Department of Ophthalmology

SOP :VITRECTOMY(FMOP-0012)

Model :RetikarePLUS

Purpose: To perform  anterior and posterior vitrectomy on a standardised basis.

Procedure and care of the machine:

1. Do not use this device in the presence of flammable anaesthetics.To avoid risk of electric shock, this equipment must only be connected to a supply mains with protective earth.

2. Preventative scheduled maintenance is recommended once a year.

3. Never turn the power switch off or disconnect the power without proper system shutdown.

4. Avoid concentrating the illumination output on a small area of the retina for prolonged periods of time.

5. Always clean the tubing system before packing the instrument away.

6. The cutters should always be sterilised in ETO before usage.

SOP: Operation Theatre(FMOP004)

Purpose: To operate the patients for routine and emergency ophthalmic cases and train the post graduates in a supervised manner in a safe environment. Hence, providing standard care possible to the patients.

• OT sterilization by OT incharge/Team

• Entry of the patient in waiting area with OT dress taken from ward

• OT Incharge/PGs will check the information of the patients operation

• Arrangement of necessary instruments

• Surgical intervention by the operating team

•   Recovery room

• Patient will be sent to ward

Procedure:

The OT is divided into zones to avoid and limit the spread of infection.

·        Sterile Zone : (Main OT) is the innermost area where the staff enters only after changing into sterile clothing.

·        Clean zone : For anesthesia premedication , store of sterile supplies and scrubbing.

·        Protective Zone : Has the changing rooms, toilets

·        Disposal Zone : Used for used linen and garbage for disposal.

SOP: ARGON GREEN LASER (FM017A)

Model:Visulas 362S

Purpose : To treat all retinal cases requiring laser.

Procedure:

• Adjust the slit lamp. Turn on the power, move it to mid position with the joystick, adjust the brightness, pupillary distance, eyepiece.

• Position the patient : set optimum chair height, head on head rest and chin on chin rest. Use controls to adjust the length and width of the slit.

• Adjust the IPD on the binocular tube and set your refractive error if any.

• Turn on the laser with the actutate key switch and set the laser parameters.

• Use only the contact lenses designed for use with Green photocoagulation Laser

• Use the slit lamp joystick to carefully focus the four spots of the aiming beam into one on the tissue to be treated.

• Only press the foot switch or the hand release button when the area of treatment is directly localised and laser radiation is desired.

• Always turn on the STANDBY mode when not performing Laser.

Precautions :

• Keep the laser hazard area as small as possible by using suitable screens or controlling accesss. Limit the number of exposed people.

• Install a warning light to indicate laser is in operation.

• Except the patient all the people in laser hazard area must be wearing laser protective goggles. Treating physician is protected by the physician safety filter built in with the slit lamp.

• A safety officer must be designated for the safekeeping of the instrument, the key switch and entries in the instrument log book.

• Remove the key switch when the instrument is not in use.

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SOP: Double Frequency Nd YAG LASER (FM017B)

Model:Visulas YAG II

Purpose : To perform laser iridotomies and posterior capsulotomy.

Procedure:

• Adjust the slit lamp. Turn on the power, move it to mid position with the joystick, adjust the brightness, pupillary distance, eyepiece.

• Position the patient : set optimum chair height, head on head rest and chin on chin rest. Use controls to adjust the length and width of the slit.

• Adjust the IPD on the binocular tube and set your refractive error if any.

• Turn on the laser with the actutate key switch and set the laser parameters.

• Use only the contact lenses designed for use with Nd YAG Laser.

• Use the slit lamp joystick to carefully focus the four spots of the aiming beam into one on the tissue to be treated.

• Only press the foot switch or the hand release button when the area of treatment is directly ,localised and NdYAG laser radiation is desired.

• Always turn on the STANDBY mode when not performing Laser.

Precautions :

• Keep the laser hazard area as small as possible. Limit the number of exposed people.

• Install a warning light to indicate laser is in operation.

• Except the patient all the people in laser hazard area must be wearing laser protective goggles.

• Treating physician is protected by the physician safety filter built in with the slit lamp.

• Remove the key switch when the instrument is not in use.

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SOP: WET LAB (FM016)

Purpose:To provide hands on training to the resident on animal eyes and simulators so that they are well acquainted with various ophthalmic surgical procedures before operating on human eyes. It helps to polish their surgical skills.

SOPs for AUTOCLAVE (FMOP-015)

Purpose: To sterilise instruments and equipments used in the OT.

Preparation and Care :

• Ensure that the material is autoclavable.

• Wrap/bag loose dry materials in steam-penetrable paper or loosely covered with aluminium foil.

• Fill liquid containers only upto 2/3^rd level.

• Cover all containers with a loosened lid or steam-penetrable bung to prevent pressure build up.

• Tag items with autoclave temperature tape to verify adequate thermal treatment.

• Never place autoclave bags or glassware in direct contact with the bottom of the autoclave.

• Firmly lock autoclave door prior to starting the run to prevent sudden release of high-pressure steam.

• After the run is completed, check the pressure gauge to ensure that the pressure in the chamber is “0”. If pressure is not released, do not open the door.

• Before opening the door put on your eye protection and heat-resistant gloves or mitts and closed-toed shoes.

• Carefully crack door open to release residual steam.

• Use caution when removing liquids, molten agar, etc. Do not agitate containers of super-heated liquid or remove caps before unloading to avoid getting splashed with scalding liquid.

SOP: AUTOREFRACTOMETER (FM014)

Model: NIDEK AR1

Purpose: Automated measurement of refractive errors of the eye.

Procedure :

1. Turn on the power switch.On the TV monitor, you will see the target, the Cylinder mode, and measuring count.

2. Open the cover for switches and set measurement conditions. The cover can be opened by sliding it to the left.

3. Instruct patient to place his chin on the chinrest and to rest his forehead on the forehead rest.Adjust the height of the chinrest by turning the chinrest knob .

4. Perform alignment and focusing.

5. Perform measurement.

Precautions:

• Do not hold the power cord, but hold the mains plug to disconnect it from an outlet.

• Wipe between the prongs of the mains plug with a dry cloth every once in a while

• After measurement of each patient, wipe the forehead rest and chinrest with a clean cloth.

• Keep fingerprints and dust off of the measuring window.

• Avoid storing the device in an area with excessive heat, humidity, or dust.

SOP :Non Contact Tonometry (FM013)

Purpose : To measure intraocular pressure by non contact method.

Procedure :

1. Connect to power and switch it on.

2. Perform checks  - move the instrument up down right and left.

3. Make sure the measurement is displayed on the screen.

4. Patient should take off spectacles or contact lenses.

5. Adjust the patient’s head on chinrest and against the forehead rest. Adjust the height of the chinrest of the patient.

6. Perform alignment of the reflected spot over the patient’s eyes with the joystick  and measure. The machine will click itself when the autoshoot mode is turned on.

7. Before and after use and before measuring patients, wipe the forehead rest and chin rest with  a clean cloth a cloth damped with rubbing alcohol.

Precautions:

1. Switch off the instrument when not in use.

2. Always explain the procedure to the patient before performing the instrument.

3. Immediately replace the cord if internal wiring is exposed.

4. Always keep the instrument covered with a dust cloth when not in use.

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SOP : Phacoemulsification machines (FMOP011)

Model : Centurion Vision System

Purpose:To ensure proper usage of the phacoemulsification machine and to ensure better cataract surgery rates and better maintenance of the machine.

Precautions:

• Avoid flammable or explosive environments, dust, or high temperatures. Keep the machine clean and dry.

• Check that all wires are correctly and firmly connected before using.

• Use the supplied power cable with this instrument.

• Turn off the main power first before replacing the illumination bulb and fuse.

• Turn off the power and cover the instrument with a dust cover when not in use.

SOP: Fundus Photo Camera (FM0010 ).

Purpose: Routine used to take fundus photographs.

Procedure:

• Explain the procedure to the patient.

• The camera, table height, and chin rest are adjusted so that the patient is comfortable with chin and forehead in the headrest. Chin height should be adjusted so that the eyes are approximately level with the height adjustment mark on the face rest pole.

• Pupillary dilatation should be ensured.

Precautions:

• Avoid flammable or explosive environments, dust, or high temperatures.

• Check that all wires are correctly and firmly connected before using. Ensure that the instrument is well grounded.

• Use the supplied power cable with this instrument.

• Do not touch the surface of the lens or prism with the hand or any hard object.

• Turn off the power and cover the instrument with a dust cover when not in use.

SOP: Operating microscopes (FM0009).

Purpose: To perform all ophthalmic surgerieswith a stereoscopic high quality magnified image for better surgical outcome.

Procedure:

• The illumination and observation systems must be coupled and in focus for the observer, and the surgeon must be seated comfortably.

• Suspension arm is adjusted to position the optics exactly.

• Use the dioptre adjustment ring for uncorrected refractive errors.

• Magnification can be changed by turning a knob or by using a motorised zoom controlled by a foot pedal.

• Foot pedal is used to control the focus, the zoom, the position of the optics over the eye (the x,y position on the horizontal plane) and to turn the illumination on and off.

Precautions:

• Keep the microscope in a dry, cool and well-ventilated place.
• Every week, clean the optics according to the optical cleaning instructions described in a previous issue.
• Cover the foot pedal with a clear plastic bag to prevent surgical and cleaning fluids from entering and damaging the electronics.
• Use a voltage stabiliser with the microscope.
• Before using, check that the suspension arm can be fixed into position to ensure that it does not fall on the patient.
• Avoid kinking or bending the fibre optic cables.
• When replacing the bulbs, avoid touching them with your fingers.
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SOP: Slit lamp (FM0008).

Purpose: Routinely use to examine ocular surface, anterior & posterior segments of the eye.

Procedure:

• The illumination and observation systems must be coupled and in focus for the observer.

• Use the dioptre adjustment ring for uncorrected refractive errors.

• Seat the patient on slit lamp with his or her chin in the rest, head firmly against the headrest and eye level at the centre of the vertical travel of the instrument and ensure they are seated comfortably.

Align the horizontal mark adjacent to the headrest with the outer canthus of the eye to ensure the head position is optimal.

• Use the focussing rod/joy stick provided with the slit lamp to ensure a narrowslit beam is clearly in focus through each eyepiece.

• Accessories like applanation tonometer and laser delivery system can be attached whenever needed.

Precautions:

• Avoid flammable or explosive environments, dust, or high temperatures. Keep the slit lamp clean and dry.

• Check that all wires are correctly and firmly connected before using.Ensure that the instrument is well grounded.

• Use the supplied power cable with this instrument.

• Do not touch the surface of the lens or prism with the hand or any hard object.

• Turn off the main power first before replacing the illumination bulb and fuse.

• To prevent instrument from falling, it should be placed on a surface with an inclination angle of less than 10°.

• Turn off the power and cover the instrument with a dust cover when not in use.

SOP Perimetry (FMOP007)

Purpose: To examine visual field of patients as per indications.

Procedure:

• Switch on the power of Humphrey field analyzer and check system assembly.

• Select test pattern and test eye and occlude the non-test eye.

• Enter patient data and explain to the patient the nature of the examination.

• Align the patient on the video eye monitor so that the pupil is centered in the target. Review the patient’s position in the video eye monitor. The cross (+) should be in the center of the pupil. Adjust as necessary.

• Select test parameters and strategies as required.

• Start testing and check for reliability.

• Perform STATPAC analysis and print result.

Precautions:

• HFA should be turned off
  when not used for an extended period of time and covered with the dust cover.

• Do NOT connect or disconnect cables while power is on.

• Air filter must be cleaned or replaced every three months.

• DO NOT let the printer run out of paper. When you see the red stripe appear on the printout, change the paper roll. Letting the printer completely run out of paper can cause the need to restart the and may cause loss of data.

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SOP: Inpatient Department Services (IPD) (FMP003)

Purpose: To admit the patients for detailed examination and for pre and post operative care under supervision and to provide quality care to the admitted patients.

Procedures:

• Food and linen provided as per hospital norms.

• Rest ward rules as per JNMCH guidelines.

• Visitors are allowed as per the hospital schedule.

SOP: Administrative Office (FMOP-001)

Purpose: To carry out all administrative work related to the department and to maintain all records and assist in all academic activities.

Daily duties:

• To carry out administrative orders as per the Director,AMUIO.

• Maintain attendance register of MBBS/ PG’s/ interns

• Typing of professional document

• Provide duty rosters and schedules for academic activities.

• Maintaining leave record of each individual

• Keeping records of finances and purchases.

• Co-ordinating with other departments and higher offices for smooth functioning.

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SOP: Out Patient Department(OPD) services (FMOP 002)

Purpose: To provide diagnostic, preventive, curative and rehabilitative ocular consultation; while providing opportunity to hone the trainees’ skills in a safe and supervised environment.