Vitrectomy for traumatic eyes

Ocular trauma is caused by mechanical, physical, chemical and other factors directly affecting the eye, causing structural and functional damage to the eye. According to the traumatic factors of trauma, ocular trauma can be divided into mechanical and non-mechanical. Mechanical ocular trauma usually includes contusion, penetrating injury, foreign body injury, etc.; non-mechanical ocular trauma includes thermal burns, chemical injuries, radiation injuries and gas injuries. Treatment of diseases: eye injury, eyeball rupture Indication 1. Non-punctual ocular trauma to vitreous hemorrhage. 2. Puncture ocular trauma proliferative vitreous lesions. 3. Through-hole traumatic retinal incarceration. 4. Foreign matter in the ball (including metal or non-metallic foreign matter). 5. Traumatic traction retinal detachment. 6. Traumatic endophthalmitis. Preoperative preparation 1, visual function check: optical positioning, two-point resolution, electrophysiological examination: when the visual function is seriously low, it is used to estimate retinal function. 2, eye tissue examination: (1) cornea: transparency. (2) Iris: presence or absence of new blood vessels. (3) Pupil: Reacts to light and can be fully dispersed. (4) Crystal: transparency and presence of blood cells or pigmentation on the front and back surfaces of the crystal. (5) vitreous: the color, location, and density of vitreous hemorrhage; vitreous retinal adhesion, proliferation, and the presence or absence of neovascularization. (6) Retina: presence or absence of retinal detachment, retinal tears, neovascularization, anterior membrane, etc. (7) Foreign bodies in the eye. 3, systemic examination: cardiovascular disease, diabetes and so on. 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. Fixation of contact lens ring (landers ring): sutured on the superficial sclera of 3 and 9:00 near the limbus by suture. 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. complication 1. After the body is rebleeding: see the diabetic retinopathy. 2. Sawtooth detachment: occurs more often 3 to 10 days after surgery, especially after endophthalmitis. Immediate scleral compression or cerclage should be performed, combined with extrascleral condensation and gas-liquid exchange. 3. Grape membrane reactive exudation: especially after the removal of foreign bodies in the ball and endophthalmitis, severe uveal exudative reaction may occur, sometimes in the form of cotton batt or causing pupillary membrane closure. In addition to the application of broad-spectrum antibiotics, the dosage of glucocorticoids should be increased and the use time should be extended, and secondary glaucoma should be noted. 4. Recurrence of vitreous proliferation: The postoperative vitreous repopulation is mild or there is no dissociation of retinal traction. Clinical follow-up is feasible and closely observed. If the formation of the retinal anterior membrane affects vision or causes traction retinal detachment, it is necessary to perform vitreous surgery to remove the retinal anterior membrane and release traction.