Yu Shaobin (1967-), male, from Baotou City, Inner Mongolia. Master of Medicine, Attending Physician.
The invention of the sputum of the sputum of the sputum of the sputum of the sputum of the sputum of the sputum of the sputum of the sputum of the sputum of the sputum of the sputum of the sputum of the sputum of the sputum of the sputum Institute of Occupational Health and Occupational Diseases, Baotou, Inner Mongolia 014010, China) Objective: To evaluate the efficacy of surgical methods for vitrectomy in the treatment of vitreoretinopathy. Methods: 60 cases of 66 eyes with vitreoretinal lesions were subjected to scleral cerclage, silicone outer cushion pressure, vitreous resection, retinal anterior membrane separation, resection, retinal release, incision, resection, peroxidative effusion injection, eye Treatment with internal fluid discharge and silicone oil filling to observe the therapeutic effect. Results: 54 eyes were cured, the success rate was 90%; 5 eyes were improved, accounting for 8.33%; 1 eye was ineffective, accounting for 1.67%. Conclusion: The improvement of understanding and treatment ability of vitreoretinopathy by vitreoretinal microsurgery can be improved. The success rate of most severe vitreoretinal surgery is significantly improved.
Vitreoretinopathy; Vitrectomy Retinal vitreous lesions are common eye diseases with a blindness rate. With the increasing maturity of vitrectomy, the cure rate of vitreoretinopathy has been greatly improved. Since 2001, our department has performed vitrectomy and achieved satisfactory results. The report is as follows.
1 Materials and Methods 1.1 Clinical data age 2572 years, mean age 54.22 years old. There were 28 cases of right eye, 26 cases of left eye and 6 cases of both eyes. There were 24 cases of complicated retinal detachment (10 cases of rhegmatogenous retinal detachment, 2 cases of giant hiatus, 2 cases of choroidal detachment retinal detachment, 3 cases of yellow disease hiatus, 7 cases of traction retinal detachment); 12 cases of diabetic retinopathy ( 5 cases of both eyes), 23 cases of vitreous hemorrhage (6 cases of retinal vein occlusion, 16 cases of traumatic vitreous hemorrhage, 1 case of Terson syndrome, 1 case of both eyes), 1 case of acute retinal necrosis. The shortest duration of Id, the longest 90d, the actual length of hospital stay is 5d, the longest is 60d. 1.2 Surgical method vitreous cutter, equipped with ultrasonic pulverization, gas-liquid exchange, bipolar coagulation, etc., is a pneumatic reciprocating cutting head; German Chua The operating microscope produced by the company; the intraocular perfusate is 500ml of lactated Ringer's solution plus 4ml of 50% glucose and 0.5ml of adrenaline of 1:1000; the intraocular filler is made of hexafluoride produced by the Institute of Special Gas of Physicochemical Engineering Institute of Tianjin Nuclear Industry Department. Sulfur, QFe and silicone oil imported from Germany.
Preoperative preparation: 1 General preparation: Detailed slit lamp examination, focusing on iris and pupil conditions and lens position and turbidity. At the same time, according to vision, intraocular pressure, visual function positioning, binocular indirect ophthalmoscope and ultrasound examination to understand the fundus. 2 whole body examination: regular ECG, chest and blood glucose tests. The eyes were treated with antibiotic eye drops, 4 times a day, to clean the conjunctival sac. Compound tropamide eye drops and 5% Xinfulin eye drops are fully dilated for examination and surgery.
Surgical methods: routine post-balloon anesthesia, patients with cardiovascular disease at the same time heart rhythm monitoring, scleral incision using standard three-incision vitreous surgery, respectively for placement of intravitreal perfusion (infraorbital incision), optical fiber, vitreous cutting head, The contact lens holder is sutured, the perfusion head is confirmed in the eye, the perfusion is opened, the vitreous is cut, and then the retina is photocoagulated or condensed. The mixed gas is slowly injected into the eye through the infusion tube, and the scleral incision is opened at the same time, so that the gas in the eye is continuously excluded from the eye. When about 20 ml of the mixed gas remains in the syringe, the scleral incision is closed, and finally the insufflation is continued. Pull out the perfusion head. Silicone oil filling is feasible for severely complicated cases, and special cases require intraocular treatment such as retinal incision and stripping.
Take the prone position, change the medicine every day, and check the vision, slit lamp, fundus and intraocular pressure.
2 Results 66 eyes were followed up for 24 months of visual acuity results, see attached table.
The visual acuity of the light finger touched before and after surgery has different degrees of improvement, and the traumatized person determines the visual acuity according to the injury.
Complications: According to reports, common complications after vitrectomy include secondary retinal detachment, iatrogenic retinal tears, postoperative hypertension, traumatic or complicated cataract, endophthalmitis, and 1 case in this study. The source of the medical source was found to be treated in time, and the retinal reattachment and visual acuity were not affected after the operation. One case was congenital white cataract extraction and intraocular lens implantation. The posterior pole hole was treated with vitrectomy and silicone oil filling. The postoperative intraocular pressure was high. After removing silicone oil, the intraocular pressure returned to normal and the retina was repositioned.
3 Discussion Vitreous blood is a common eye disease, traditional drug treatment has little effect, long-term blood accumulation, will lead to proliferative vitreoretinopathy traction retinal detachment. During the operation, we found that the proliferative changes of the vitreous retina were significantly aggravated with the prolongation of the disease course. Therefore, early vitrectomy can avoid the occurrence and development of PVR and obtain satisfactory results. In this study, 6 patients with retinal vein occlusion with vitreous hemorrhage, visual acuity increased from preoperative manual/intraocular, to 0.2 after surgery. This is clinically common with Oyakawa et al. reported that vitreous hemorrhage caused by retinal vein occlusion is clinically common. Although vitreous surgery can restore useful vision in some patients, the surgery itself can also produce many complications, such as iatrogenic holes and late lens opacity. Therefore, it should be emphasized that patients with venous obstruction should have early fundus fluorescein angiography and find that there is no perfusion area and neovascularization on the retina. Proper laser treatment should be given in time to reduce future vitreous hemorrhage, traction or rhegmatogenous retinal detachment. The macula is affected by traction and other complications to protect the eyesight of the affected eye.
Retinal detachment is one of the serious blinding eye diseases. Conservative therapy does not work at all. The traditional reduction method can not achieve satisfactory results, such as huge holes, retinal funnel-shaped detachment, choroidal detachment retinal detachment, etc., which was considered to be incurable in the past. The occurrence and application of vitrectomy greatly enhances the success rate of surgery and plays an extremely important role in the treatment of complex retinal detachment. It can treat cases that cannot be treated by conventional surgery. For example, vitreous hemorrhage combined with retinal detachment, vitrectomy to remove blood, opaque vitreous and traction cords, retinal reattachment in the case of clear eyes, but also use heavy water to smooth the retracted retina, made with silicone oil Intraocular filling, the rate of retinal reattachment is greatly improved. With the deepening of the understanding of retinal detachment, we also found that vitreous lesions are closely associated with the course of retinal detachment. Retinal detachment occurs mostly in myopia, especially in high myopia, but less in patients without obvious refractive error. It is reported that the total cure rate and the success rate of one operation in patients with retinal detachment are significantly lower than those in myopia. This is related to the low incidence of posterior vitreous detachment and the incidence of vitreous concentration in the retinal detachment of the emmetropic eye. This special recursive detachment of the vitreous is a special pathological process that is more likely to cause the occurrence and development of proliferative vitreoretinopathy. Thereby affecting the prognosis of surgery.
Intraocular foreign body is a common ocular trauma, often accompanied by vitreous lesions. Vitrectomy is one of the effective methods for the treatment of traumatic proliferative lesions. In the early stage of trauma, vitrectomy is used to treat endophthalmitis after perforation, to remove the lens and vitreous of the anterior chamber, to remove blood from the vitreous, and to inject appropriate antibiotic into the eye, which can effectively prevent traumatic infection and late vitreous. Proliferation, vitrectomy, is the first choice for patients with traction retinal detachment, but vitrectomy does not prevent the proliferation of fibroblasts and pigment epithelial cells in the vitreous after trauma. It has a good effect on retinal detachment and functional recovery.
Vitreous surgery is the most common type of surgery for intraocular tissue. If the intraocular operation is improper, it can cause flattening of the ciliary body, choroidal detachment and retinal detachment. Close observation should be performed after surgery, and regular follow-up is required after discharge. Therefore, the surgeon must fully understand the seriousness of the surgical complications, master the operation skills, and reduce the occurrence of complications.
Retinal necrosis is an ocular syndrome including acute uveitis, vitreous fusion retinoic retinitis, occlusive retinitis and neuropathy. It is currently believed to be associated with herpes virus infection. The prognosis is extremely poor. The situation of one patient in this study also fully illustrates this point. Postoperative visual acuity is not compared with preoperative visual acuity, both manual/anterior. We believe that the main reason for hindering the recovery of vision in patients is: A surgery is too late, only 3 months after the onset of the disease; B retinal necrosis is extensive, involving the posterior pole, optic neuropathy. We believe that vitrectomy can remove the infection and improve the environment inside the eye, which is conducive to the recovery of the disease.
Diabetic retinopathy is the main blinding eye disease in the age group over 50 years old. About 25% of diabetic patients have different degrees of retinopathy, and 5% of them are proliferative diabetic retinopathy. Repeated vitreous hemorrhage can lead to retinal detachment, which is the main cause of blindness in patients. The clinical data of this group suggest that patients with diabetic retinopathy should undergo early vitrectomy in the treatment of vitreous hemorrhage or localized retinal detachment in order to obtain better postoperative visual acuity. For long bleeding time and range of traction retinal detachment Larger patients should not give up treatment because vitrectomy may still improve vision in patients.
In the 1980s, vitrectomy combined with silicone oil filling used a surgical retinal detachment with a success rate of 50% to 97%. However, after silicone oil filling, there were still 22% of Sun Xiaodong, Zhang Zhe, and Huang Wei. Surgery prognosis and vitreous lesions in the retinal detachment of the eye. Chinese Journal of Ophthalmology, 1999, 35 (6) Yuan Liangli vitrectomy for the treatment of ocular penetrating injury. The first international essay on eye trauma, 1988: 59. Li Xiaoxin. Vitreoretinal Surgery Beijing: People's Medical Publishing House, 2000: 295. Lu Lin, the application of silicone oil in retinal reattachment. Foreign medical ophthalmology sub-hole Xin Ping (1958), female, Yuanping County, Shanxi Province.
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