Vitreous surgery in children with eye diseases

Characteristics (1) Traumatic vitreoretinopathy and endophthalmitis are mostly. (2) Congenital vitreoretinopathy is more difficult to treat. (3) The eyeball is developing. (4) Eyeball atrophy is very likely to occur after failure of vitreous surgery. (5) Children's metabolism is strong, and the vitreous and neovascularization proliferate rapidly. (6) poor postoperative coordination, position control and nursing difficulties. Treating diseases: eye disease vitreopathy Indication 1. Severe traumatic vitreous hemorrhage remains unabsorbed for 1 month. 2. Traumatic endophthalmitis. 3. Eyeball perforation and foreign body retention. 4. Congenital crystals after fibrosis. 5. Congenital retinal folds. 6. Congenital and traumatic cataracts. 7. Cats disease. 8. Intraocular parasites (such as vitreous cysticercosis). Contraindications 1. Severe traumatic vitreous hemorrhage remains unabsorbed for 1 month. 2. Traumatic endophthalmitis. 3. Eyeball perforation and foreign body retention. Preoperative preparation 1. Whole body health check. 2. Pay attention to cardiopulmonary function tests. 3. Check out clotting time and thrombin activity. Surgical procedure 1. Conjunctival incision: 2mm posterior corneal incision of the bulbar conjunctiva. The scleral surface is electrocoagulated to stop bleeding. 2. Straight muscle traction line: the same as the upper and lower rectus muscle traction fixation line; if the circumcision is intended, the four rectus muscles should be included. Most need to do wide cerclage, preset scleral sputum suture. 3. Scleral incision: first place the perfusion head and then make other incisions. The position should be close to the upper level of the upper, lower and upper and lower, but should avoid injury to the anterior ciliary artery. The distance between the upper two instruments is not less than 120 ° (150 ° ~ 170 ° is suitable). Those who intend to retain the lens, 4 mm from the limbus, do not retain the lens or aphakic, 4 mm from the limbus, do not retain the lens or aphakic and intraocular lens is 3.5 mm from the limbus. Retaining the lens or aphakic scleral incision: Parallel limbus, with the mvr knife perpendicular to the scleral surface, puncture in the direction of the center of the ball, until the double-edged part completely enters the sclera, visible from the pupil area, and the mvr knife is extracted. The size of the incision is the length of the incision with the maximum diameter of the mvr blade. 4. Placement and fixation of the perfusion head: Before the scleral puncture, the preset suture stitch is preset, the perfusion head is placed on the vertical surface, and the preset suture is tightly tied on the two wings of the head to activate the knot. The head is pressed against the center of the ball, and it is determined from the pupil area that the opening of the perfusion head has completely entered the vitreous cavity, and the tee is opened to enter the perfusate. 5. Fixation of contact lens ring (landers ring): sutured on the superficial sclera of 3 and 9:00 near the limbus by suture. The suture is tightly tied. Handheld contact frames do not have to be fixed. 6. The light guide fiber head and the vitreous cutting head enter the eye and first insert the light guide fiber head. After seeing in the pupil area, insert the cutting head, and the opening of the cutting head should face the surgeon. Since the incision is equal to the diameter of each instrument, the incision is tight, and the head is relatively easy to enter, and the direction of the head is directed to the center of the ball. The light guide fiber is held in the left hand and the cutting head is held in the right, but the device can be exchanged if necessary. 7. Start intraocular operation: excision of the vitreous body, including the base portion; treatment of the proliferating membrane, gas/liquid exchange, laser-enclosed slit. Inject inflation gas or silicone oil if necessary. 8. End the surgery: remove the intraocular device and suture to close the incision. Always keep injecting gas or liquid into the eye to maintain a stable intraocular pressure. Ligation of each pair of preset scleral sutures. Finally, under the required intraocular pressure, the preset line of the perfusion incision hits the first knot and is tightened, and the perfusion head is taken out, and there should be no gas or oil overflow, and the suture is closed to close the incision. 9. Suture conjunctival incision: injection and application of anti-inflammatory and dilated drugs. complication Inflammatory diseases: such as sandstone, conjunctivitis, keratitis, etc. The main cause is microbial infection.