Deep corneal foreign body removal

When the eyeball is penetrating, there is often a foreign body in the eyeball. Foreign matter entering the eyeball can be metallic or non-metallic. Metal foreign bodies can be divided into magnetic or non-magnetic. Therefore, when a penetrating injury occurs in the eyeball, it is first necessary to find out whether there is foreign matter in the eye, the nature and position of the foreign matter. The surgical plan can only be developed after the situation has been identified. Treatment of diseases: eye injury, eyeball rupture Indication Deep corneal removal is applicable to: Deep foreign bodies with some corneal lacerations, such as small broken glass, plastic, sand, and even metal foreign matter, should be taken out, but they can be temporarily retained without significant irritation. Plant foreign bodies, iron foreign bodies, and foreign objects located on the visual axis must be taken out as soon as possible. Contraindications Gunpowder powder, coal dust, and sediment located at different depths in the cornea should not be forcibly removed. Because the number is too large, it is covered with face, eyelids, conjunctiva, and cornea. The depth is different, and the foreign matter is soft and loose and cannot be clamped. Such foreign bodies are small, their boundaries are neat, and there is no infiltration; there is no connection between the points, and light can enter the fundus through these gaps, and the patient can maintain certain vision; and these foreign objects can be automatically exposed to the cornea after a certain period of time. In the epithelial layer, the patient has a foreign body sensation in the injured eye. At this time, the foreign body needle is used for picking up or washed with physiological saline. This method of automatic discharge does not damage the corneal parenchyma and does not enlarge the corneal cloud or plaque. Preoperative preparation 1. Perform a slit lamp microscope examination. Identify the size and depth of the corneal laceration; identify the nature of the foreign body; find out the depth of the foreign body into the cornea; whether the elastic layer behind the cornea is broken. If the foreign body is incarcerated in the deep cornea and the posterior corneal elastic layer has broken, you should pay attention to whether the foreign body has reached the anterior chamber. 2, take saline to wash the conjunctival sac and the corneal surface, pay special attention to the upper iliac crest, no foreign matter remains. 3. Drop antibiotic solution. On the day before surgery, every 2 hours. 4. Prepare the surgical microscope. Surgical procedure 1. Substantially deep magnetic foreign matter (1) After fixing the eyeball, under the microscope, look at the foreign body, follow the original entrance of the foreign body, cut the corneal tissue on it, and if necessary, slightly enlarge the incision to separate it from the nearby tissue, but the direction of expansion must be It is toward the periphery of the cornea. (2) After the foreign matter is loosened, the foreign matter is sucked out by a hand-held electromagnet. After the operation, 1% of atropine liquid was scattered, antibiotic eye ointment was applied, and single eye bandage was applied. 2. Substantially deep non-magnetic foreign bodies (1) The "V" shape of the tip of the limbus is cut at the tip of the foreign body and deepened to the plane of the foreign object. (2) Taking the tip of the "V" shape as the starting point, the keratotomy of the lamellar layer is cut, and after the foreign matter is exposed, the foreign body is picked up by the foreign object needle or the foreign matter is pinched out with the foreign matter, and then washed with physiological saline. (3) The corneal flap was repositioned, and the large flap was sutured. The small flap did not need to be sutured, and 1% atropine liquid and antibiotic liquid were dripped, and the single eye was bandaged. 3. One end of the anterior chamber of the cornea is deep in foreign bodies, such as wood chips, thorns, glass or metal debris. (1) Located in the center of the cornea: 1 After a brief contraction, make a small incision in the limbus, inject sodium hyaluronate into the anterior chamber to restore the anterior chamber, or take a 30-gauge needle and an empty needle, enter the anterior chamber, inject BSS fluid to restore and maintain the anterior chamber. depth. 2 In the corneal foreign body, cut part of the cornea to loosen the foreign body, and at the same time with the corneal edge on the opposite side of the perfusion tube, make the iris recovery device from the incision into the anterior chamber, directly to the location of the foreign body, and push it to the top Trust. At this time, the assistant grasps the foreign matter from the corneal surface with the foreign matter, and pulls it outward vertically. (2) located in the vicinity of the cornea: 1 After the maximal contraction, according to the cataract surgery, the incision of about 5 to 8 mm in the posterior border of the limbus is performed, and the two angles of the scleral pre-sewn are placed. 2 Open the corneal flap, expose the foreign body located in the posterior wall of the cornea and protrude into the anterior chamber. Use a foreign body to clamp the foreign object, then ligature the suture and close the limbal incision. After the operation, 1% atropine solution was administered, antibiotics were injected under the conjunctiva, and monocular bandaging was performed.