Peripheral iridectomy

Currently, peripheral iridotomy is basically replaced by laser iridotomy. However, it still applies in the following cases: 1. When the iris is not visible, such as corneal opacity. 2. The patient cannot sit before the slit lamp or does not cooperate due to systemic reasons. 3. Continuous or recurrent inflammation caused by multiple interruptions in the laser iris resection hole. 4. When a laser device is missing. Treatment of disease: secondary glaucoma with acute angle-closure glaucoma with iridocyclitis Indication 1. The early stage of primary angle-closure glaucoma caused by pupillary block, that is, the range of pre-irisal adhesion in the peripheral part is small, small The net drainage water function is normal or close to normal, 2. There is no secondary glaucoma caused by pathological pupillary blockage in the peripheral peripheral iris membrane. 3. Part of the conventional extraocular filtration surgery can prevent the iris tissue from clogging the scleral resection. 4. Some special cases of cataract surgery. 5. Apply vitreous retinal surgery with silicone oil, and perform peripheral iridotomy on the lower iris to avoid pupil block caused by silicone oil. Currently, peripheral iridotomy is basically replaced by laser iridotomy. However, it still applies in the following cases: 1. Can not see the iris, such as corneal opacity. 2. The patient cannot sit before the slit lamp or does not cooperate due to systemic reasons. 3. Continuous or recurrent inflammation caused by multiple interruptions in the laser iris resection hole. 4. When a laser device is missing. Preoperative preparation The anterior chamber angle must be checked before surgery. Broad-spectrum antibiotic eye drops were applied several days before surgery. 2% pilocarpine eye drops were administered 1 to 2 hours before surgery to prevent the expansion of the pupil during surgery, which is conducive to the completion of surgery. For those with stress, a small amount of barbiturates (such as luminal 0.06 to 0.1 g) was given one night before surgery and 2 hours before surgery. Surgical procedure 1. It is best to choose the angle of the upper quadrant of the surgical site to keep the conjunctival sac wide sacral image is limited to the need for extraocular filtration. 2. The conjunctival incision can choose the bulbar conjunctival incision of the limbus, or the bulbar conjunctival flap with the sclera as the base. Regardless of which incision is used, the range of the peeling ball conjunctiva does not need to be large. When the corneoscleral incision is used, the length of the bulbar conjunctiva is cut to 3.5 to 4 mm, and then separated from the iliac crest to 3 to 4 mm after the corneoscleral margin. For example, the bulbar conjunctival flap with the corneoscleral margin as the base is about 3 mm wide and is separated forward to the corneoscleral margin. It is best not to exceed 12 points in the conjunctival incision. Hemostasis should be adequately after exposure to the limbus. 3. The limbal limbus incision clamps a horizontal rectus end with a forceps to adequately fix the eye. Use a razor blade or a small round blade No. 15 to make a parallel to the limbus incision in the middle of the corneal gray-blue half-moon zone. The tip of the knife points to the front of the center of the eye, allowing the knife to enter the anterior chamber at an angle of approximately 80° perpendicular to the direction of the cornea. 4. If the surgeon suddenly feels that the resistance to the knife has disappeared, or if there is room water overflow, it indicates that the anterior chamber has been cut. Continue to complete the corneoscleral incision so that the outer mouth is about 3 mm long and the inner mouth is about 2.5 to 3 mm long. 5. When the tip is withdrawn from the corneoscleral incision, the peripheral iris will naturally come out. Or use the tip of the tweezers to quickly press the lower lip of the corneoscleral incision to remove the peripheral iris from the corneoscleral incision. 6. Use the iris to hold the iris around the exit, gently lift it, and cut the iris with the iris cut and attached to the limbus. The blade of the scissors can be parallel to the limbus. The iris defect is elliptical. Or the scissors are perpendicular to the limbus. The iris defect is small and triangular. Check whether the cut iris has a pigment epithelial layer and determine if the iris is completely removed. 7. After the iris is removed, the corneal limbus incision is gently washed with balanced saline, which often resets the iris. However, the flushing needle cannot be inserted into the incision during flushing. Or use a squint hook or iris restorer to gently massage around the corneoscleral incision several times, so that the inner opening of the incision is opened, the iris is reset in the incision, and the pupil is rounded and located in the center. If the iris can not be restored after the massage incision, use the iris restorer to gently extend into the end of the incision to complete the iris 1 or 2 times in the center of the incision. The iris restorer should be perpendicular to the incision, and parallel to the incision, the iris can be restored. 8. The corneoscleral incision generally does not require suturing. If the incision is large, a needle can be sutured with a 10-0 nylon thread. 9. Continuous suture of the bulbar conjunctival flap.