Anterior chamber angle foreign body removal

When the eyeball is penetrating, there is often a foreign body in the eyeball. Foreign matter entering the eyeball can be metallic or non-metallic. Metal foreign bodies can be divided into magnetic or non-magnetic. Therefore, when a penetrating injury occurs in the eyeball, it is first necessary to find out whether there is foreign matter in the eye, the nature and position of the foreign matter. The surgical plan can only be developed after the situation has been identified. Treatment of diseases: anterior chamber hemorrhage and glaucoma anterior chamber hemorrhage Indication The removal of foreign bodies in the anterior segment of the eye is applicable to: The anterior chamber gonioscopic examination confirmed the foreign body located on the anterior chamber angle and the iris surface. Slit lamp examination of negative aqueous humor, no iris inflammation can temporarily not surgery, but persistent inflammation, rust, corneal endothelial injury, should be surgically removed to remove foreign bodies. Contraindications The anterior chamber is full of blood, and the foreign body cannot be seen under the microscope. Preoperative preparation 1. Slit lamp When checking the anterior chamber, you should pay attention to whether there is small bleeding and inflammatory reaction in the aqueous humor. Most of the anterior chamber foreign bodies are located on the surface of the iris, which can be seen by diffuse irradiation and low magnification. If the cornea has a penetrating injury and the iris and the lens are normal, the foreign body may be in the anterior chamber angle and should be used for anterior chamber gonioscopic examination. Foreign matter can be embedded in any part of the anterior chamber, and free small foreign objects can sink in the lower corner of the anterior chamber. Foreign bodies can cause irritation and exudation in the corner of the room, causing adhesion in the periphery. When there is rust, you can see the light brown rust on the trabecular. 2. Make a foreign object location and mark its time by clock. 3. For those who have blood in the anterior chamber, first treat the anterior chamber blood, and after the blood is absorbed, make a gonioscopic keratoscopy. 4. Drop the antibiotic solution in the conjunctival sac and drip the sputum. Surgical procedure Magnetic foreign body (1) Right at the location of the foreign body, cut the cornea 1mm in the limbus, the incision should be perpendicular to the cornea, slightly skewed to the front corner, should be slightly larger than the foreign body, generally about 2mm, so as not to be sucked out because the incision is small foreign matter. (2) The foreign body is sucked out by the hand-held electromagnet, and its long axis should be in line with the slit and the foreign matter, and the current is gradually increased to directly suck out the foreign matter. 2. Non-magnetic foreign bodies (1) A conjunctival flap is made in the vicinity of the foreign body, and a scleral incision is made in the posterior border of the limbus. The length is about 8 mm, and the front lip of the incision is used as a preset suture. When the incision is about to pass through the anterior chamber, the tip of the knife is lifted upwards, not downwards, so as not to push the foreign matter into the iris, which is difficult to find. (2) Lift the preset suture, open the incision, expose the foreign object in the anterior chamber, and clip it directly with the foreign body. The scleral suture was ligated and the conjunctival flap was sutured. After the operation, the sputum and the antibiotics were injected under the conjunctiva, and the eyes were bandaged. complication 1. Damaged lens: Due to the interruption of the electromagnet current, the foreign matter is pulled by the mechanical tissue and the lens is injured. 2. Iris root disconnection: When the iris comes out of the wound with the foreign body, if it is not stopped in time, it can cause excessive pulling of the iris, leading to the roots breaking off. 3. Iris prolapse: Whether it occurs in the original corneal wound or in the corneal incision, do not attract foreign objects from the prolapsed area to avoid aggravating the damage. The solution is to perform a scleral incision in the limbus. 4. When aspirating the anterior chamber foreign body, be careful not to damage the corneal endothelium, and do not scratch the iris tissue to avoid pre-iris adhesion. Such damage is common when foreign matter is located around the iris and when the anterior chamber becomes shallow. The first method of prevention is to maintain intraocular pressure, the second is to maintain the depth of the anterior chamber, and the third is to try to reduce the pupil. 5. The anterior chamber hemorrhage is generally not heavy.