Résumé
Background: Glaucoma is one of the major causes of irreversible blindness in the world, with trabeculectomy still being the primary surgical modality for the management of glaucoma. Glaucoma drainage devices (GDDs) have been conventionally used for the treatment of refractory glaucoma and are found to be beneficial in eyes with prior unsuccessful filtration surgeries and primary choice of surgery in certain glaucoma. Aurolab aqueous drainage implant (AADI) is a nonvalved device useful in refractory glaucoma to achieve low intraocular pressure (IOP). The device has been commercially available in India since 2013 and is like the Baerveldt glaucoma implant in design and function. AADI being the most economical and effective GDD in controlling IOP is becoming a popular choice among ophthalmologist in developing countries. AADI surgery has steep learning curve due to large end?plate surface area which needs a rigorous conjunctival dissection, muscle hooking, meticulous plate fixations, and careful tube ligations and insertion. There are different techniques of performing AADI surgery, but the authors have tried to simplify the complex surgery for easy and catchable learning of the procedure by novice surgeon with their experience and have elaborated a step?wise most effective way of performing surgery. Purpose: This video?based skill transfer depicts steps of AADI surgery with compilation of various modifications and authors’ tips and tricks to novice surgeons. Synopsis: This video depicts detailed steps of AADI surgery with micro?points and authors experience. Video also shows various tailor?made modifications of surgical techniques for different case scenarios. Highlights: Steps of AADI surgery, modifications, and surgical pearls.
Résumé
Background: Trabeculectomy is still the most frequently performed glaucoma surgery. But being an invasive procedure, it has numerous vision?threatening complications along with bleb?related complications like cystic bleb, overhanging bleb blebitis, or endophthalmitis. The choice of therapy between medical laser and filtering surgery is now bridged by minimally invasive glaucoma surgeries (MIGS), which are conjunctiva?sparing procedures with adequate intraocular pressure (IOP)?lowering effects and good safety profiles. Among the armamentarium of MIGS procedures, gonioscopy?assisted transluminal trabeculotomy (GATT) is a frontrunner safe procedure. The procedure is a blebless and sutureless procedure in which a readily available Prolene suture is used to cleave the entire trabecular meshwork. An ab interno approach also allows direct visualization of a so?called trabecular shelf that, when present, indicates an open, cleaved collector system commonly associated with a positive postoperative outcome. Thus, it not only saves the eye from various postoperative complications of other previous penetrating procedures, but is also an effective glaucoma surgery that can be performed with very low costs, which would have big economic implications for glaucoma carein developing countries. Purpose: The purpose of this video is to illustrate transluminal novel trabeculotomy technique and video?based skill transfer to a novice surgeon. Synopsis: This video depicts detailed steps of GATT surgery in a patient with primary open angle glaucoma and in a case of silicon oil induced secondary open angle glaucoma. The authors also share their experience regarding possible intraoperative problems and solutions with some tips and tricks to make the surgery easy. Highlights: GATT can be performed with cataract surgery with minimal patient morbidity and a short recovery time with preserving healthy conjunctiva. There is no risk of post op hypotony or bleb related complications, with a short surgical learning curve
Résumé
Due to an urgent need for information on the coverage of health service for women and children after the fall of Taliban regime in Afghanistan, a multiple indicator cluster survey (MICS) was conducted in 2003 using the outdated 1979 census as the sampling frame. When 2004 pre-census data became available, population- sampling weights were generated based on the survey-sampling scheme. Using these weights, the population estimates for seven maternal and child healthcare-coverage indicators were generated and compared with the unweighted MICS 2003 estimates. The use of sample weights provided unbiased estimates of population parameters. Results of the comparison of weighted and unweighted estimates showed some wide differences for individual provincial estimates and confidence intervals. However, the mean, median and absolute mean of the differences between weighted and unweighted estimates and their confidence intervals were close to zero for all indicators at the national level. Ranking of the five highest and the five lowest provinces on weighted and unweighted estimates also yielded similar results. The general consistency of results suggests that outdated sampling frames can be appropriate for use in similar situations to obtain initial estimates from household surveys to guide policy and programming directions. However, the power to detect change from these estimates is lower than originally planned, requiring a greater tolerance for error when the data are used as a baseline for evaluation. The generalizability of using outdated sampling frames in similar settings is qualified by the specific characteristics of the MICS 2003—low replacement rate of clusters and zero probability of inclusion of clusters created after the 1979 census.