| Compared with traditional vitrectomy,minimally invasive vitrectomy has advantages in the treatment of diseases of the posterior segment of the eye:it can control stable intraocular pressure during surgery,reduce the risk of intraoperative retinal choroidal bleeding and choroidal detachment,and can effectively remove the substrate In the vitreous body.The high-speed wave-cutting rate can reduce the pulling of the retina and the probability of iatrogenic retinal holes is greatly reduced.For the treatment of intraocular foreign bodies and endangered ocular trauma after severe ocular trauma,it is necessary to solve the problem of foreign body extraction or restoration of anatomical structure,and to deal with intraoperative vitreous and retina complications.,also,may consider the long-term effect after surgery.The application of some new technologies in minimally invasive vitrectomy may achieve better surgical results.Part one Application of "L"-shaped incision in the treatment of large intraocular foreign bodies in the posterior segment with minimally invasive vitrectomyObjective:To evaluate the clinical effect of removing large foreign bodies in the posterior segment with the minimally invasive vitrectomy through the L-shaped incision of the ciliary body.Methods:A two-way cohort study was used to analyze the clinical data of 29 patients(29 eyes)with foreign bodies in the posterior segment from January 2013 to June 2019;the posterior segment was determined based on preoperative orbital CT and/or B-ultrasound examination The length,width and height of the foreign body.The patients are divided into groups a,b and c according to the maximum width(W)of the foreign body with W≤3mm,5mm≥W>3mm and W>5mm.The flat part of the ciliary body is enlarged and the limbus incision is removed.Group b use the "L"-shaped incision to take out of the foreign body,that is,a vertical incision of about 2mm in the direction of the corneal limbus at the end of the "一"-shaped incision.After the foreign body is removed,the scleral foreign body is closed to remove the incision,the vitrectomy channel is inserted into the 23G/25G+minimally invasive puncture sleeve Minimally invasive glass cutting.Follow-up≥6 months after operation.The foreign body removal rate,visual acuity results and complications of the three groups were compared to evaluate the safety and effectiveness of the "L" incision.Results:A total of 13 cases were included in group a,8 cases in group b,and 8 cases in group c.All foreign bodies in group b were removed at one time,and the omentum was reset at the last follow-up.The foreign body length was 5.4 ± 2.9mm,the maximum width was 2.2 ± 0.8mm,and the height was 1.6 ± 0.9mm.IOP is higher than baseline IOP.One case(12.5%)had recurrent retinal detachment after operation;2 cases(25.0%)had PVR.Followed up for 6 months there were no serious complications.Conclusion:In the treatment of larger foreign bodies in the posterior segment with minimally invasive vitrectomy,the "L"-shaped incision through the flat part of the ciliary body can safely remove the larger foreign bodies that meet the conditions(5mm≥the maximum width>3mm),with fewer postoperative complicationsPart two Application of foldable capsular vitreours body in endangered eyes after severe ocular traumaObjective:To evaluate the clinical effect and significance of implanting foldable capsular vitreours body(FCVB)in endangered eyes after severe eye trauma.Methods:A prospective single-group cohort study was used.Choose the patients with severe ocular trauma who were treated at Xiaolan People’s Hospital of Zhongshan from January 2018 to January 2020,who had indications of foldable capsular vitreours body implantation and agreed to surgical treatment.After phase I debridement and suture,according to the injury,some of minimally invasive vitrectomy was implanted with FCVB at the same time;the other vitrectomy was performed first,and an appropriate time was selected for phase II implantation of FCVB.Follow up regularly after the operation to observe indicators such as vision,intraocular pressure,FCVB presence,postoperative adverse reactions,and eyeball atrophy.Paired t test was used for statistical comparison of patients’ intraocular pressure.Results:A total of 7 patients were enrolled,including 6 males,1 female,3 left eyes,4 right eyes,aged(32 ± 8.9)years,and were followed up for an average of 6.9 months after surgery.The eye retention rate was 100%,and no case had major intraocular hemorrhage,endophthalmitis,or eyeball removal.6 cases(85.7%)of the eyeball atrophy were controlled,and 1 cases(14.3%)had no eyeball atrophy.All remaining retinas were reset.Postoperative vision:2 patients(28.6%)were higher than before surgery,and 5 patients(71.4%)had no change compared with preoperative.The average intraocular pressure(10 ± 1.7)mmHg(1 mmHg=0.133 kPa)at 1 week after surgery was higher than the baseline intraocular pressure(9.6 ±3.8)mmHg,but the difference was not statistically significant(Z=0.45,P=0.71).The final mean intraocular pressure(6.5±1.6)mmHg was lower than the baseline IOP,and the difference was not statistically significant(Z=-1.41,P=0.17).Follow-up showed 5 cases(71.4%)with low intraocular pressure and 2 cases(28.6%)with shallow anterior chamber.Conclusion:The implantation of FCVB in endangered eyes after severe ocular trauma is safe and effective.It plays a role in saving eyeballs,controlling early eyeball atrophy,and avoiding removal of eyeballs.It can preserve vision after injury.Common complications are low intraocular pressure and shallow anterior chamber. |
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