Application of single-pass four-throw releasable suture drainage tube ligation technique in Ahmed glaucoma valve implantation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the application of single-pass four-throw releasable suture drainage tube ligation technique in Ahmed glaucoma valve(AGV)implantation.METHODS: A total of 78 patients(78 eyes)with refractory glaucoma who underwent AGV implantation in the People's Hospital of Leshan from May 2020 to January 2022 were retrospectively analyzed. According to the treatment, the patients were divided into the modified AGV implantation group, with 43 patients(43 eyes)treated by modified AGV implantation, ligating the drainage tube with single-pass four-throw releasable suture, and the traditional AGV implantation group, with 35 patients(35 eyes)treated by traditional AGV implantation. Followed-up for 6mo, the intraocular pressure(IOP), success rate and complications were observed at 1d, 1 and 2wk and 1 and 6mo after operation.RESULTS: Postoperative IOP at all follow-up visits was significantly lower than that before surgery in both groups(all P<0.05). There was no significant difference in IOP between groups at all follow-up visits(all P>0.05). The incidence of shallow anterior chamber was 5% in the modified AGV implantation group and 23% in the traditional AGV implantation group at 1wk after surgery(P<0.05). At 6mo after operation, the overall success rate was 98% in modified AGV implantation group and 89% in the traditional AGV implantation group(P>0.05).CONCLUSION:During AGV implantation, ligation of drainage tube with single-pass four-throw releasable suture can effectively reduce IOP and reduce the incidence of shallow anterior chamber in early postoperative stage. Furthermore, the technique is safe and efficacious.

Twofold technique for iridodialysis repair

Background: Disinsertion of iris leads to debilitating sequelae like diplopia and glare. Hence, iridodialysis repair is essential to optimize the visual quality. Iris base repair often leads to corectopia that necessitates an additional procedure to optimize the pupil shape and size. Twofold technique helps to achieve both the aspects. Purpose: To highlight the technique of twofold iridodialysis repair. Synopsis: The video highlights the method of twofold iridodialysis repair, wherein nonappositional repair is followed by single?pass four?throw (SFT) pupilloplasty thatallows adequate closure of varied degrees of iridodialysis along with centration of eccentric pupil. Highlights: The twofold technique is a combination of nonappositional iris repair and SFT procedure. It can be clinically applied in all cases of iridodialysis with varied degrees of severity

Innovation Urrets-Zavalia syndrome

Background: Surgeons often notice unexplained dilation of the pupil following an uncomplicated intra-ocular surgery. No definite line of treatment has been proposed for managing Urrets-Zavalia syndrome (UZS). The authors have previously documented the results of surgical pupilloplasty and have outlined this modality of treatment for cases with UZS. Purpose: To highlight the aspect of development of UZS post-operatively in the eyes following an intra-ocular surgery. Synopsis: The video highlights the aspect of prevalence of the persistently dilated pupil that is non-responsive to topical miotics. Apart from associated glare, these cases often have raised intra-ocular pressure because of appositional closure of the anterior chamber angle. Surgical pupilloplasty pulls the iris tissue centrally, eventually releasing the mechanical blockage and often breakage of the peripheral anterior synechias as demonstrated by intra-operative gonioscopy and anterior segment optical coherence tomography. Highlights: Performing a surgical pupilloplasty can resolve the UZS, and timely intervention can also prevent the development of secondary glaucoma because of fallback of the iris tissue on the structures of the anterior chamber angle.

Iris and knot configuration after Single Pass Four Throw (SFT) pupilloplasty as imaged by the spectral-domain optical coherence tomography

Purpose: To analyze the morphological changes in the iris-knot complex configuration using spectral-domain optical coherence tomography (SD-OCT) following the single pass four throw (SFT) pupilloplasty. Methods: In this retrospective case series, eyes with SFT pupilloplasty were examined by SD-OCT (Optovue). Iris morphology compared to the normal iris, presence of specific patterns (single hump, double humps, peaks and valleys, tethering), prolene suture, knot complex (length and orientation), and intraocular lens (IOL) vault were evaluated. Results: Overall, 41 knots of 26 patients with a mean time duration of 3.1 � 2 months from surgery were analyzed. Iris configurations seen were single hump (n = 28, 63.8%), double humps (n = 7, 17%), loop (n = 2, 4.8%), flat (n = 3, 7.3%), and mulberry (n = 1, 2.4%). The mean length and the height of the knot complex was 784.1 � 433.7 ?m and 317.7 � 110.4 ?m, respectively. Knot positions were at 3 clock hours in 9 eyes (21.9%), 9 in 8 eyes (19.5%), and others in 24 eyes (58.5%). Cut end of the prolene suture was detectable in 26 eyes (63.4%) as hyper-reflective line, and the mean cut length was 465.8 � 321.1 ?m. The suture was predominantly vertically oriented (80.6%) to the iris with a mean distance of 3.6 � 0.3 mm (2.6�mm) away from corneal endothelium. The mean distance from the knot complex and the IOL was 289.2 � 146 ?m and the mean anterior chamber depth was 4.1 � 0.1 mm. Conclusion: A significant change in iris configuration was noted after SFT pupilloplasty, and vertically oriented retained prolene suture was predominant with good endothelial vault.

Curative application analysis of single-pass four-throw pupilloplasty in combined surgery of cataract and glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the application effect of single-pass four-throw pupilloplasty in combined surgery of cataract and glaucoma.<p>METHODS: Twenty eight patients(30 eyes)suffered from acute attack of glaucoma with large pupil and cataract, received cataract phacoemulsification and intraocular lens implantation combined with angle separation or trabeculectomy and single-pass four-throw pupilloplasty in apllication. Preoperative and postoperative visual acuity, pupil diameter and complications were observed, and postoperative visual quality were measured.<p>RESULTS: The visual acuity of 7d after operation was significantly improved without double vision and glare. The preoperative pupil diameter was 5.9+0.25mm, and the postoperative was 4.1±0.13mm(<i>P</i><0.05). Postoperative visual quality was significantly improved(<i>P</i><0.05). Among the intraoperative complications, there were 5 cases 5 eyes of iridodelamination avulsion after suture, 1 case 1 eye of small holes near the formed pupil and 3 cases 3 eyes of small blood seepage at the iris root, which recovered well after the corresponding treatment. The inflammation of anterior chamber were common at the early postoperative period, and inflammatory absorption after anti-inflammatory treatment. Long-term observation showed no loosening or shedding of the line knot in the pupil area.<p>CONCLUSION: Single-pass four-throw pupilloplasty is simple, safe and effective. It can obviously eliminate the visual impairment caused by the large pupil after acute glaucoma attack.

Phacoemulsification with single-pass four-throw pupilloplasty and pre-Descemet's endothelial keratoplasty for management of cosmetic iris implant complication

Placement of an anterior chamber iris implant for cosmetic reasons has been associated with development of various complications. Even after the implant has been explanted from the eye, it leaves a trail of after effects that necessitate surgical management. We describe a technique that comprises of performing phacoemulsification with single-pass four-throw pupilloplasty and a pre-Descemet's endothelial keratoplasty procedure for this eye with cosmetic iris implant complication.