New Surgical Techniques

Glaucoma ◽  
2012 ◽  
Author(s):  
Anand Mantravadi
Keyword(s):  
Anterior Chamber ◽  
Corneal Endothelium ◽  
Surgical Techniques ◽  
Suture Technique ◽  
Fort Worth ◽  
Scleral Flap ◽  
Conjunctival Flap ◽  
Partial Thickness ◽  
Surgical Options ◽  
Filtering Procedure

The surgical options for glaucoma are expanding with a growing body of evidence of the short- and longer-term results. This chapter will focus on description of newer surgical techniques that hold promise in the treatment of glaucoma. The ExPRESS Mini-shunt (Optonol Ltd., Neve Ilan, Israel/Alcon, Fort Worth, TX) has emerged as a device used to help standardize one part of the trabeculectomy filtering procedure. This biocompatible, stainless-steel device, which measure 400 microns wide by 3 mm long, contains a 50-micron non-valved opening to enable filtration for the treatment of glaucoma (Fig. 14.1) Currently recommended for use underneath a partial-thickness scleral flap • Using a standard fornix- or limbus-based conjunctival flap, and after application of antimetabolites, this device is placed underneath a partial-thickness scleral flap, fashioned identically to a trabeculectomy procedure. • A 26-gauge needle or commercially available Sapphire blade is used to enter the anterior chamber under the scleral flap at the color transition from clear cornea at an angle parallel to iris plane. • Using a preloaded injector, the device is placed into the anterior chamber through the previously fashioned tract so that the plate is flush with the bed of the sclera flap. • The desired position of the device under the sclera flap is into the anterior chamber with distance from the corneal endothelium. • The flap is then sutured as is typical for a trabeculectomy, titrating tightness of sutures to desired amounts of flow. These sutures can, as with a trabeculectomy, be released or lysed with laser subsequently depending on the suture technique. • An iridotomy is not performed with this procedure. Therefore, this procedure represents a modification of a guarded filtration procedure using a device with a standardized ostium size to replace the sclerostomy and iridotomy portions of the trabeculectomy procedure. • By eliminating the sclerostomy, the rate of aqueous egress from the 50-micron opening into the subconjunctival/sub-Tenon’s plane is reportedly more standardized in comparison to trabeculectomy. • Although there are reports suggesting a lower incidence of hypotony with the ExPRESS in the immediate postoperative period as compared to trabeculectomy, the rate of flow in both ExPRESS use and trabeculectomy is critically determined by the tension of the sutures at the scleral flap, which was not standardized among the two groups.

scholarly journals Scleral-Fixated Intraocular Lenses

2017 ◽  
Vol 1 (2) ◽  
pp. 144-152 ◽  
Author(s):  
Maxwell S. Stem ◽  
Bozho Todorich ◽  
Maria A. Woodward ◽  
Jason Hsu ◽  
Jeremy D. Wolfe
Keyword(s):  
Cataract Surgery ◽  
Anterior Chamber ◽  
Ocular Trauma ◽  
Surgical Techniques ◽  
Intraocular Lenses ◽  
Alternative Placement ◽  
Complicated Cataract ◽  
Surgical Options ◽  
Capsular Support ◽  
Capsular Bag

Intraocular lenses (IOLs) can have inadequate support for placement in the capsular bag as a result of ocular trauma, metabolic or inherited conditions such as Marfan syndrome or pseudoexfoliation, or complicated cataract surgery. Surgical options for patients with inadequate capsular support include alternative placement of the IOL in the anterior chamber, fixation to the iris, or fixation to the sclera. The surgical techniques for each of these approaches have improved considerably over the last several decades resulting in improved visual and ocular outcomes. If no capsular or iris support exists, the surgeon can fixate an IOL to the sclera or the patient can remain aphakic. IOLs can be fixated to the sclera using sutures or by tunneling the IOL haptics into the sclera without sutures. This review summarizes the preoperative considerations, surgical techniques, outcomes, and unique complications associated with implantation of scleral-fixated IOLs.

scholarly journals Microsurgical scleral drainage and trabeculectomy-scleral flap adjustable suture combination technique in the treatment of primary glaucoma

2019 ◽  
Vol 36 (2) ◽  
Author(s):  
Li Xiahou ◽  
Chunlan Liu ◽  
Weihong Zhou ◽  
Shasha Yang
Keyword(s):  
Intraocular Pressure ◽  
Anterior Chamber ◽  
Suture Technique ◽  
Control Group ◽  
Study Group ◽  
Treatment Technique ◽  
Scleral Flap ◽  
Combination Technique ◽  
Primary Glaucoma ◽  
One Year

Objective: To investigate the clinical effect of microsurgical scleral drainage and trabeculectomy combined with scleral flap adjustable suture technique in the treatment of primary glaucoma. Methods: One hundred primary glaucoma patients (120 eyes) in Xinyu People’s Hospital of Jiangxi province were selected from July 2014 to June 2016. The patients were randomly divided into control group and study group. The control group was treated with compound trabeculectomy, while the study group was treated with microsurgical scleral drainage and trabeculectomy combined with scleral flap adjustable suture technique. In both groups of patients, intraocular pressure, functional filtering bleb formation, and complications before and after surgery were monitored for three days, one week, one month, three months, six months and one year, while anterior chamber depth was determined one week after operation. The extent of success of operation was compared between the two groups. Results: At three days, one week, one month, three months, six months and one year after surgery, intraocular pressure of study group was significantly lower than that of the control group (P<0.05). There was 93.33% formation of functional filtering blebs in the study group, which was significantly higher than that in the control group (60.00%, P<0.001). Moreover, normal anterior chamber formation was significantly higher in the study group (91.67%) than in the control group (71.67%, P<0.01). There was 95.00% operation success in the study group, relative to 68.33% success in the control group (P<0.001). Conclusion: Microsurgical scleral drainage and trabeculectomy combined with scleral flap adjustable suture technique has better curative effect on primary glaucoma than compound trabeculectomy. Moreover, it does not exacerbate complications. Therefore, the combination treatment technique merits clinical application. doi: https://doi.org/10.12669/pjms.36.2.1439 How to cite this:Xiahou L, Liu C, Zhou W, Yang S. Microsurgical scleral drainage and trabeculectomy-scleral flap adjustable suture combination technique in the treatment of primary glaucoma. Pak J Med Sci. 2020;36(2):---------. doi: https://doi.org/10.12669/pjms.36.2.1439 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Complications Specific To Ex-Press™ Shunts

2013 ◽  
Author(s):  
Steven R. Jr. Sarkisian ,
Keyword(s):  
Kansas City ◽  
The United States ◽  
External Diameter ◽  
Fort Worth ◽  
Filtration Surgery ◽  
Scleral Flap ◽  
Laser Trabeculoplasty ◽  
Topical Medications ◽  
Glaucoma Filtration Device ◽  
Filtration Device

The EX-PRESS™ Glaucoma Filtration Device (Alcon Laboratories, Inc., Fort Worth, Texas) has been commercially available in the United States since 2002 and was originally developed by Optonol, Inc. (Kansas City, Kansas) for implantation directly under the conjunctiva for an indication of control of intraocular pressure (IOP). It is a nonvalved, stainless steel device almost 3 mm long with an external diameter of approximately 400 microns and a 50 or 200 micron lumen, depending on the model. It has an external disc at one end and a spur-like extension on the other to prevent extrusion. The EX-PRESS™ shunt is one option for controlling IOP available to today’s glaucoma surgeon. The challenges and complications involved with EX-PRESS™ shunts are addressed below, as well as how to manage and prevent such scenarios. The original unguarded technique of implantation under the conjunctiva resulted in numerous complications, including hypotony, extrusion, and, most commonly, erosion of the implant. Typically, there was a period of hypotony followed by failure and erosion of the implant. Endophthalmitis has also been associated with an exposed implant. To avoid complications associated with subconjunctival implantation, Dahan and Carmichael proposed implanting the device under a scleral flap. This technique has greatly reduced erosions, and EX-PRESS™ shunts have been reported to have a lower rate of hypotony than trabeculectomy (15.8% with EX-PRESS™ shunt versus 22.5% in trabeculectomy). Since 2003, the manufacturer has recommended all users only implant the device under a scleral flap. Like all filtration surgery, failure is most commonly from episcleral and subconjunctival fibrosis. As with traditional filtration surgery, intraoperative adjunctive antimetabolites, such as mitomycin-C, may be used to limit the degree of postoperative scarring. However, should failure due to fibrosis occur, there are several options. The first is to add topical medications or perform laser trabeculoplasty. The second is to perform bleb revision or needling with an antifibrotic agent. Finally, as in a failed trabeculectomy, the surgeon may abandon the EX-PRESS™ shunt and perform a second unrelated procedure.

Endoscopic Vitreoretinal Surgery; Basic Principles, Indications and New Directions

2021 ◽  
pp. 320-326
Keyword(s):  
Anterior Chamber ◽  
Historical Development ◽  
Surgical Techniques ◽  
Vitreoretinal Surgery ◽  
Basic Principles ◽  
Complementary Method ◽  
New Directions ◽  
Ocular Media ◽  
Media Opacities ◽  
Basic Features

In this review, we aimed to give information about the historical development, basic features, and major indications of microendoscopy in vitreoretinal surgery. Microendoscopy permits vitreoretinal surgery for tissues that are not visible using operating microscopy ophthalmoscopy. Evolving technology may overcome the technical limitations of current endoscopic technology. Endoscopic vitreoretinal surgery is particularly useful when tissue details blurred by ocular media opacities or anterior chamber aberrations in contemporary surgical microscopic ophthalmoscopy. Microendoscopy is a robust platform for vitreoretinal surgery. Ophthalmic microendoscopy as a complementary method to modern vitreoretinal surgical techniques is very useful for safe surgery when an operating a microscope becomes insufficient.

Factors Predictive of Venous Thromboembolism in Bariatric Surgery

2011 ◽  
Vol 77 (10) ◽  
pp. 1403-1406 ◽  
Author(s):  
Hossein Masoomi ◽  
Brian Buchberg ◽  
Kevin M. Reavis ◽  
Steven D. Mills ◽  
Michael Stamos ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Gastric Bypass ◽  
Venous Thromboembolism ◽  
Surgical Techniques ◽  
Significant Risk ◽  
Patient Characteristics ◽  
Morbidly Obese ◽  
Open Gastric Bypass ◽  
Open Operation ◽  
Surgical Options

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in bariatric surgery. The aim of this study was to evaluate the effect of patient characteristics, payer type, comorbidities, and surgical techniques on development of VTE in bariatric surgery. Using the National Inpatient Sample (NIS) database from 2006 to 2008, clinical data of 304,515 morbidly obese patients who underwent bariatric surgery were examined. Multiple regression analysis was performed to identify factors predictive of VTE. The overall rate of in-hospital VTE was 0.17 per cent, with the highest rate of VTE observed in open gastric bypass (0.45%). The VTE rate was significantly lower in laparoscopic compared with open gastric bypass (0.13% vs 0.45%, respectively, P < 0.01) and in nongastric bypass compared with gastric bypass procedures (0.06% vs 0.21%, respectively, P < 0.01). Alcohol abuse [odds ratio (OR): 8.7], open operation (OR: 2.5), gastric bypass procedures (OR: 2.4), renal failure (OR: 2.3), congestive heart failure (OR: 2.0), male gender (OR: 1.5), and chronic lung disease (OR: 1.4) were associated with a higher rate of VTE. This study identified several significant risk factors for development of VTE in bariatric surgery. To minimize the risk of VTE, surgeons may consider these factors in selection of appropriate prophylaxis and bariatric surgical options.

Total vs. partial aponeurectomy for Dupuytren’s contracture — A literature review

Open Medicine ◽  
2010 ◽  
Vol 5 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Astrid Högemann ◽  
Daniel Kendoff ◽  
Ulrich Wolfhard ◽  
Patrick O’Loughlin ◽  
Lucien Olivier
Keyword(s):  
Recurrent Disease ◽  
Early Stage ◽  
Meta Analysis ◽  
Surgical Techniques ◽  
Review Article ◽  
Surgical Indications ◽  
Hand Dexterity ◽  
Surgical Options ◽  
Partial Fasciectomy ◽  
And Function

AbstractThe etiology of Dupuytren’s disease is controversial and thus the disease can only be treated when it presents with symptoms to warrant intervention. Surgical treatment is the method of choice to preserve hand dexterity and function. It is advisable to perform surgery at an early stage of disease progression, but various surgical techniques have been advocated. A partial fasciectomy is recommend by many authors, whereas a total aponeurectomy, where all palmar tissue is removed, might reduce the risk of recurrent disease due to the widespread removal of aponeurosis. The total aponeurectomy is performed less frequently due to the potential complications of this technique. In order to achieve an objective comparison of both surgical options we performed a literature meta-analysis, involving a comparison of surgical indications, results and complications following partial and total aponeurectomy, which are described in detail within this review article.

scholarly journals Incisional hernia after 2498 single-port access (SPA) gynecologic surgery over a 10-year period

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Joseph J. Noh ◽  
Tae-Hyun Kim ◽  
Chul-Jung Kim ◽  
Tae-Joong Kim
Keyword(s):  
Incisional Hernia ◽  
Single Port ◽  
Surgical Techniques ◽  
Patient Characteristics ◽  
Suture Technique ◽  
Perioperative Outcomes ◽  
Gynecologic Surgery ◽  
Single Port Access ◽  
Interrupted Suture ◽  
Port Access

Abstract The present study was conducted to report the perioperative outcomes of single-port access (SPA) laparoscopic gynecologic surgeries with focus on the incidence of postoperative incisional hernia from our cumulative data of 2498 patients. A retrospective review was performed on the women who had received SPA surgeries from 2008 to 2018. Patient characteristics and perioperative outcomes including the incidence of postoperative incisional hernia were analyzed. There were 2498 Korean patients who received SPA surgeries for various gynecologic diseases. The median age of the patients was 40.3 ± 9.2 years, and the mean body mass index (BMI) was 22.6 ± 3.2 kg/m2. A total of 3 postoperative incisional hernia occurred during the study period. Two patients whose fascial layers were closed in running sutures developed hernias 6 and 8 months after their operations. One patient whose fascial layers were closed in interrupted sutures developed hernia 11 months after her operation. The incidence of postoperative incisional hernia following SPA surgery is low in Asian women whose BMI is relatively lower than other patient populations. Interrupted suture technique may reduce postoperative incisional hernia by providing a distinct visualization of fascial layers during closure. Detailed descriptions of our surgical techniques of closing the port incision are provided.

scholarly journals Evolution of therapies for the corneal endothelium: past, present and future approaches

2020 ◽  
pp. bjophthalmol-2020-316149
Author(s):  
Hon Shing Ong ◽  
Marcus Ang ◽  
Jodhbir S Mehta
Keyword(s):  
Corneal Endothelium ◽  
Medical Science ◽  
Corneal Transplantation ◽  
Surgical Techniques ◽  
Corneal Transplant ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Immunological Rejection ◽  
Transplantation Procedures ◽  
Rejection Rates

Corneal endothelial diseases are leading indications for corneal transplantations. With significant advancement in medical science and surgical techniques, corneal transplant surgeries are now increasingly effective at restoring vision in patients with corneal diseases. In the last 15 years, the introduction of endothelial keratoplasty (EK) procedures, where diseased corneal endothelium (CE) are selectively replaced, has significantly transformed the field of corneal transplantation. Compared to traditional penetrating keratoplasty, EK procedures, namely Descemet’s stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK), offer faster visual recovery, lower immunological rejection rates, and improved graft survival. Although these modern techniques can achieve high success, there are fundamental impediments to conventional transplantations. A lack of suitable donor corneas worldwide restricts the number of transplants that can be performed. Other barriers include the need for specialized expertise, high cost, and risks of graft rejection or failure. Research is underway to develop alternative treatments for corneal endothelial diseases, which are less dependent on the availability of allogeneic tissues – regenerative medicine and cell-based therapies. In this review, an overview of past and present transplantation procedures used to treat corneal endothelial diseases are described. Potential novel therapies that may be translated into clinical practice will also be presented.

scholarly journals Peripheral Nerve Reconstruction after Injury: A Review of Clinical and Experimental Therapies

2014 ◽  
Vol 2014 ◽  
pp. 1-13 ◽  
Author(s):  
D. Grinsell ◽  
C. P. Keating
Keyword(s):  
Peripheral Nerve ◽  
Nerve Repair ◽  
Peripheral Nerve Regeneration ◽  
Surgical Techniques ◽  
The Body ◽  
Sensory Function ◽  
Nerve Reconstruction ◽  
Nerve Transfers ◽  
Experimental Therapies ◽  
Surgical Options

Unlike other tissues in the body, peripheral nerve regeneration is slow and usually incomplete. Less than half of patients who undergo nerve repair after injury regain good to excellent motor or sensory function and current surgical techniques are similar to those described by Sunderland more than 60 years ago. Our increasing knowledge about nerve physiology and regeneration far outweighs our surgical abilities to reconstruct damaged nerves and successfully regenerate motor and sensory function. It is technically possible to reconstruct nerves at the fascicular level but not at the level of individual axons. Recent surgical options including nerve transfers demonstrate promise in improving outcomes for proximal nerve injuries and experimental molecular and bioengineering strategies are being developed to overcome biological roadblocks limiting patient recovery.

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