Management of acute corneal hydrops with compression sutures and air tamponade

Background: Acute corneal hydrops is a vision threatening complication of corneal ectasia like keratoconus, keratoconus, keratoglobus, Pellucid marginal degeneration, Terrien’s marginal degeneration and post refractive surgery keratectasia. The associated risk factors for development of corneal hydrops (CH) are early onset of keratoconus, microtrauma associated with contact lens use, eye rubbing, allergic conjunctivitis, atopy, and Down’s syndrome. With the conservative approach of management of CH, it takes longer time (in months) for corneal oedema to get resolved and there is development of vascularization and scarring. This video presents the simple technique of using compression sutures along with pneumodescemetopexy by intracameral air injection for management of CH. It led to rapid resolution of corneal oedema. It is a simple technique, with no need of special gases like C3F8 or SF6 and can be easily performed at a very basic set up. Purpose: To highlight the efficacy of simple technique of applying compression sutures and air tamponade in management of CH and to demonstrate the efficacy of anterior segment OCT in diagnosis and to assess the prognosis of a case of CH. Synopsis: A 9-year-old boy presented with CH, with anterior segment OCT showing torn descemet’s membrane and fluid pockets in corneal stroma. Four full-thickness compression sutures were applied and intracameral sterile air was used for pneumodescetopexy. The serial post operative clinical and OCT picture showed rapid resolution of corneal oedema. Highlights: This video highlights the use of OCT imaging in the diagnosis of CH and full-thickness compression sutures as the safe and effective technique in the management of acute CH.

Conservative treatment for hemorrhage during mcaesarean operation / 中国实用妇科与产科杂志

Hemorrhage often occurs during caesarean section,which can lead to severe postpartum hemorrhage if not treated in time.Effective treatment can avoid serious bleeding and following complications.This paper discussed the advantages and disadvantages of various hemostasis schemes,which included uterotonics,uterine cavity tamponade,uterine compression suture,and vascular occlusion.Any hemostasis selected should be used as early as possible to achieve sufficient effect and reduce the morbidity of complications after massive hemorrhage.

Effect of uterine compression suture in the prevention and treatment of postpartum hemorrhage of cesarean section / 中国基层医药

Objective To analyze the clinical effect of uterine artery ligation combined with modified uterine compression suture in the prevention and treatment of postpartum hemorrhage.Methods A total of 107 patients with refractory cesarean section who were treated with uterine artery ligation combined with modified uterine compression suture were selected as treatment group.Of the patients treated with conventional treatment,83 patients were included in the control group.The effective hemostasis rate,clinical curative effect,incision infection,postpartum hemorrhage,blood transfusion rate,mattress rate and postoperative morbidity were compared between the two groups.Results The amount of intraoperative blood loss (1 106 ± 458.78) mL in the treatment group was significantly higher than (753.6 ±302.30)mL in the control group,the difference was statistically significant (t =1.892,P ＜ 0.05).The 24h total blood loss of the the treatment group [(1 028.89 ± 375.87) mL] was significantly higher than (813.87 ± 312.15) mL of the control group (t =3.872,P ＜ 0.05).The postoperative 24h blood loss in the treatment group [(70.86 ±19.30)mL] was lower than (73.50 ± 21.20)mL in the control group,and the difference was not statistically significant (t =0.045,P ＞ 0.05).The transfusion rate in the treatment group was 27.10％,which in the control group was higher than 10.84％,the difference was statistically significant between the two groups (x2 =7.722,P ＜ 0.05).The effective hemostasis rate in the treatment group was 99.66％ (106/107),which was significantly higher than 96.39％ in the control group (x2 =6.263,P ＜ 0.05).The rate of puerperal infection was 7.48％ in the treatment group,which in the control group was 6.02％,there was no significant difference between the two groups (P ＞ 0.05).The incision infection rate and postoperative morbidity rate were 0.00％ in the treatment group and the control group,and the two groups were treated with Ⅱ / A healing.Conclusion Uterine artery ligation combined with improved uterine compression suture in the prevention and treatment of postpartum hemorrhage has good hemostasis effect,hysterectomy rate is low,it is worthy of promoting and application.

Sutura compresiva invaginante para control de la hemorragia obstétrica / Invaginant compression suture for the management of obstetric hemorrhage

Resumen OBJETIVO: determinar el efecto de la aplicación de la sutura compresiva invaginante para control de la hemorragia obstétrica secundaria a atonía uterina. MATERIALES Y MÉTODOS: estudio retrospectivo, transversal y descriptivo. Expedientes clínicos de pacientes del Hospital de Ginecología y Obstetricia de Ciudad Cuauhtémoc atendidas entre enero 2015 a marzo 2016 a quienes se aplicó la sutura compresiva invaginante como primer procedimiento quirúrgico en hemorragia obstétrica secundaria a atonía, sin respuesta al tratamiento farmacológico. Para el análisis estadístico se utilizaron medidas de tendencia central y el programa SPSS versión 16.0. RESULTADOS: se identificaron 9 pacientes con edad promedio de 25.1 años (límites 14 y 40), edad gestacional de 37.2 semanas (límites 32 y 40). El sangrado promedio fue de 2033 mL (límites 1800 y 2500 mL). El tiempo promedio de la intervención quirúrgica fue de 49 minutos y el tiempo de colocación de la sutura de 1.8 minutos. La sutura compresiva invaginante fue efectiva como único procedimiento en 8 casos (89%). En un caso se requirieron otros procedimientos (B-Lynch, ligadura de arterias hipogástricas, histerectomía obstétrica). No se identificaron complicaciones a corto plazo asociadas con el procedimiento, ni hubo muertes maternas. CONCLUSIONES: la sutura compresiva invaginante fue efectiva, como primer procedimiento quirúrgico, para controlar la hemorragia obstétrica y sin complicaciones a corto plazo. La cantidad de casos es limitada por lo que no puede descartarse la posibilidad de complicaciones a largo plazo y la necesidad de más estudios.

Abstract OBJECTIVE: To determine the effect of the implementation of the invaginant compression suture in the management of obstetric hemorrhage due to uterine atony. MATERIALS AND METHODS: Observational, descriptive, transversal, retrospective study. Medical records from the Obstetrics & Gynecology Hospital of the city of Cuauhtémoc in Mexico in which the invaginant compression suture was used as a first option in the surgical management of an obstetric hemorrhage due to uterine atony unresponsive to pharmacological treatment, from January 2015 to March 2016. Measures of central tendency were performed for the statistical analysis using the software SPSS, version 16.0. RESULTS: nine patients were identified during the study. The mean age was 25.1 years (14-40y), the mean gestational age was 37.2 weeks (32-40w). The mean of the estimated bleeding was 2033 ml (1800-2500ml). The duration of the surgical procedure was 49 minutes, duration of the suture placement 1.8 minutes (1-3). The invaginant compression suture was effective as the only option in 8 cases (89%). In one case other procedures were required (B-Lynch suture, hypogastric arteries ligation, hysterectomy). There were no complications associated or maternal deaths reported. CONCLUSIONS: The invaginant compression suture was effective as a first surgical option in the management of obstetric hemorrhage in these patients, without short-term complications. There was a limited number of patients and long-term complications can not be ruled out. More studies to evaluate this parameter are required.

Transverse compression suture in lower uterine segment to control postpartum hemorrhage at cesarean delivery for placenta previa / 局解手术学杂志

Objective To study the efficacy and safety of transverse compression suture in the lower uterine segment for the control of postpartum haemorrhage in cesarean section caused by placenta previa. Methods From Jan 2011 to Jan 2013, 21 patients with postpartum haemorrhage in cesarean section due to placenta previa were given transverse compression suture in the lower uterine segment after routine medical treatment. And the hemostatic efficacy and safety were observed. Results 20 cases of the vaginal bleeding were controlled efficient-ly, with an efficiency of 95. 2%. There was no complication occurred, and menstruation were back to normal during the follow-up, and there was nothing abnormal in the uterine double accessories through B ultrasound reexamination. Conclusion Transverse compression suture in the lower uterine segment is an easy, safe and highly effective surgical technique, it is especially suitable for the control of haemorrhage in the lower uterine segment caused by placenta previa.

The Short-Term Effect of Limbal Relaxing Incision and Compression Suture on Post-Penetrating Keratoplasty Astigmatism

PURPOSE: To investigate the short-term effect of limbal relaxing incisions accompanied by compression sutures on postoperative astigmatism in penetrating keratoplasty. METHODS: The medical records of patients who underwent penetrating keratoplasty, were followed-up for at least 18 months and had residual astigmatism greater than 4.0 diopters (D), were retrospectively analyzed. The patients had paired limbal relaxing incisions on the steep axis and compression sutures on the flat axis. The paired limbal relaxing incision was done for 2 clock hours each with a depth of 85% of the corneal thickness, and the compression sutures with an average of 3.2 bites were added with a Troutman operating keratometer guide. The visual acuities, corneal astigmatism and complications were evaluated at 1 month and 6 months. RESULTS: At 1 month after the surgery, the best corrected visual acuities (log MAR) improved from 0.840 to 0.674 (p = 0.037) except for 1 patient with immediate postoperative rejection and another patient with a pre-existing cataract. The mean corneal astigmatism was reduced from 9.118 +/- 3.158 D to 4.982 +/- 3.063 D (p = 0.021). At 6 months after the surgery, the mean corneal astigmatism increased to 5.489 +/- 2.670 D (p = 0.008), and the effect of surgery became statistically insignificant (p = 0.477). CONCLUSIONS: Paired limbal relaxing incisions and compression sutures were effective short-term on reducing residual corneal astigmatism and improving visual acuities in keratoplasty patients with high astigmatism, but became less effective on corneal astigmatism at 6 months.

Treatment outcome of uterine compression sutures for massive postpartum hemorrhage / 대한산부인과학회지

OBJECTIVE: Uterine compression sutures such as modified B-Lynch suture or multiple square-shaped sutures of uterine body are simple methods for control of postpartum hemorrhage refractory to medical treatment. We evaluated the treatment outcome and morbidity of uterine compression sutures and analyzed clinical findings of patients undergone uterine compression sutures and postpartum hysterectomy. METHODS: From January 2005 through December 2008, we retrospectively reviewed the medical records of patients undergone uterine compression sutures or postpartum hysterectomy. We analyzed success rates of preserving uterus of uterine compression sutures according to operative indications and mode of delivery and compared maternal characteristics, operative findings, morbidities and mortality with those of postpartum hysterectomy. RESULTS: The frequency of uterine compression sutures for control of massive postpartum hemorrhage was 0.24% (73/30,677). The success rates of preserving uterus were 85.1% in uterine atony, 80.9% in placenta previa, and 40.0% in placenta accreta (P=0.051). The rates of preserving uterus of uterine compression sutures after vaginal delivery and cesarean section were 50.0% and 82.6%, respectively (P=0.164). The frequencies of postoperative morbidities such as disseminated intravascular coagulation, pulmonary edema, ileus were not different between immediate hysterectomy and hysterectomy after uterine compression sutures. There was no maternal mortality. CONCLUSION: Uterine compression suture was successful method for control of postpartum hemorrhage resulting from uterine atony and placenta previa. We suggest the use of uterine compression sutures as the first-line operation for control of postpartum hemorrhage.