traumatic retinal detachment surgery

Traumatic retinal detachment is a general disease name that refers to retinal detachment that occurs after an eye injury. In fact, it includes many different causes and pathogenesis. For example, it can occur after an open or closed trauma; the mechanism that occurs can be rhegmatogenous, hemorrhagic and exudative, traction or mixed. Therefore, there are a variety of clinical types and manifestations, and different approaches should be taken for the pathogenesis in treatment. After open eye injury: penetrating injury of the sclera can cause retinal rupture; larger scleral laceration often causes the retina to be incarcerated in the wound, and the resulting retinal detachment is more difficult to reset. Hemorrhagic retinal detachment is another serious complication. Sudden decompression of the eyeball during rupture or perforation can cause fulminant choroidal hemorrhage, blood entering the retina, causing hemorrhagic detachment. Hemorrhage can be a clot and takes a long time. Liquefaction, or serous exudation. Another type of retinal detachment, which is common after eyeball penetrating injury, is the traction detachment caused by scar formation in the eye, because there is cell proliferation in the eye, also known as traumatic proliferative vitreoretinopathy (tPVR). In some eyes, the time to appear tPVR may be more than half a year after the injury. In addition, traumatic endophthalmitis often causes exudative retinal detachment. Rhegmatogenous retinal detachment can occur in eyeball contusion, especially in myopia, accompanied by vitreous hemorrhage. Curing disease: Indication According to the above-mentioned type of traumatic retinal detachment, surgical treatment includes scleral surgery and vitreous surgery. The former is mostly used in simple cases, and the latter is used in complex cases. Surgical procedure Before retinal detachment surgery, the surgeon should carefully examine the medical history (including existing eye diseases and their special symptoms and time of occurrence; previous eye diseases; history of trauma or eye surgery; family history; general condition, etc.) Fundus, if necessary, can be repeatedly checked to fully understand the extent, location and morphology of retinal detachment; shape, number and location of retinal holes; retinal degeneration; vitreoretinal proliferation; familiar with anatomical landmarks near the hole, easy for intraoperative check and identification . If necessary, you can choose transillumination test and auxiliary examination such as ultrasound, electroretinogram, fundus angiography, ocular CT, magnetic resonance, radionuclide 32P examination, etc., for diagnosis and differential diagnosis. In short, before surgery, the surgeon should try to clarify the following five points in order to achieve the following: 1 diagnosis; 2 all holes; 3 vitreoretinal traction; 4 ocular concomitant diseases; 5 systemic complications. 1, systemic preparation (SystematicPreparation) Same as general intraocular surgery. For patients with medical diseases (such as hypertension, heart disease, diabetes, etc.), they should be treated accordingly. If necessary, please consult the relevant department. Sedatives were given before bedtime before surgery and before surgery. Do a good mental preparation for the patient, such as explaining the operation, explaining the prognosis of the operation and possible complications and preventive measures, eliminating the patient's fear and obtaining active cooperation. 2, bed and eyes (BedRestandEyePatching) In the early years, patients were required to stay in bed for several days before retinal detachment surgery, in order to make the retina flat and beneficial to surgery. However, bedridden can induce some unfavorable complications, such as cardiovascular complications, especially pulmonary embolism. In addition, it causes mental depression, prolonged postoperative recovery of physical strength, etc. Therefore, it is not necessary to stay in bed except for the following conditions: A. Diagnostic purposes, such as finding a hole; B. Improving the position of the retina, such as a highly bulged globular retinal detachment, vitreous liquefaction bed It can make the retina flat, and the operation is easier and safer, especially for those who are not ready to put retinal fluid. The principle of low hole splitting is generally adopted. For example, in patients with large retinal retinal reversal, due to limited economic or equipment conditions, vitreous surgery cannot be performed. With proper head position, gravity can be used to reset the inverted retinal flap, close to the pigment epithelium, and pour out the hole. The vitreous is likely to be treated by conventional retinal reduction surgery. C. Prevent macular retinal detachment. Eye movement can cause the inertial force of the vitreous and intraocular fluids, increase the vitreous retina, and produce fluid flow. The eye can effectively limit eye movement. However, eye movements are binocular, so if you need to cover your eyes, you should use both eyes. The results of a group of 312 cases of retinal detachment showed that 24% of the retinas were significantly flat or partially repositioned before surgery. 28% of the retina was actually completely repositioned and successfully achieved photocoagulation, electrocoagulation or condensation (87/88 cases). In addition, for other conditions, such as vascular bridge at the hole site or bleeding from a vascular tear, the eye can prevent the blood vessel from rupturing or sinking the vitreous hemorrhage, which is beneficial to fundus examination and surgical sight. For large holes, eye movements often cause the holes to expand rapidly, and the eye can reduce the chances of extension. 3, PupillaryDilation Clear eye examination is very important for successful completion of external retinal detachment surgery (such as scleral compression), and dilated pupils and keeping the pupils loose during surgery are important guarantees for smooth operation. Generally, 1% atropine is given to the eye 1 to 5 days before the operation. One hour before the operation, the compound tropamide or 5% phenylephrine was given to the eye every 10 to 15 minutes. Mydrin-P can also be used. In combination with 1% cyclopentolate and 10% phenylephrine, the pupil can be effectively dispersed. Generally, starting at 1 hour before surgery, the eye is taken once every 20 minutes, 1 drop each, for a total of 3 times. Because of the high concentration of phenylephrine on the heart, it should be used with caution in elderly and heart disease patients, or 2.5% phenylephrine. For example, because the posterior adhesion of the pupil can not be dispersed with the drug, it is necessary to use the iris hook to open the large pupil or the anterior chamber to inject high-quality viscoelastic agent to separate the adhesion and make the pupil dilated. 4. Prevention of infection (Prevention of Infection) There is still debate about whether prophylactic antibiotics are given before surgery. In the absence of signs of acute or chronic external eye inflammation, systemic application may not be required. Partial drops of antibiotics can be given before surgery to reduce the amount of bacteria in the conjunctiva and the gingival margin. Commonly used broad-spectrum antibiotics such as: 0.3 ~ 0.5% tobramycin, 0.3% gentamicin or 0.25% chloramphenicol, 4 times a day. In order to reduce the chance of eyelashes contaminating the surgical field, the eyelashes can be cut off before surgery. If there is significant eyelid inflammation or conjunctivitis, try to delay the surgery as much as possible. 5, corticosteroid application (SteroidsApplication) For retinal detachment and uveal inflammation, hormone therapy should be given to control inflammation before considering surgery. Especially for patients with rhegmatogenous retinal detachment complicated with choroidal detachment, the dose of hormones (such as intravenous drip) should be larger before the operation than the normal dose, and the dilated and bandaged eyes should be given at the same time to help the suprachoroidal fluid. Absorbs and reduces postoperative inflammatory response. After treatment, the choroidal detachment can be significantly reduced or disappeared.