Self-rescue technique and Yamane’s technique in situ: Management of intraoperative haptic slippage

Haptic slippage is a frequently encountered and technically demanding complication in Yamane’s surgery. The slipped haptic could be regained when bimanual operations are workable. Management of haptic slippage is difficult when the right hand is occupied by the puncture needle, which could be solved easily with the self-rescue technique, which uses the needle tip as an intraocular instrument for better exposure and easier engagement of the slipped haptic. With the aid of bimanual operations and self-rescue technique, Yamane’s technique in situ is applicable when the haptic of dislocated intraocular lens suits for flange-making.

Efficacy of two kinds of posterior chamber intraocular lens fixation in the treatment of lens dislocation / 国际眼科杂志(Guoji Yanke Zazhi)

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.

Sutureless and glue-free limbal-conjunctival autograft in primary and recurrent pterygium: A pilot study

Purpose: To evaluate and analyze the outcomes of sutureless and glue?free limbal?conjunctival autografting in cases of primary as well as recurrent pterygium. Methods: This prospective interventional study was carried out between February 2019 and February 2020 at a tertiary care hospital in North India. A total of 70 patients with pterygium underwent sutureless and glue?free limbal?conjunctival autograft. The patients were divided into two groups: group 1 patients with primary pterygium (n = 45), group 2 patients with recurrent pterygium (n = 25). The patients were followed up till 12 months postoperatively. Results: The mean age of the patients in group 1 and group 2 was 37.04 ± 8.69 years and 32.52 ± 6.49 years, respectively (P = 0.04). Postoperatively, no recurrence was recorded in group 1. Recurrence was noticed in two patients (8%) of group 2. The BCVA changed from 78.73 ± 9.86 letters to 80.15 ± 7.29 letters (P = 0.45) and from 79.6 ± 6.44 letters to 79.8 ± 5.86 letters (P = 0.45) in group 1 and group 2, respectively. Graft edema was found in seven (15.55%) cases of group 1 and four (16%) cases of group 2. Graft retraction was found in two (4.44%) cases of group 1 and three (12%) cases of group 2. Conclusion: Sutureless and a glue?free limbal?conjunctival autograft is a safe and effective treatment option for primary as well as recurrent pterygium.

A Case of Left Ventricular Free Wall Rupture with Suspected Posterior Papillary Muscle Necrosis / 日本心臓血管外科学会雑誌

We report a case of arbitrary delayed surgical repair for left ventricular free wall rupture (LVFWR) after acute myocardial infarction with suspected posterior papillary muscle necrosis. The case was a 67-year-old woman who had chest and back pain in the morning, and relapsed in the evening, and was urgently transported. She had an acute lateral wall myocardial infarction on an electrocardiogram and pericardial effusion on transthoracic echocardiography (TTE). She was found to have an obstruction at the origin of the left circumflex branch on coronary angiography. TTE showed low-intensity findings on the head of the posterior papillary muscle, suggesting necrosis of the papillary muscle. For LVFWR, conservative treatment was prioritized and IABP (intra-aortic balloon pumping) management was performed for the purpose of reducing after load because there was concern about papillary muscle rupture (PMR) due to cardiac manipulation and because it was an oozing type and did not disrupt respiratory of circulatory dynamics. On the 7th day after the onset, TTE showed improvement in echo-luminance of the posterior papillary muscle head and gradual increase in pericardial fluid, and a non-suture procedure was performed. She withdrew from the IABP on the third day after surgery and was discharged home on the 12th day.

A modified sutureless technique treating total anomalous pulmonary venous connection / 中国胸心血管外科临床杂志

@#Objective    To introduce a modified sutureless technique and its surgical results in the treatment of total anomalous pulmonary venous connection (TAPVC). Methods    Clinical data of 11 patients with TAPVC who underwent the modified sutureless technique treatment from 2014 to 2019 in our center were retrospectively analyzed, including 4 males and 7 females. The median surgical age was 1.4 (0.3, 27.0) months. The median weight was 4.3 (3.5, 8.5) kg. Six (54.5%) patients were of supracardiac subtype, and five (45.5%) patients were of infracardiac subtype. Five (45.5%) patients had preoperative severe pulmonary hypertension, and three (27.3%) patients had preoperative pulmonary vein obstruction. The surgical results were compared with those of 10 patients treated with conventional surgical technique. Results    The median follow-up was 12 (range, 1-65) months. During the follow-up, no death or postoperative pulmonary vein obstruction occurred in the modified sutureless technique group. The perioperative data and relief of re-obstruction were superior in the modified sutureless technique group, but the difference was not statistically significant (P>0.05). The postoperative survival of the the modified sutureless technique group was better than that of the traditional surgery group (P=0.049). Conclusion    The modified sutureless technique which includes partial suture and then incising, and eversion of pulmonary vein incision, is a safe and reliable method for the treatment of TAPVC with satisfactory short-term results.

25G lens resection combined with anterior vitrectomy in the treatment of congenital cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the clinical efficacy of 25G lens resection combined with anterior vitrectomy in the treatment of congenital cataract.<p>METHODS: This retrospective case series study included 55 eyes of 38 children with congenital cataract, age from 3mo to 5 years old, who were recruited between May 2013 and August 2017. The children were divided into two groups according to the different surgical methods. Group A(25 eyes of 17 children)received a 25G sutureless lensectomy combined with capsulotomy and anterior vitrectomy, and group B(30 eyes of 21 children)received a cataract phacoemulsification combined with capsulotomy and anterior vitrectomy. The mean follow-up time was 43.4(range: 36-74)mo. The postoperative best corrected visual acuity(BCVA), axial length, and complications were compared. <p>RESULTS: The age, sex distribution, duration, preoperative BCVA, and preoperative axial lengths were not significantly different between the two groups(<i>P</i>>0.05). The BCVA improved significantly at postoperative compared with BCVA at baseline in both gorups(Group A: <i>P</i><0.001; Group B: <i>P</i><0.001). The BCVA was better in Group A than Group B at 6mo postoperatively(<i>P</i>=0.043). No statistically significant difference was found in BCVA between the two groups at 12, 24 and 36mo after initial treatment(<i>P</i>=0.727, <i>P</i>=0.286, <i>P</i>=0.889). No statistically significant difference was found in axial lengths between 6mo of postoperation and preoperation in both groups(Group A: <i>P</i>=0.206, Group B: <i>P</i>=0.082). The mean postoperative axial lengths at 12, 24 and 36mo were longer than that at baseline in both group(Group A: <i>P</i>=0.023, <i>P</i>=0.015, <i>P</i><0.01, Group B: <i>P</i>=0.018, <i>P</i><0.01, <i>P</i><0.01). There were no significantly different in mean axial length after operation between the two groups(6mo: <i>P</i>=0.195, 12mo: <i>P</i>=0.313, 24mo: <i>P</i>=0.485, 36mo: <i>P</i>=0.089). The rate of postoperative complications was lower in Group A than Group B(<i>P</i>=0.042).<p>CONCLUSION: 25G sutureless lensectomy combined with capsulotomy and anterior vitrectomy is an effective and safe treatment method for congenital cataract, the visual acuity after treatment was improved significantly.

Experiencia inicial del cierre sin sutura de la gastrosquisis. Reporte de casos en un hospital de la ciudad de Puebla, México / Initial experience of the sutureless closure of gastroschisis. Report of cases in a hospital in the city of Puebla, México

Resumen Introducción: La gastrosquisis es una de las malformaciones congénitas más frecuentes. En países subdesarrollados su mortalidad es mayor al 15% siendo la sepsis su principal causa. Su manejo implica el cierre de la pared abdominal mediante diferentes métodos, dependiendo del nivel de complejidad y del tipo de intervención. Objetivo: Describir la experiencia inicial del cierre sin sutura de la gastrosquisis, en una unidad de neonatología de Puebla, México. Materiales y métodos: Se realizó un estudio observacional, descriptivo, transversal y retrospectivo; en el cual se estudiaron 9 expedientes de recién nacidos con cierre sin sutura de gastrosquisis, en el Hospital General del Sur de Puebla. Resultados: Se estudiaron a los pacientes de Diciembre 2018 a Agosto 2019, de los cuales el 56% correspondía al sexo masculino. Se dividieron en 3 grupos: Cierre inmediatamente posterior a la cesárea (67%), retardo inmediato (11%), y retardo con uso del separador Alexis (22%). De los pacientes, el promedio fue de 25.67 + 1.56 días de estancia intrahospitalaria. Únicamente un paciente del grupo 2 presentó como complicación sepsis, el resto no manifestó complicación alguna. Conclusiones: El cierre sin sutura en nuestros pacientes resultó ser un procedimiento confiable y con buen pronóstico para su evolución, debido a resultados favorables en los días de estancia intrahospitalaria y el tiempo de inicio de la vía oral. MÉD.UIS.2020;33(3): 43-7.

Abstract Introducción: La gastrosquisis es una de las malformaciones congénitas más frecuentes. En países subdesarrollados su mortalidad es mayor al 15% siendo la sepsis su principal causa. Su manejo implica el cierre de la pared abdominal mediante diferentes métodos, dependiendo del nivel de complejidad y del tipo de intervención. Objetivo: Describir la experiencia inicial del cierre sin sutura de la gastrosquisis, en una unidad de neonatología de Puebla, México. Materiales y métodos: Se realizó un estudio observacional, descriptivo, transversal y retrospectivo; en el cual se estudiaron 9 expedientes de recién nacidos con cierre sin sutura de gastrosquisis, en el Hospital General del Sur de Puebla. Resultados: Se estudiaron a los pacientes de Diciembre 2018 a Agosto 2019, de los cuales el 56% correspondía al sexo masculino. Se dividieron en 3 grupos: Cierre inmediatamente posterior a la cesárea (67%), retardo inmediato (11%), y retardo con uso del separador Alexis (22%). De los pacientes, el promedio fue de 25.67 + 1.56 días de estancia intrahospitalaria. Únicamente un paciente del grupo 2 presentó como complicación sepsis, el resto no manifestó complicación alguna. Conclusiones: El cierre sin sutura en nuestros pacientes resultó ser un procedimiento confiable y con buen pronóstico para su evolución, debido a resultados favorables en los días de estancia intrahospitalaria y el tiempo de inicio de la vía oral. MÉD.UIS.2020;33(3): 43-7.

A comparative study between harmonic scalpel hemostasis and conventional hemostasis in total thyroidectomy

Background: Thyroidectomy is the most commonly performed procedure in endocrine surgery. Since the thyroid gland is highly vascular, therefore, rapid and absolute hemostasis is extremely required. Conventional thyroidectomy is commonly used with acceptable outcomes, however, it is time‑consuming and resulted in significant intraoperative blood loss with the possible risk of postoperative hemorrhage, injury to parathyroid glands and laryngeal nerves. The advent of focus harmonic devices was encouraging for improving safety, effectiveness, and reduction of operative time, especially in thyroid surgery. Aim of this study: The purpose of this study was to analyze the effectiveness and surgical outcomes of using ultrasonic harmonic scalpel for thyroid surgery compared to conventional techniques.Methods: This was a prospective, randomized study in which 60 patients with various types of goiters presented for thyroidectomy. The patients were divided into two comparable groups. Group A (30 patients) included patients who had focus harmonic thyroidectomy and Group B (30 patients) included patients who underwent conventional thyroidectomy.Results: Focus harmonic thyroidectomy showed a significant reduction in operative time, intraoperative blood loss, volume of postoperative fluid drainage and meantime for hospital stay compared with conventional thyroidectomy. There were no significant differences in the incidence of postoperative hypocalcemia, seroma, hematoma, wound infection and laryngeal nerve injury between both groups.Conclusions: Focus harmonic thyroidectomy was a safe, effective, faster, and appealing alternative to conventional technique since it reduced the operative time, intraoperative blood loss, postoperative drainage and hospital stay with comparable postoperative complications.

Intraocular lens-sling technique: A safe approach for lens implantation in complicated cataract surgery and secondary intraocular lens implantation

Among 20 million cataract surgeries being performed worldwide every year, approximately 5% are being complicated by posterior capsule rent or zonular dialysis. Intraocular lens (IOL) implantation in such cases with intraoperative complications is quite challenging. Our next course of action is to place the IOL in the ciliary sulcus, however, there is a risk of IOL drop into the vitreous in cases of inadequate support. We have described a novel idea of using a suture material through the dialling hole of a three-piece rigid IOL which can be used as a leash to reduce the risk of IOL drop during implantation in such cases. This technique could also be used during sutureless scleral fixated IOL and retro-pupillary iris claw lens implantation. We found that in 90 consecutive patients where this technique was used, there was no incidence of IOL drop or retinal detachment.

Efectividad de la técnica manual de cirugía de catarata con incisión pequeña en un establecimiento privado de salud / Effectiveness of the manual technique of cataract surgery with small incision in a private health facility

Resumen Objetivo: Determinar la efectividad de la técnica manual de cirugía de catarata con incisión pequeña (MSICS) considerando agudeza visual, astigmatismo postoperatorio, complicaciones perioperatorias y mejora de la calidad de vida de los pacientes en función de la visión. Material y métodos: Estudio observacional, descriptivo, de corte transversal de pacientes operados de catarata con MSICS, entre el 2 de noviembre del 2009 y 30 de abril del 2010 en un centro oftalmológico privado de Lima. Se registraron las características demográficas y socioeconómicas, agudeza visual (AV), complicaciones perioperatorias, astigmatismo pre y postoperatorio y calidad de vida en función de la visión (CVFV). Resultados: Se realizaron 806 cirugías en 591 pacientes. La media de edad fue 75 años, 304 (51,49%) casos fueron del sexo femenino y 501 (84,74%) procedentes de Lima Metropolitana. Al alta, la AV sin corrección fue de 20/40 o mejor en 481 casos (59,64%), con astigmatismo quirúrgicamente inducido menor de 2,00 D en 732 (90,80%). En 64 (7,94%) casos ocurrieron complicaciones intraoperatorias y en 52 (6,45%), postoperatorias. La percepción de la CVFV del paciente en función de la visión a los 30 días fue: "Buena" en 311 (41,25%), "Muy Buena" en 405 (53,71%) con diferencia significativa (p<0.05) en relación a la evaluación preoperatoria. Conclusiones : El MSICS es una técnica quirúrgica altamente efectiva considerando una buena agudeza visual y bajo astigmatismo inducido postoperatorios, bajo porcentaje de complicaciones y significativa mejora de la CVFV del paciente.

Objective: To determine the effectiveness of the manual technique of cataract surgery with small incision (MSICS) considering visual acuity, postoperative astigmatism, perioperative complications and improvement of the quality of life of patients based on vision. Methods: Observational, descriptive, cross-sectional study in patients operated on cataract with MSICS, between November 2, 2009 and April 30, 2010 in a private ophthalmological center in Lima. Demographic and socioeconomic characteristics, visual acuity (VA), perioperative complications, pre and postoperative astigmatism and quality of life based on vision (CVFV) are included. Results: 806 surgeries were performed in 591 patients. The mean age was 75 years, 304 cases (51.49%) were female and 501 (84.74%) from Metropolitan Lima. The VA without correction at discharge was 20/40 or better in 481 (59.64%) cases, with surgically induced astigmatism less than 2.00 D in 732 (90.80%). Intraoperative complications occurred in 64 cases (7.94%) and postoperative complications in 52 (6.45%). The patient's CVFV perception based on vision at 30 days was "Good" in 311 (41.25%), "Very Good" in 405 (53.71%) with significant difference (p <0.05) in relation to the preoperative evaluation. Conclusions: The MSICS is a highly effective surgical technique considering good visual acuity and low postoperative induced astigmatism, low percentage of complications and significant improvement of the patient's CVFV.

Audit of 1000 consecutive cases of sutureless cataract surgery in children above two years of age

Purpose: To study the safety of sutureless cataract surgery and risk factors for wound leak of clear corneal incision in children affected with congenital or developmental cataract. Methods: It is a retrospective, noncomparative interventional case study involving children in the age group of 2 to 16 years, who underwent cataract surgery with intraocular lens implantation with the minimum follow up of 1 month. Results: Out of 1000 eyes studied, lens matter aspiration with intraocular lens implantation with or without primary posterior capsulorhexis and anterior vitrectomy was done in 609 and 391 eyes, respectively. Incisions of 943 eyes did not require sutures while sutures were applied for wound leak in 57 eyes on the table and in 5 eyes on postoperative day 1. Risk of wound leak for suture application was found to be greater in patients; having age less than 5 years (P < 0.0001), surgeries performed by junior surgeons (P < 0.0003), wound problems (P < 0.0001), intraocular lens (IOL) related factors (P < 0.0001), use of iris hooks (P < 0.0001), and anterior capsulorhexis extension (P < 0.0001). On the first postoperative day, anterior chamber reaction (P < 0.0001) and fibrinous membrane (P = 0.0007) were significantly more in the sutured group. Incidence of postoperative complications was 0.98 per sutured eyes (59 complications in 60 eyes). One patient developed endophthalmitis after suture removal. Conclusion: Sutureless clear corneal incision in pediatric patients undergoing cataract surgery can achieve stable wound. However, after hydro closure, every wound should be checked for water tightness and the leaky wound should be sutured.

To Study the Outcome of Inguinal Hernia Repair with Sutureless Self-Gripping Mesh in Terms of Postoperative Pain, Complications and Recurrence

The concept of sutureless mesh as well as light weight mesh came into play because of inguinodynia. Thisstudy was chosen most importantly to determine the post-operative persisting chronic pain after the use ofsutureless mesh. Data was collected from patients attending Govt. Medical College & Hospital, Jammu OPD,admitted in the department of surgery that underwent sutureless mesh hernioplasty for inguinal hernias. Thesepatients were followed up at 3 days, 3 weeks, 3 months and 6 months for postoperative pain, any recurrenceor development of complications. In this study, 40 patients having inguinal hernia were taken. 38 (95%) weremales and 2 (5%) were females. The age of the patients ranged between 30 to 80 years with mean age of54.53±14.88 years. Post-operative pain was studied according to VISUAL ANALOG SCALE scoring, out of10. Mean post-operative pain score after 3 days was 2.70±1.16, which decreased to 0.85± 1.10 at 3 weeks(68.52% decrease) and after 3 months it was 0.30±0.72 (with an 88.89% decrease). There were no othercomplications. The study concluded that the use of self-fixating mesh in open inguinal hernia repair is asimple, safe, rapid and effective option and is associated with low post-operative pain.

Outcomes of the sutureless-intrascleral fixation of posterior chamber intraocular lens implantation using modified Yamane's technique / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To observe the post-operative outcomes, safety and complications of the sutureless-intrascleral fixation of posterior chamber intraocular lens(SF-PCIOL)by using the modified Yamane's technique.<p>METHODS:This study involved 5 patients who underwent SF-PCIOL with the modified Yamane's technique, from December 2017 to September 2018. The longest follow-up time was 12mo, and the primary outcomes included uncorrected visual acuity(UCVA, LogAMR)and bestcorrected visual acuity(BCVA, LogMAR), intraocular pressure and the location and stability of IOLs.<p>RESULTS: The BCVA of 3 patients were ranged from 0.0 to 0.1 by the time of following up 12mo postoperatively. The difference between the spherical equivalent refraction and the predicted spherical equivalent refraction was in a range of 0.11-0.62 diopters. In the other two cases, at 3mo after the surgery, the UCVA was 0.2 for one case, and the BCVA was the same as preoperative corrected visual acuity for another case, where the patient manifested corneal leucoma and macular edema prior to surgery. During the follow-up period, the flanges and the IOL haptics of all the recruited patients were maintained in an ideal position, the optics were located in center of the pupils, and no visible IOL decentration or tilt was observed. Neither hypotony nor other complications were discovered in all the cases.<p>CONCLUSION: For SF-PCIOL by using modified Yamane's technique, smaller incisions and shorter operation time are feasible, and the need for scleral flaps, sutures and fibrin glue is eliminated. The IOLs are well centered and fixed securely. A learning curve is necessary to master this surgery technique. As revealed by our initial observation, the surgery is capable of producing satisfactory and consistent postoperative outcomes for patients with fewer postoperative complications as long as the crucial points are fully understood.

Surgical treatment of infracardiac total anomalous pulmonary venous connection: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To compare the outcomes of sutureless technique and conventional technique in the surgical repair for infracardiac total anomalous pulmonary venous connection (TAPVC). Methods    The clinical data of 46 consecutive patients with infracardiac TAPVC undergoing surgical repair in our hospital between June 2014 and April 2019 were retrospectively analyzed. Patients with combined congenital cardiac anomalies such as single ventricle and tetralogy of Fallot were excluded. Patients were divided into a conventional technique group and a sutureless technique group according to the surgical techniques. There were 35 patients in the conventional technique group, including 28 males (80.0%) and 7 females (20.0%) with a median age of 21 (8, 42) d and a median weight of 3.6 (3.0, 4.0) kg. There were 11 patients in the sutureless technique group, including 8 males (72.7%) and 3 females (27.3%) with a median age of 14 (6, 22) d and a median weight of 3.5 (2.9, 3.6) kg. The curative effect of the two groups was compared. Results    There were 5 deaths (10.9%) in the conventional technique group, including 4 in-hospital deaths (8.7%) and 1 late death (2.2%). Overall mortality of the conventional technique group (14.3%, 5/35) was higher than that of the sutureless technique group (0.0%, 0/11), although the difference was not statistically significant (P=0.317). Cox regression analysis showed that sex (P=0.042), age at repair (P=0.028), cardiopulmonary bypass time (P=0.007), aortic cross-clamping time (P=0.018) and duration of ventilation (P=0.042) were risk factors for postoperative mortality. The median follow-up was 18.00 (5.00, 37.75) months. Postoperative pulmonary venous obstruction occurred in 22 patients of the conventional technique group, which was significantly more than that of the sutureless technique group (P=0.000). Conclusion    For infracardiac TAPVC, sutureless technique can reduce the incidence of postoperative pulmonary venous obstruction compared with conventional technique.

Sutureless transconjunctival intrascleral intraocular lens fixation: the modified Yamane technique / Fixação de lente intraocular intraescleral transconjuntival sem sutura: técnica de Yamane modificada

ABSTRACT Purpose: To evaluate the efficacy and safety of the modified Yamane technique with sutureless transconjunctival intrascleral intraocular lens fixation. Methods: Sutureless transconjunctival intrascleral haptic fixated intraocular lens implantation was performed in patients with aphakia and dislocated intraocular lenses. A clear corneal incision (2.8 mm) was made into the temporal quadrant and a three-piece intraocular lens was implanted into the anterior chamber. The haptics of the intraocular lens were externalized with a 27 G needle via transconjunctival scleral tunnels at the 6 and 12 o'clock positions. The transconjunctival scleral tunnels were prepared to conform to the haptic position and curvature. The site of the scleral tunnels was 2mm from the limbus with a length of 2 mm in the sclera and was aimed at the end of the posterior chamber. The tips of the haptics were cauterized to create a terminal knob. The haptics were pushed back and the knobs were implanted into the scleral tunnels. Results: The study cohort included 21 patients with unilateral aphakia and dislocated intraocular lenses. All patients were examined postoperatively and at postoperative day 1, day 7, month 1, and month 3. All examinations revealed formation of the anterior chamber and well-centralized intraocular lenses. No haptic-related complications of exposure, foreign body sensation, or discomfort were observed. Conclusion: Sutureless transconjunctival intrascleral haptic fixated intraocular lensimplantation is an effective, safe, and practical surgical alternative. This technique was superior to the Yamane method with regard to comfort and surgical duration. Further studies with longer follow-up evaluations are warranted to verify long-term complications.

RESUMO Objetivo: Avaliar a eficácia e a segurança da técnica de Yamane modificada com a fixação de lenta intraocular transconjuntival sem sutura. Métodos: O implante de lente intraocular intraescleral e transconjuntival sem sutura foi realizado em pacientes com afacia e lentes intraoculares luxadas. Uma incisão em córnea clara (2,8 mm) foi feita no quadrante temporal e uma lente intraocular de três peças foi implantada na câmara anterior. Os hápticos da lente intraocular foram externalizados com uma agulha 27G através de túneis esclerais transconjuntivais nas posições de 6 e 12 horas. Os túneis esclerais transconjuntivais foram preparados para se ajustarem à posição e curvatura hápticas. O local dos túneis esclerais foi de 2 mm do limbo com um comprimento de 2 mm na esclera e foi destinado ao final da câmara posterior. As pontas dos hápticos foram cauterizadas para criar uma saliência terminal. Os hápticos foram empurrados para tras e as saliências foram implantadas nos túneis esclerais. Resultados: A coorte do estudo incluiu 21 pacientes com afacia unilateral e lentes intraocular deslocada. Todos os pacientes foram examinados no pós-operatório e no dia 1, 7, 1 mês e 3 meses do pós-operatório. Todos os exames revelaram formação da uma câmara anterior e lentes intraoculares bem centralizadas. Nenhuma complicação hápticas relacionada à exposição, sensação de corpo estranho ou desconforto foram observadas. Conclusão: O implante de lente intraocular transconjuntival intraescleral sem sutura é uma alternativa cirúrgica eficaz, segura e prática. Esta técnica foi superior ao método de Yamane no que diz respeito ao conforto e duração cirúrgica. Mais estudos com avaliações de seguimento mais prolongados são necessários para verificar as complicações de longo prazo.

Teoría Bifásica del Movimiento Dentario Aplicada Mediante Micro-Osteo-Perforaciones / Teeth Movement Bifasic Theory Applied by Micro-Osteo-Perforations

RESUMEN: Un desafío común en la ortodoncia es la realización de cierres de espacio en brechas largas con pérdida ósea significativa producto de extracciones tempranas, sitio de extracciones traumáticas o expansiones en adultos con tabla vestibular delgada. El propósito de este artículo es difundir una teoría del movimiento dental desarrollada a partir de una serie de investigaciones que intentan probarla en animales como seres humanos. Las dos fases de remodelación de hueso son la "activación - reabsorción" (proceso catabólico) y "activación-formación" (proceso anabólico) de las superficies del hueso, resultando en los cambios de tamaño, forma y posición del hueso. La inflamación es necesaria para el movimiento dentario. Se puede estimular ambas fases mediante pequeñas perforaciones del hueso que pueden ser realizadas de forma segura en la superficie vestibular o lingual de las tablas corticales pudiendo ser superficiales o profundas. Se muestran ejemplos clínicos de pacientes tratados con el enfoque de la Teoría bifásica mediante estimulación ósea transgingival. Se concluye que esta teoría bifásica permite explicar la favorable respuesta que se observa en situaciones clínicas complejas cuando se estimula el movimiento con micro-osteoperforaciones.

ABSTRACT: A common challenge in orthodontics is the task of space closures in long gaps with significant bone loss due to early extractions, site of traumatic extractions or expansions in adults with thin vestibular table. The purpose of this article is to disseminate a theory of dental movement developed from a series of investigations that try to test it in animals as human beings. The two phases of bone remodeling are the "activation - resorption" (catabolic process) and "activation-formation" (anabolic process) of bone surfaces, resulting in changes in bone size, shape and position. Inflammation is necessary for tooth movement. Both phases can be stimulated by small perforations of the bone that can be performed safely on the vestibular or lingual surface of the cortical boards, which may be superficial or deep. Clinical examples of patients treated with the biphasic theory approach by transgingival bone stimulation are shown. It is concluded that this biphasic theory allows to explain the favorable response observed in complex clinical situations when the movement is stimulated with micro-osteoperforations.

Assessment of Results of Sutureless Mesh Repair of Inguinal Hernia: An Institutional Based Study

Background: Hernia is generally defined as the protrusion of aviscus from the cavity in which it is normally contained or moreprecisely, as the protrusion of a loop or knuckle of an organ ortissue through an abnormal opening. Hence; the present studywas undertaken for assessing results of sutureless mesh repairof inguinal hernia.Materials & Methods: A total of 20 patients with inguinalhernia were enrolled in the present study. Patients who fulfilledthe inclusion criteria were included into the study after takingdetailed consent for the procedure. Inguinal hernia repair wasperformed by placing mesh on posterior inguinal wall andwithout applying fixation suture or glue. Postoperative follow-upwas done and Visual analogue scale (VAS) was used forassessment of postoperative pain on follow-up. All the resultswere recorded in Microsoft excel sheet and were analyzed bySPSS software.Results: Majority of the patients i.e. 45 percent of the patientsbelonged to the age group of 41 to 50 years, followed by 35percent of the patients who belonged to the age group of 20 to30 years. Punched out/diverticular defect in transversalis fasciawas present in 10 percent of the cases while normal posteriorwall was present in 90 percent of the cases. Mean duration ofoperative procedure was 41.25 minutes. Mean postoperativepain score at 12 hour and 24 hours was 2.95 and 1.84respectively.Conclusion: Sutureless tension free mesh repair in thetreatment of inguinal hernia cases is an effective technique.However; further studies are recommended.

Novel technique of sutureless glueless scleral fixated intraocular lens (SFIOL)

Purpose: To report results of a novel technique for sutureless, glueless intrascleral fixation of three-piece posterior chamber intraocular lens (IOL) using 26-G needle for management of aphakia. Methods: In this prospective series, 30 eyes of 20 patients with aphakia, subluxated IOL, or crystalline lens were included. 26-G-needle-guided intrascleral fixation of three-piece posterior chamber IOL was performed according to the described technique. The patients were evaluated on day 2, 1 week, 6 weeks, and 3 months postoperatively for change in best-corrected visual acuity (BCVA), intraocular pressure (IOP), IOL centration, and any other complications. The postoperative tilt of the IOL was indirectly measured by determining the lenticular astigmatism which in turn was calculated by the difference between net corneal astigmatism and refractive astigmatism. Paired t-test was used to determine the significance of any association between the preoperative and postoperative BCVA and IOP. P < 0.05 was considered significant. Results: Of 30 eyes (n = 30 patients), 18 were surgical aphakia, 6 traumatic aphakia, 5 subluxated IOL, and 1 ectopia lentis (Marfan syndrome). The mean preoperative BCVA was 1.37 ± 0.37 (logMAR) and postoperative BCVA at 3 months was 0.37 ± 0.29 (logMAR). A significant improvement in the mean BCVA (P < 0.05) was observed after the procedure. The mean IOP preoperatively was 13.33 ± 4.18 and postoperatively at 3 months was 12.82 ± 3.97 (P > 0.05), which was not significant. None of the eyes developed any intraoperative and postoperative complications. The IOLs had appropriate centration and stability. Conclusion: We have developed this new technique for intrascleral IOL fixation which is quite simple, cost-effective, minimally invasive, neither requires glue nor suture and gives consistent outcome.

Comparative analysis of retropupillary iris claw versus scleral-fixated intraocular lens in the management of post-cataract aphakia

Purpose: To compare the visual outcomes and complications between the eyes receiving retropupillary iris claw intraocular lens (IOL) and scleral-fixated IOL (SFIOL) for post-cataract aphakia. Methods: Medical records of consecutive patients who had iris claw IOL and SFIOL surgery from January 2010 to March 2015, with > 1 year of follow up were retrospectively analyzed. The surgical technique was based on individual surgeon preference. The best-corrected distance visual acuity (BCDVA), previous surgery, surgical technique, and complications were analyzed. Results: Retropupillary iris claw IOL was fixated in 48 eyes (46%) and SFIOL was performed in 56 eyes. Iris claw was performed more frequently at the time of primary cataract surgery (56%) compared to SFIOL (14%) (P < 0.001). At 1 month postoperative, BCDVA was significantly better in the SFIOL group [0.7 ± 0.5 logarithm of minimum angle of resolution (logMAR) in iris claw vs. 0.3 ± 0.2 logMAR in SFIOL, P < 0.001] but this difference did not persist at 1 year (0.4 ± 0.4 logMAR in iris claw vs. 0.3 ± 0.2 logMAR in SFIOL, P = 0.56). Eyes with iris claw IOL experienced significantly more postoperative iritis (17%), intraocular pressure spikes (10%), and ovalization of the pupil (16%). Conclusion: Retropupillary iris claw IOL fixation is as safe as SFIOL for visual rehabilitation of post-cataract aphakia. Visual rehabilitation following iris claw IOL might take longer than SFIOL. Ovalization of the pupil is the commonest adverse effect reported with this type of IOL design.

CT-guided minimally-invasive penile fracture repair

ABSTRACT We present the case of a 28 year old patient with an incomplete tear of the tunica albuginea occurred after having sexual intercourse in the female superior position. The diagnostic assessment was performed first clinically, then with CT, owing to its high resolution, allowed to exactly detect the tear location leading to precise preoperative planning. After adequate diagnosis through imaging and proper planning, the patient was performed a selective minimally invasive surgical approach to repair the lesion. The patient had good erection with no angular deformity or plaque formation after a 3-month follow-up.