Qianjiang Evening News Hourly News reporter Cao Luting
"I want to be a doctor when I grow up", the day after the operation, Xiaonan (pseudonym) returned to exponential vision, bluntly saying that the black fog that covered his eyes had dissipated, and he took the hand of Chief Physician Weng Yan and said his wish.
Xiaonan is examining
A week ago, the fundus disease department of Zhejiang University Eye Hospital came to a special patient, he is Xiaonan, 14 years old this year. After careful consultation and examination, the doctor found that Xiaonan's condition was dangerous and special: the danger was that his vision plummeted within ten days, and the fundus of his right eye showed multiple huge holes, accompanied by choroidal detachment, which was on the verge of blindness; especially because he suffered from opticoblastoma in his left eye when he was a child, which had long been removed.
The right eye is the only light left for Xiaonan, and we should make every effort to keep it from slipping away. "I'll refer you to Director Weng Yan of the Vitreoretology Department, and she can do this surgery." Considering that Xiaonan's situation should not be delayed any longer, the first physician immediately began to apply for the green channel of the specialty surgery, and explained to the life teacher of the welfare home to arrange Xiaonan's hospitalization.
Four major difficulties
It is easy to "blind"
The case reached Weng Yan's hands, she carefully studied it, "there are 3,000-4,000 cases of retinal detachment in our hospital every year, but his situation is too complicated and slightly careless..." Weng Yan did not continue, but she clearly pointed out that it is not easy to "remove the time bomb in Xiaonan's eyes", and there are four major difficulties in summary.
Preoperative fundus color photographs show retinal detachment
First of all, Xiaonan has three large, continuous holes in the fundus of her right eye, accompanied by retinal detachment, involving a range of 270 degrees, which means that three-quarters of the retina is problematic. Second, the general "reticulotic" is only for the retinal detachment, and Xiaonan's choroidal detachment also progresses rapidly, the intraocular fluid is precipitated through the choroid, the intraocular pressure drops sharply to 2.5, which is nearly 10 times lower than that of ordinary people, and the "bilayer detachment" greatly reduces the success rate of surgery. Third, the structure of children's eyes is different from that of adults, in vitrectomy surgery, it is quite difficult to separate the retina from the vitreous body, plus most of Xiaonan's retina is in a "floating state" due to reticuls, during the intraoperative operation, the floating retina is easily sucked into the cutting head, causing new holes, which makes the operation difficulty rise to another level.
"In addition, Xiaonan has a problem of developmental delay since childhood, if local anesthesia, I am afraid that he can not cooperate well, and it is one-eyed, if the operation is not successful, it means that his long life in the future will be spent in the dark, which is also a test for the doctor's psychology, which is also the fourth difficulty." Weng Yan has been engaged in the clinical diagnosis and treatment of fundus disease for nearly 30 years, and in the fundus disease specialty, her surgery is recognized as "fast and good". The condition is dangerous, and the fact that this operation is crucial for the child, all decisions must be made with caution. "After consulting with the anesthesiologist department, a comprehensive evaluation was conducted and a surgical plan was established: general anesthesia under vitronectomy + retinal reduction + laser photocoagulation + silicone oil filling, although the pressure is very high, we must also go all out to do it."
"See the flowers in the clouds"
Good news came from the surgery
The condition is urgent, urgent, Xiaonan was lucky to catch the first green "through train" of the new hospital, accompanied by a skilled medical team and an experienced anesthesia team in the operating room, everything is developing in a good direction.
On the 9th, Xiaonan underwent surgery. Compared with most other ophthalmic surgeries, fundus surgery takes a long time and requires a very high level of endurance, physical strength, and care on the doctor. "The detached retina is like a translucent tulle floating inside the glass, and the cloud-like vitreous body adheres to it", Weng Yan carefully peeled off the boundary between the two, while also controlling the distance between the device and the omentum at all times. The operation was completed within an expected period of more than an hour, and there were no complications in the process, which meant that Xiaonan had passed the most critical level again, and the hope of regaining sight was imminent.
Weng Yan during surgery
The next day's vision review, the original preoperative can only feel the manual, even the toilet to touch the vision, has returned to the finger index vision. For Xiaonan, this is already a big step forward, and more importantly, after this eye -- "repair", many risk alerts have been lifted.
Postoperative OCT: retinal flat volts
Today, Xiaonan came to the fundus disease center again for re-examination, as Weng Yan predicted, the retina has been flattened, and the vision has reached 0.1. According to his own feedback, the rhythm of life has returned to before the onset of the disease, and everything seems to have a dream. "I want to be a doctor when I grow up." Perhaps, the beginning of his life was not as smooth as ordinary people, and I hope that all the efforts of this operation can light up ten thousand possibilities for him in the future.
Related Links+
According to statistics, the incidence of retinal detachment in the population is about fifteen in 100,000, but its proportion in fundus disease is quite high, "In general, patients with reticulopause have a 20% chance of retinal detachment, and if delayed, the prognosis will be worse." Weng Yan mentioned that after hyalectomy in patients with net prolapse, vision difficulties have an immediate effect like cataract surgery, and its recovery period is a relatively long process. It is worth noting that patients after reticulothesis need to go to the ophthalmology department regularly for re-examination and follow up on the fundus.
As early as 1978, the Ophthalmology Center of the Second Hospital of Zhejiang Medical University became one of the few hospitals in China to carry out vitreoretinal surgery, and has now developed into the largest professional group in our province, with the most complete equipment and the most advanced diagnosis and treatment technology for the treatment of posterior ocular diseases. With world-class vitreoretinal surgery system and modern diagnosis and treatment equipment, experienced doctor team, the annual vitreous surgery volume ranks first in the province. Recently moved into the new hospital, exponentially expanded the clinic and operating room, optimized and improved the treatment environment and process, opened up a green channel, I believe that in the future, more patients like Xiaonan can get more timely diagnosis and treatment, and reappear in the light.
Expert Profile+
Weng Yan
Chief Physician of the Second Affiliated Hospital of Zhejiang University School of Medicine
Deputy Director of the Department of Ophthalmology
He is a member of the Chinese Medical Association
He has rich clinical work experience and is familiar with the diagnosis and treatment of various common and incurable diseases of ophthalmology.
Proficient in the management of cataract phacoemulsification, various eye trauma. He is especially good at vitreoretinal manual treatment of macular hiatstomy, diabetic retinopathy, vitreous volume blood, and retinal detachment. as well as the diagnosis and treatment of senile macular degeneration. The annual operation volume reaches more than 1700 units.
He has published dozens of papers in domestic and foreign journals, and many papers are included in SC I.
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