Stephen Lash Eye Surgery

As a retinal surgeon I am often called in to see patients following trauma. The first stage is almost always to close wounds in the eye and allow it time to settle and then to address issues with the retina, infection or intraocular foreign bodies at a later stage. Here are a few cases. Remember to wear safety goggles when doing DIY and avoid becoming another entry on this page.

This chap had a fragment of metal go through his eye whilst doing DIY without protective eye wear. The surgery is vitrectomy performed under a local anaesthetic. You will see the gel being cleared and then the bright reflection of the metal come into view. The metal is grasped with tiny forceps and removed from the eye. At this point you will see the entire eye and perhaps, just like the time I showed this video to my son's class of 6 year old kids, there may be some screams and tears at that point!

This is an example of a traumatic cataract where the support of the lens is poor as a result of damage. The lens wants to drop back and so I hold it up with little hooks. The Jelly comes forward and so I put in some white stuff to show up the gel and cut it. The lens capsule also wants to collapse and so I hold it open with thin strip of plastic (A tension ring). The lens goes into the bag and the patient did very well achieving 6/6 vision unaided.

What is 6/6?

Everyone has heard of 20/20 vision. This is all to do with how far the chart is away form the person reading it (in this case 20 feet) which forms the top part of the fraction. The bottom part is the distance at which that letter forms a certain angle at the eye and is all a bit complex but basically a normal sighted person can see this letter at 20 feet which is good because it is tiny. In England we are metric and so rather than 20 feet, we talk about 6 metres! Hence 6/6

The top letter of the chart is very large and a normal person can see it at 60 metres. If with all the correction possible you can only see this top letter you could be eligible for blind registration.

Driving vision is about half way down the letter chart.
I am grateful to L for allowing me to video and share his surgery. He was stabbed through the eye and had his initial excellent repair by my colleague Mr Aby Jacobs who sutured the wound on the surface of the eye. I then saw him for his secondary repair. He had blood in the eye and I could not see to the back and detected the retinal detachment using ultrasound and took him to theatre the next day.

At first you see the blood altered Jelly which appears white and looks pulled towards the right side (It is incarcerated in the entry wound from the knife). After cutting the gel into tiny pieces and sucking it away I lift the entire Jelly off the back of the eye, a critical step in order to be able to remove it. The retina can be seen to be detached at the top and billows around. The exit wound of the knife can be seen on the left.

After clearing the Jelly I make a deliberate hole in the retina and then fill the eye with air whilst draining the fluid from under the retina. The retina goes flat again and I am then able to laser the retina around the holes. The laser causing a small scar which acts like glue. I then put oil in the eye to hold it.

In the final scene you will see the lens being placed infront of the lens capsule. I took out his lens to help me to clear blood and jelly and improve our chances of first time success.This was all done under a local anaesthetic and although painless he did swear at me once!

He healed very well and can now see clearly with spectacles in the distance and clearly close up without spectacles (I have told him he will appreciate this more as he gets old!!)
This patient lost their lens and most of the iris Iris in an injury (You can see a small remnant of the blue iris on the right side). Like a camera, if the aperture is wide open there is too much light and the picture is blurred. The human eye needs a smaller aperture to see and this is provided by the iris. This lens corrects the extreme longsightedness from loosing the lens and also provides a false iris to improve the optics of the eye.

It is extremely fiddly to do this and took me about an hour to do. It is very satisfying surgery.

This is another example of what can happen when eye protection is not used. This patient was cleaning metal with a spinning metal brush and part of the brush flew off and went through his eye. The entry wound was over towards his nose and was tiny. It has also entered the eye where we would usually enter the eye surgically and so he spared his cornea, lens and the edge of his retina although the metal came to rest under his retina at the back as you will see.

A big challenge was getting the gel off the back of the eye (inducing a PVD). HIs retina was also badly damaged and swollen, I elected to put oil into the eye without sticking the retina back with laser. We can wait for it to settle and then apply the laser through the oil.

Thanks to (Dr) J for allowing me to share this video of his surgery. Following a blow to the eye he suffered a traumatic cataract which was operated on last year with no complications. However, the damaged iris was causing glare and difficulty with vision. Following finals (good decision to wait!) I repaired the iris defects with the priority getting a smaller rounder pupil to aid vision. The iris defect is repaired using the Seipser slip knot technique allowing the knot to be slipped into the eye and then locked on subsequent throws. The inferior Iris dialysis was repaired using a double ended 10-0 Prolene suture using the Hoffman Pouch technique where the knot is buried in a pouch such that the surface layer of the eye including the conjunctiva is left undisturbed with no sutures required. This is more comfortable for patients. I am hoping he does well!

Thanks to L for allowing me to share his video. L had suffered trauma to the eye and as a result had developed cataract and a dilated pupil (traumatic mydriasis). After cataract surgery vision was excellent at 0.1 however he was getting signifincat glare and so we proceeded to suture the iris in a purse string manner- so called pupil cerclage. Surgery was under a local anaesthetic and he coped well! It took around half an hour to complete and was fiddly with the 10-Prolene on a straight needle hard to control! A curved needle (Not available at the time) would have been much easier. I saw him in clinic today and he has 0.02 (20/20) vision now and is settling well after surgery.