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The objective of the study was to evaluate the curative effect of a modified technique of scleral suture fixation with a four-loop foldable intraocular lens (IOL) for eye with inadequate capsule support. This was a retrospective study of 22 eyes with inadequate capsule support of 20 patients who underwent the scleral suture fixation technique with 9-0 polypropylene suture and foldable four-loop IOL implant. Preoperative and follow-up data were collected for all patients. The mean follow-up was 5.08 ± 0.48 months (range: 3–12 months). The mean pre- and postoperative log of minimum angle of resolution (logMAR) uncorrected distance visual acuity was 1.11 ± 0.32 versus 0.09 ± 0.09 (P < 0.001). The mean pre- and postoperative logMAR best corrected visual acuity was 0.37 ± 0.19 versus 0.08 ± 0.07 (P < 0.001). The intraocular pressure (IOP) increased briefly (range: 21–30 mmHg) in eight eyes on the first day postoperatively and returned to normal within 1 week. No IOP drops were used postoperatively. The IOP was 12–19.3 (13.72 ± 1.28) in this follow-up, which had no significant difference compared to the preoperative IOP (t = 0.34, P = 0.74). At this follow-up, there was no hyperemia, local hyperplasia, obvious scar, suture knots, or segment ends observed under the conjunctiva, as well as no pupil deformation or vitreous hemorrhage. The mean postoperative IOL decentration degree was 0.22 ± 0.08 mm. At the 7-day follow-up postoperatively, one side of the IOL was dislocated to the vitreous cavity in one case, which was resolved by reimplantation of a new IOL in time with the same technique. Scleral suture fixation technique of a four-loop foldable IOL was a feasible operation method for an eye with inadequate capsular support.
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AIM: To compare the efficacy of 25-gauge(25G)vitrectomy combined with intraocular lens transciliary sulcus scleral suture fixation and sutureless scleral tunnel interlamellar fixation in the treatment of complete lens dislocation.METHODS: Retrospective case-control study. A total of 40 patients(40 eyes)diagnosed with complete lens luxation in the vitreous cavity in our hospital from May 2015 to September 2021 were selected, among which 21 eyes(suture group)underwent 25G vitrectomy combined with intraocular lens fixation via ciliary sulci scleral suture, and 19 eyes(sutureless group)underwent 25G vitrectomy combined with interlamellar scleral tunnel fixation of intraocular lens. The patients in both groups were followed up until 3mo after surgery to observe the operative time, best corrected visual acuity(BCVA), corneal endothelial cell count(CECC), central corneal thickness(CCT)and postoperative complications.RESULTS: The operation time was significantly shorter in the sutureless group than in the suture group(31.79±6.01min vs. 45.38±8.04min, P<0.001). BCVA in both groups was significantly improved after surgery(all P<0.05), and the BCVA(LogMAR)at 1wk after operation in the sutureless group was significantly better than that in the suture group(0.32±0.14 vs. 0.57±0.25, P<0.001). At 3mo after surgery, CECC in both groups was lower than that before surgery(all P<0.01). The CCT at 1wk after operation in the suture group was greater than that before operation and at 3mo after operation(all P<0.01), and there was no significant change in CCT before and after surgery in the sutureless group. During follow-up period, the total complication rate in the sutureless group was lower than that in the suture group(26% vs. 38%, P>0.05).CONCLUSION: 25G vitrectomy combined with intraocular lens sutureless scleral tunnel interlamellar fixation in the treatment of complete lens luxation has shorter operation time, faster postoperative visual acuity improvement and fewer postoperative complications.
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@#AIM: To compare the curative effect of retropupillary iris claw intraocular lens(IOL)implantation and posterior chamber ciliary scleral suture fixed IOL in the aphakic eyes without capsular support.<p>METHODS: The present retrospective study included 70 aphakic eyes without capsular support. According to the different surgical methods, the patients were divided into two groups, including group A(35 eyes)with treatment of retropupillary iris claw IOL implantation, group B(35 eyes)with treatment of posterior chamber ciliary scleral suture fixed IOL. The uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), intraocular pressure(IOP)and corneal endothelial cell density(CECD)of the two groups were documented and compared before operation and 3d, 1, 3, 6mo and 1a after operation. Furthermore, the stability of IOL in both groups, as well as the intraoperative and postoperative complications were recorded.<p>RESULTS: The patients in the present study were followed up for 12 to 14mo. 3d after surgery, UCVA in group A was significantly improved compared with that before surgery(<i>P</i><0.01), while BCVA had no difference compared with that before surgery(<i>P</i>=0.073).UCVA in group B showed no difference(<i>P</i>=0.097), while BCVA was worse(<i>P</i>=0.002). UCVA and BCVA in both groups were significantly elevated 1mo after surgery(<i>P</i><0.05), and remained stable 6, 3mo later,respectively. Furthermore, IOP in both groups remained in normal level during the follow up period, 0.7% and 2.3% reduction of CECD in A group and B gruop was observed at 1a after operation respectively(<i>P</i><0.05). Both IOP and CECD between the two groups have no significant differenc at each time point during the follow up period(<i>P</i>>0.05).There was no significant difference between whole eye astigmatism and corneal astigmatism in A group and B gruop at 1 and 6mo after operation(<i>P</i>>0.05). Additionally, There was 1 case of IOL dislocation in each group after operation, which was further recovered by operation. Significant tilt and deviation of IOL were not observed in the rest of the patients during the follow up period. The other postoperative complications were mild with no difference in complications between the two groups(<i>P</i>>0.05).<p>CONCLUSION: For aphakic eyes without capsular support, both retropupillary iris claw IOL implantation and posterior chamber ciliary scleral suture fixed IOL are safe and effective surgical methods. Retropupillary iris claw IOL implantation has relatively simple operation, lower damage to the eyeball tissue, the shorter operation time, and the quicker recovery of postoperative visual acuity, which is one of the effective clinical treatments.
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Objective: To investigate the early effectiveness of three-point suture technique in treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture by arthroscopy. Methods: Between January 2016 and December 2017, 12 patients with ACL tibial eminence avulsion fractures underwent arthroscopic fixation of avulsion fractures with Ethibon suture using three-point suture technique. There were 9 males and 3 females, with an average of 36.4 years (range, 18-50 years). The fracture caused by traffic accident in 10 cases and sports in 2 cases. Among them, 1 patient was old fracture and 11 was fresh fracture. According to the modified Meyers-McKeever classification criteria, the fractures were rated as type Ⅲ in 7 cases and type Ⅳ in 5 cases. There were 2 cases of medial collateral ligament injury and medial meniscus injury. The preoperative International Knee Documentation Committee (IKDC) score was 37.9±4.7 and Lysholm score was 46.0±3.7. Results: All operations completed smoothly. The operation time was 45-70 minutes (mean, 61.3 minutes). The incisions healed by first intention in all patients. The hospitalization stays ranged from 4 to 9 days (mean, 5 days). All patients were followed up 3-20 months (mean, 9.3 months). The anterior drawer test, Lachman test, and axis shift test in all patients were negative after operation. At last follow-up, the IKDC score was 89.7±2.5 and Lysholm score was 90.2±1.9, which were significantly higher than those before operation ( t=-30.94, P=0.00; t=-33.03, P=0.00). At last follow-up, the X-ray films showed 9 cases of fracture anatomical reduction and 3 cases of almost anatomical reduction, and 12 cases of fracture healing. Conclusion: For ACL tibial eminence avulsion fracture, arthroscopic three-point suture technique can effectively restore the stability of knee joint and obtain satisfactory early effectiveness.
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@#AIM: To explore the clinical efficacy of ciliary sulcus fixation of posterior chamber intraocular lens(IOL)in aphakic eyes with inadequate capsule support. <p>METHODS: A retrospective review of medical records of 38 eyes of 38 patients who were underwent ciliary sulcus fixation of posterior chamber IOL from 2015 to 2018 were analyzed for the intraoperative and postoperative complications, intraocular pressure and position of intraocular lens. Also, the preoperative and postoperative visual acuity and refractive status were compared respectively. The follow-up time was 3mo after surgery. <p>RESULTS:The intraoperative hyphema occurred in 6 eyes(16%)postoperative hypotony in 4 eyes(11%)transient high intraocular pressure in 11 eyes(29%), yet all were cured by treatment. Four eyes(11%)with obvious tilt of intraocular lens were observed. All the cases were an visual improvement according to the last postoperative follow-up(<i>P</i><0.05). No obvious difference between target refraction(spherical lens)and actual refraction(spherical lens)at postoperative 3mo was discovered(<i>P</i>>0.05).<p>CONCLUSION: The ciliary sulcus fixation of posterior chamber IOL is a safe and effective way to treat the aphakic eyes, but the possible complications should be attentional.
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@#AIM: To assess the application of ciliary sulcus suture fixation of intraocular lens(IOL)through reverse partial-thickness scleral flap.<p>METHODS: The clinical data of 14 patients(14 eyes )who needed secondary IOL implantations due to different reasons in our department were retrospectively analyzed. All cases underwent ciliary sulcus suture fixation of IOL through reverse partial-thickness scleral flap. One or two reverse partial-thickness scleral flap were made during the surgery. Preoperative and postoperative visual acuity, intraoperative and postoperative complications and the stability of the IOLs were observed.<p>RESULTS: The mean follow-up time was 3.5-6mo. The preoperative best-corrected visual acuity(BCVA)(LogMAR)was 0.50±0.54, and the uncorrected visual acuity(UCVA)at 1mo after surgery was 0.46±0.39(<i>P</i>>0.05). The BCVA at 1mo after surgery was 0.36±0.35, which was improved compared with the preoperative one, but the difference was not statistically significant(<i>P</i>>0.05). Three cases had transient intraocular hypertension postoperatively. One case had vetrious hemorrhage. One case had moderate anterior chamber inflammatory response. There were serious complications, such as cystoid macular edema, choroidal detachment, retinal detachment during the follow-up period.<p>CONCLUSION: Ciliary sulcus suture fixation of IOL through reverse partial-thickness scleral flap is a effective and safe method for aphakia.
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Objective To summarize the experience of clinical application of combining double suture fixation and resection of partial fat retro-orbicularis oculus in some specially difficult blepharoplasty.Methods During upper blepharoplasty,patients with heaviness and bulkiness in the both upper eyelid and lateral upper orbital region,we combined double suture fixation and resection partial fat retro-orbicularis oculus.First,partial pretarsal bulky fat was resected,and to form skin-orbicularisoculi composite below incision line.And then,some thickened fat retro-orbicularis oculus was resected,which was also named preseptal and retro-orbicularis oculus fat (ROOF).Double suture fixation techniques were applied to form dynamic and physiological double eyelid.Results 146 cases had satisfactory effectiveness,except for 2 cases with secondary operation because of some superficial double eyelid creases,and 1 case had hematoma,and 3 had transient numbness in the lateral supraorbital nerve region.They were satisfied with healthy eyelid skins,concealed incision and non-serious complications followed at 3-24 months postoperatively.Conclusions Combining double suture fixation and resection of partial fat retro-orbicularis oculus would appear to be a useful adjunct to standard blepharoplasty techniques in selected patients.
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AIM:To explore the cataract suspensory ligament rupture and artificial lens implantation suture fixation into capsular bag without capsular tension ring(CTR).METHODS:We reviewed 20 cases of 20 cataract suspensory ligament rupture without CTR intraocular lens (IOL) implantation fixation in our department from Jan.2012 to Dec.2016.The needle crossed into ocular ciliary sulcus, in the equator of the eye ball which suspensory ligament rupture from, then the needle crossed out 1.5mm away from the angle of sclera.Sutures fixed on the IOL, then the artificial lens implantation in the pouch, carried out in accordance with the Z type suture, or to the beforehand prepared triangle scleral flap.The visual acuity, intraocular pressure, the anterior chamber and the IOL position were measured after operations.RESULTS:All of the postoperative visual acuity improved different level.The postoperative best corrected visual acuity(BCVA) was ≥0.8 in 4 eyes(20%), 0.5-0.6 in 7 eyes(35%), 0.3-0.4 in 8 eyes(40%), 0.1 in 1 eye(5%) because of the glaucoma optic atrophy.There were 12 cases with mild corneal endothelium edema, 4 cases exudation membrane in the pupil area, 2 cases hyphema, all of which recovered after treatment.There were 2 eyes with vitreous prolapse in the pupil, 1 case appeared mild IOL center deviation and no special treatment for the vision did not be involved.Followed up for 6mo, displaced stitches or artificial lens shift did not occur.CONCLUSION:Without CTR, the IOL implantation and suture fixation in capsular bag during cataract surgery is a surgical method for basic-level hospitals.
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PURPOSE: The purpose of this study was to analyze the clinical results of medial horizontal suture fixation of Akin osteotomy in hallux valgus and present its advantages. MATERIALS AND METHODS: This study was based on 48 cases of 35 patients with Akin osteotomy, who underwent surgery of hallux valgus between December 2014 and July 2015, and with at least 12 months of follow-up. The mean age of patients was 46.9 years (range, 16~71 years). The mean follow-up duration was 15.9 months (range, 12~18 months). Clinical evaluations included pain visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS hallux metatarsophalangeal interphalangeal scale) score, and satisfaction score. Weightbearing anteroposterior radiographs were taken to measure the distal articular set angle (DASA) of the hallux. Radiographic bone union at 6 months follow-up was regarded as a success, while a loss of reduction and nonunion was regarded as a failure. RESULTS: The mean pre- and postoperative pain VAS scores were 4.27 and 1.67, respectively (p<0.05). The mean AOFAS score improved from 59.7 to 80.5 (p<0.05). The DASA was improved from 8.15 to –2.57 (p<0.05). There was no case of skin irritation, cortical breakage, inflammation from the knot, and infection. All patients showed union without fixation failure. CONCLUSION: The clinical and radiological evaluations in this study demonstrate reliable results without complication. The medial horizontal suture fixation of the Akin osteotomy was effective, and the advantage of this procedure was unnecessity of the material removal, preservation of the joint, and no skin irritation.
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Humans , Ankle , Follow-Up Studies , Foot , Hallux Valgus , Hallux , Inflammation , Joints , Osteotomy , Pain, Postoperative , Skin , Sutures , Weight-BearingABSTRACT
The Akin osteotomy is a complimentary procedure in hallux valgus surgery. Surgical techniques may vary depending on the operators or fixation devices. Suture fixation, for which a removal procedure is not necessary, can often be recommended. However, there is a risk of failure due to the thin cortex of the phalanx. We describe a new technique using Ethibond suture fixation in Akin osteotomy, which can lower the risk of phalangeal cortical failure and articular cartilage irritation. First, the Akin osteotomy was performed on the proximal phalanx 5 to 6 mm distal to the first metatarsophalangeal joint. Then bone holes were drilled from dorsum to plantar parallel to osteotomy with the Kirschner wire. The final procedure involved passing the Ethibond sutures connected to a straight needle through the holes and tying it. This fixation method offers an effective and easy technique for performance of Akin osteotomy.
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Cartilage, Articular , Hallux Valgus , Metatarsophalangeal Joint , Needles , Osteotomy , SuturesABSTRACT
Purpose: The purpose of this study was to evaluate the clinical efficacy and safety of modified posterior chamber intraocular lens (PCIOL) implantation with transscleral fixation. Design and Setting: This is a study, which is conducted at Department of Ophthalmology, Jinan Eye Hospital, Jinan Second People’s Hospital. Materials and Methods: A total of 82 patients who were scheduled for sutured PCIOL were divided randomly into modified and conventional groups. The former underwent PCIOL through pars plana fixation with knot buried and without scleral flap and the latter underwent transscleral fixation of PCIOL in the ciliary sulcus. The main outcome measures included operative time, postoperative visual acuity, and postoperative complications. Results: The mean operative time of the modified group was 39.95 ± 5.87 min, which was significantly less than that of the conventional group (45.77 ± 5.21 min; P < 0.05). No difference was found in postoperative visual acuity between the two groups. There were no significant postoperative complications, including knot exposure, endophthalmitis, and retinal detachment in either group. The optical clamping of PCIOL was prone to occur in the conventional group. Conclusion: Modified sutured PCIOL implantation is a safe, effective, and feasible technique for the correction of aphakia in eyes without adequate posterior capsular support.
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Background Trans-scleral fixation of intraoculalen(IOL) hamade greaprogress,buthe long-term stability of the implanposition of IOL aftesurgery inoideal.Objective Thistudy wato investigate the relevanfactorof IOL dislocation aftetrans-scleral fixation of IOL.Methodrespective case-observational study wadesigned.The clinical datfrom 321 eyeof 321 patientwho had received trans-scleral fixation of IOL were collected.total of 263 patientcompleted the effeetive follow-up,and 164 patientwith the follow-up fomore than 5 years.No IOL dislocation occurred within 5 yearin all 263 eyes.The relationship between IOL material,IOL implantation location,the time of IOL dislocation and the intraoculapressure with IOL dislocation were analyzed.ResultIOL dislocation appeared 7-10 yearaftesurgery in 9 eyewith an incidence rate of 5.49％.Breakage of IOL suture wafound in all the eyewith IOL dislocation.Dislocation wamore frequently found in IOL performed in the oblique position than thain the horizontal position (10.0％ vs.3.5％).The rate of IOL dislocation wahighesin traumatiretinal detachmeneyes,apercentage of 33.33％.Single piece IOL wamore easily dislocated.ConclusionThe breakage of anchosuturein IOL ileading cause of IOL dislocation aftetrans-scleral fixation of intraoculalens,which may be associated with the weighresulting from the fixation procesin non-level angulaIOL.Iirecommended thaIOL should be fixed in the horizontal position.
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PURPOSE: Meyers-McKeever and Zaricznyj proposed a classification for intercondylar eminence fractures of the tibia. Type III and IV classifications are generally accepted as surgical indications for the fractures. The purpose of the present study was to evaluate the effectiveness of arthroscopic reduction and multiple pull-out suture fixation for displaced intercondylar eminence fractures of the tibia. MATERIALS AND METHODS: Twenty two cases were examined, with a average age of 14(5~23) years, and the average follow-up was 34 months(24 months~6 years). Patients were evaluated according to the Meyers and McKeever criteria, and were scored at 6 weeks, 4 months, 8 months, each year and at the last follow-up. Patients underwent the following evaluations: radiological, range of motion, Lachman test, pivotshift test and the KT 2000 arthrometer. RESULTS: The average union time was postoperative week 9.3(6~12 weeks). According to the Meyers and McKeever criteria, the cases showed the following outcomes at the final follow-up: 19(86.4%) excellent, 2(9.1%) good and 1(4.5%) poor. CONCLUSION: Using the short- and mid-term arthroscopic reduction and multiple pull-out suture fixation procedure for displaced intercondylar eminence fractures of the tibia resulted in 95.5%(19) of cases showing good or excellent outcomes, indicating this procedure is effective.
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Humans , Arthroscopy , Classification , Follow-Up Studies , Range of Motion, Articular , Sutures , TibiaABSTRACT
PURPOSE: To evaluate exposure rate of suture material at the transscleral suture fixation of posterior chamber intraocular lens (TSFPCIOL) with the method in which the scleral suture knots are trans positioned from both nasal and temporal sclera to superonasal. METHODS: With retrospective chart review 16 eyes of 15 patients who underwent TSFPCIOL with the transpositioned suture site, the authors checked their visual recovery rate and complicated disorders after the surgeries. RESULTS: Average corrected visual acuities at final visits improved to 0.67+/-0.32 from 0.14+/-0.17 at initial. Six eyes (37.5%) had complicated disorders at early postoperative period and 5 eyes (31.25%) had at their final visits. No exposure of suture material over the conjunctiva did occur. CONCLUSIONS: These results suggest that translocated suture to superotemporal sclera may be an efficient method for reducing exposure rate of suture material after TSFPCIOL.
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Humans , Conjunctiva , Lenses, Intraocular , Postoperative Period , Retrospective Studies , Sclera , Sutures , Visual AcuityABSTRACT
We reviewed medical records of 24 eyes which had undergone transscleral suture fixation of PC IOL after removal of clear or cataractous lens combined with pars plana vitrectomy from May 1992 to December 1996. The follow u[ [eropds fpr tjos seroes ramged frp, 54 to 772 days(mean 253 days). The visual acuity of 21 eyes (87.5%) was improved and that of 1 eyes(4.2%) was not changed. Postoperative complications, such as IOL precipitates(9 eyes), anterior chamber fibrin exudation (2 eyes), elevation of intraocular pressure(2 eyes)intraocular bleeding(2 eyes), corneal edema (1 eye), tilting of IOL(1 eye), decentration of IOL(1 eye), and retinal detachment(1 eye), were developed. Based on these results, transscleral suture fixation of PC IOL may be a good operative technique in aphakic eyes undergone pars plana vitrectomy and removal of lens.
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Anterior Chamber , Cataract , Corneal Edema , Fibrin , Lenses, Intraocular , Medical Records , Postoperative Complications , Retinaldehyde , Sutures , Visual Acuity , VitrectomyABSTRACT
The long-term results of implantation of posterior chamber intraocular lens (PC IOL) by transscleral suture fixation in 23 patients without zonular or capsular support were reviewed. Preoperatively, 15 were aphakic, 5 had cataracts and 3 were aphakic with concurrent corneal opactiy. The latter had penetrating keratoplasty as well at the time of surgery. They were followed up for more than 1 year, and the best corrected vision remained the same or improved in all cases after surgery. The transsclear sutre fixationrelated complications included vitreous hemorrhage, hyphema and retinal detachment.
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Humans , Cataract , Hyphema , Keratoplasty, Penetrating , Lenses, Intraocular , Retinal Detachment , Sutures , Vitreous HemorrhageABSTRACT
We retrospectively analyzed the correlation between location of transscIeral sutures and the postoperative vision, refraction, anterior chamber depth (ACD) with linear regression, in eyes with posterior chamber intraocular lenses (PCL's) implanted by transscleral suture fixation. The suture to limbus distances at 12 and 6 o'clock position measured in average 2.4mm and 1.7mm respectively. The location of the sutures had no statistically significant relationship with postoperative vision, spherical equivalent, astigmatism, ACD.
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Anterior Chamber , Astigmatism , Lenses, Intraocular , Linear Models , Retrospective Studies , SuturesABSTRACT
The long-term results of implantation of posterior chamber intraocular lens (PC IOL) by transscleral suture fixation in 23 patients without zonular or capsular support were reviewed. Preoperatively, 15 were aphakic, 5 had cataracts and 3 were aphakic with concurrent corneal opactiy. The latter had penetrating keratoplasty as well at the time of surgery. They were followed up for more than 1 year, and the best corrected vision remained the same or improved in all cases after surgery. The transsclear sutre fixationrelated complications included vitreous hemorrhage, hyphema and retinal detachment.
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Humans , Cataract , Hyphema , Keratoplasty, Penetrating , Lenses, Intraocular , Retinal Detachment , Sutures , Vitreous HemorrhageABSTRACT
We retrospectively analyzed the correlation between location of transscIeral sutures and the postoperative vision, refraction, anterior chamber depth (ACD) with linear regression, in eyes with posterior chamber intraocular lenses (PCL's) implanted by transscleral suture fixation. The suture to limbus distances at 12 and 6 o'clock position measured in average 2.4mm and 1.7mm respectively. The location of the sutures had no statistically significant relationship with postoperative vision, spherical equivalent, astigmatism, ACD.
Subject(s)
Anterior Chamber , Astigmatism , Lenses, Intraocular , Linear Models , Retrospective Studies , SuturesABSTRACT
We reviewed the long-term results of implantation of posterior chamber intraocular lens (PC IOL) by suture fixation in 23 patients without zonular or capsular support. In terms of preoperative state, 15 were aphakic, 5 had cataracts and 3 were aphakic with concurrent corneal opacity. The latter had penetrating keratoplasty as well at the time of surgery. They were followed up for more than 1 year, and the best corrected vision remained the same or improved in all cases after surgery. The transscleral suture fixation-related complications included vitreous hemorrhage, hyphema and retinal detachment.