Oculus Jeopardy Yay!

Cataract Corner

100

The mark that surgeons use to line up the lense to fix astigmatism

What is a toric mark?

200

Are sutures used in cataract surgery?

Why?

not typically, the incision is self sealed

300

Where is a sulcus lens placed?

behind the iris and in front of the capsular bag

400

What are the different viscoelastics and when are they used?

• Totalvisc, stablevisc, amvisc+, amvisc, clearvisc, ocucoat, Duovisc, Provsic, Viscoat (B&L and ALCON)
• Why are different ones used?
• Dispersive: helps coat the corneal endothelium, more liquid
• Cohesive: helps create space within the capsular bag, easier to remove at the end, more solid

500

In this procedure the haptics of the lens is secured in the sclera

yamane lens

Retina & Cornea

100

This dye is used to stain the membrane during retina surgery

Tissue Blue

200

This is a retina surgery where the vitreous gel is removed

Pars plana vitrectomy (PPV)

A pars plana vitrectomy (PPV) is surgery where the doctor removes the jelly (vitreous) from inside the eye.

This is done when the jelly is causing a problem, such as blood, scar tissue, or pulling on the retina.

Simple version:
➡️ Take out the bad jelly and clean up the inside of the eye.

PPV for Retinal Detachment

A retinal detachment means the retina (the "film" or "screen" at the back of the eye) has come loose.

The doctor:

1. Removes the jelly (PPV).
2. Puts the retina back in place.
3. Uses a gas bubble or silicone oil to help hold it there while it heals.

Simple version:
➡️ Take out the jelly and repair the retina so it sticks back where it belongs.

Easy difference

• PPV alone: Clean out the jelly.
• PPV with retinal detachment: Clean out the jelly and fix the detached retina

300

Where is a block injected

Eye blocks are ways doctors make the eye numb for surgery.

• Retrobulbar block → medicine goes deep behind the eye
  • space inside the extraocular muscle cone

  This area contains:

• Optic nerve
• Motor nerves to eye muscles
• Blood vessels

• Peribulbar block → medicine goes around the eye
• Sub-Tenon’s block → medicine goes under a thin layer covering the eye
• Topical anesthesia → just eye drops on the surface

400

Difference between DMEK and DSEK

• DMEK = Minimal tissue
• DSEK = Some Extra tissue

Bottom line: DMEK replaces only the damaged cell layer, while DSEK replaces the cell layer plus a thin layer of supporting tissue. Both use a bubble to hold the transplant in place while it heals.

DMEK vs. DSEK

The cornea is the clear front window of the eye. It helps focus light so we can see clearly. On the back of the cornea is the endothelium, a layer of cells that acts like a pump to keep the cornea clear and dry. When these cells stop working, the cornea becomes swollen and cloudy.

Both DMEK and DSEK replace this damaged endothelial layer.

🏠 Think of the cornea like a wall with wallpaper:

• DMEK = replace only the wallpaper (Descemet membrane + endothelial cells)
• DSEK = replace the wallpaper plus a thin piece of the wall behind it (a thin layer of stroma)

DMEK uses thinner tissue, which can lead to faster recovery and sharper vision, but it is more delicate and harder for the surgeon to handle. DSEK uses slightly thicker tissue, making it easier to work with but sometimes resulting in slightly less crisp vision.

🫧 Both surgeries use an air or gas bubble. The bubble acts like an internal bandage, gently pressing the donor tissue against the back of the cornea so it can attach properly. This is especially important in DMEK because the graft is extremely thin and can easily detach.

500

This reflex can cause ___ when traction is placed on the ocular muscles

Bonus: What surgery is this seen in?

Bradycardia, Oculocardiac reflex, Most commonly seen during pediatric strabismus surgery.

A trigeminovagal reflex in which pressure on the globe or traction on extraocular muscles causes bradycardia.

Common triggers:

• Traction on extraocular muscles (medial rectus most common)
• Globe pressure
• Orbital manipulation

Manifestations:

• Sinus bradycardia (most common)
• Arrhythmias, AV block
• Hypotension
• Rarely asystole

Management:

1. Stop the stimulus (release muscle traction/pressure).
2. Give oxygen and correct hypoxia.
3. Deepen anesthesia if needed.
4. IV atropine or glycopyrrolate if bradycardia persists.

OR Staff

100

What is in a time out?

(extra points if you get them all)

1. Patient Identity Confirmed

2. Operative consent signed

3. Procedure verified

4. Allergies verified with patient

5. Site-marked

6. Implants verbally verified by surgical team

7. Sterility confirmed

8. Fire Risk Assessment/Prevention Discussion

9. Any additional concerns

(What we actually say, this is pt, dob, allergies, what surgery they are having, confirm lens prn)

200

What are the rules of prepping?

prep inside to outside. 3 wipes per 4x4, 3 4x4s, and 2 cotton tip applicators

300

How does a nurse know when to call out?

When the physician is using weck-cells

Anatomy Challenges

100

A procedure to fix the eyelid turning out

Ectropion

Problem with eyelid positioning

One-line OR memory

• Ectropion = lid OUT (can see pink of eyelid) → main problem: dry eye, exposure, symptoms: tearing, irritation, TOO EXPOSED – tears don’t drain properly
• Entropion = lid IN (usually lower lid) → main problem: lashes rubbing eye, symptoms: pain, foreign body sensation SCRATCHED EYE
• 
  
  • Can cause corneal damage

200

The structure that connects the ciliary body to the lens capsule

The zonules

The zonules of Zinn are fibers that connect the ciliary body to the lens capsule.

Functions:

1. Suspend and center the lens in position behind the iris.
2. Transmit forces from the ciliary muscle to the lens during accommodation.
3. Help change the lens shape for focusing:
4. 
   
   • Ciliary muscle contracts → zonular tension decreases → lens becomes more convex → near vision
   • Ciliary muscle relaxes → zonular tension increases → lens flattens → distance vision

300

This procedure includes weakening a muscle to correct strabismus

Recession

• Recession vs resection

• Recession = move muscle back so it pulls less
• Resection = make muscle shorter so it pulls more

Recession weakens a muscle by moving its insertion posteriorly, while resection strengthens a muscle by shortening it.

400

A graft from the patient used for a pterygium

Autograft 

• Autograft (the patient's own conjunctiva, usually from the superior bulbar conjunctiva) is considered the gold standard because it has lower recurrence rates and avoids risks associated with donor tissue.
• Allograft (donor tissue, such as preserved amniotic membrane or donor conjunctiva) may be used when insufficient healthy conjunctiva is available, such as in: Recurrent pterygium, large defects, or for preservation of conjunctiva

500

This procedure creates a new drainage pathway between the lacrimal sac and the nasal cavity

DCR

A DCR is an eye surgery to fix watery eyes when tears can’t drain properly. Your tears normally drain from your eye into your nose through a small tube.

Sometimes that tube gets blocked.

Medications, Complications, & Safety

100

This medication is added to the BSS bag to maintain pupil dilation during surgery

epinephrine

to maintain mydriasis (pupil dilation) throughout the procedure. Helps prevent intraoperative miosis caused by surgical manipulation and release of inflammatory mediators. Improves visualization of the lens and posterior segment.

200

What fluid do we give to a diabetic patient

normal saline

300

Which items are MRI conditional?

istent, idose, and susvimo

400

What are the roles in the event of an anterior vitrectomy?

Nurses/ORNA grab the vitrector and vision blue and hand off to the techs. 

Anterior Vitrectomy

            An anterior vitrectomy is the careful removal of vitreous gel from the front of the eye after a capsular tear, helping protect the retina and stabilize the eye during surgery.

(Think of the vitreous like a delicate spider web attached to the back of the eye. If part of the web gets pulled into the front of the eye through a hole in the capsule, you don't want to yank it out because that could pull on the entire web and damage what's attached behind it. Instead, you carefully trim away only the strands that have moved forward.)

500

What happens when the pupil in not dilated for FEMTO?

Bonus: in the OR?

The pupil has to be manually stretched on the screen

Malyugin ring or iris hooks

"A Malyugin ring is a tiny spring-like ring that holds the pupil open during cataract surgery so the surgeon can see better and work more safely."

-  The pupil does not dilate enough with drops.

-  Conditions such as:

• Intraoperative Floppy Iris Syndrome
• Pseudoexfoliation
• Small pupils from diabetes or previous surgery