Week 3 - Rios

The third week a summer immersion has come to an end. The beginning of this week was exciting since finally I made it to the OR. I saw a couple of pediatric ophthalmic surgeries. One of the surgeries was performed on a baby born with an obstructed nasalacrimal duct system. This causes an excess tears in the eye and can lead to infections. The surgery was very simple and consisted of inserting a dilating probe into the lacrimal punctum, which can be appreciated in the image below. Once the punctum is dilated the surgeon uses a syringe to inject fluid into the inferior punctum and confirming that the duct is obstructed, since instead of the fluid going to the nose, it comes back to the eye via the superior punctum. Then a long flexible probe of known diameter is inserted into the punctum and pushed into the nasolacrimal duct until the obstruction is reached, at this point the surgeon positions the probe forces it through to open the duct. Finally a syringe is used again to inject fluid into the lacrimal punctum and is collected through the nose to confirm the opening of the chanel.

http://kidshealth.org/parent/general/eyes/tear_duct_obstruct_surgery.html

The second one was a cataract surgery on a 5 month old baby who was born with this defect. This surgery consisted in making a couple of incisions on the outer rims of the cornea to gain access to the anterior chamber. A purple dye is injected to color the lens capsule to make it visible to the surgeon. Then very fine tweezers are use to peel of the anterior part of the lens capsule which is then aspirated. Then an ultrasound probe was used to break down the lens which was then aspirated, thus removing the cataract. A small problem arise since a vitreous filament from the posterior region of the eye got out into the anterior chamber. If left like that, it can get stuck somewhere in the anterior chamber and as the pupil constricts it can pull on the retina of the eye, which could cause a retinal detachment. Therefore the surgeon spent a good amount of time removing this filament, then he suture back the cornea.

Overall, it was a good week. I learned a great deal from both surgeries. Additionally, I kept assisting clinic, and now I am able to recognize several things the ophthalmologists see in patients and got a quick training session on the slit lamp. And all of this was follow by the weekend of doom…