Artikel
Primary globe repair
Meeting Abstract
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Veröffentlicht: | 18. Juni 2008 |
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Gliederung
Text
Concepts in management of corneo scleral lacerations:
Approach to a patient with Ocular Trauma:
Whenever confronted with a patient of ocular trauma, as an ophthalmologist one must 'take a step back' and try and rule out life threatening injuries. All the patients with open globe injuries should be evaluated on a emergency basis, evaluation should include brief history mainly highlighting about the details of incidence and object which lead to ocular trauma. Quick comprehensive clinical examination, making sure that no more trauma is caused to the traumatized eyes. The initial four prong management is carried out in patients with ocular trauma.
Four Pronged Initial Management
- To minimize possibility of further trauma.
- Minimize risk of infection.
- Minimize psychological trauma to the patient and his family
- Minimize legal problems to yourself and to your institute
Goals of primary globe repair:
- Restoration of structural integrity
- Achieve watertight closure
- Prevent infection
- Smooth and optically effective refractive surface
- Refractive closure: Spherical cornea
- minimize astigmatism
- better contact lens fitting - Reduce scarring
- Removal of disrupted lens and vitreous
- Avoid uveal and vitreous incarceration
- Removal of intraocular foreign bodies
- Do no harm !
Surgical Principles:
- 10-0 Nylon or 11-0 Nylon for cornea, 7-0 vicryl or 8-0 vicryl for sclera
- Perpendicular to laceration
- 90 % Depth
- Equal depth
- Length 1.5 - 2 mm
- Knot : 2 - 1 - 1 or 3 - 1 - 1
- Burying the knot
- Vertical & Shelved Linear lacerations - Vertical incisions closed first