Corrosive perforation of the cornea

Uncomplicated perforating wound of the cornea is not accompanied by trauma of the deep tissues. If the brine is small and the edges are well adapted, the anterior chamber is preserved, and the iris with the wound does not contact. But it happens that in the presence of anterior chamber, the moisture oozes out. As a minimal intervention, the application of biological glue or y-globulin is applied, followed by the application of a soft hydrogel contact lens or the introduction of a small amount of autoblood in the anterior chamber, and it is not necessary to enter the anterior chamber of the cannula, since there is already a fistula. After the introduction of blood, the patient is placed for 2 hours in the face down position to form a hyphema in the corneal wound area. If these procedures in sealing the fistulous wound, especially if it is located on the periphery, did not give an effect, make a conjunctival coating according to Kunt.

After epibulbar and subconjunctival anesthesia, in which novocaine is injected shallowly under the epithelial layer of the conjunctiva, a flap-apron is cut out by separating the conjunctiva along the limb and by superficial shearing in the desired sector with sharp scissors. When cutting a flap, it is necessary to visually check the level of each section of the submucosa so as not to get an accidental perforation, especially in the area that should move to the wound of the cornea. The main stitches are placed at the corners of the conjunctiva incision near the limbus, with the capture of the epic gland tissue. Use thick, slowly penetrating silk.

Uncomplicated wound of the cornea, especially long, can be sealed and sealed, but it causes additional trauma - the iris can fall out and chamber moisture may drain through the seams, since it almost does not contain protein.

Uncomplicated perforation of the cornea with poorly adapted edges, even if it does not fistulate, is subject to hermification. If the wound is fairly straight, then a continuous seam of synthetic material 09-010 is applied.

With a curvilinear wound, a continuous seam should not be applied, as when tightening, it tends to straighten and can deform the cornea. If it is not tightened tightly, the edges of the wound will converge, but their tight closure will not be ensured. In this case it is necessary to impose knotty seams from the slit 08.

In complex forms of wounds without a tissue defect, you can combine both types of joints by applying individual nodal seams to particularly critical areas. The frequency of the stitches (stitches) of the front should correspond to 1 to 1 to 1.5 mm of tissue. When the oblique direction of the wound in the stroma, the sutures are superimposed less often. The first are usually superimposed nodal stitches, which restore the overall shape of the cornea. Particular care is taken when the front chamber is missing or emptied when the first stitches are applied, and the lens is transparent (especially when manipulated in the central area of the cornea). With peripherally located wounds, it is especially necessary to monitor the iris, which can be sewn unnoticed when applying another, even blind, suture. To avoid this, the stitch is held on a spatula, which the assistant very gently squeezes the breath-proof diaphragm into the depth of the eyeball. Particular attention should be given to an accurate comparison of the edges of the wound on the not yet sewn piece.

To reduce the risk of infringement in the iris wound, the sutures need to be made to the Descemet's membrane or even to the seizure of its slightly divergent edges so that the deepest parts of the wound edges are sealed. Before tying the last seam, the front chamber is filled with sterile air taken through the flame of the alcohol lamp. A thin cannula is only slightly inserted into the wound, so that its internal edges provide a valve effect without letting air out of the anterior chamber. The air bladder should not be excessively large, since pressing the pupillary margin to the lens can lead to an acute increase in intraocular pressure. Do not introduce a lot of air and peripheral wounds, because the gas first properly forms the anterior chamber, but then, after the merging of individual vesicles and the restoration of the eye turgor, the air bubble contracts and becomes almost spherical, the lens is squeezed to the back, and the iris root is fed forward and comes into contact with the area of the corneal wound.

If the fluorescence test shows that the wound wound is somewhere not hermetically sealed, 1-2 drops of autoblood are injected into the chamber between the sutures, after which the patient is put down face for 1 h, but without resting the wounded eye on the pillow.

A wound of the cornea with infringement of an iris. If the corneal wound is not closed, and the iris dropped out in it, and since the trauma was only a few hours, it is washed with a solution of an antibiotic. Release from fibrinous layers and glueing with wound edges, and then carefully immerse in the anterior chamber, putting in the corneal seams on the spatula. If there is any doubt about the viability of the fallen iris, its contamination or defect, the iris is excised within the unaltered tissue, i.e., each time pulls the iris slightly into the wound, so that the cut lies on those parts that were previously in the anterior chamber (with their maximum shyness, especially with regard to the sphincter of the iris). If the size of the corneal membrane is sufficiently large and the iris is moderately excised, it is possible to suture the defect formed in the iris with an automatic needle from a synthetic pituitary 010. The corneal wound is then sealed.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Perforated corneal wound with lens damage

When the lens is injured, surgical treatment consists in the possible complete removal of the lens material. Both the clouded and barely transparent masses in children are easily washed through the wound with a well-worn, not very tight syringe with an average curved cannula. At the time of aspiration, the lens material is crushed and then easily washed from the anterior chamber by regular portions of an isotonic solution of sodium chloride heated in a water bath to 30-35 ° C. Before the pupil (even if its edge is damaged) is expanded by introducing into the chamber 0.2 ml of a 1% solution of mezaton. This makes it easier to control the complete removal of the lens material.

With a similar extension in an adult, the hard core of the lens is rarely removed through the wound. Having an ultrasonic or mechanical fanfragmentator, you can do it.

A small peripheral wound of the cornea is accompanied by an extensive rupture of the anterior lens sac and rapid swelling of soft cataracts. The extensive peripheral wound of the cornea is accompanied by damage to the lens without significant trauma to the iris.

It is possible to plan the implantation of the artificial lens during the primary surgical treatment of a complicated wound of the cornea only in the absence of signs of infection of the wound, absence of intraocular foreign bodies, and also in the normal functioning of the optic nerve apparatus.

A perforated corneal wound with damage to the lens and the exit of the vitreous body into the anterior chamber or into the wound is difficult for surgical treatment, since it is almost impossible to aspirate the kerstic substance from the more viscous vitreous body. Such wounds should be handled by special devices, for example, by the mechanical facs-fragment of Kossovsky.

If there are no such devices, first the main corneal sutures are applied, the iris part is cut if necessary, catarrhal masses are aspirated, and then lenevitrorectomy is performed through the same wound, capturing the blocks of a turbid lens substance with a vitreous stroma with a spoonful of tweezers.

The bulk of the masses are removed from the eye only together with the lens bag - in whole or in parts.

The resulting deficiency of the contents of the eyeball is replenished by one of the vitreous substitutes with the obligatory addition of sterile air at the end of the procedure, which is necessary for vitreous body remnants posteriorly.

A perforated wound of the cornea with signs of a purulent infection should not be sealed. The front chamber is washed with a solution of antibiotics, purulent-fibrinous films from the cornea, iris, from the anterior chamber, if possible, remove with spatulas and tweezers and the wound is covered with a flap-apron of the conjunctiva, which does not prevent repeated therapeutic manipulations in the chamber and at the same time protects the wound from further infection. After such treatment begin intensive general and local therapy.