Pars plana vitrectomy plus anterior chamber air or fluid injection

Malignant glaucoma is a serious complication after glaucoma surgery. It is characterized by a shallow anterior chamber or anterior chamber disappearance with elevated intraocular pressure. Treatment with conventional glaucoma is ineffective or worse. In the past, malignant glaucoma was thought to occur because the edema of the ciliary body moved forward after surgery, and the ciliary ring was blocked by the equator of the lens, causing the aqueous humor to flow backward and accumulate in the vitreous. In recent years, it has been clinically found that malignant glaucoma can also occur in patients who have not undergone surgery, patients after cataract extraction surgery, or from ocular trauma, inflammation of the eye, or after the use of a miotic agent. The main clinical features of malignant glaucoma are: the central and peripheral parts of the anterior chamber become shallower, producing a shallow anterior chamber with a shallow II to III degree. The early intraocular pressure is slightly higher, 15-20 mmHg, and then gradually increases. The use of ciliary muscle paralysis can alleviate some of the clinical symptoms, and the use of miotic agents can aggravate the condition. Ultrasound biomicroscopy revealed that a small number of patients with malignant glaucoma did have ciliary body edema, forward migration, ie, ciliary ring block, while most patients showed extreme advancement of the iris lens or vitreous-ciliary body-iris compartment. The back room disappeared completely. Medication for Malignant Glaucoma: When clinically found to have a risk of malignant glaucoma, timely use of ciliary muscle paralysis, such as atropine, tropine, etc., to reduce the contraction of the ciliary muscle, local The use of corticosteroids reduces edema in the ciliary body and relieves ciliary ring block. Beta blockers and carbonic anhydrase inhibitors are used to reduce aqueous humor secretion, while systemic hypertonic agents are used to dehydrate the vitreous and reduce posterior chamber pressure. In general, early recognition of the signs of malignant glaucoma, using active drug therapy, more than 50% of patients can reverse the pathological process of malignant glaucoma. If the drug is treated for 3 to 5 days, the anterior chamber does not form an increase in intraocular pressure, and surgery can be taken. Treatment of diseases: malignant glaucoma Indication Ciliary body flat vitreous suction plus anterior chamber insufflation or infusion is applicable to: 1. Patients with malignant glaucoma. 2. There is no anterior chamber patient after operation. The choroidal effusion is not released during the anterior chamber angioplasty. The anterior chamber can not inject and retain air. The posterior chamber pressure is high. It is also possible to withdraw part of the glass volume from the flat part of the ciliary body. Liquid or liquefied glass body. Surgical procedure 1. Avoid the original surgical site, and cut the bulbar conjunctiva to expose the sclera in a convenient area such as the iliac crest. 2. The surface of the sclera is fully hemostasis. The center of the limbus is 3~3.5mm, and the depth of the sclera is cut horizontally or vertically by about 1/3~1/2, and a needle-type suture is preset. 3. Use a sharp blade to make a deep scleral cut, expose a little uveal, pay attention to the deep incision not too long, the vertical incision should not extend too far back. 4. Using a disposable 2ml or 5ml syringe, make a mark on the needle 12mm, slowly penetrate the center of the eye through the incision, and gently lift the needle when moving forward, causing a little negative pressure inside the empty needle, but Be careful not to create too much negative pressure. When sucking into the liquefaction chamber or the liquefied glass body, the needle in the hand has a feeling of falling, and the liquid can be sucked out by 0.8 to 1 ml. If the effusion cannot be extracted, the needle will be slightly moved back and forth, left and right, and generally can be sucked out smoothly, taking care not to damage the lens and retina. 5. Using a fine iris restorer, gently separate the anterior chamber from the uveal and subscleral space until the iris restorer is visible through the cornea. Note that the separated tunnel should not be too large, and it can be done by injecting air with a blunt needle. 6. Inject disinfectant air (balanced salt solution) into the front room to deepen the anterior chamber and return the iris-lens to the original position. 7. After exiting the air needle, a small amount of injected viscoelastic agent is injected from the original passage, and the needle is retracted while being injected, and the anterior chamber is closed to the wound of the ciliary body. 8. Ligation of the preset suture and suturing the conjunctiva. 9. Subconjunctival injection of 20,000 units of gentamicin, dexamethasone 2.5mg, 1% atropine eye ointment coated with sac.

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