Vitrectomy for traumatic endophthalmitis

Uveitis caused by infection is called endophthalmitis. Traumatic endophthalmitis occurs when microbes invade the eye after a breach of the wall of the eye. The most common pathogenic microorganism is bacteria, and the course of the disease can be acute, subacute or chronic. Traumatic endophthalmitis accounts for about 20-30% of all cases of endophthalmitis and is the second most common cause of endophthalmitis. The incidence of eyeball penetrating injury was 2%, and the high was 7.4%. There is a risk of endophthalmitis in the eye, which is twice as high as no foreign body in the eye. It is also a common cause for children to play with disposable syringes to accidentally injure the eye. Curing disease: Indication 1. Highly suspicious traumatic endophthalmitis. 2, acute and serious traumatic endophthalmitis. 3, combined with intraocular foreign body or retinal detachment and other complications. Contraindications 1. Severe acute intraocular infection, cornea and sclera have dissolved, or have developed into full ophthalmia. 2, advanced cases, eyeball atrophy, retinal necrosis, detachment, a hard funnel-like. Preoperative preparation 1. Improve various examinations, including ocular ultrasound. 2, continuous systemic application and frequent use of antibiotics and glucocorticoids. Surgical procedure 1. Establish a standard three-channel ciliary body flat vitreous surgery, and use a 6mm long perfusion needle. 2, the vitreous sample to send the bacteria culture before opening the perfusate, first use the cutting head (absorber tube about 15cm with a joint) to reach the center of the vitreous cavity, cut and attract the glass body fluid about 0,5 ~ 1ml, extracted from the joint The vitreous humor in the pipette is sent for bacterial staining, culture and susceptibility testing. 3. Add antibiotics and dexamethasone to the perfusate. The choice of drugs is seen in vitreous aspiration and drug injection. 4, in the iris, lens surface often have a continuous inflammatory membrane-like substance, the inflammatory exudative membrane should be removed. This film can be picked up with a sharp needle and then cut. 5, because in many cases there is anterior chamber exudation, the pupil is difficult to enlarge, the structure of the eye is unclear, the need to remove the lens. 6. When the vitreous is removed, first remove the vitreous at the center. If the vitreous has been formed and detached, it can be completely removed easily. However, surgery should be performed in a limited manner, and excessive cutting may cause retinal rupture. 7, in the presence of retinal rupture or detachment, can be performed outside the scleral pad. 8, gas-liquid exchange according to the degree of inflammation and retinal conditions, long-acting gas or silicone oil filling. 9. Close the scleral incision and suture the bulbar conjunctiva. 10. Regular injection of gentamicin and dexamethasone into the bulbar sac. complication 1. Intraoperative complications are intraocular hemorrhage and retinal detachment. The anterior bleeding is mainly seen in the incision, the iris root and the surface vessels. The perfusate bottle can be raised to increase the intraocular pressure to stop bleeding; the posterior bleeding can be treated by intraocular electrocoagulation or photocoagulation. For retinal detachment, scleral buckling and coagulation can be used. 2, other complications see vitreous surgery.

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