GOOD眼外伤处理的战略性思考范例.ppt

 Strategic thinking in eye trauma management Overview Surgical expertise Manual skills Adequate equipment Knowledge of anatomy physiology pathophysiology Based on scientific literature and personal experience Individualized management plan Make adjustments Strategically planned approach Thinking “from the desired endpoint back” Plan for fully restoring the eye’s visual functions and perform surgery , prevent complications expected to occur Plan for partially restoring the eye’s visual functions Plan for restoring the eye’s normal intraocular anatomy remove the eye or restore the eye’s normal intraocular anatomy as close to the normal as possible Basic principles Relationship-chance not choice Attitude, behavior, words,and metacommunication Partnership between patient and ophthalmologist discussion: management options risks and benefits short-and long-term implications potential for multiple surgeries expected prognosis issues relating to visual rehabilitation services wearing eye protection in the future likeihood of periodic follow-ups History and evaluaton How the injury occurred What its immediate consequences which tissues are involved and to what extent Had prior surgery History and evaluaton Assess the VA in both eyes Avoid causing iatrogenic damage Order only necessary diagnostic tests Document drawings, photographs and intraoperative videos Surgeon must know his or hercapabilities and limitations Surgical reconstruction of a severely traumatized globe is a complex procedure life does not recognize artificial divisions such as “anterior” versus “posterior” segments if you can’t, don’t Surgical manipulations to reconstruct an injured eye Eyes with NLP-reconstruction or enucleation? There are two truly medical reasons to perform primary enucleation: The eye is so badly injured that its external integrity cannot anatomically be reconstructed All/most of the globe’s contents is lost, leaving no hope for any function and phthisis is unavoidable NLP