tailieunhanh - Opthalmic microsurgical suturing techniques - part 10

Bệnh nhân kỹ thuật có thể được gây mê với 10-20 mg diazepam uống 30 minbefore thủ tục. Mắt là prepped với bệnh phẩm povidone iodine, sau khi nhỏ thuốc của hai bộ proparacain giọt hydrochloride mắt 0,5%, 5 minapart. Biên nắp sau đó được xác định tại đèn khe. | 132 Gaston O. Lacayo III and Parag A. Majmudar Fig. Eight-incision radial marker to the surface of the flap making sure the radial marks cross the interface in nu-l ti Surgical Indications Treatment of recalcitrant flap striae or epithelial ingrowth affecting quality of vision following LASIK. Fig. Seven interrupted radial sutures are placed along premarked locations Instrumentation and Equipment Proparacaine 25-Gauge needle on syringe No. 64 blade Merocel sponges Balanced salt solution Eight-incision radial marker 10-0 nylon suture Soft contact lens 10-0 Nylon suture Fig. Flap suturing technique Fig. five to seven interrupted 10-0 nylon sutures are placed full thickness through the edge of the flap and partial thickness into the base of the adjacent corneal surface Technique Patients may be sedated with 10 to 20 mg of oral diazepam 30 minbefore the procedure. The eye is prepped with povidone iodine swabs following the instillation of two sets of proparacaine hydrochloride eye drops 5 minapart. The flap margin is then identified at the slit lamp. Using a sterile 25-gauge needle attached to a syringe the flap edge is identified. A Sinskey hook is used to undermine the edge of the flap for two to three clock hours. The patient is then placed under an operating microscope a lid speculum is applied and the flap is lifted from the stromal bed using forceps and Merocel sponge applied to the undersurface of the flap. Epithelial ingrowth if present is removed from both the stromal side and the underside of the flap with a gentle scraping with a no. 64 blade. Propara-caine drops are placed on both surfaces for 30 s in an attempt exploit the known epithelial toxicity of this agent 17 18 . The flap undersurface and stromal bed are irrigated with balanced salt solution injected through a cannula. It is advisable to recess 1 mm of epithelium around the entire flap edge excluding the area occupied by the hinge with a Merocel .

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