CN115414177A

CN115414177A - Simple vitreous cavity gas-liquid exchange technique

Info

Publication number: CN115414177A
Application number: CN202211136053.7A
Authority: CN
Inventors: 赵永旺; 陈佳玉; 郑新宝; 杨爱萍; 夏静
Original assignee: Shanghai Songjiang Central Hospital (songjiang Branch Hospital First People's Hospital Affiliated To Shanghai Jiaotong University)
Current assignee: Shanghai Songjiang Central Hospital (songjiang Branch Hospital First People's Hospital Affiliated To Shanghai Jiaotong University)
Priority date: 2022-09-19
Filing date: 2022-09-19
Publication date: 2022-12-02

Abstract

The invention belongs to the technical field of vitreous cavity gas-liquid exchange, and discloses a simple vitreous cavity gas-liquid exchange, which comprises the following specific operation steps: s1, performing eye instillation with a surface anesthetic in advance, sterilizing skin around the eye, performing eye instillation with a 5% povidone iodine solution, and washing with physiological saline after 30 seconds. Selecting injection position including the position of 5-7 points on the corneal limbus of the operative eye, and selecting injection point 3.5-4mm behind the corneal limbus; s2, during puncture, the needle is firstly inserted into the vitreous cavity vertically by about 0.2mm (the inclined plane of the puncture needle is upward), then is inserted into the vitreous cavity horizontally by about 0.2mm and then is inserted into the vitreous cavity vertically. The invention can quantify through the normalized operation flow, the intraocular pressure fluctuation is slight, and almost no infection risk occurs, the fine operation and the normalized operation flow are performed, and the self-made vitreous cavity gas-liquid exchange device is used for performing the simple vitreous cavity gas-liquid exchange operation, so that the complications such as traumatic cataract, retinal injury, infectious endophthalmitis and the like can not occur.

Description

Simple vitreous cavity gas-liquid exchange technique

Technical Field

The invention belongs to the technical field of vitreous cavity gas-liquid exchange, and particularly relates to simple vitreous cavity gas-liquid exchange.

Background

The Vitreous Hemorrhage (VH) is one of the common and serious complications after the vitrectomy surgery (PPV), and the VH prevents the patients from reaching the expected vision, and part of the patients have anxiety (especially obvious in one eye) and also affects fundus observation and subsequent further treatment. Some of the recurrent VH after PPV surgery are absorbed by themselves for several weeks (1 month), and many recurrent VH require PPV, multiple combined retinal detachments, and the like, by performing PPV, vitreous cavity lavage, or vitreous cavity gas-liquid exchange again.

Vitreous cavity lavage: the conventional PPV preoperative preparation, standard pars plana three-channel incision, clean vitreous cavity blood drainage by a whistle needle, detailed examination of the whole fundus condition by intraocular illumination, treatment of abnormal conditions, and filling of the vitreous cavity with balanced salt solution or sterile air after the operation. The detailed examination of the eyeground condition and the timely treatment of the lesion part can be realized in the 'vitreous cavity lavage' operation, and if the balanced saline solution is filled, the early vision recovery is fast, so the method is widely applied to clinic. Because the operation needs to be performed again in a hundred-grade operating room, the psychological burden of patients and doctors is increased, and the medical cost is greatly improved.

Vitreous cavity gas-liquid exchange: at present, no unified standard exists, and most of the standard is performed in an outpatient clinic. There are single syringe or 2 syringes, and also self-made exchange device for vitreous cavity gas-liquid exchange. The technology has the defects that the 'sterile' air acquisition is not reliable in experimental basis, or the device is complex and is difficult to acquire, or a puncture needle is too thin, a blood clot easily blocks a needle tube, blood and water exchange is not thorough, the operation is not accurate, quantification cannot be realized, the intraocular pressure cannot be controlled, and the like.

Disclosure of Invention

The present invention is to provide a simple vitreous chamber gas-liquid exchange technique to solve the problems of the background art.

In order to achieve the above purpose, the invention provides the following technical scheme: a simple vitreous cavity gas-liquid exchange technique comprises the following specific operation steps:

s1, performing eye operation by using a surface anesthetic in advance, sterilizing skin around the eye operation, performing eye operation by using a 5% povidone-iodine solution, performing physiological saline washing after 30 seconds, selecting an injection position including a position of 5-7 points of the corneal limbus of the eye operation, and selecting an injection point 3.5-4mm behind the corneal limbus;

s2, when the vitreous body gas-liquid exchange device is used for puncture, the vertical sclera enters about 0.2mm (the inclined plane of the puncture needle is upward), the horizontal sclera is submerged for 0.2mm, and then the whole needle is vertically inserted into the vitreous body cavity;

s3, after the puncture is successful, firstly pushing 0.5ml of sterile air into the vitreous cavity, then slowly pumping back the blood water in the vitreous cavity, repeating the operation, and finally pushing 0.5ml of sterile air into the vitreous cavity to enable the intraocular pressure to be slightly higher than the normal intraocular pressure.

Preferably, the injection position further comprises the temporal or nasal direction, and the six-point direction is not recommended.

Preferably, when the operative eye is a left eye, the injection position is specifically a 5-6 point position of the corneal limbus (according to the habit of an operator);

when the operation eye is the right eye, the injection position is specifically the position of the corneal limbus at 6-7 points (according to the habit of the operator).

Preferably, when the operated eye is a phakic eye, the injection point is selected to be about 4mm behind the limbus;

when the operative eye is an artificial lens eye, the injection point is selected to be about 3.5mm behind the limbus.

Preferably, when the operated eye is a phakic eye and has a short axis or a long axis, the injection point is 3.5-3.9mm or 4.1-4.5mm from the back of the corneal limbus;

when the operation eye is an artificial lens eye and is a short eye axis or a long eye axis, the injection point is 3-3.4mm or 3.6-4mm away from the back of the corneal limbus.

Preferably, in the puncture process in S2, the bulbar conjunctiva is gently moved by a cotton swab, so that the conjunctiva puncture and the sclera puncture are dislocated.

Preferably, the sterile air is obtained according to GB/T18204.3-2013 standard.

The invention has the following beneficial effects:

1. the invention can quantify through the normalized operation flow, the intraocular pressure fluctuation is slight, and almost no infection risk occurs, and after the refined operation, the complications such as traumatic cataract, retina injury, infectious endophthalmitis and the like can not occur when the simple vitreous cavity gas-liquid exchange operation is carried out by using the self-made vitreous cavity gas-liquid exchange device.

2. According to the invention, a self-made vitreous cavity qi and blood exchange device is adopted to be matched with a fine puncture needle insertion technology and a circulating pushing and pumping means of sterile air and blood, so that the lens and the retina are not easy to touch, drainage is easy, the injection needle cylinder corresponds to the graduations of the measuring cylinder, quantification can be realized, the size of the needle cylinder covers almost all the range of the eye axis, the blood drainage is thorough, the sterile air meets the GB15982 standard, and the safety and reliability are realized.

Drawings

FIG. 1 is a schematic view of a self-closing scleral tunnel puncture needle access pathway of the present invention;

FIG. 2 is a comparison of the self-closing scleral tunneling needle insertion path of the present invention;

FIG. 3 is a 45 degree diagonal needle access roadmap;

FIG. 4 is a 45 degree cross-threading map;

FIG. 5 is a view of a vertical needle insertion pathway;

FIG. 6 is a vertical needle insertion map;

FIG. 7 is a drawing showing the operation of the present invention in vitreous humor gas-liquid exchange.

Detailed Description

The technical solutions in the embodiments of the present invention will be clearly and completely described below with reference to the drawings in the embodiments of the present invention, and it is obvious that the described embodiments are only a part of the embodiments of the present invention, and not all of the embodiments. All other embodiments, which can be derived by a person skilled in the art from the embodiments given herein without making any creative effort, shall fall within the protection scope of the present invention.

As shown in fig. 1 to 7, the embodiment of the present invention provides a simple vitreous humor gas-liquid exchange,

1. and (3) carrying out ultraviolet air disinfection in an outpatient clinic for 40 minutes before operation. The compound tropicamide eye drops are used for mydriasis, the proparacaine hydrochloride eye drops (75 mg/15 ml) are surface-anesthetized for 2-3 times, and then the skin around the eyes is disinfected by an aniodination method for 3 times. Placing an eye speculum, dropping 5% povidone iodine solution on eyes, and flushing with physiological saline after 30 seconds;

2. the patient takes the seat, the chin is arranged on the lower jaw support, and the forehead is tightly attached to the forehead support;

3. the light zone of the slit lamp is adjusted to be the longest and the light spot size is proper. Ordering the patient to watch the vertex by two eyes, and marking the position 3.5-4mm away from the corneal limbus in the position of 5-6 points or 6-7 points;

4. the self-made vitreous cavity gas-liquid exchange device is vertical to the sclera, enters about 0.2mm (the inclined plane of the puncture needle is upward), is parallel to the sclera, is submerged about 0.2mm, is then vertically and completely inserted into the vitreous cavity, and the inclined plane of the needle point faces to the operator in the whole process; 5. the assistant pushes about 0.5ml of sterile air into the vitreous cavity and then slowly pumps back, so that blood can slowly flow into the bottom of the syringe cylinder, the sterile air is positioned above the blood, then 0.5ml of sterile air is pushed into the vitreous cavity to replace part of the blood, the operation is repeated until the whole blood in the vitreous cavity is replaced, then 0.5ml of sterile air is pushed in to enable the intraocular pressure to be slightly higher than the normal intraocular pressure, the needle point is moved, and the needle is withdrawn; 6. tobramycin dexamethasone eye ointment is coated, sterile gauze is used for covering, and the whole operation is carried out under the direct view of a slit lamp microscope.

The operation key points of the simple vitreous cavity gas-liquid exchange operation are as follows: (1) selection of injection site: the position of 5-6 points (left eye) or 6-7 points (right eye) on the corneal limbus is generally selected according to the difference of the left eye and the right eye, so that the operation is convenient, the position below the temporal region or the position below the nasal region can be selected according to the operation habit of an operator, and the operation does not suggest the selection of the position of 6 points and is inconvenient to operate; (2) selection of injection point: selecting a distance of about 3.5-4mm from the limbus, a distance of about 4mm for phakic eyes, a distance of about 3.5mm for pseudophakic eyes, and a distance of about 0.1-0.5mm for short or long axis, slightly anterior or posterior to the original position; (3) the puncture method comprises the following steps: "self-imposed scleral tunneling" (approximately 0.2mm perpendicular to the sclera, approximately 0.2mm parallel to the sclera, and all the needles perpendicular to the vitreous cavity, as shown in fig. 1-2), 45 degree oblique penetration (as shown in fig. 3-4) and perpendicular penetration (as shown in fig. 5-6) into the vitreous cavity are prone to leakage of water from the puncture and increase the risk of infection. In addition, the cotton swab is used for slightly moving the bulbar conjunctiva, so that the conjunctiva and sclera puncture ports are dislocated, and the intraocular infection risk is reduced; (4) "simple vitreous cavity gas-liquid exchange technique": an operator controls the slit lamp operating rod with the left hand to focus a target conveniently, the injector needle cylinder is fixed with the right hand, the needle point direction is changed at any time, and an assistant pushes air, sucks and drains, and simultaneously observes the drainage condition (as shown in figure 7).

Self-made vitreous chamber gas-liquid exchange device (patent number: ZL 202220013147.4): consists of three parts of sterile air, a syringe needle and a syringe needle cylinder. Sterile air: obtained according to GB15982 (national medical institution). Injection needle (patent No.: ZL 202122311731.6): it features short (10 mm), moderate size (23G), quantifiable (marked with scales), not easy to touch the crystalline lens and retina, and easy to drain. Injecting a syringe: the scale of the measuring cylinder corresponds to that of the measuring cylinder, quantification can be realized, the size of the needle cylinder covers almost all the range of the eye axis, and the bloody water drainage is thorough.

It is noted that, herein, relational terms such as first and second, and the like may be used solely to distinguish one entity or action from another entity or action without necessarily requiring or implying any actual such relationship or order between such entities or actions. Also, the terms "comprises," "comprising," or any other variation thereof, are intended to cover a non-exclusive inclusion, such that a process, method, article, or apparatus that comprises a list of elements does not include only those elements but may include other elements not expressly listed or inherent to such process, method, article, or apparatus.

Although embodiments of the present invention have been shown and described, it will be appreciated by those skilled in the art that various changes, modifications, substitutions and alterations can be made in these embodiments without departing from the principles and spirit of the invention, the scope of which is defined in the appended claims and their equivalents.

Claims

1. A simple vitreous cavity gas-liquid exchange surgery is characterized in that: the vitreous cavity gas-liquid exchange operation comprises the following specific operation steps:

s2, during puncture, the sclera is vertically penetrated by about 0.2mm, the inclined plane of the puncture needle is upward, the puncture needle is parallel to the sclera and is submerged by 0.2mm, and then the whole puncture needle is vertically inserted into the vitreous cavity;

s3, pushing 0.5ml of sterile air into the vitreous cavity by using a vitreous gas-liquid exchange device, slowly pumping back the blood in the vitreous cavity, repeating the operation for multiple times until the blood in the vitreous cavity is completely replaced, and finally pushing 0.5ml of sterile air into the vitreous cavity to ensure that the intraocular pressure is higher than the normal intraocular pressure.

2. The simplified vitreous chamber gas-liquid exchange procedure of claim 1, wherein: the injection position also comprises a temporal lower part or a nasal lower part, and the injection position does not select a positive six-point direction.

3. The simplified vitreous chamber gas-liquid exchange procedure of claim 1, wherein: when the operation eye is a left eye, the injection position comprises but is not limited to a 5-6 point position of a membrane edge;

when the operative eye is the right eye, the injection position includes, but is not limited to, the limbus 6-7 point position.

4. The simplified vitreous chamber gas-liquid exchange procedure of claim 1, wherein: when the operated eye is a lens eye, the injection point is selected to be 4mm away from the corneal limbus;

when the operation eye is an artificial lens eye, the injection point is selected to be 3.5mm away from the corneal limbus.

5. The simplified vitreous chamber gas-liquid exchange procedure of claim 1, wherein: when the operation eye is a phakic eye and is a short eye axis or a long eye axis, the injection point is 3.5-3.9mm or 4.1-4.5mm away from the corneal limbus;

6. The simplified vitreous chamber gas-liquid exchange procedure of claim 1, wherein: in the puncture process in the S2, the bulbar conjunctiva is moved slightly by a cotton swab, so that the conjunctiva puncture opening and the sclera puncture opening are dislocated.

7. The simplified vitreous chamber gas-liquid exchange procedure of claim 1, wherein: the sterile air is obtained according to GB/T18204.3-2013 standard.