and final surgical preparation is listed in Boxes 2.23 and 2.24, and shown in Figures 2.34 and 2.35, respectively.
Surgical Supplies
Ophthalmic surgical instrumentation must be handled, disinfected, and reprocessed with care. Microsurgical instruments are particularly delicate and expensive. Instruments should only be used for their intended purpose as improper usage may cause irreparable damage. It is thus advantageous to have dedicated sterile surgical instrument sets for procedures related to anatomic ocular structures (i.e. intraocular vs. eyelid packs) to separate instruments based on intended use (Boxes 2.25–2.27). Surgical grade colored vinyl tape is an acceptable method used to easily identify which instruments belong to each set, although it is imperative to follow the manufacturer's instructions for use precisely and to confirm that the product can sustain sterilization. An eye utility set consisting of basic instrumentation required for draping the patient (Box 2.28), the surgical approach, and a bowl for irrigation, should be used for all operative procedures, in addition to the main procedure set.
Box 2.22 Instruments and Supplies for Initial Wound Management
Routine soft tissue instrument set
Blunt probe (Figure 2.32)
Sterile, water‐soluble gel
Copious amounts of sterile lavage (sterile, isotonic, and buffered)
35–60‐ml syringe, and 19‐gauge needle
Wound cleansing antiseptics (0.05% chlorhexidine, povidone‐iodine 0.1–1%)
Passive drains
Active closed suction drains
Contact layer dressingsa
Umbilical tape
Vacuum‐assisted wound closure (Figure 2.33)
Bandaging material
Culturettes
a The contact layer dressing will vary depending on the phase of wound healing. See Chapter 56 for specific dressing recommendations.
Figure 2.32 Blunt probe.
Figure 2.33 Materials used for vacuum‐assisted wound closure.
Box 2.23 Preoperative Periocular Surgical Preparation
Lab coat
Clippers
Pair of exam gloves
Plastic specimen cups (3)
Rinse bottle of 0.9% saline (NaCl)
Rinse bottle of dilute povidone‐iodine solution (10 ml povidone‐iodine to 500 ml NaCl)
Rinse bottle of dilute baby shampoo (50 : 50 mixture with NaCl)
Cotton tip applicators (20)
Cotton balls (30)
Box 2.24 Final Sterile Periocular Surgical Preparation
Metal bowl
Metal cannula (23‐ or 25‐gauge)
3 × 3 gauze (10)
Pair of sterile gloves
Two packets of 10% povidone–iodine swab stick (threes)
250 ml bottle sterile 0.9% NaCl (single use)
10 ml syringe with needle
Figure 2.34 Equipment for preoperative periocular surgical preparation.
Figure 2.35 Sterile preparation kit used to aseptically cleanse the patient's upper and lower eye lids, and conjunctival fornixes, and to irrigate the ocular surface prior to the start of an intraocular surgical procedure. Note that non‐sterile personnel will tear open and hold the distal end of the swabstick packet to allow the sterile individual preparing the patient to grab each of the swabsticks as needed.
Box 2.25 Intraocular Instrument Set
Foerster iris tissue forceps
Bishop–Harmon forceps
Colibri corneal utility forceps
Harms tying forceps (curved, straight)
Barraquer curved needle holder
Castroviejo needle holder (straight, locking)
Castroviejo tissue forceps
Tenotomy
