F4 Phase 8 (with video)|Fantastic sharing of FCVB surgery cases

Ophthalmology FCVB, 铿锵4人行. During the epidemic period, Vesber held the FCVB online F4 cloud conference, focusing on the hot topic of folding artificial vitreous balloon (FCVB). The eighth session of the Cloud Conference invited four professors: Professor Tian Xuemin of the 988th Hospital of the Joint Logistics Support Force as the chairman of the conference, Professor Zhang Guisen of Chaoju Eye Hospital in Inner Mongolia, Professor Chen Wei of Southeast Eye Hospital of Fuzhou, Professor Ding Yali/Professor Xu Liang of Nanyang Eye Hospital Guests, have a wonderful academic discussion on “FCVB surgical case sharing”.

Professor Sharing

Professor Xu Liang shared: The first patient was a 39-year-old male. His right eye was scratched by steel wire when he was working outdoors in April last year. In the emergency department, he underwent debridement and suture for corneal penetrating injury of the right eye. More prolapse, symptomatic treatment after surgery. One month later, “right eye vitrectomy + complex retinal reduction + FCVB implantation + silicone oil filling surgery” was performed.
The second patient was a 57-year-old male who fell from a high position and injured his left eye while working in February 19th. In the emergency department, he underwent debridement and suture surgery for rupture of the left eye. Postoperative symptomatic treatment. In March, left eye vitrectomy + complex retinal detachment reduction + FCVB implantation + silicone oil filling surgery. “.
Professor Chen Wei shared: Patient 31-year-old male, left eyeball sclera penetrating injury, traumatic cataract, large metal foreign body retention in the eye, retinal choroidal detachment, corneal sclera debridement and suture, cataract extraction, foreign body removal, vitrified silicone oil filling. July left eye silicone oil eye, PVR. Glass cutting, silicone oil removal, film stripping, silicone oil filling. 19 months after vitrectomy of the left eye, the cornea showed band degeneration and the eyeballs were slightly atrophy. Professor Chen made vitrectomy for his left eye, took out silicone oil, and implanted FCVB.
Q: One month after the operation, the reason why the fibrinized membrane and corneal opacity began to be decompensated?
A: The main reason is that after serious trauma, the function of the eyeball is damaged, and the development of the pre-PVR cannot be prevented, and the decompensation of corneal opacity cannot be reversed.
Q: When is the best time for balloon implantation?
A: After eye trauma, usually emergency suture within 3 days is a first-stage operation. It is necessary to choose implantation of FCVB very carefully during the first-stage suture; vitrectomy + silicone oil or FCVB operation is a second-stage operation after 7-14 days. For patients treated with silicone oil, silicone oil filling must be considered first. Patients who are expected to use silicone oil to fill the retina (choroid) can consider implanting FCVB.
Professor Zhang Guisen shared: The patient is a 46-year-old man with a blunt contusion in his left eye and a vitreoretinal surgery one week after debridement and suture of ruptured eyeball. Seventeen months after silicone oil filling, the cornea showed band degeneration, and silicone oil was removed and combined with FCVB implantation. After operation, the depth of the anterior chamber is maintained, the retina is well reset, the intraocular pressure is maintained at about 10 mmhg, and the vision maintenance index is maintained.

Professor Tian Xuemin shared: The patient was a 9-year-old boy who was accidentally injured by glass 3 years ago, which made his right eye unclear. Corneal laceration suturing, traumatic cataract surgery in the right eye, intraocular lens implantation, vitrectomy for the right eye combined with silicone oil injection were performed successively. More than a year after the operation, the silicone oil overflowed into the anterior chamber, and the cornea became whiter and larger. After consultation with many hospitals in the province, eyeball removal was recommended. The family members were unwilling to give up and eventually transferred to the Joint Logistics Support Force 988 Hospital for treatment. Diagnosed as vitrectomy in the right eye filled with silicone oil, banded corneal degeneration in the right eye, and corneal penetrating injury in the right eye. After fully communicating with the patient’s family, Professor Tian performed FCVB implantation for him. Observed half a year after surgery, the patient’s corneal degeneration was significantly improved, the cornea became clear, and her vision improved.

Q: What is the prospect of FCVB implantation in children with severe eye trauma and silicone oil-dependent eyes?
A: At present, FCVB is rarely used in children. Children’s eyeballs will continue to develop after surgery, and there are many uncontrollable risk factors for long-term prognosis of the operation, which needs to be carefully considered.
Q: The technical points of artificial vitreous implantation in children?
A: Choose your child’s indication carefully. According to the current eyeball shape selection, the main incision is the superior temporal, the scleral incision is posterior, and the amount of silicone oil is injected according to the doctor’s pocket book. Strictly follow the doctor’s pocket book, and carefully consider postoperative medication.
FCVB has carried out more than 1,000 operations nationwide, most patients achieved the expected results, and a few patients had postoperative complications. Professor Gao answered that the patients with good results concentrated on the correct choice of the timing of the operation, and the ciliary body of the patients remained relatively complete; The main complications of FCVB are: ① shallow anterior chamber, which can be effectively resolved 5 mm behind the incision of the corneal sclera; ② corneal opacity, first manifested as shallow anterior chamber, which is closely related to the patient’s ciliary body function. In theory, corneal opacity mainly occurs in patients without iris, and doctors need to be careful about vitrectomy. It is expected that a fixed point will be added on the opposite side of the drainage tube in the future to prevent the balloon from advancing.
Finally, Professor Tian summarized the meeting, and standardized operation skills and attention to operation details were closely related to the success of the operation. Thanks to TVB for providing a platform for everyone to fully communicate and exchange online. This exchange will help you in your future clinical work, improve the success rate of surgery, and ultimately provide better services for patients with severe eye trauma and silicone oil-dependent eyes.