Traumatic Membranous Cataract Extraction

Curing disease: Indication The formation of a mechanized fibrous membrane in the pupil area caused by trauma. Usually, the residual lens capsule, the residual cortex, and the disordered vitreous body are mixed together with the cellulose exudate after the injury. It may be associated with adhesional corneal palsy, or may be associated with the mechanized tissue of the wound site, or it may be part of the iris-vitreous adhesion machine to form a fibrous membrane, or it may be an intraocular lens-iris adhesion-pupil locking Joint group sign. In short, it is a complex of anterior segmental traumatic tissue and abnormal repair of inflammatory response. Severely affecting vision and appearance, severe obstacles are placed on re-establishing surgery for visual function, and more severe cases cause traction retinal detachment. It can only be removed by surgery. Contraindications Combined with low intraocular pressure and traction retinal detachment. UBM may help to identify causes of low intraocular pressure. Vitrectomy and membranous cataract surgery combined with surgical retinal detachment should be performed. Preoperative preparation 1. Comprehensively evaluate the systemic and local lesions and perform necessary treatment. 2. Topical application of antibiotics was started 3 days before surgery. The conjunctival sac and lacrimal passage were washed with 0.25% chloramphenicol or gentamicin on the day of surgery. 3. Anesthesia after routine or after ball. Surgical procedure The pupillized fibrous membrane is completely different in nature from the aforementioned traumatic cataract caused by residual lens material. This membrane is mainly composed of collagen fibrous tissue, which is very hard, and slender scissors (such as capsule scissors) are difficult to be tailored. Glass cutting scissors are generally powerless for cutting operations. Surgery can be divided into two types of surgery, one is to use a limbal incision, with the help of a viscoelastic agent, first use a sharp instrument to cut a tough membrane into a small mouth, and then enter a thicker scissors, which After the blade is inserted into the membrane from a small mouth, the membrane is sequentially cut into strips, and then the fine dentate scorpion is used to enter the anterior chamber, and the free end of the membrane strip is clamped, and the scissors are cut one by one. After suturing the incision, one end of the incision enters the perfusion needle, and the other end of the incision enters the vitreous cutting head to clean residual viscoelastic material, excision of the vitreous body in the anterior chamber and the anterior portion, and trimming the resection stump and pupil formation. After the surgery, the anterior chamber is fully formed. This procedure is suitable for simple membrane ablation. Another procedure is to establish perfusion at the beginning, which can establish perfusion in the anterior chamber through the lower limbus, or through the perfusion of the vitreous cavity of the flat sclera, and then cut at the 2 and 10 points of the limbus respectively. A small mouth enters two instruments for two-hand operation. The advantage of this procedure is that it operates in a closed environment, the intraocular pressure is always stable, the eye is safer, and the incision is small. Perfusion through the vitreous cavity develops more mobility for the posterior part of the surgery, such as the treatment of the internal sclera of the anterior sclera, the removal of the anterior vitreous foreign body, and the operation of the ciliary body. However, it is best not to use the vitreous perfusion in the vitreous surgery experience, because the perfusion cannot be established before the perfusion head is confirmed to enter the vitreous cavity, and it is difficult to confirm before the membrane has been removed. It is very dangerous to establish perfusion without confirmation. The point of attention for the removal of the mechanized membrane is to avoid forcibly pulling the membrane tissue. Can only use sharp instruments to remove and never tear the film weaving, otherwise it will cause severe anterior chamber hemorrhage, more serious consequences are retinal serrated dissociation, postoperative retinal detachment. complication The anterior chamber hemorrhage and retinal detachment, avoiding excessive traction of the membrane tissue during surgery is the main preventive measure. If there are more intraoperative operations and there is a fear of retinal detachment after surgery, a prophylactic scleral cerclage may be performed.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.