choroidal tumor resection

Since Raubitzschek first attempted surgery on uveal melanoma in 1914, only a few reports of local excision of choroidal melanoma have been used instead of enucleation, making it possible to make a histopathological diagnosis while retaining useful vision. In 1971, Peyman began a laboratory animal experiment to study the feasibility of eye wall resection. He replaced the sclera that removed the wall of the eye with a graft of different materials. He evaluated the effects of preoperative diathermy, photocoagulation, and cryotherapy and determined the limits of the technique for eye wall resection. He recently evaluated intraocular surgery with carbon dioxide lasers and used vitrectomy, inflation gas, and fluid-to-gas exchange to reduce postoperative complications. He also made some improvements to these eye wall resection techniques for choroidal retinal biopsy and removal of choroidal and retinal tumors, including large Von Hippel hemangiomas. Treatment of diseases: choroidal osteoma choroidal melanoma Indication 1. Benign choroidal tumors located in front of the equator, limited, and not suitable for photocoagulation or condensation. 2. Choroidal melanoma located in front of the equator, no more than 6PD in diameter and <3 mm in elevation. 3. Ciliary body choroidal melanoma. Contraindications 1. The choroidal tumor after the equator of the eye can not be surgically removed. Because of the edema, posterior ciliary artery, ciliary nerve, larger retinal artery, vein and macular area, the surgery will cause serious complications. The disease is so blind. 2. Tumors with eyelids and other organs of the body, or other organ malignant tumors to the eye in the late stage. Preoperative preparation In addition to the preoperative preparation of the Ciliary Body Tumor Resection, a Peyman eye basket is also prepared. The pupil of the surgical eye is fully scattered before surgery. Surgical procedure 1. Disinfect the drape according to the ophthalmology routine and expose the surgical eye. The annular incision of the limbal conjunctiva is performed, and the rectus end of the rectus muscle and the sclera of the tumor area are exposed after separation, and the rectus end of the area is cut off if necessary. The transilluminator is used to illuminate the eye from the pupil, showing the tumor area and performing transillumination at the scleral surface of the tumor edge. Transillumination describes the shape of the tumor. 2. Sewing the Peyman eye basket on the sclera: the large ring of the basket is placed under the end of each rectus, the small ring is placed at the sclera of the tumor surface, the tumor area is placed in the small ring, and the ring is continuously sutured. The scleral plate layer firmly fixes the eye basket on the sclera, and should not pass through the sclera when suturing to prevent the vitreous from coming out. 3. Scleral incision: In the outer edge of the sclera, the outer edge of the choroidal tumor, a large semicircular scleral plate incision, the base is posterior to the posterior pole, and the depth is about 3/4 to 4/5 of the sclera. Or use a trephine of the corresponding diameter (about 8mm) to drill the scleral lamina, and the posterior pole portion is not incision. 4. Peel the scleral lamina to form a scleral flap with a posterior base. Do not wear through the sclera. 5. Do the surface and penetrate the heat at the edge of the tumor. The penetration needle should not be too long (can not exceed 0.3 ~ 0.5mm) to avoid damage to the retina and vitreous. 6. On the opposite side of the choroidal tumor, or avoiding the rectus end of the rectus, on the side of the contralateral rectus muscle, make a scleral incision in the flat part of the ciliary body, and pre-separate the suture, and then wear it through the incision with a puncture knife Into the center of the vitreous cavity, and then a part of the vitreous body is sucked with a needle to reduce the pressure inside the vitreous and prevent the extracorporeal overflow of the choroid when the choroid is removed. Or do a vitreous cut there if necessary. 7. Excision of the mass: the scleral lamellar layer, the choroidal tumor, and the retina attached to the tumor are removed along the hot spot of the scleral lamina, that is, the edge of the choroidal tumor. At this time, if the glass body is decompressed well, the glass body can be prevented from coming off. Otherwise, there may be a vitreous prolapse. This step is a critical step in the operation and should be handled with care and care. 8. After the tumor is resected, the tissue near the wound is well-repaired, and the scleral flap is immediately covered for continuous or intermittent suture. To prevent postoperative bleeding and retinal detachment, a row of scleral surfaces is diathered or condensed around the scleral incision. If the vitreous body is aspirated before the tumor is removed, the extracted vitreous portion can be injected into the vitreous cavity by the original scleral incision. After the operation, Peyman's eye basket was removed, the conjunctival incision was sutured, and 20,000 units of gentamicin and 2 mg of dexamethasone were injected under the conjunctiva. Apply 1% atropine eye ointment and bandage. complication 1. Intraocular hemorrhage: Because of the incomplete hemostasis during surgery, small blood vessels ooze. In addition to adequate electrocautery in the operation, 1 / 1000 adrenaline can be used in the surgical area, and appropriate hemostatic agents can be used before and after surgery to prevent intraocular hemorrhage. 2. Vitreous prolapse: Because the surgical incision is large, and the intraocular pressure is not low, the vitreous prolapse is prone to occur. Therefore, it is important to reduce intraocular pressure before resection of the tumor. If the vitreous is lost too much, disinfectant air or other vitreous filler should be injected into the vitreous cavity. 3. Choroidal or retinal detachment: The choroid or retinal wound does not heal well, causing the incision to rupture and detach. In the long-term, if vitrification occurs, or proliferative retinal detachment occurs, vitrectomy should be performed. 4. Postoperative infection: Ophthalmitis occurs. First, we must pay attention to prevent surgical contamination. It requires strict disinfection and sterility. Antibiotics and hormones can be used to prevent infection and reduce inflammatory reactions. 5. Tumor recurrence: close observation of the fundus, if there is recurrence, you need to remove the eyeball early. If there is eyelid spread, you still need to do eyelid removal. If there is a transfer, even need to do radiotherapy or chemotherapy.