anterior chamber puncture

Diagnostic anterior chamber puncture is suitable for the following situations: (1) There are signs of microbial infection, and it is urgent to determine the nature of the infection. (2) Need to determine the cause of immunological diseases of eye diseases. (3) Trace element analysis is needed to determine the nature of foreign bodies in the eye or to understand the metabolism of certain elements in the eye. (4) Primary or metastatic tumors in the eye require atrial cytological diagnosis. (5) Other diagnostic factors for aqueous humor. Treatment of diseases: high ocular hypertension, anterior chamber hemorrhage Indication 1. Diagnostic anterior chamber puncture is applicable to the following situations (1) There are signs of microbial infection, and it is urgent to determine the nature of the infection. (2) Need to determine the cause of immunological diseases of eye diseases. (3) Trace element analysis is needed to determine the nature of foreign bodies in the eye or to understand the metabolism of certain elements in the eye. (4) Primary or metastatic tumors in the eye require atrial cytological diagnosis. (5) Other diagnostic factors for aqueous humor. 2. Anterior chamber angioplasty is suitable for the following situations (1) All or part of the anterior chamber disappeared due to factors such as trauma, inflammatory adhesions, or the anterior chamber became shallow. (2) After glaucoma surgery, the anterior chamber is delayed and conservative treatment is ineffective. (3) In the posterior segment of the eye, the anterior chamber is squeezed and disappeared due to the injection of silicone oil and gas. 3. Anterior chamber irrigation is suitable for the following situations (1) severe eye alkali burns. (2) anterior chamber blood with high intraocular pressure. Preoperative preparation 1. Qualitative examiner If the pupil is too large, the sputum can be deflated, and the quantitative examiner does not dilate in order to avoid the effect of the mites. 2 to 3 days before surgery, the conjunctival sac drops antibiotic eye drops. 2. Prepare the appropriate water collection tube. 3. If the eye pressure is high, give the eye drop pressure medicine. 4. Eyes with new blood vessels and suspected bleeding, given hemostatic drugs. 5. Prepare an appropriate amount of viscoelastic. Surgical procedure 1. Open the upper and lower eyelids. 2. Fix the ankle and clamp the puncture point on the opposite side or the ipsilateral limbus to remove the conjunctiva and fascia. (1) A 1 mm horizontal incision was made with a sharp knife at the upper limbus of the ankle. (2) The 25- to 27-gauge needle is connected to a 1 ml tuberculin syringe with the slope facing down and piercing the anterior chamber horizontally through the incision. (3) Relax the fixed sputum, turn the needle bevel to the cornea, slowly draw 0.2 to 0.3 ml of aqueous humor, and then gently pull out the needle. Anterior chamber angioplasty The anterior chamber is filled with air, a balanced salt solution or an ophthalmic viscoelastic to fill or expand the anterior chamber. (1) Balanced salt solution: After the 5th needle is connected with the balanced salt solution, the needle tip obliquely faces the lower level and penetrates the incision. The perfusate switch is opened. The saline bottle should be at least 60cm higher than the surgical eye plane. The current room is gradually deepened and observed under the microscope, the iris and After the cornea has completely detached from contact, use a cotton swab to press the puncture and quickly withdraw the needle. (2) Air: In the case where the perfusion liquid cannot maintain the anterior chamber and there is no viscoelastic agent on hand, air can be injected to form the anterior chamber. The injection method is similar to that of injecting saline, but the needle should be directly connected to the 5ml glass syringe, and the amount of air to be extracted should not be too much, generally 1~2ml. The force should be kept even when injecting gas, not too strong, so as to avoid the anterior chamber suddenly deepening. The needle should be protected from the vitreous, part of the blood clot. The air bubble injected into the anterior chamber is disc-shaped, and the diameter is consistent with the limbus, indicating that the anterior chamber has been completely filled with air. The gas injection is too slow, and the bubbles will become many fine foams, which is not conducive to observation. (3) Viscoelastic: A viscoelastic agent is injected into the anterior chamber to obtain a satisfactory anterior chamber forming effect. Suitable for shallow anterior chamber after glaucoma surgery. The 5th tip needle was connected to the viscoelastic syringe, and the 12 corneal full-thickness incision was made obliquely downward. When the pinhole begins to be exposed within the incision, a slight force is applied to inject the viscoelastic agent into the confined anterior chamber air within the incision. Slightly push the needle into the middle of the anterior chamber viscoelastic and inject a little more. In the future, the viscoelastic agent is injected while pushing the needle. In order to evenly fill the anterior chamber, the tip of the needle should be extended into the shallower part of the anterior chamber. The needle is injected in a fixed space, and the anterior chamber filled with the viscoelastic unevenness may tear the anterior chamber angle. In the case of a strong iris front edge, more viscoelastic agents can be injected around the adhesion, and the needle tip is used to horizontally sweep the adhesion to promote separation. If the adhesion is very strong, the incision can be enlarged and the adhesion can be cut with scissors. Quickly withdraw the needle and press the puncture for a while. Anterior chamber irrigation Anterior chamber irrigation is only an adjuvant treatment for primary disease, so the primary disease should be treated promptly. (1) Single puncture rinsing: use a 20-gauge needle to make a full-thickness horizontal puncture at 0.5~1mm in the upper limbal rim of the iliac crest, and connect the balanced salt solution in the sling bottle with a 5th flat needle or a cataract needle, with a height of about 60cm. The liquid produces two semicircular eddy currents in the anterior chamber, and the harmful substances in the anterior chamber are taken out of the incision, and the incision is gently pressed at any time to maintain the balance between the perfusion amount and the discharge amount. When the pupil is small, the needle tip can also be crossed across the pupil. District, this method is suitable for washing the anterior chamber chemicals, a small amount of uncoagulated blood and empyema. (2) Double-incision flushing: Large blood clots stored in the anterior chamber are suitable for discharge by double-notch flushing. A curved full-thickness corneal incision of 2 to 3 mm is made 0.5 to 1 mm on the opposite side of the first puncture or closest to the limbus of the blood clot, parallel to the iris plane. A hand-held flat head continuously injects balanced salt liquid or viscoelastic agent from the first small puncture mouth, and the other hand uses a micro-iris shovel to protrude into the incision, and gently presses the back lip to discharge the blood clot from the incision. Finally, the viscoelastic agent is replaced. 10-0 nylon thread sutured a 3mm incision needle. The eye was sutured and the corneal suture was removed after 4 weeks. complication 1. Puncture leaks. The anterior chamber disappears (low intraocular pressure, positive for fluorescein staining), and those without infection can be pressure-wrapped for 1 to 2 days until the anterior chamber is re-formed. 2. The necrosis of the puncture is enlarged and the anterior chamber is empy. Found in the anterior chamber of the infected person, fluorescein staining positive, low intraocular pressure. Immediately do the conjunctival sac swab bacterial culture, systemic administration of large doses of broad-spectrum antibiotics and corticosteroids. According to the results of bacterial culture and drug susceptibility test, the type of antibiotics was adjusted. If there is more empyema in the anterior chamber, the anterior chamber can be opened and irrigated, the incision can be sutured, and the antibiotics can be injected under the conjunctiva. 3. Secondary glaucoma. Empty bubble pupillary glaucoma occurs when lying on the back. Immediately after the discovery, the semi-recumbent or lateral position is adopted to prevent the air bubbles from avoiding the pupillary area. At the same time, the drop of the compound tropamide and the large pupil can quickly relieve the pupillary block. Increased intraocular pressure caused by anterior chamber viscoelastic agents can last for several days. If the intraocular pressure is too high or has serious symptoms, mannitol, oral acetazolamide and timolol can be instilled. It is also possible to puncture the anterior chamber to release a little sticky aqueous humor. 4. The anterior chamber has blood. A ciliary body from an iris, a new blood vessel, or a tear. General bleeding can stop on its own. If bleeding does not stop, you should take a sitting position or a lateral position. When there is air in the current room, the bleeding point is at the highest point, and the floating air is used to stop the bleeding. When the anterior chamber is a viscoelastic or liquid, the bleeding is at the lowest point, so that the blood is deposited locally to form a blood clot to stop bleeding. If the intraocular pressure is low, the eye can be pressure-wrapped. More bleeding associated with secondary glaucoma should be promptly anterior chamber irrigation. 5. After the air bubble block, the anterior chamber disappears again. When the position changes, the air in the anterior chamber of the aphakic eye can be moved into the vitreous cavity through the periorbital or perforation of the iris. The back-moving bubbles are difficult to return to the anterior chamber, and the iris is pushed forward, and the anterior chamber becomes shallower or disappears again. Therefore, it is not advisable to inject air into the anterior chamber of the aphakic eye without posterior capsule. It is recommended to use viscoelastic.