Surgical treatment of malignant glaucoma

Malignant glaucoma refers to the condition of a shallow delivery room or no anterior chamber that occurs after closed-angle glaucoma surgery, although the iris resection hole is smooth but the intraocular pressure is elevated. Treatment with a miotic agent can worsen the condition. If not treated properly in time, malignant glaucoma can lead to blindness. Treatment of diseases: glaucoma chronic angle-closure glaucoma open angle glaucoma acute angle-closure glaucoma malignant glaucoma Indication Treatment of malignant glaucoma includes medication and laser treatment. Once suspected or confirmed malignant glaucoma, it should be treated with the following drugs: dilated agents - ciliary body paralysis, such as 1% atropine eye drops, 5% new foro eye drops; beta adrenergic receptor blockers, Such as 0.5% timolol eye drops; carbonic anhydrase inhibitors, such as acetazol 250mg, 4 times a day; hypertonic agents, such as 50% glycerol saline orally, 1.5g per kg body weight or 20% mannitol intravenously Kg body weight 2g. If the drug treatment is not effective, when the ciliary process can be seen through the iris resection hole, the argon laser photocoagulation can be considered to cause contraction and release the ciliary body block. In the case of aphakic eyes, yag lasers can also be used for pre-vitrary membrane and iridotomy. If both drug and laser treatments are ineffective, surgery should be performed. Preoperative preparation 1. Carefully consider the differential diagnosis, except for choroidal detachment, pupillary block, and suprachoroidal hemorrhage. 2. Try drugs and laser treatment first. 3. Drop antibiotic eye drops. Surgical procedure 1. After opening the device, perform a anterior chamber puncture in the limbus to allow for the injection of balanced saline or air in the anterior chamber. 2. A 5 mm long bulbar conjunctiva and a radial fascia radial incision were made in the underarm and lower nasal quadrants, and a radial incision of about 3 mm in length was made in the posterior margin of the scleral margin. 3. Note whether the scleral incision is out of the fluid. If it is a straw yellow liquid, it should be considered as choroidal detachment. In the case of blood or bloody fluids, supraorbital hemorrhage should be considered. If no fluid is flowing out, use a ciliary body stripper to enter the scleral incision for separation in the suprachoroidal space. If it is determined that no fluid is flowing out, the diagnosis of malignant glaucoma can be confirmed. 4. Lightly cauterize the inner layer of the scleral incision below the iliac crest, until the sclera is slightly yellowed, and the choroidal blood vessels under it are slightly coagulated. This prevents choroidal hemorrhage from occurring when the choroid is puncture. 5. Using a slender sharp knife to puncture the choroid and vitreous cavity through the lower scleral incision, the depth is about 10mm, the direction is the optic nerve head and the center of the vitreous cavity to avoid damage to the lens and retina. 6. Take a disposable 18-gauge needle and use a hemostat to clamp it 12 mm from the needle. The needle was inserted into the vitreous cavity 12 mm through the choroidal wound, and the direction was toward the optic nerve head. The hemostat prevents the needle from penetrating too deeply into the vitreous cavity. 7. Gently swing the tip of the needle inserted into the vitreous cavity from front to back, left and right, and swing about 4 mm to gently separate the vitreous membrane. 8. The surgeon holds the needle with one hand and the other with a hemostat, carefully controlling the needle position in the eye. The assistant attached a 5 ml syringe to the needle. The surgeon then controls the position of the needle with one hand and slowly absorbs 1 to 1.5 ml of the vitreous body with the other hand. Before the needle is withdrawn, 0.25 ml of the aspirated glass body is reinjected into the vitreous cavity to remove the vitreous filaments that may be drawn into the needle. 9. It is also possible to remove the vitreous body without using a needle and use the suction and cutting head for vitreous surgery to remove some of the vitreous or intravitreal fluid. 10. After the above treatment, the eyeball is very soft, the intraocular pressure is very low, and the cornea and sclera are wrinkled. A small amount of balanced saline is injected into the front chamber through the corneal puncture to partially restore the shape of the eye. Air bubbles are then injected into the front chamber through the corneal puncture. The air bubbles should be large enough to make the anterior chamber deeper than the anterior chamber of the commonly seen myopia. 11. Intermittent suture of two scleral incisions, intermittent or sacral suture of conjunctival wounds. complication Intraocular pressure is the pressure inside the eyeball, referred to as intraocular pressure. It is the equilibrium pressure exerted by the contents of the eye on the wall of the eye. The eyeball is divided into two parts: the eye wall and the eye content. Intraocular pressure is the pressure that interacts between the contents of the eyeball and the wall of the eyeball.