iridotomy

Particularly suitable for cases with a tendency to iris bleeding. Treating diseases: glaucoma Indication 1. Iris atrophy, small pupils, drugs can not be scattered. 2. Small pupil and pupillary membrane closure require surgery to open large viewers. 3. Pupil deviation, affecting vision. 4. Not suitable for iridotomy. 5. Adhesion of tightly inseparable irises, or reluctance to separate cases that may cause corneal perforation, or corneal cramps. 6. Pupil occlusion, iris bulging, leading to pupillary block glaucoma. 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. Radial total iridotomy It is suitable for cases of atrophic iris, post-adhesion, small pupils where the drug cannot be scattered, and cases requiring cataract surgery. Operate from the upper cataract incision. The 12-point root iris was clamped with tweezers, and a small peripheral iris resection was performed first. Inject a small amount of viscoelastic agent from the incision into the posterior chamber, and separate the iris after the pupil in the pupil area. Use the microcapsule to cut one side of the blade to the back of the iris, the tip of the scissors to reach the pupil, close the scissors, and cut the 12 points to open the pupil. Muscle and sphincter all. In order to prevent the pupils from moving up after surgery, the pupil sphincters of 0.5 to 1 mm can be cut at 6 o'clock in the pupillary margin to continue the cataract surgery. Radial sphinctertomy (1) Single or multiple sphincter incision: suitable for trauma, iris defect caused by surgery, and pupil deformation displacement. Eliminate and prevent iris occlusion in the visual axis. Preoperative contraction to determine the width of the iris to be cut. Injecting a viscoelastic agent into the anterior chamber, make a 2mm full-thickness incision from the contralateral limbus of the meridian where the iris is pre-cut, and the scissors are placed on the pupil sphincter. The scissors are 3 to 4 mm from the contralateral limbus and the sphincter is cut. If the visual axis is still not wide enough, you can do the same sphincter cut a few times. (2) Peripheral radial sphincter partial incision: It is suitable for the iris to have a certain ability to move, but it is difficult to enlarge the amount of light due to the small pupil caused by adhesion after the pupil. Also suitable for small cataract surgery with small nuclear. This operation can maintain a certain pupil movement ability, and the appearance is more beautiful. Unlike resection, this procedure involves making 9 to 21 short sphincter incisions in the pupil, weakening the sphincter force. In addition to the use of the main incision of the cataract, a 2mm horizontal full-thickness incision was made at 0.5 to 1 mm in the limbus at 4 o'clock and 8 o'clock. The anterior chamber was injected with viscoelastic agent and injected into the posterior chamber through the pupil. The scissors were inserted into the main incision at 4 o'clock and the incision at 4 o'clock and 8 o'clock, respectively, and the sphincters about 0.5 to 1 mm wide on the opposite side were cut, and 3 to 7 identical incisions were made in the range of 120°, and 9 to 21 in total. At this time, the pupil has been moderately enlarged and the edges are serrated, and the cataract surgery can be continued. (3) Iris bulging puncture and incision: suitable for cases of pupillary atresia, iris bulging, anterior chamber, and secondary glaucoma. The cornea was inserted into the cornea from the temporal margin of the temporal margin with a cataract linear knife or a 20-gauge needle, and was perforated through the bulging iris, and then penetrated from the contralateral dilated iris and penetrated through the nasal corneal limbus. Use a cotton swab against the corneal puncture outlet to prevent excessive water from overflowing and slowly withdraw the puncture needle from the original road. Four iris puncture holes can be produced after operation, and the posterior aqueous water flows into the anterior chamber through the small holes. The iris bulge subsides and the intraocular pressure drops. In the case of peripheral anterior iris adhesion, a viscoelastic agent can be injected into the front chamber through the puncture opening to loosen the adhesion. (4) Optical iridotomy: The iris is extremely biased due to trauma or surgical injury, and the pupil area is covered by the open muscle of the greater tension. A large open muscle incision is made in the visual axis area to obtain a satisfactory artificial pupil. The anterior chamber was injected with a viscoelastic agent, and a puncture was made from the iris at 3 mm from the limbus to withdraw the puncture needle. The iris blade cuts to the back of the iris and extends to about 3 mm from the opposite corneal edge. The large muscle fibers are cut open and the scissors are withdrawn. 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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