Qianjiang Evening News·Hours News Correspondent Lin Yangqing Reporter Wu Chaoxiang
In the operating room of the Ophthalmology Center of Zhejiang Provincial People's Hospital, a micro-injection needle as thin as a hair was accurately pierced into the eyeball under the operation of a doctor and reached the bottom of the retina in the macular area. With the slow injection of the potion in the needle, the originally dark blood clot under the retina dissolved and faded at a speed visible to the naked eye... This is a scene where Chen Yiqi, deputy director of the Ophthalmology Center, performed ultra-minimal invasive surgery on a patient with a large amount of subretinal bleeding in the macular area.
"forbidden area" bleeding, her vision was at risk
patient Ms. Huang (pseudonym) suddenly showed signs of blurred vision in the left eye 1 week ago. She was diagnosed with "left eye macular degeneration" in a local hospital, and then received intraocular drug injection. However, the condition was not effectively controlled, and the left eye could not distinguish the object after 3 days of treatment. Then, after being introduced by the local doctor, Ms. Huang immediately found Deputy Director Chen Yiqi for treatment.
Chen Yiqi confirmed that Ms. Huang had "polypoid choroidal vascular disease" (PCV) through detailed ophthalmic imaging examinations such as fundus angiography, and secondary to a large number of submacular bleeding and vitreous hemorrhage . This is a very difficult problem. The macular area, as the most sensitive part of vision, is often regarded as a restricted area for surgery by ophthalmologists. This area has a large amount of bleeding. If it is not well controlled and treated, it will lead to permanent blindness.
treatment is urgent, and Chen Yiqi proposed a surgical plan for microincision vitrectomy combined with subretinal injection of drugs to dissolve bleeding. The surgery uses ultra-subtle needles, with only 41G. Chen Yiqi vividly explained to Ms. Huang that the letter G is used to measure the thickness of the needle. The larger the number, the thinner the needle. For example, the diameter of the needle used for the skin test when hanging water is about 26G (about 0.45mm), then the 41G needle is really as thin as a hair (about 0.1mm in diameter). After puncture, it causes almost no damage to the omental tissue. The wound is almost invisible after surgery, the sealing is better, and there are fewer surgical complications.
as thin as hair, super-subtle needles to save vision
Ms. Huang agreed to the operation immediately, and Chen Yiqi immediately made strict preoperative preparations. During the operation, under an ophthalmic microscope, Chen Yiqi first performed local anesthesia on Ms. Huang, and then used a 23G piercing knife to make three small holes with a diameter of only 0.5mm on the sclera to establish a surgical channel. vitreous was removed through an ultra-high-speed vitreous cutting machine, and then about 0.1 ml of drug was injected under the retina through a 41G ultrascientific injection needle. After the drug injection, it was obvious that the subretinal hemorrhage was spread. Finally, long-acting gas is filled in the vitreous cavity to press the retina to remove the dissolved subretinal hemorrhage, and the incision is sutured.
After nearly 2 hours of hard work, Chen Yiqi successfully performed the operation on Ms. Huang. Two months after the operation, Ms. Huang's vision had increased from large-scale darkness in the preoperative field to 0.5, and there was no problem with taking care of herself. Ms. Huang is still undergoing follow-up treatment and her vision is expected to be further improved.
treatment time window is very important
Chen Yiqi introduced that polypoid choroidal vascular lesions (PCV) is a macular disease characterized by subretinal orange-red nodule-like lesions and abnormally dilated polypoid-like changes at the end of the choroidal vascular intravascular. It is a type of macular degeneration with a higher prevalence in Asians. The cause is usually congenital abnormal choroidal vascular development. In the early stage, patients rarely find that they have no feelings. When symptoms such as intravenous ejaculation and/or subneural neuroepithelial, bleeding lead to dark shadow obstruction, vision loss, and visual deformation, , etc., the patient will come to the doctor. Therefore, most patients have poor vision at the first diagnosis.
Because the clinical manifestations of polypsic choroidal vascular lesions (PCV) are similar to wet age-related macular degeneration (AMD), and are both more common in middle-aged and elderly people, the diagnosis of the two is more likely to be confused in clinical practice. Through detailed ophthalmic imaging examinations such as fundus angiography, the two can be clearly identified and diagnosed, and appropriate treatment methods can be adopted to further save the patient's vision.
In the past, the treatment methods for this submacular bleeding were very limited, and most ophthalmologists would recommend conservative treatment of drugs.However, blood gathers in the macular area for a long time, which not only contains toxicity and mechanical damage, but also affects the metabolism of retinal photoreceptor cells. It is difficult to absorb blood accumulation. Even after the blood accumulation is absorbed, the macula will inevitably atrophy, and the patient's final vision is generally very poor.
minimally invasive vitrectomy combined with 41G ultra-spermial needle subretinal drug injection is currently an effective method for treating submacular bleeding, and is also an ultra-fine and ultra-invasive surgical treatment carried out by the Eye Department of Zhejiang Provincial People's Hospital on the basis of minimally invasive vitreous retinal surgery. It requires doctors to have the skilled minimally invasive vitrectomy technology, which can promote bleeding absorption by injecting drugs directly into the subretinal bleeding area of the macular retinal, so as to restore the function of the macular fovea as soon as possible, so as to achieve the purpose of precise treatment and restore vision.
Chen Yiqi particularly emphasized the importance of the treatment time window. He pointed out that it is generally believed that the best time for hemolysis of subretinal drug injection is 3-14 days after bleeding, which will obviously affect the surgical effect if it is too late. Chen Yiqi called on patients: "With the further improvement of surgical technology, patients with macular bleeding can receive very effective treatment. If you experience symptoms such as black shadow blocking, vision loss, and visual deformation, you must go to a professional doctor as soon as possible."
This article is an original work of Qianjiang Evening News. Reproduction, copying, excerpting, rewriting, and online dissemination are prohibited without permission. Otherwise, this newspaper will pursue the legal responsibility of the infringer through judicial channels.
