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Same-Day Surgery Summary
Date: 1/29/19
History of Present Illness: This is a 62-year-old male with a progressive painful blurring of vision due to aphakic bullous keratopathy with moderate stage glaucoma in the left eye. He has undergone a previous Molteno implant with poor vision and pain due to a ruptured bulla. The patient is admitted for transplant, vitrectomy, and lens implantation at this time.
Past Medical History: The patient has angina and COPD. There have been no recent episodes of chest pain or shortness of breath. The patient also underwent a prostatectomy six years ago for prostatic carcinoma.
Allergies: None known
Chronic Medications: Ventolin and nitroglycerin as needed for chest pain.
Social History: The patient is a 62-year-old male who is married and lives with his wife. He has 5 grandchildren. He is a nondrinker and a nonsmoker.
Review of systems: The patient has normal bowels. He has had no problems with his urine since his prostatectomy. There is no hematuria or dysuria. The patient has had two colds in the past six weeks. He states that he has been having some difficulty sleeping because of the pain in his shoulder. This has limited some of the activities that he normally does, such as golf.
Physical Examination: This is a well-developed, well-nourished 62-year-old male who appears younger than his stated age.
HEENT: Aphakic, neck supple
Chest: The lungs are clear to percussion and auscultation. The heart has a normal rhythm and pulse.
Abdomen: Abdomen revealed no masses; bowel sounds are heard.
Extremities: Extremities revealed no edema.
Operative Report:
Preoperative Diagnoses:
- Aphakic bullous keratopathy left eye
- Open-angle glaucoma left eye
- Chronic iritis bilateral
Postoperative Diagnosis:
- Aphakic bullous keratopathy left eye
- Open-angle glaucoma left eye
- Chronic iritis bilateral
Operation:
- Aphakic penetrating keratoplasty left eye
- Posterior chamber intraocular lens scleral implant left eye
- Open-sky mechanical automated vitrectomy left eye
Anesthesia: Retrobullar block, monitored anesthesia care
Complications: None
Indications: This is a 62-year-old gentleman with the progressive painful blurring of vision due to aphakic bullous keratopathy with glaucoma. He has undergone a previous Molteno implant with poor vision and pain due to a ruptured bulla. The patient is admitted for transplant vitrectomy and lens implantation of the left eye at this time. After informed consent, the patient agreed to the benefits and risks of surgery.
Procedure Description: The patient was taken to the operating room. Under monitored anesthesia care, he was given a retrobulbar block in the standard fashion for a total of 4 cc of a 50/50 mixture 0.75% Marcaine and 4% lidocaine with Wydase.
After ensuring adequate anesthesia as well as akinesia, the patient was prepped and draped in the usual sterile ophthalmic fashion. A wire lid speculum inserted, and a small conjunctival peritomy was made at the two o’clock and ten o’clock hour positions to prepare for half-thickness scleral flaps for suturing a scleral-supported lens in the left eye. A Flieringa ring was then attached in the standard fashion using four interrupted 5-0 Dacron sutures. Attention was then placed to the back Mayo, and a 7.75-mm donor button was harvested, epithelial side down, in the standard fashion. Routine surveillance cultures were sent, and the donor button placed on the Mayo stand in a Petri dish. Attention was then placed on the donor’s cornea and using a Barron-Hessburg trephine device, a 7.50-mm button was harvested under viscoelastic support. Corneoscleral scissors were used to the left and right respectively to remove the button in toto. Vitrectomy was then performed due to prolapsing vitreous, and an attempt to reposition the iris was made. However, due to loss of iris material during prior surgeries, I was unable to close the sphincter defect. After completing the vitrectomy, a scleral-supported CZ70VD 7-mm lens was secured using a 10-0 Prolene suture at the ten and two o’clock hour positions. Scleral flaps were then closed over the 10-0 Prolene to maintain a tight closure. The button was then sewn into position using 16 interrupted 10-0 nylon sutures in the standard fashion. All the knots were cut short and buried in the recipient site of the host junction. A final check to make sure the chamber was watertight was unremarkable, and the Flieringa ring was removed followed by the bridle sutures. Subconjunctival Ancef and Celestone were placed, and a bandage contact lens was placed on the eye.
The patient was taken to the recovery room in good repair without the complication of the above procedure.