Republic of the Philippines

Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU

Checklist of Requirements on Equipment and Instruments for

Ophthalmologic Ambulatory Surgery

The following equipment/instruments shall be required for the specified procedure. Place a check (/) if the ASC
is compliant and x mark (X) if not compliant.

PROCEDURE AVAILABILITY ADDITIONAL COMPLIANCE REMARKS

(/ if available) EQUIPMENT/INSTRUMENTS
1. Cataract Surgery (Phaco) Major cataract set
Operating microscope
Ophtha pack
Phacoemulsification
Machine
2. Extracapsular Cataract Major cataract set
Extraction (ECCE)
3. Secondary implantation Operating microscope
of intraocular lens
4.Scleral fixation of Ophtha pack
intraocular lens
5. Intracapsular Cataract
Extraction (ICCE)
6. Corneal Transplant Major corneal transplant set

Operating light
Operating microscope

Operating light

7. Glaucoma Surgery – Glaucoma set

Filtering Procedures
like Trabeculectomy
(Primary or Revision)
8. Glaucoma Valve Ophtha pack
Implantation
9. Glaucoma Surgery - Operating microscope
Cycloablative
Procedures
10. Blepharoplasty Major plastic set

11. Ptosis repair Ophtha pack

12. Entropion Repair Overhead light

13. Ectropion Repair

14. Lid Margin
Excision

DOH-ASC-LTO-AT Checklist Ophtha

Revision:01
01/26/2015
Page 1 of 2
 PROCEDURE
(/ if available)
15. Phaco or ECCE with
Trabeculectomy
16. Phaco with Vitrectomy
17. EDTA
18. Electoepilation
19. Excision of cyst
20. Excision of
pterygium
21. Incision and curettage
22. Probing and
irrigation
23. Punctoplasty
24. Removal of silicon
oil
25. Removal of suture
26. Tarsorrhapy
27. Temporal artery biopsy
28. Laser Assisted In Situ
Keratomileusis (Lasik)
29. Photorefractive
Keratectomy (PRK)
30. Other refractive
procedures [e.g. Laser-
Assisted Subepithelial
Keratectomy (LASEK),
Phototherapeutic
Keratectomy (PTK),
Conductive Hyperopic
Keratoplasty (CK/HK/Near
Vision CK)]
31. Muscle Surgery
AVAILABILITY ADDITIONAL COMPLIANCE REMARKS
EQUIPMENT/INSTRUMENTS
Major cataract set
Major glaucoma set
Phacoemulsification machine
Ophtha pack
Operating microscope
Compressed air
Major cataract set
Major retina set
Operating microscope
Ophtha pack
Overhead light
Phacoemulsification machine
Special retina instruments
(Retina forceps & scissors)
Syringe pump
Vitrectomy machine
Loupe
Wetfield cautery machine
Ophtha pack
Minor incision and curettage
set
Corneal pachymeter
Corneal topographer/
aberrometer
Keratome
Operating microscope
Refractive laser machine
Refractive surgery pack
Slit-lamp
Wetfield cautery machine
Overhead light
Ophtha pack
Muscle Surgery Set
DOH-ASC-LTO-AT Checklist Ophtha
Revision:01
01/26/2015
Page 2 of 2