Liangshan guy Xiao Chen is only 23 years old, but he was told that his right eye might not be saved. This is undoubtedly a bolt from the blue. In order to save his right eye, he and his mother went to many hospitals in Chengdu to seek medical treatment. They were diagnosed with thyroid-related eye disease and corneal ulcer with perforation.
In order to protect Xiao Chen’s eyeballs, the MDT (Multidisciplinary Collaboration) team composed of experts from the keratology department, orbital ophthalmology department, ultrasound imaging department, laboratory department and other departments of several eye hospitals jointly consulted. .
During surgery
The guy suddenly lost sight of his right eye
Told to “remove the eyeball” “
Around June last year, Xiao Chen felt that his right eye was protruding a little, and it was still red, swollen and tearful. Went to the hospital for examination, the doctor said it was keratitis, and prescribed some medicine. The redness and swelling got better after taking the medicine, but Xiao Chen didn’t take it seriously, thinking that he might be too tired.
“After the fifteenth year of the new year this year, I can’t see it anymore, and my eyes are full of pus.” Xiao Chen said that he had seen several hospitals, and the treatment plan given by the doctor was “removal of pus.” Eyeballs”, which made the young Xiao Chen and his family unacceptable. “I just wanted to ask a few more hospitals, hoping to save my eyes.”
On March 6, Xiao Chen and his family came to Chengdu Aier. In the eye hospital, the examination results were consistent with those of the previous hospitals: thyroid-related ophthalmopathy (grade VI), bilateral proptosis, right eyelid redness and insufficiency, and corneal ulcer with corneal perforation.
Thyroid-related ophthalmopathy is the most common orbital disease in adults. Common manifestations include eyelid retraction, proptosis, and diplopia. In severe cases, corneal ulcers and compressive optic neuropathy can lead to blindness. And grade VI is the highest level of serious illness, which means that the chances of keeping Xiao Chen’s eyeballs are really small.
The doctor communicated with Xiao Chen about the condition
“Corneal ulcers can be transplanted, but the problem is that if the The root cause of the ulcer, corneal transplant is also useless.” Wu Tong, vice president of Aier Sichuan Eye Hospital, explained, The root cause of Xiao Chen’s corneal ulcer is the hyperplasia of eye muscles and fat, orbital orbital caused by thyroid-related eye disease. The increased pressure causes the eyeball to bulge and the eyelids fail to close.
“When we close our eyes, there is a thin tear film that lubricates and keeps the eyes moist. However, Xiao Chen’s eyelids cannot be closed for a long time, resulting in corneal dryness. Time After a long time, corneal ulcer occurs.” Wu Tong said, so the problem of high intraocular pressure and protuberance is not solved, even if a new cornea is transplanted, it will not survive, and it will not help.
One of Wu Tong’s main areas of focus is thyroid-related ophthalmology. He is good at decompression of orbital wall through nasal endoscopy.
Removal of orbital bone wall
“make room” for eyeball
“Orbital removal is necessary Bone decompression surgery.” Wu Tong said, for example, the leaking “hole” needs to be blocked first, in order to cure the symptoms and the root cause.
What is orbital bony decompression? Wu Tong said that it is generally understood that there are four bone walls in the eye socket, inside and outside, up and down. Parts of these bone walls are removed to make room for the proliferating eyeball muscles and fat, and the eyeball “falls back”. Compression of the optic nerve.
Multidisciplinary consultation
It may sound simple, but there are important nerves and blood vessels around the eye, and it is necessary to safely remove the bone wall. It’s not that easy.
Wu Tong said that according to the complexity and severity of Xiao Chen’s condition, after a comprehensive evaluation, he believed that “decompression of the inner and inferior orbital wall under the right eye endoscope + balanced decompression of the deep lateral wall” can be used to achieve Balanced decompression of the inner and outer walls of the orbit.
Endoscopic orbital inferior wall decompression surgery is currently the mainstream surgery in the world. The chief surgeon is required to have at least 10 years of professional orbital surgery foundation and long-term experience in endoscopic surgery. . “The (endoscope) enters from the nasal cavity, above the cranial cavity, and passes through important parts such as the ethmoid labyrinth. In addition, everyone’s anatomical structure is different, and there is a slight difference, which may cause major bleeding, blindness, cerebrospinal fluid leakage or meningitis, etc. Complications.” Wu Tong explained that this operation is minimally invasive for patients, but it is a technical and experience challenge for doctors.
Three-Hospital Joint MDT Consultation
Patients,family members and doctors all want to try it< /p>
“He is only 23 years old, and he is still very young.” Wu Tong said that the doctor fully communicated with the patients and their families about the risks of surgery. Although there are currently surgical methods to choose from, if there are complications or the recovery is not good Well, the end result is still enucleation. “The wishes of patients and their families are very strong, and there is a little hope of keeping their eyeballs, and they all want to give it a try.” Wu Tong said, this is also what the doctors hoped.
During surgery
Unfortunately, on the evening of the end of the consultation, due to the long delay in the early stage, little Chen’s condition deteriorated sharply, and the cornea was completely perforated, so he could only perform an emergency cornea transplant operation.
“The leak must be plugged first.” Wu Tong said, if it is not transplanted, the tissue in the eyeball will be drained, so the eyeball will no longer be preserved.
On March 12, the cornea was collected from Aier Eye Bank (Sichuan), and Director Lu Jing, an expert in the cornea department of Chengdu Aier Eye Hospital, successfully performed “right eye penetrating” for Xiao Chen. Corneal Transplantation”.
On the 5th day after the operation, the doctor tried to suture the eyelid to protect the transplanted cornea, but Xiao Chen’s proptosis was too severe and the orbital pressure was too high, so it was imminent to perform orbital bone decompression.
In surgeryXiao Chen’s mother who was waiting outside
On the morning of March 30, Wu Tong and Dr. Wang Lina, director of the Orbitophthalmology Department, performed the surgery on Xiao Chen smoothly.
Currently, Xiao Chen was transferred to Chengdu Aier Eye Hospital again to receive recovery treatment after corneal transplantation. Before being transferred to the hospital, Xiao Chen’s right eye had changed from a condition where he could only see light when he was first admitted to the hospital, and he could not even see Wu Tong’s face when he moved his hand in front of him. Wu Tong said that at present, if Xiao Chen successfully passes the edema period after corneal transplantation, the vision level of his right eye is expected to be further improved.
Red Star News reporter Yu Zunsu Tuyu Hospital
Editor Zhang Li
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