WEBVTT 00:00:08.130 --> 00:00:17.940 [National Library of Medicine. HF 1613. This transfer made: 12/21/05. Length: 00:15:00] 00:00:28.260 --> 00:00:32.090 [UNITED STATES NAVY TRAINING FILM. NONCLASSIFIED] 00:00:32.710 --> 00:00:36.870 [EYE SURGERY] 00:00:37.540 --> 00:00:45.570 [REMOVAL OF INTRA-OCULAR FOREIGN BODIES. MN-2477B. 1945.] 00:00:47.160 --> 00:00:55.560 Rapid evacuation by air to a base hospital is essential in the treatment of eye injuries involving intra-ocular foreign bodies. 00:00:55.560 --> 00:01:00.500 Loss of time may result in critical degenerative changes. 00:01:00.500 --> 00:01:08.670 Immediately upon arrival x-ray examination is made to confirm the presence of a foreign body. 00:01:08.670 --> 00:01:13.100 An anterior posterior plate is made. 00:01:20.770 --> 00:01:27.400 Then another is taken in the lateral direction. 00:01:37.810 --> 00:01:45.440 In the anterior posterior view a foreign body is seen. 00:01:45.440 --> 00:01:53.740 The lateral plate also confirms the diagnosis, and it is now necessary to localize its position. 00:01:54.430 --> 00:01:57.820 A contact glass technique is used. 00:01:57.820 --> 00:02:04.940 The cornea is anesthetized with Pontocaine. 00:02:05.380 --> 00:02:17.870 The contact glass has four radio opaque dots which appear on the x-ray plate, and are used in measurements to locate the foreign body. 00:02:18.220 --> 00:02:24.820 This glass is inserted under the lids and over the cornea. 00:02:31.040 --> 00:02:37.650 Two x-rays are again taken, with the contact glass in place. 00:02:37.650 --> 00:02:48.240 The eyes are fixed by having the patient look through the peepholes. 00:02:50.970 --> 00:02:59.100 In the front view, a foreign body is seen in relation to the opaque dots of the contact glass. 00:02:59.100 --> 00:03:06.960 The lateral plate of the orbit also shows the dots of the contact glass, one above, one below, and two in the center 00:03:06.960 --> 00:03:12.630 superimposed all in a vertical line. 00:03:12.630 --> 00:03:20.660 Measurements are then taken from the horizontal and vertical meridians, and the angle is plotted. 00:03:20.660 --> 00:03:25.550 The distance the foreign body is located from the limbus is measured. 00:03:25.550 --> 00:03:31.220 With this information the surgeon is enabled to know where to make the incision. 00:03:31.220 --> 00:03:40.620 Surface anesthesia is obtained with one-half percent Pontocaine, and regional anesthesia with two percent procaine. 00:03:40.620 --> 00:03:47.690 The site of the foreign body as computed on the localization chart is determined by measuring the distances on the surface of the globe 00:03:47.690 --> 00:03:56.940 and the position is marked by a black suture. 00:03:56.940 --> 00:04:09.840 The conjunctiva is incised and undermined, exposing the sclera. 00:04:15.890 --> 00:04:20.740 Following this, diathermic cautery procedure is performed. 00:04:20.740 --> 00:04:28.220 Multiple punctures are made through the sclera with the Lockaray needle. 00:04:28.220 --> 00:04:34.020 These punctures are made all around the area of the intended incision. 00:04:34.020 --> 00:04:42.670 The purpose of these punctures is to prevent a detachment of the retina. 00:04:42.670 --> 00:04:50.750 An opening is made through the sclera with a one and a half millimeter trephine over the site of the foreign body. 00:04:50.750 --> 00:04:59.310 By slanting the instrument as it is cutting through the sclera, a hinge of the scleral tissue is made. 00:04:59.310 --> 00:05:17.340 A catgut suture is placed through the free margins of the plug. 00:05:17.340 --> 00:05:33.680 The needles are passed through the opposite edge of the sclera. 00:05:36.110 --> 00:05:41.520 The tip of a magnet is placed at the lips of the incision. 00:05:41.520 --> 00:05:47.380 A current is applied, and the magnetic foreign body is extracted. 00:05:47.380 --> 00:05:51.680 The foreign body is seen on the tip of the magnet. 00:05:51.680 --> 00:05:58.430 Pencillin therapy is instituted to gaurd against the spreading infection. 00:05:58.430 --> 00:06:13.260 After the foreign body has been removed, the scleral opening is closed by tying the catgut sutures. 00:06:24.510 --> 00:06:36.610 The conjunctival incision is sutured. 00:06:56.140 --> 00:07:11.010 The speculum is removed, and sulfathiazole ointment and a dressing are applied. 00:07:11.010 --> 00:07:13.790 [Non-Magnetic Foreign Bodies] 00:07:13.790 --> 00:07:21.390 In the care of a non-magnetic foreign body, which cannot be removed with a magnet, another procedure is followed. 00:07:21.390 --> 00:07:29.380 The instrument specifically designed to aid the surgeon in the removal of non-magnetic foreign bodies is the Thorpe ocular endoscope. 00:07:29.380 --> 00:07:37.790 This instrument is designed on the principle of a cystoscope, with a light bulb for intra-ocular illumination and with grasping forceps attached. 00:07:37.790 --> 00:07:46.720 These grasping forceps may be moved up and down to get the proper depth, or revolved around the axis. 00:07:46.720 --> 00:07:56.300 By employing a contact glass technique for localization, the foreign body is charted. 00:07:56.300 --> 00:08:08.130 In this case the exact position is found to be posterior to the equator, near the surface, and just below the border of the lateral rectus muscle. 00:08:08.130 --> 00:08:23.820 A speculum is inserted, first under the upper lid, and then under the lower lid. 00:08:23.820 --> 00:08:39.440 After anesthesia, the conjunctiva is incised over the region of the foreign body, and reflected backward exposing the sclera. 00:08:39.440 --> 00:08:44.000 The lateral rectus muscle is isolated, 00:08:44.000 --> 00:08:53.840 a muscle hook is placed under it, and the suture is passed through its tendon at the insertion. 00:08:53.840 --> 00:09:00.230 The muscle is then cut, thus giving a good exposure of the sclera. 00:09:00.230 --> 00:09:07.410 The location of the foreign body is measured on the scleral surface corresponding with the spot on the localization chart. 00:09:07.410 --> 00:09:18.240 The location is marked with a black silk suture. 00:09:18.240 --> 00:09:32.260 A scleral flap seven millimeters long and four millimeters wide is outlined with a double-bladed knife. 00:09:32.260 --> 00:09:48.690 The incision is deepened with a cataract knife. 00:09:58.270 --> 00:10:08.990 The two ends of the incision are joined by a third incision 00:10:08.990 --> 00:10:24.110 and the flap is lifted and dissected back, carefully avoiding tramautism of the choroid. 00:10:42.800 --> 00:10:59.830 A catgut suture is placed through the end of the flap. 00:10:59.830 --> 00:11:06.770 The choroid and the retina are then incised. 00:11:06.770 --> 00:11:14.460 The tip of the ocular endoscope, with the light and grasping forceps, is now placed into the eye. 00:11:14.460 --> 00:11:18.570 The assistant holds the instrument, preventing it from going too far 00:11:18.570 --> 00:11:23.490 while the operator searches for the foreign body while looking through the eyepiece. 00:11:23.490 --> 00:11:31.830 Here is an actual view of the endoscope in the eye grasping the foreign body. 00:11:31.830 --> 00:11:36.880 The foreign body may now be seen on the end of the thumb. 00:11:36.880 --> 00:11:42.450 It is a piece of copper from a detonator cap. 00:11:42.450 --> 00:12:07.520 The catgut suture which was placed through the flap is then carried through the opposite edge of the scleral incision. 00:12:07.520 --> 00:12:20.590 The flap is then sutured with tantalum wire, which has great strength, is non-absorbable, and need not be removed. 00:12:23.940 --> 00:12:34.390 The tantalum suture is then tied. 00:13:13.180 --> 00:13:25.520 Another suture of the same material is placed through the edge of the flap and the opposing edge of the scleral incision. 00:13:25.520 --> 00:13:47.470 This type of suture is ideal for this operation, due to its high tensile strength, and because it causes very little tissue reaction. 00:13:57.830 --> 00:14:10.750 Cortory punctures are made all around the region surrounding the incision with one millimeter Walker needles to prevent a detachment of the retina. 00:14:10.750 --> 00:14:20.640 The needles are then removed. 00:14:25.920 --> 00:14:41.390 The cut end of the lateral rectus muscle is sutured back to its insertion. 00:14:41.390 --> 00:14:57.380 Tenon's capsule and the conjunctiva are sutured with catgut. 00:15:11.260 --> 00:15:22.710 Conjunctival sac is irrigated, the speculum is removed, and sulfathiazole ointment and a dressing are applied. 00:15:23.280 --> 00:15:28.530 [THE END]