectomy, is performed by making three openings into the vitreous cavity. One of these openings is used to instill balanced salt solution; another is made for insertion of a fiberoptic light. The third opening is made for the insertion of various instruments used to remove abnormal tissue from the vitreous cavity. Frequently, a gas bubble is introduced during vitrectomy to tamponade retinal tears.
2. Preoperative assessment
a) History and physical examination: Individualized based on patient’s history and medical condition
b) Patient preparation
(1) Laboratory and diagnostic tests: These are as indicated from the history and physical examination.
(2) Medications: Midazolam, 1 to 2 mg, may be given intravenously in divided doses as a premedication. The anesthesia provider must be aware that ocular drugs applied topically can have systemic effects. These include hypertension, arrhythmias, nausea and vomiting, agitation, excitement, disorientation, seizures, hypotension, and metabolic acidosis.
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