Patient XX, female, 28 years old, was injured by scissors in her right eye 8 months ago while making clothes for her one-year-old child, and underwent corneal laceration and cataract extraction in the emergency department of a local hospital, after which her visual acuity was manual in front of her eyes only, and her corrected visual acuity did not improve, but other conditions were unknown. 7 months ago, she underwent vitrectomy of her right eye in the local hospital again, and her visual acuity did not improve significantly after the operation, and her pupil area started to turn white. Two months before her visit, she started to have eye swelling and headache, which was diagnosed as “secondary glaucoma in the right eye” in the local hospital, and she used many kinds of intraocular pressure-lowering medicines, but the effect was poor, and the intraocular pressure could not be controlled. After a period of treatment, the local doctor was very difficult and suggested the patient to give up the treatment and have the eyeball removed and implanted with a prosthetic eye table. However, the patient, a young woman, was unwilling to accept such a treatment plan and was convinced that her eyes were expected to be cured. It just so happened that a relative of her husband’s colleague had been treated for ocular trauma at our clinic and had recovered her vision very well, so she came to our clinic with high hopes. Wang Hongge, the ophthalmologist of the studio, examined the right eye: right eye vision HM/prior eye, intraocular pressure 29 mmHg, mixed congestion of the conjunctiva of the right eye, diffuse corneal edema thickening, grayish-white in color, with very poor transparency, neovascularization is seen growing in the upper part of the cornea, temporal cornea is transparent, the iris surface is temporal and lower flake hemorrhage, and the pupil and the posterior part of the situation can not be seen.B ultrasound: aphakic eye, vitreous clouding. Closure, except for the 3 clock point range below the temporal, the rest of the atrial angle is seen at the mechanized membrane, and adhesion with the atrial angle, above the 11-2 point range of the anterior PVR. visual acuity of the left eye -3.75 DC = 1.0, intraocular pressure of 20 mmHg, no other abnormalities. Admission diagnosis: right eye ① corneal endothelial dysfunction ② secondary glaucoma ③ aphakic eye ④ post-corneal scleral laceration suture ⑤ post anterior vitrectomy ⑥ APVR ⑦ old penetrating eye injury. Left eye Myopia . The patient presented the two objectives of the visit, which were to maximize the restoration of visual function and to preserve the eye without affecting her aesthetics. When I faced this young mother, I looked at her extremely eager eyes and the cute little baby in her arms, I felt sympathy and a sense of responsibility as an ophthalmologist, and I had to do my best to help her restore her visual function. However, the pressure was immense and I was not sure whether secondary glaucoma had caused serious damage to the optic nerve or not. How is the macular function? How much vision can be restored after surgery? In case the surgery is not effective, the patient will have to suffer great pain both financially and mentally, and there will always be a lingering psychological shadow in the future. At this point, however, my sense of responsibility and mission to save lives prompted me to think about how to restore optimal vision to this patient. The key problems of this patient are corneal endothelial dysfunction, anterior PVR and secondary glaucoma. Since there is no obvious abnormality in the vitreous and retina, according to the past clinical experience, if the cornea and intraocular pressure can be solved, and if the anterior PVR can be treated to prevent the occurrence of retinal detachment, the patient should be able to get some vision. How to go about solving these problems? The UBM shows that the atrial angle has closed and lost its drainage function. If a corneal graft combined with anterior chamber mechanized membrane resection is performed alone, then the IOP will not be resolved, and ultimately the corneal graft will fail. As for secondary glaucoma drugs have lost their effect, conventional trabeculectomy is difficult to work, and destructive surgery often causes atrophy of the eye, at this time the situation glaucoma valve implantation should be a best choice. In addition, the patient was very young, the vitreous was not completely removed combined with anterior PVR, it is very easy to have the aggravation of vitreous proliferation or the reappearance of PVR, the vitreous must be removed as much as possible during the operation. Placing the catheter in the glass cavity after vitrectomy helps to prevent the catheter of the valve from contacting the corneal endothelium and protects the corneal implant. Considering that glaucoma valve implantation is prone to the formation of encapsulated cysts, it was decided to combine the intraoperative application of mitomycin and retinoic acid drug retardation system in order to prevent their formation. In view of the above analysis, the final surgical procedure was PKP + vitrectomy + glaucoma valve implantation (Ahmed) + RA-DDS implantation in the right eye. The cloudy cornea in the center of the recipient was removed with an 8.25-mm-diameter ring drill, and an 8.25-mm temporary artificial cornea was placed to form the anterior chamber. The white polarized membrane covering the surface of the iris was excised, and iris atrophy was found, with iris agenesis in the upper 10-2 o’clock range. Examination of the external scleral apex revealed the formation of a white mechanized membrane in front of the serrated rim of the vitreous base in the 11-2 o’clock range, covering the flattened portion of the ciliary body, and the remaining portion of the base and the retina did not show any abnormality. The adherent atrial horn was detached and all the vitreous was excised as far as possible with the help of imported tretinoin staining.Twelve interrupted sutures were used to fix the 8.5-mm-diameter donor cornea in pairs on the implant bed. The scleral wall where the Ahmed valve was fixed was rinsed with 50 ml of saline after placing a cotton pad soaked with 0.4 mg/ml mitomycin for 3 minutes. The glaucoma valve body was sutured in the equatorial part of the superior temporal quadrant, and the catheter was implanted into the glass cavity 4 mm behind the corneal limbus at about 10 o’clock, with the broken end located in the center of the pupil. 1 mgM of RA-DDS was placed on both sides of the valve body, and the reset bulboconjunctiva was fixed with interrupted sutures. On the first postoperative day, the patient had no special discomfort, ophthalmologic examination: visual acuity of the right eye was HM/10CM, intraocular pressure finger test was within the normal range, the corneal implant was mildly edematous and thickened, and the posterior elastic lamina was visible as a fold, and the corneal sutures were in place. Depth of anterior chamber was available, atrial flashes (+++), cells (+++), iris atrophy, pupil was not round. The broken glaucoma valve catheter was visible in the center of the pupil in the glass cavity, the fundus was hazy, and the retina was in place. The patient’s condition gradually improved and he was discharged two weeks later. Ophthalmologic examination at the time of discharge: visual acuity of 0.1 in the right eye, intraocular pressure of 16 mmHg, bulbar conjunctival congestion, glaucomatous valve and catheter visible under the bulbar conjunctiva in the superior temporal quadrant, good transparency of the corneal implant, sutures in place neatly without loosening, atrial flashes and cells (+) fundus is clear and no abnormality is seen. The left eye was the same as before. The patient was given 0.5% cyclosporine ophthalmic solution and 0.02% fluoromethionine ophthalmic solution four times a day for a long period of time after the operation, and he had several follow-ups in 3 months. The corneal implant was transparent, the visual acuity was 0.12, the intraocular pressure (IOP) was always in the range of 14-18 mm Hg, and there was no abnormality in other conditions. Five months after the operation, the patient’s right eye began to feel ocular distension, which gradually worsened. He was given 0.5% thimerosal, alfagan, and pallidomide by the local hospital to control his eye swelling. Examination: visual acuity in the right eye was 0.12, corrected 0.7 (+12.00DSM-2.50DC×115°), intraocular pressure 32mHg, vascularization of the superior temporal conjunctiva, localized dilatation, and clear borders around the valve. Corneal implants were clear with no loose sutures. The iris is atrophic with 11 to 5 occlusions, pupil diameter 6 mm, light reflex (-). The crystalline lens was absent, the fluid in the glass cavity was clear, and the supratemporal glaucoma valve catheter was patent. Funduscopic examination of the retina was normal. Corneal endothelial count was 1273/mm2. no abnormality was seen in the left eye. From the examination, the patient’s intraocular pressure was high, and combined with the conjunctival situation around the glaucoma valve body, it was judged that an encapsulated cyst had formed, which made the glaucoma valve lose its drainage function. To solve the current IOP problem, the encapsulated cyst should be removed first. In addition, the patient’s corrected vision is relatively good, so joint IOL suspension can be considered to improve the patient’s vision while solving the IOP. After calculating the expected IOL implantation of +16.0D, the decision was made to reoperate. Before surgery, the patient was asked to implant the RA-DDS again, but he refused to do so because he had failed to prevent the formation of an encapsulation the first time. Under local anesthesia, the right glaucoma valve encapsulated cyst excision + atrial angle separation + IOL suspension was performed. During the operation, it was found that the glaucoma valve body was encircled by hyperplastic tissues, and the aqueous humor could not be drained outward, and after incision of the encapsulated tissues, there was a large amount of clear fluid flowing out of the peripheral part of the valve body, and the intraocular pressure decreased, which further proved the preoperative diagnosis. IOL suspension was performed by implanting a CZ70BD suspension lens using a 7-mm long angular scleral rim posterior incision centered at 12 o’clock above, and two loops of the crystal were secured by horizontal position sutures at 3 and 9 o’clock, which resulted in a smooth operation. The postoperative reaction was mild and the recovery was good. 10 days later, he was discharged from the hospital: visual acuity of the right eye was 0.5, small hole 1.0, intraocular pressure was 18mmHg, glaucoma valve was in place, the conjunctiva was congested with blurring of the border, the corneal implant was transparent, the IOL was in the right position, and there was no abnormality in the fundus. One month after discharge from the hospital, the IOP of the right eye began to be unstable, sometimes high and sometimes low, the local observation of IOP between 8-38mmHg, gradually stabilized in the state of high IOP, the follow-up examination found that the glaucoma valve at the bulbar conjunctiva bulge obvious, blood vessel filling, diagnosis of parcel formation, try to puncture the parcel, can be extracted from the clear fluid, followed by the decline in intraocular pressure, and repeated for three times. Obviously resolving the parcel formation became the key issue now, although the first RA-DDS implantation did not prevent the formation of parcel cysts, but based on the previous experience RA-DDS implantation still has the hope of success. Otherwise, there is no other better way to prevent it. Three months after the second surgery, the patient was readmitted with “encapsulated cyst formation” in the right eye and underwent glaucoma valve exploration + excision of the encapsulated cyst + RA-DDS implantation (2 capsules, 1mgM), which revealed that the valve was again encapsulated by hyperplastic tissue. During the operation, it was found that the valve was again wrapped by hyperplastic tissue, and the glaucoma valve and catheter were clear during the washout examination. The encapsulated cyst was excised, and the two RA-DDS capsules were then placed on both sides of the valve. Postoperative intraocular pressure was well controlled and he was discharged after the fourth postoperative day. Examination: visual acuity of the right eye was 0.6, intraocular pressure was 14 mmHg, cornea, IOL and fundus were normal. Six months after the last surgery, the patient was discharged from the hospital and had several follow-up examinations. The visual acuity of the right eye was 0.6, the intraocular pressure was between 12-16mmHg, the sutures of the corneal implant had been removed, the cornea and IOL were in good condition, and there was no abnormality in the rest of the eyes. The patient has resumed his normal life and work, and his family is living a happy life. Reviewing the whole treatment process of this patient, we have the following points to realize: ① Don’t give up lightly. The patient was advised to have his eyes removed when his intraocular pressure could not be controlled at the local hospital. It would be a serious medical error to remove an eye whose visual acuity could be restored to 0.6. Many cases that make patients and even doctors despair often have unexpected results after efforts are made. Especially some primary hospitals have a lot of difficulties in diagnosing and treating certain diseases due to the objective conditions and limitations of medical standards. Do not prematurely give the patient some irreparable surgery, try to create a good condition for the patient’s future treatment, unsure of the patient should be promptly transferred to a higher level of hospital treatment, so as to avoid delays in the condition of the patient’s lifelong pain, and increase the unnecessary burden on society. ② The glaucoma valve provides a good way for us to treat some intractable glaucoma. However, before the advent of the RA-DDS delivery system, the chance of encapsulated cyst formation was high. Although we have some methods, such as applying mitomycin to the scleral wall during surgery and taking care to avoid damaging the surface of the valve by clamping the valve with as few instruments as possible, surgical failures due to the formation of encapsulation occur from time to time, which often makes the surgeon feel a headache. How to effectively avoid or prevent the formation of packages is still a big problem we face. Our hospital has done a lot of research work on retinoic acid slow-release system to prevent the formation of encapsulated cysts, and applied it to the clinic, which has achieved certain results and drastically reduced the formation of encapsulated cysts. In the future, we will continue our work in this area and develop and improve it for the benefit of patients. ③ Organic combination of anterior and posterior segment surgery will maximize the benefit to the patient. A lot of ocular trauma often involves multiple specialties, such as plastic surgery, corneal disease, cataract, glaucoma, fundoplication and many other specialties, and the management of the patient needs to be considered in an integrated manner in order to obtain an optimal treatment plan and achieve the best therapeutic results. I have received specialized training in cataract, glaucoma, and keratoconus, and I have a solid foundation in theory and surgical operation. Now I specialize in fundoplication, but the knowledge and skill training of the previous specialties has enabled me to benefit from the diagnosis and treatment of complex cases, and to make the best diagnosis and treatment plan on the basis of comprehensive consideration. Many patients with anterior and posterior section of the surgery is completed by me alone, that is, to save the time of both doctors and patients, but also to avoid the inconvenience of resorting to other doctors, or the shortcomings of each specialty doctors only consider their own specialty and lack of a holistic view of the problem. ④The treatment plan that the doctor considers correct, with no potential or definite danger to the patient, should try to gain the patient’s understanding and support, and obtain active cooperation in order to obtain the best treatment results, which is the basis for the treatment of all diseases. If the doctor had not communicated with this patient several times and persuaded her to accept RA-DDS implantation again, it is very likely that another parcel would have formed, leading to the failure of the surgery and causing the patient to suffer great pain both physically and mentally.