15 - Ophthalmic surgery

Summary

Assisting in ophthalmology has a different culture to assisting in many other surgical subspecialties. Gone are the Wellington boots, the muscle-seizing retractors, the gurgling suction devices and the general banter that progresses under general anaesthetic in a happy operating theatre.

These are replaced with microscopes, smaller areas of Betadine, often rapid turnover of patients, and a respect for the fact that for most operations, the patient is well awake. Ophthalmic surgery is performed more and more in specialised day surgical facilities, rather than in major general hospitals. Patients are therefore seen by the assistant post-operatively less and less, as this usually takes place in the surgeon's outpatients or rooms, and less and less on the ward.

The spectrum of ophthalmic operations at which you may assist, varies from cataract surgery to complex procedures such as anterior reconstructive surgery, involving delicate suturing of the sclera, cornea, iris, and perhaps intraocular lens, vitreo-retinal surgery, extraocular muscle surgery, and oculoplastic surgery.

By far the commonest ophthalmic operation is cataract surgery. Indeed, it is the world's commonest prosthetic operation. However, the proportion of cataract operations being performed with an assistant is rapidly decreasing, because improvements in design of the prosthetic lenses have made the operation simpler to perform. The most common assistant at cataract surgery is a future cataract surgeon honing his or her skills.

Pre-operative preparation

The surgeon may expect you to procure the intraocular lens of a particular type and power as stated on the operating list.