Novel and easy techniques for 27-gauge silicone oil infusion and removal.

PURPOSE: To introduce novel and easy techniques for 27-gauge silicone oil (SO) infusion and removal. METHODS: Consecutive patients treated with 27-gauge pars plana vitrectomy (PPV) plus SO infusion (Infusion Group) and scheduled to have SO removal (Removal Group) were prospectively included, respectively. Patients in Infusion Group underwent 27-gauge PPV plus SO infusion. SO infusion was performed with a 24-gauge intravenous catheter connected with the SO syringe. Patients in Removal Group underwent machine-independent SO removal using a short section of infusion tube connected with a 10-mL syringe. Main outcomes were best-corrected visual acuity, intraocular pressure, surgical time and intra- and postoperative complications. RESULTS: There were thirty-five eyes (35 patients) and forty eyes (40 patients) included in Infusion and Removal Groups, respectively. Mean surgical time of complete SO infusion and removal was 5.5 ± 0.9 and 9.6 ± 2.1 min, respectively. In both groups, no patient experienced postoperative vision deterioration or hypotony. No obvious intra- and postoperative complications were observed. CONCLUSIONS: We recommend the use of the 24-gauge catheter method for 27-gauge silicone oil infusion when commercial infusion cannula is unavailable. The machine-independent method using easily available plastic infusion tube and syringe would be an ideal option when 27-gauge surgery is anticipated.

A Novel Approach to In-Office Air-Fluid Exchange Utilizing a 27-Gauge Valved Trocar Cannula.

BACKGROUND AND OBJECTIVE: To describe a new approach for in-office air-fluid exchange. PATIENTS AND METHODS: This manuscript describes a procedural technique. A retrospective chart review of three patients on whom the procedure was performed is presented. RESULTS: The authors have performed this novel procedure on three eyes of three patients. All patients were followed for at least 3 months after the procedure. No short-term complications occurred, and no secondary procedures were required to achieve a near-complete air-fluid exchange. CONCLUSION: This novel technique is a reliable and reproducible procedure that allows for in-office air-fluid exchange with good results in this small cohort of patients. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:799-801.].

Vitrectomy with and without encircling band for pseudophakic retinal detachment: VIPER Study Report No 2-main results.

BACKGROUND: It is unclear whether or not an additional encircling band improves outcome in vitrectomy for pseudophakic retinal detachment (PRD). Also unclear is whether small gauge transconjunctival trocar-guided vitrectomy is as successful as conventional 20 gauge (G) vitrectomy. METHODS: 257 adult patients with uncomplicated PRD were enrolled in 14 vitreoretinal centres across Germany. Contingent on availability of qualified surgeons, eligible patients were randomly assigned either (i) with ratio 1:1 to 20 G vitrectomy plus encircling band (group E1) or 20 G vitrectomy without any buckle (group C) or (ii) with ratios 1:1:1 to group E1, C or 23/25 G vitrectomy without any buckle (group E2). Treatment success was defined as no indication for any retina reattaching procedure during the follow-up of 6 months. RESULTS: Success was reached in 79.0% (=79/100, group E1) versus 73.5% (=72/98, group C) (p=0.558, OR 1.32, 95% CI 0.65 to 2.65. In group E2 87.7% (=50/57) of patients reached success compared with 78.7% (=48/61) in group C, demonstrating non-inferiority of E2 to C regarding the prespecified margin of 0.8 (OR scale; p=0.05, OR 2.17, 95% CI 0.80 to 5.89). Best corrected visual acuity significantly increased after surgery independent of technique, that is, on average -0.7 (from 1.0 to 0.3) logMAR. Patients suffered from a shift in spherical refraction of -1.0 D in group E1 compared with -0.1 D in group C. Similarly, intraoperative complications (15.2% vs 8.8% of patients) and serious adverse events (30.3% vs 22.5% of patients) were more frequent in group E1. CONCLUSIONS: Vitrectomy with gas is an efficient and safe treatment for uncomplicated PRD. An additional encircling band does not significantly reduce the risk for any second procedure necessary to reattach the retina in 20 G vitrectomy. Small gauge transconjunctival vitrectomy is not inferior to the conventional 20 G technique. TRIAL REGISTRATION NUMBER: DKRS 00003158, Results.

Outcomes of transconjunctival sutureless 27-gauge vitrectomy with silicone oil infusion.

PURPOSE: To demonstrate the safety and efficacy of 27-gauge pars plana vitrectomy (PPV) in selected patients with vitreoretinal diseases requiring silicone oil (SO) tamponade. METHODS: Retrospective review of a consecutive interventional case series at a single center. RESULTS: Twenty-one eyes of 19 patients were included in the study. The indications for PPV and SO tamponade were as follows: fibrovascular tractional retinal detachment (12 eyes), rhegmatogenous retinal detachment with proliferative vitreoretinopathy (three eyes), primary rhegmatogenous retinal detachment (two eyes), macular hole (two eyes), vitreous hemorrhage (one eye), and endophthalmitis (one eye). All eyes underwent transconjunctival sutureless 27-gauge PPV with either 1000-cS (16 eyes) or 5000-cS (five eyes) SO tamponade. No intraoperative complications occurred. Mean preoperative best-corrected visual acuity (BCVA) was 20/300 (range, light perception to 20/40; median, counting fingers). Mean postoperative BCVA was 20/160 (range, no light perception to 20/25; median 20/300; p = 0.022). Follow-up was 6.4 ± 8.8 months (range, 1-38 months; median, 4 months). No complications relating to 27-gauge placement of SO were observed. CONCLUSIONS: Results show that 27-gauge PPV with SO injection appears safe, is efficient, and may be considered for the surgical management of vitreoretinal diseases requiring SO tamponade.

Conceptualized Use of Self-Expanding Foam to Rescue Special Operators From Abdominal Exsanguination: Percutaneous Damage Control for the Forward Deployed.

BACKGROUND: Noncompressible hemorrhage is the leading cause of potentially survivable death on the battlefield. In Special Operations Forces (SOF), 50% of potentially survivable deaths have been related to noncompressible hemorrhage. Currently, there are no widely available presurgical interventions that can slow abdominal bleeding. Consequently, many of the preventable deaths occur en route to definitive care as a failure to rescue from exsanguination. A self-expanding polyurethane foam has been developed as a percutaneous damage control intervention to rescue casualties who would otherwise die of noncompressible hemorrhage, and allow them to survive long enough to reach surgical intervention. The purpose of this paper is to summarize the existing preclinical data, describe the role of SOF personnel in foam delivery-system development, and to integrate these together to conceptualize how foam could be incorporated into SOF medical care. METHODS: All existing publications on self-expanding foam are reviewed. Additionally, eight SOF medical providers with combat experience provided end-user input to delivery-device design through an interactive human-factors testing process. RESULTS: Ten preclinical publications described efficacy, safety, dose translation, and risk-benefit analysis of exsanguination rescue with percutaneous-foam damage control. SOF medical providers guided weight, cubic, operational requirements, and limits for the foam delivery device. CONCLUSION: Presurgical exsanguination rescue with percutaneous foam damage control is safe and effective with a favorable risk-benefit profile in preclinical studies. Battlefield, presurgical use by SOF medical providers is conceptually possible. Adoption of the technology on the battlefield should proceed with SOF medical provider input.

Safety and efficacy of manual syringe infusion of distending media for hysteroscopic procedures: a case-control study.

OBJECTIVES: Adverse events associated with large volumes of distending media in hysteroscopic procedures can be life-threatening. The aim of this study was to evaluate the safety and efficacy of manual syringe infusion (MI) of distending media for hysteroscopic procedures. STUDY DESIGN: Between January 2011 and December 2013, the medical records of all women who underwent hysteroscopic procedures using MI or the conventional pump-infusion method (PI, the control group) were reviewed. The Wilcoxon rank-sum test, the Chi-square test and the multivariate logistic regression analysis were employed for statistical analysis. RESULTS: The MI group (n=82) had a significantly lower average volume of infused fluid (1117 ± 712 mL vs. 2216 ± 1502 mL, respectively; p<0.001), less operative time (22.2 ± 9.7 vs. 30.4 ± 9.8 min, respectively; p<0.001) and lower postoperative abdominal pain scores (0.6 ± 0.7 vs. 0.8 ± 0.7, respectively; p=0.04) than the PI group (n=58). Subgroup analysis of women who underwent hysteroscopic myomectomy revealed a significantly lower amount of infused fluid for the MI group than for the PI group (1737 ± 905 mL vs. 3441 ± 1952 mL, respectively; p=0.001). Infused fluid amount (coefficient=0.08, p<0.001) was the only significant independent factor affecting fluid deficit, with a constant of 76.1. CONCLUSION: The MI method appears to be a safe and feasible method for delivering distending media during hysteroscopic procedures.

The FRED flow-diverter stent for intracranial aneurysms: clinical study to assess safety and efficacy.

BACKGROUND AND PURPOSE: Flow-diverter stents are emerging for the endovascular treatment of difficult-to-treat or otherwise untreatable cerebral aneurysms (wide-neck, fusiform, dissecting, blisterlike, or giant). We assessed the clinical safety and efficacy of the Flow-Redirection Endoluminal Device. MATERIALS AND METHODS: This was an institutional review board-approved single-center observational clinical study in 29 patients with 34 aneurysms elected to be treated by endovascular intervention. After providing informed consent, patients were included according to the following criteria: aneurysm fundus-to-neck ratio <2 or neck diameter >4 mm, fusiform, dissecting, or giant aneurysms. The primary end point for clinical safety was the absence of death, absence of major or minor stroke, and absence of transient ischemic attack. The primary end point for treatment efficacy was complete angiographic occlusion according to the O'Kelly Marotta grading scale immediately after the procedure and at follow-up after 3 and 6 months (O'Kelly Marotta D: complete occlusion). RESULTS: The Flow-Redirection Intraluminal Device deployment was technically successful in all cases. In 26/29 (89%) of patients, the primary end point of safety was reached; in the 3 remaining patients, 1 disabling ischemic stroke and 2 minor strokes with complete recovery at follow-up were observed. Angiographic (DSA and MRA) and clinical follow-up were available after 3 months in 29/29 (100%) and after 6 months in 25/29 (86%) patients (after 6 months, only MRA follow-up was performed according to our study protocol and institutional standard). At 3-month follow-up, complete occlusion was reached in 19/34 aneurysms (O'Kelly Marotta D: 19/34; 56%). At 6-month follow-up, aneurysm occlusion was complete in 22/30 aneurysms (O'Kelly Marotta D: 22/30; 73%). CONCLUSIONS: Deployment of the Flow-Redirection Intraluminal Device flow-diverter stent is safe and effective in the treatment of difficult-to-treat or otherwise untreatable intracranial aneurysms.

[The first experience with X-ray endovascular closure of the left atrial auricle using an Amplatzer Cardiac Plug in patients with atrial fibrillation].

Atrial fibrillation is the most common cardiac arrhythmia in clinical practice. Long-term anticoagulant therapy is used to prevent thrombosis in the left atrial (LA) auricle and, as a consequence, thrombolisms. However, some patients have contraindications to its use. The paper considers different alternative methods for preventing thromboembolic events and particularly one of the most common presently encountered ones - percutaneous transcatheter LA auricle excision, by applying the Amplatzer Cardiac Plug. There are also data on the authors' experience in using this device.

[Morphogenesis of complications after long-term intraocular silicon oil filling (clinical histopathological study)].

The question of necessity and time of silicon oil (SO) removal after tamponade for traumatic retinal detachment (TRD) is still controversial. So the study of changes in the eye filled with SO for a long time is of great interest. Histopathologic analysis of 9 enucleated eyes filled with SO for TRD during long-time period (from 6 months till 30 years) was performed. The characteristic change was inflammatory reaction with fibrin membranes surrounding silicon drops and development of proliferative vitreoretinopathy and tractional retinal detachment in the following. In 2 cases the inflammatory process around SO was associated with bone formation. The most severe complication was the imbibition of retina with SO in a vacuole-like manner associated with total atrophy of neural structures. Obtained data show that time for SO removal should be less than 6 months after surgery.