Anterior scleral laceration surgery

The primary treatment level of corneal mechanical injury is very close to the visual prognosis, and the level of scleral wound treatment is related to the final fate of the injured eye. Because scleral damage means damage in the second and third regions, the threat to the vitreous, retina, and macular areas increases as the scleral wound moves back and increases in length. For the safety of the injured eye, the treatment of the scleral wound is more important than the treatment of the corneal wound. In the past, the focus was on the pigment film. Since the use of microsurgical treatment of scleral wounds, the problem of poor pigmented film exposure in wounds has become less common. The key is the vitreous and retinal treatment. Treating diseases: scleritis Indication Anterior scleral laceration surgery is applicable to: Anterior scleral laceration or posterior scleral laceration. Preoperative preparation Clean the face, especially the eyelids, rinse the lacrimal passages, fresh open wounds should not be washed with normal saline before surgery, and should be thoroughly rinsed with diluted antibiotic solution before the wound is cleaned. Surgical procedure Because the scleral wound does not appear as the cornea, sometimes the rectus stop also makes the wound difficult to handle. Therefore, adequate exposure to the wound is a prerequisite for handling the wound. It is usually necessary to set the traction line of two adjacent rectus muscles, which makes the eyeball flip easier. If the wound is too large, worrying that the eye content will be lost when the eyeball is pulled, you can suture 1 to 2 needles at the midpoint of the wound, and then place the rectus muscle traction line. The suture sequence of the scleral wound is different from the corneal wound and should start from the ends of the wound. The reason is that there is no vitreous inlay at both ends of the wound due to the normal scleral tension, and the vitreous is not embedded in the wound after suturing. In this way, as the suture is turned to the midpoint of the wound, the state in which there is no vitreous inlay in the wound can be continuously continued until the vitreous body is completely pushed into the original position. Usually, by simply using this type of stitching, it is impossible to push the removed vitreous body back into place without treatment, because the integrity of the dense part of the vitreous has been destroyed, and cellulose exudation will adhere the vitreous fiber to the wound section. It is necessary to cooperate with the method of suturing and cutting. The method is to adopt an open vitreous resection method before the suture, that is, to constantly balance the salt liquid to the surgical field point, and maintain a certain amount of liquid volume in the local area, because the excision of the vitreous tissue requires the suction of water flow, and the vitreous tissue floats in the water. It is easy to identify so that it can be removed thoroughly. In addition to the scleral surface and the vitreous in the wound need to be completely removed, the vitreous layer of the vitreous membrane should also be removed together. The surgical microscope must adjust the focal length to avoid accidental injury to the pigment film. When the vitreous near the suture is completely removed, a needle can be sutured. If you wait until the midpoint of the meeting, you can ensure that there is no vitreous inlay in the wound. In large scleral wounds, because the vitreous body is excessively lost, and the vitreous body is not detached from the retina at this time, a large area of the retina is often prolapsed. The effective operation of preserving the retina is to distinguish the retina under the microscope and remove the vitreous tissue. . The operation also provides sufficient balance of saline to float the retina and vitreous tissue for observation and cutting operations. Then, the pulling force of the scleral wound and the retracting force of the intraocular portion of the tissue are gradually sutured at both ends to return it to the eye. It is hard to work with metal equipment and it is hard to work. After the above-mentioned scleral wound suture is completed, it is not the end of the operation, but there is no vitreous impaction in the wound, and the basic condition of the displaced vitreous body and the retina is returned to the original position, but the low intraocular pressure state at this time There is no power to return the vitreous and retina to their original position. Immediate recovery of intraocular pressure is the main measure to promote the return of tissue to the in situ, and is also one of the main differences with traditional scleral laceration treatment. The method is to use an eye-balanced saline solution to penetrate from the flat portion through a sharp needle and push it into the vitreous cavity to raise the intraocular pressure to a normal or high level. With the opening of the wall of the eyeball, the vitreous and retina of the wound are completely disconnected from the wound by the retraction force of the opposite side of the wound and the posterior vitreous and retina. However, it is not advisable to use gas to restore intraocular pressure. To date, there are still many units that condense around the wound as a routine surgical procedure, the motivation of which is to promote the closure of the retinal tears in the wound, but it is actually not only unhelpful but rather exacerbates the proliferation process. Because the vitreous and retina of the wound in the wound will definitely proliferate, it is essential to treat the scleral wound. An effective measure to promote retinal tear closure is to apply a scleral press at the wound site rather than blindly freezing. Sometimes even extrascleral compression does not have to be performed, as most of the similar eye injuries require vitreous surgery to get a thorough treatment.