closed vitrectomy

Closed vitrectomy is an intraocular surgery and is a vitrectomy. A surgical treatment for severe opacity and posterior detachment of the vitreous. If the retinal optic nerve is damaged, the removal of the vitreous is unable to completely restore vision. The best treatment time: general surgery is recommended to be treated after the initial diagnosis of the disease, special surgery should be prescribed. Treatment of diseases: vitreous glaucoma Indication 1. Anterior segmental lesions: (1) The lens surgery is accompanied by vitreous hemorrhage, and the cutting head is used to remove the embedded in the wound and the anterior vitreous to avoid late complications such as cystoid macular edema and traction retinal detachment. (2) The corneoscleral laceration combined with vitreous incarceration, and at the same time damage the crystal, can be removed together. (3) Penetrating keratoplasty with opacity of the lens or posterior cataract, while opaque lens resection. (4) Dislocation or subluxation after crystal. (5) malignant glaucoma. (6) Aphakic pupil-blocking glaucoma. (7) Correct the position of the implanted posterior chamber intraocular lens, or suture the posterior chamber intraocular lens. (8) Uveitis complicated with cataract, requiring removal of all lens material. 2. Posterior segmental lesions: (1) Endophthalmitis. (2) Vitreous hemorrhage caused by trauma and fundus diseases. (3) Great retinal detachment. (4) Retinal detachment of the posterior pole. (5) severe pvr retinal detachment. (6) Diabetic proliferative vitreoretinopathy with traction retinal detachment. (7) Pulling retinal detachment. (8) Intraocular foreign body combined with retinal detachment. (9) Congenital anomalies combined with retinal detachment. (10) Retinal vitreous lesions in infants and young children. (11) Intraocular parasites. (12) Macular anterior membrane. (13) Choroidal neovascular membrane and subretinal hemorrhage. 3. Anterior and posterior segmental lesions: Combined lens or posterior capsule opacification, uveitis and retinal detachment with pre-pvr, were treated with lens resection or ultrasonic comminution combined with vitreoretinal surgery. Post-dislocation of lens or intraocular lens combined with intraocular lens fixation. In addition, corneal opacity can be applied to the temporary artificial cornea for the above operation, and finally combined with keratoplasty; and diagnostic vitrectomy, uveal mass resection, combined with vitreous surgery. Contraindications 1. The cornea is turbid, and the anterior and posterior segments of the eye are unclear. 2, severe eye trauma, the eyeball tends to shrink. 3, severe respiratory or circulatory diseases can not tolerate this operator. 4, the visual function has been lost (no light). 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. The fixation of the contact lens ring (landers ring) was fixed by suture on the superficial sclera of the 3 and 9:00 near the limbus. 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.