Definition
Excision of a section of the iris.
Discussion
- This procedure is usually indicated for primary angle-closure glaucoma, secondary angle-closure glaucoma, and occluded angle glaucoma.
- The creation of a new communication or channel for aqueous chamber is the basic goal of the procedure.
- To relieve the papillary block and reestablish the flow of aqueous through Schlemm’s canal.
Positioning
- Supine position, slightly elevated or flat.
- Arms are tucked and with soft restraints.
Drapes/ Packs
- Ophthalmic packs
- Special eye fenestrated sheet
- Basic pack
- Head or neck pack
Instrumentation
- Basic eye procedure tray
- Glaucoma procedure tray
- Handgrips or drape for microscope
Suppplies/ Equipment
- Headrest
- Sitting stool with backrest
- Microscope or loops
- Basin set
- Ophthalmic sponges
- Blade
- Multipore filter
- Cautery
- Balanced saline solution
- Medication
- Sutures
Procedure
- A small periotomy (2 mm) is made at the superior limbus.
- The epithelium is scraped away from the corneoscleral junction.
- Preplaced sutures are placed in the cornea.
- Prolapse of the iris is facilitated by gentle traction of the sutures.
- The iris is grasped, and the excision is performed.
- Balanced saline solution is used to flush away the remaining pigmented epithelium.
- The preplaced sutures are tied. Additional sutures may be necessary.
- Topical corticosteroids and antibiotic ointment may be instilled, and an eye pad is applied.
Perioperative Nursing Considerations
- Patient education is important, since the majority of patient’s will recuperate at home without the aid of direct nursing supervision.
- Written materials, audiovisual presentations, and formal education sessions in which questions and / or concerns can be addressed will alleviate anxiety associated with surgical event.
- Allow the nurse to strengthen any postoperative instruction for the patient and family.
- The patient should be well informed about the specific agents prescribed during the recovery period and notify the physician concerning any problems associated with the agents.
