PMC6005293_01
Protrusion of left eye globe from its orbit attached to the optic nerve with its adjacent connective tissue, indicating exposed left eye orbital space and teared periocular tissue. Hyphema cannot be viewed from this angle.
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The left eye globe with hyphema was protruded from the orbital space and attached to the optic nerve (Figure 1).
Schematic diagram of the ocular trauma.
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The left orbital space was exposed and periocular tissue tear was present around the left orbit (Figure 2).
Cownose in the induction tank that contains 17 ppm of isoeugenol.
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The Cownose was left in the anaesthetic bath for 10 minutes until its ventilation rate ceased to 40 breaths per minute and dropped in pectoral fin stroke activity (Figure 3).
Maintenance of surgical plane was achieved by continuously flushing marine water that contains 17 ppm isoeugenol through spiracle by using a 20 mL syringe.
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Later she was transferred by using canvas hammock to surgical tank with wet towel at the bottom and covered with another wet towel on her dorsum to maintain skin moisture (Figure 4).
A ring block was made by using 5 mL of lidocaine to infiltrate and desensitize the periocular skin. This served as local block as well as short term local analgesia.
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fig5
A ring block was done around the left eye by using 5 mL 20 mg/mL Lidocaine as local anaesthesia to reversibly desensitize the skin as well as analgesia (Figure 5).
Diluted gentamycin was used to flush the orbital space and globe to reduce contamination.
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Diluted gentamycin (5 mL, 100 mg/mL gentamycin + 5 mL sterile water) was prepared to flush the left orbital space and globe to minimize secondary infection since sterile surgical field is impossible to be established in the field setting (Figure 6).
2 Rochester Pean forceps were placed on the optic nerve, while ligation was done proximal to first forceps for haemostasis.
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The optic nerve was clamped by using 2 Rochester Pean forceps (Figure 7).
The optic nerve was transected between the Rochester Pean forceps by using scalpel blade #20.
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Then the optic nerve was transected between the 2 forceps by using scalpel blade #20 (Figure 8).
Inner and outer muscular layer were sutured by 2.0 PDS in interrupted suture pattern.
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PDS using interrupted suture pattern to close the orbital space (Figure 9). Periorbital skin closure was done with 2.0 PDS in interrupted suture pattern (Figure 10).
Periocular skin closure was done by 2.0 PDS in interrupted suture pattern.
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PDS using interrupted suture pattern to close the orbital space (Figure 9). Periorbital skin closure was done with 2.0 PDS in interrupted suture pattern (Figure 10).
Day 7 after enucleation. There was no suture break, no skin discolouration, and no fungal growth on the surgical wound. Besides, the abrasion on the left cranial margin of pectoral fin was healing well with white fibrous scar tissue. According to the caretaker, she was having good appetite after operation.
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She was responding well to the treatment with good appetite and no clinical abnormalities were observed, and suture materials were still intact (Figure 11).