Chapter 815 Closed three-incision vitrectomy

Besides, this patient has a lot of troubles.

For example... how did the angiostrongylus infect the eyes?

Clinical angiostrongylus infection is actually not common. Except for the opening match in Guangdong Province, which made the safety issue of golden apple snails enter the public eye for the first time, the angiostrongylus infection caused by golden apple snails is rare, and it can almost be said to have disappeared.

And the presence of worms in the eyes is even rarer.

No one present has much experience in how to deal with parasites in the eyes.

"Why did it enter the eyes? Did it enter the eyes directly or from other ways?" asked the ophthalmologist.

His expression was very solemn... Different ways of entering the eyes also represent different treatment methods. The source of the angiostrongylus in the eyes determines the final solution.

However, now, they don't even know how the angiostrongylus enters the eyeball...

Everyone's eyes fell back on Xu Qiu again.

Thigh, thigh... Although no one spoke, these two words were revealed in the eyes of many directors.

Xu Qiu didn't say much, and said directly: "At present, there are three main ways.

"The first is that the third-stage larvae did not enter the brain, but directly entered the eyes, and then developed into the fourth and fifth-stage larvae in the eyes.

"The second is that after developing into the fifth-stage larvae in the brain, they enter the eyes through the central retinal artery, or from the vortex veins and ciliary arteries.

"The last possible way is somewhat similar to the second one. After developing into the fifth-stage larvae in the brain, the worm body migrates along the surface of the skull to the base of the skull, and then from the base of the skull to the optic nerve, sneaking in the meningeal gap of the optic nerve, gradually reaching the posterior pole of the eyeball, and then passing through the scleral sieve plate to enter the eye; of course, there is another way, which is to reach the posterior pole of the eyeball and continue to crawl along the eyeball, and enter the eyeball from the edge of the sclera! "

Xu Qiu analyzed slowly.

The three routes are the main possibilities for Angiostrongylus to enter the eye.

Among them, the second route has the lowest probability.

Because the diameter of the worm body is still too large compared to the tiny blood vessels in the eye, it is unlikely for them to enter the tiny blood vessels of the eyeball.

In addition, the worm body has little penetration ability and it is difficult to enter the blood vessels directly.

The greater possibility is that the third-stage larvae enter the eye; or reach the base of the skull and then enter the brain indirectly.

The two routes correspond to different treatment methods.

If it is the former, it is the simplest, just remove the worm body directly from the incision at the edge of the cornea.

But the latter...the situation is much more complicated.

Because the worm body passes through too many places in the middle, the movement of the worm body will cause a series of inflammatory reactions, so simple removal may not work, and often requires a more thorough transvitreal surgery to remove it.

"To confirm this, just see whether the worm body is in the anterior chamber or in the vitreous body or under the retina. "Xu Qiu said.

The worms of the first route often only stay in the anterior chamber, posterior segment of the eye and other parts.

But those that migrate from the skull base are much deeper, often passing through the scleral cribriform plate into the eye...

"The worms are under the retina, and the vitreous is also turbid!" The ophthalmologist immediately remembered Xiaojie's examination results.

The vitreous is slightly turbid, and there is a white, thin nematode under the retina behind the equator above the temporal... According to Xu Qiu, this is definitely entering the eye through the third route.

In other words, it is necessary to perform a transvitreal surgery with a higher risk factor to remove it.

"My understanding of angiostrongylus is still in the era of local condensation..." The ophthalmologist was a little surprised.

Angiostrongylus infection is something that ordinary doctors will never encounter once in their lifetime, and the worms entering the eye are even rarer, so few doctors go back to specialize. Understand the latest guidelines.

The previous treatment method was to perform local condensation, thermocoagulation or photocoagulation after scleral positioning, and then cut the sclera and choroid to clamp or suction the worm body.

This method has great disadvantages, such as low positioning accuracy and the possibility of serious tissue trauma, so it has been controversial.

But despite this, it has been used.

It is because there is no better way in clinical practice.

However, now, a vitreous surgical removal has emerged!

The ophthalmologist couldn't help but be a little eager and asked: "Doctor Xu, can you tell me how to do this operation?"

"Sure."

It just happened that all departments had to cooperate, so they were familiar with the surgical plan in advance... Xu Qiu immediately agreed and began to explain.

"Vitreous surgical removal is actually a treatment based on vitreous surgery.

"This operation, the full name of which is closed three-incision vitrectomy, is mainly used to remove vitreous, retinal and subretinal lesions. It is precisely because it can penetrate deep into the fundus that it can be used to remove the worms of Angiostrongylus.

"This operation can not only completely remove the worms, but also reduce the specific protein reaction caused by the death and fragmentation of the worms. At the same time, if the patient's vitreous has lesions, it can be removed simultaneously.

"In addition, it has the advantages of restoring the transparency of the refractive medium and reducing the occurrence of tractional retinal detachment..."

"..."

Hearing these introductions, the ophthalmologist swallowed his saliva.

So... this operation can not only be used for infection caused by Angiostrongylus entering the eye, but also for intraocular cysticercus?

In other words, all diseases caused by parasites entering the eye can be removed through the same operation!

Xu Qiu gave a positive answer: "Theoretically, this is the case. For parasites in the anterior chamber, enter the anterior chamber through a tunnel-like incision at the corneal margin, and then inject viscoelastic behind the worm body to gradually push or suck out the worm body; for parasites under the conjunctiva, directly cut the conjunctiva to remove the worm; for parasites under the vitreous and retina, a three-incision minimally invasive surgery is used."

"I feel that after this operation with Dr. Xu, the intraocular parasites in our hospital will also bloom..." The ophthalmologist sighed.

"The welfare has finally come to your ophthalmology department." Director Lin of the neurosurgery department had an expression of "I am invincible, you can do whatever you want".

The other people in the conference room glared at him immediately.

Relying on Dr. Xu's favor, neurosurgery has become one of the signs of Linyi, and has won the second national neurosurgery center... and now it has been installed!

It seems like Director Lin should be beaten up!

Feeling the unfriendly gazes around him, Director Lin quickly retracted his neck and changed the subject: "We have already thought of a solution for the parasites in the eyes, and there are other aspects, such as the lesions in the brain and the intestines..."

Hearing this, everyone's expressions became serious again.

Xiao Jie's problem is not just the parasites in the eyes.

Or to put it bluntly, the eyes are the least problematic part of Xiao Jie. The truly fatal ones are the lesions in the brain, brain abscesses, and the large clusters of eggs and parasites in the sigmoid colon!