iridectomy

Including peripheral iridotomy and optical iridotomy, it is particularly suitable for cases with a tendency to have iris bleeding. Treatment of diseases: chronic angle-closure glaucoma Indication 1. Clinical observation of closed angle glaucoma. 2. Aphakic eye pupillary block glaucoma. 3. Components of glaucoma extrabulous drainage. 4. Prevention of pupillary block during cataract extraction, easy to remove the crystal nucleus. 5. Very small iris tumors. 6. Iris sputum atresia. 7. Prevention of pupillary block during corneal transplantation. 8. Reduce the muscle strength of the iris sphincter and increase the pupil. 9. Optical iris resection. 10. The pupil moves up and the boresight light is obscured. 11. Smaller central corneal leukoplakia. Contraindications 1, with systemic diseases, can not tolerate surgery. 2, local infection, not suitable for surgery. Preoperative preparation 1. Shrinking. Combined cataract surgery requires dilation. 2. Those with high intraocular pressure need to take blood pressure first. 3. Preoperative glucocorticoids and indomethacin reduce postoperative reactions. Surgical procedure 1. Open the eyelids with the opener, and fix the eyeball with the upper rectus suture. 2. Incision: A conjunctival flap with a length of about 5 mm and a base of the iliac crest is placed above the limbus. A 3 mm long curved scleral incision was made in the posterior corneal sclera, and the width of the inner and outer incisions was uniform. Relax the upper rectus suture. Peripheral iridotomy (1) Lightly press the posterior lip of the incision and release a little aqueous humor until the iris is released a little outside the incision. (2) Clamp the highest point of the iris, and lift the iris about 0.5 to 1 mm perpendicularly to the sclera. The right hand-held scissors cut the iris from the surface of the sclera. (3) Lightly press the closed incision, open the inner incision, loosen the iris trapped in the incision, the sphincter contracts, and the pupil recovers round. (4) If the roots of the iris on both sides of the incision are difficult to recover, a small amount of viscoelastic agent may be injected into the incision to squeeze the iris to the root. Or use an iris shovel to push the iris sandwiched in the incision directly into the anterior chamber. (5) It is also possible to directly grasp the surrounding iris and pull out the incision to cut out. Optical iridotomy For corneal leukoplakia, static congenital pre-polar cataract and nuclear cataract, pupillary shift. The preferred optical iris removal site is a central region in turn, the iris corresponding to the clear corneal region closest to the visual axis when b is not dilated, and the iris at the axial position where the best visual acuity is measured by the cleft slit mirror; Below the nose. (1) Local sphincter resection: the purpose is to remove the iris adhesion and increase the amount of pupillary light. Applicable to small central corneal leukoplakia, the iris is slightly atrophied. Use the forceps to clamp the 12-point pupil edge iris through the incision. The incision is pulled out, the cut is directed toward the superior rectus muscle, the tissue about 1 mm long is cut off, and the rest of the iris tissue is returned, and the upper iris has a half moon-shaped notch. If the pupil is moved up, the incision should be selected at 6 o'clock and the lower sphincter is removed. If the operation is difficult, the upper incision can be used for iridotomy. (2) Middle iris resection: the indications are the same as the sphincter resection, and the resection range is slightly larger. (3) segmental iridotomy: also known as fan-shaped resection, for complex glaucoma surgery, iris atrophy, cataract surgery with small pupils, in principle, the upper iris is selected, the corneal scar is above or central, and the nose can be selected. It is not recommended to use this method to improve the vision of advanced nuclear bypass cataract. The scope of resection should include all iris tissue including the sphincter and the open muscle. Use the forceps to grasp the iris tissue located in the center of the center, and pull out the iris until the edge of the pupil exposes the incision. Pulling vertically upwards, the scissors cut upward to expose the root of the iris to obtain a narrower resection range. The scissors are cut horizontally to give a wider resection range. (4) elschnig iris capsular resection: also known as double-incision lens capsule and iris resection. At 10 o'clock and 2 o'clock, a full-slice scleral horizontal incision of about 3 mm was made, and a viscoelastic agent was injected into the anterior chamber. The iris was pierced 3 mm from the limbus with a 20-gauge needle. The blade on one side of the scissors extends under the iris, and the blade is cut once at 6 o'clock and 2 o'clock, respectively, and the length is about 5 mm, and the scissors are withdrawn. From this incision, the iris is clamped and the free end of the cut iris is pulled to the outside of the incision to be flattened. From the 2 o'clock position again into the scissors, one side of the blade extends into the back of the iris, the tip of the knife is facing 6 o'clock, the curved surface of the scissors is facing the limbus, and the free part of the iris is cut to obtain a slightly curved triangular incision. (5) Wilmer iridotomy: also known as single-incision iridotomy. Suitable for patients who require cataract surgery. A corneal half-section was made at 1 o'clock above, and the incision was 7 mm long. After cutting the posterior half of the corneal tissue with a special keratome, the tip pierces the iris from the surface of the iris 3 mm from the limbus. Expand the iris incision to 5 ~ 6mm. Extend the edge of the iris to the back of the iris, the tip of the knife is facing 6 o'clock, 3 mm from the limbus, and cut the iris on the line of 10 to 6 and 2 to 6 respectively. The tweezers pinch the free iris. organization. complication 1. Bleeding: from the radial blood vessels of the iris, or the deep blood vessels of the sclera in the incision, causing blood in the anterior chamber. Should take a semi-recumbent rest, if you find iris neovascularization, you can do argon laser iris photocoagulation to close the blood vessels. Use hemostatic drugs. 2. Iris inflammatory post-adhesion, which is related to surgical trauma and individual differences. Conventional anti-inflammatory treatment, dilated pupils. 3. The iris is not completely cut through and a layer of dark brown pigmented epithelium remains. No additional surgery is required, and the epithelial layer can be cut with a nd:yag laser. 4. Aphakic eye pupillary glaucoma, anterior chamber shallow, elevated intraocular pressure. A anterior vitrectomy and another peripheral iridotomy are required. 5. Hemorrhage or inflammatory exudation causes vitreous opacity. The lighter patients were treated with conservative drugs, and more vitreous hemorrhage could be closed vitrectomy within 2 weeks.

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