Most of the patients who are blind due to corneal opacity can improve their vision through penetrating keratoplasty. However, some patients are not suitable for traditional corneal transplantation, such as severe chemical burns, severe corneal scar vascularization caused by thermal burns, complete closed symblepharon, multiple corneal transplantation rejection, severe xerophthalmia, etc. Artificial cornea implantation is an effective means to achieve long-term vision restoration.
The artificial cornea is generally composed of two parts: the lens column which plays an optical role in the middle and the peripheral stent which plays a supporting and fixing role. Because the patient's condition and operation are more complex, and some serious complications after the operation are difficult to handle, even affecting the recovery and maintenance of visual function, preoperative and postoperative nursing is very important. Today, I would like to share with you the relevant nursing methods and requirements since the operation was carried out in the ophthalmology department of the PLA General Hospital.
Preoperative care
Preoperative care includes four tasks: psychological care, preoperative eye examination, preoperative eye care, and preoperative general care.
Psychological nursing before operation
As we all know, most of the patients who use artificial cornea are blind with long course of disease. During this period, many operations were carried out and the economic conditions were poor. Many patients undergoing surgery often have pain, irritability, anxiety and other emotions. They have both an urgent desire for surgery and a fear of psychology, and have great hopes for the success of surgery.
For these people, in addition to the doctors and nurses who need to comfort them when they are admitted to the hospital and popularize the knowledge of diseases and surgery, their families should also do a good job in the preoperative ideological work of patients, build their confidence, stabilize their emotions, and make them fully prepared for surgery.
Preoperative eye examination
Before the operation, the patient needs to be led by a specially assigned person to do various examinations, and before the examination, the patient's eye secretions should be cleaned and precautions explained to them. Before operation, the patient's intraocular pressure should be measured regularly by a designated person. If the intraocular pressure is high, the patient should be treated in a timely manner according to the doctor's advice.
Preoperative eye care
Patients need to drip antibiotic eye drops 3 times a day after admission; The bilateral lacrimal passages were washed before operation, the eyelashes were cut one day before operation, and the conjunctival sac was repeatedly washed 20 minutes before operation.
Preoperative general care
After admission, the doctor will understand and master the patient's health status, understand whether there is a history of allergy, and instruct the patient not to smoke or drink before surgery. At the same time, doctors will also know the menstrual history of female patients. One night before the operation, the patient needs to take sedatives orally, take a bath and change clothes, especially the elderly should keep their stools smooth, and eat some food that is easy to digest three days before the operation; Patients with high intraocular pressure should be fully depressurized before surgery.
Postoperative care
Postoperative nursing includes: observation and treatment of complications.
Corneal histolysis
Corneal tissue lysis is one of the common and important complications after surgery. In the late stage, it can lead to aqueous humor leakage, implant displacement, endophthalmitis, etc. Therefore, antibiotic eye drops should be routinely used after surgery to prevent infection.
It should be noted that corticosteroids should be used under the guidance of doctors, because long-term use is prone to complications of tissue lysis and infection. After operation, keep the eye dressing dry and replace it once or twice a day; Open eye drops one day after surgery and apply eye ointment every night.
Be careful not to scratch the surface of the mirror column with hard objects; If there is a lot of eye secretions, wipe them off with sterile cotton swab eye drops. In addition, the nutritional status of the affected cornea itself is poor, such as corneal dryness, which is also one of the factors that cause corneal dissolution. Therefore, artificial tears can be applied to the eyes 6 to 8 times a day after surgery.
Postoperative glaucoma
The destruction of the structure of the angle, inflammation and inappropriate use of hormone drugs increase the risk of glaucoma. Therefore, the intraocular pressure should be observed and recorded regularly after surgery. In addition, patients should pay attention to whether they have headache, eye swelling, eye pain, nausea, vomiting and other conditions in a timely manner. Once found, they should report to the doctor for treatment.
Warm prompt: The patient's water intake should not exceed 400ml each time to prevent the sudden increase of blood volume from causing elevated intraocular pressure.
Whole body care
Antibiotics were used throughout the body to prevent infection. The doctor will ask the patient to establish a registration card, and start to record the far vision, cornea conditions, eye medication times, diet, family conditions, social concerns, psychological conditions and emotions after vision recovery on the first day after surgery.
At the same time, the doctor will also teach the patient how to walk, such as stretching out the forearm first, lowering the head, or wearing a hat with a brim to avoid collision with the surgical eye. The patient should take easy to digest food within 1 week after operation to keep the stool smooth.
Discharge guidance and follow-up
Before discharge, the hospital will issue a detailed discharge guidance, including eye symptoms, precautions during activities, time for follow-up, observation items and self-care methods. Instruct the patients and their families to take the correct eye drops. Do not rub the eyes forcibly. If there is eye swelling and vision loss, see the doctor in time. Pay attention to avoid eye bruises and maintain a good attitude.
A follow-up registration card will be established for patients after surgery, and they will go to the hospital to recheck their vision and intraocular pressure and record them one week after discharge. Recheck the vision and intraocular pressure for 1 month, and pay attention to whether there are complications such as corneal dissolution and water leakage.
Recheck the vision, intraocular pressure and visual field within 3 months. Follow up and observation will be conducted every six months, and patients from other places will be contacted by phone or online.
The implantation of artificial cornea is the only hope to save and restore vision. Proper selection of products and effective surgical measures, combined with careful preoperative and postoperative care, can effectively promote the recovery of the affected eye and enable the patient to return to society and family. If you have any questions about artificial cornea and surgical care on the screen, you can call the official customer service hotline of Mihm Medical: 400-111-8801 for consultation