The Fourth People’s Hospital of Shenyang City carried out FCVB case discussion

On the evening of May 8, the Department of Ocular Trauma of the Fourth People’s Hospital of Shenyang held an online folding artificial vitreous balloon (FCVB) seminar. The conference was chaired by Professor Lin Xiaofeng, Sun Yat-sen Eye Center of Sun Yat-sen University, Professor Xu Li of the Fourth People’s Hospital of Shenyang, Professor Wang Lijie, Professor Cao Yehong, Professor Qi Fei of Shenyang Fourth People’s Hospital, and Professor Gao Qianying, product developer , Everyone discusses the hot topic of FCVB surgery.

Professor Gao first shared the video of the operation performed by Professor Shi Xiangyu in Beijing Tongren Hospital, explaining the operation process and the operation precautions in detail. Professor Lin and the Committee of Experts proposed that with the promotion of FCVB surgery in the whole country, it is hoped that professors across the country will form a standardized operation. Later, the professors shared the application of FCVB in severe eye trauma.

Professor Xu Li shared: Professor Xu once carried out the first FCVB operation in Liaoning Province. The patient shared this time is a 58-year-old man who was diagnosed with a rupture of the right eye and a right eyelid laceration, a right frontal facial skin laceration, and a right eye and right face 9-hour injury with an angle grinder blade in September last year. Right orbital upper arm fracture, right eye glass volume blood, retinal detachment, choroidal detachment, ciliary body detachment, emergency debridement of right eye rupture wound debridement + eyelid laceration debridement suture. Due to the serious injury, FCVB operation was performed for him.

How to choose the first-stage implantation and the second-stage implantation in surgical indications?

After eye trauma, usually emergency suture within 3 days is a first-stage operation. FCVB should be selected very carefully during the first-stage suture; vitrectomy + silicone oil or FCVB surgery is a second-stage operation after 7-14 days. Silicone oil can be used For patients treated, silicone oil filling must be considered first, and it is expected that patients who cannot fill the retina (choroid) with silicone oil filling can consider implanting FCVB. Be cautious about the first-stage surgery, because it will make the patient lose the opportunity to save the eyeballs using traditional treatments; the first-stage surgery has more surgical complications, especially postoperative hemorrhage resulting in high intraocular pressure, shallow anterior chamber and other difficult to deal with; early injury Severe inflammation is caused. After implantation of the balloon, foreign bodies are more likely to cause more serious inflammation. Therefore, choose a stage of surgery carefully.
Professor Cao Yehong shared:
Is the chance of eye atrophy after FCVB surgery?
It is closely related to the function of the ciliary body of the patient’s own eyes. Before the operation, the function of the ciliary body of the patient needs to be evaluated and fully communicated with the patient. The measures to reduce eye atrophy include: patients who have been bleeding are not recommended to perform artificial vitreous balloon surgery immediately, it is recommended to inject silicone oil first; intraoperative TA anti-inflammatory; model selection is appropriate; the implantation point is located 5mm behind the corneal sclera; there is an iris Make a weekly incision; posture posture for a week after operation; postoperative medication strictly follow the doctor’s pocket book; postoperative mydriatic application. These measures can delay the shrinkage of the eyeball.
Professor Wang Lijie shared: The patient was admitted to the hospital with a hook injury to his right eye for 7 hours in October last year. He was diagnosed with a rupture of the sclera in the right eye, and the emergency department was anesthetized with suture + vitreous cavity injection for the rupture of the sclera in the right eye. Because the right eyeball was severely ruptured and the omentum was funnel-shaped, an artificial vitreous balloon implantation was performed for him two months later, and the surgical procedure was demonstrated through the surgical video. The postoperative effect was good, the patient’s cornea was clear, and the depth of the anterior chamber was maintained.
Professor Lin commented that during the first stage of scleral injury repair, a viscoelastic agent can be applied in the center of the eyeball. The viscoelastic can improve the appearance and reset the retina. Resection of the retina is not recommended. It is recommended to cut at multiple points. If the retina is defective, electrocoagulation can be performed at a few points to reduce choroidal exposure. There was a difference between balloon eyes and normal intraocular pressure after surgery.

Know whether there is detachment of the ciliary body before implantation, predict the occurrence of postoperative low intraocular pressure and shallow anterior chamber, pay attention to patient changes, and consider countermeasures in time. Professor Lin mentioned that the problem of shallow peripheral anterior chamber is related to inflammation; the backward incision can solve the shallow anterior chamber problem. In the future, it is expected to add a fixed point on the opposite side to prevent the balloon from running forward. Professor Gao added that with regard to postoperative low intraocular pressure, the best state of the balloon is the state of slight expansion, and there is a non-stick between the balloon and the retina. Pay attention to the details such as model selection, dosage, implantation point, postoperative anti-inflammatory and prone position.

Professor Qi Fei shared the indications that most patients choose to have iris incomplete after trauma. Most of the patients done were satisfied with the postoperative appearance. Each professor expressed his opinions and asked questions, and Professor Lin also answered them one by one.