Release and extraction of retained subfoveal perfluorocarbon liquid facilitated by subretinal BSS, vibration, and gravity: a case report

Background Perfluorocarbon liquid (PFCL) is an effective surgical adjuvant in performing vitrectomy for severe vitreoretinal pathologies such as proliferative vitreoretinopathy and giant retinal tears. However, subretinal retention of PFCL can occur postoperatively and retained PFCL causes severe visual disorders, particularly when PFCL was retained under the fovea. Although several procedures have been proposed for subfoveal PFCL removal, such as direct aspiration or submacular injection of balanced salt solution (BSS) to dislodge the subfoveal PFCL, the retinal damage associated with these procedures has been a major problem. Here, we report a case of subfoveal retention of PFCL for which we performed a novel surgical technique that attempts to minimize retinal damage. Case presentation A 69-year-old man presented with subfoveal retained PFCL after surgery for retinal detachment. To remove the retained PFCL, the internal limiting membrane overlying the subretinal injection site is first peeled to allow low-pressure (8 psi) transretinal BSS infusion, using a 41-gauge cannula, to slowly detach the macula. A small drainage retinotomy is created with the diathermy tip at the inferior position of the macular bleb, sized to be slightly wider than that of the PFCL droplet. The head of the bed is then raised, and the surgeon gently vibrates the patient’s head to release the PFCL droplet to allow it to migrate inferiorly towards the drainage retinotomy. The bed is returned to the horizontal position, and the PFCL, now on the retinal surface, can be aspirated. The subfoveal PFCL is removed while minimizing iatrogenic foveal and macular damage. One month after PFCL removal, the foveal structure showed partial recovery on optical coherence tomography, and BCVA improved to 20/40. Conclusion Creating a macular bleb with low infusion pressure and using vibrational forces and gravity to migrate the PFCL towards a retinotomy can be considered as a relatively atraumatic technique to remove subfoveal retained PFCL.

Different Injection Pressure on VCR Engine using Hibiscus Oil

This present examination researches the presentation and outflow qualities distinctive infusion pressure on factor pressure proportion of a diesel motor utilizing Hibiscus oil. With different mixes of hibiscus seed oil, biodiesel and diesel mixes are set up to use as fuel on factor pressure proportion diesel motor. The outcomes indicated that decrease in brake warm effectiveness, nitric oxide and increment in brake explicit fuel utilization, carbon monoxide, hydrocarbon with Blends of hibiscus seed biodiesel mixes than flawless diesel. The minor departure from execution parameters like Brake explicit fuel utilization, Brake warm effectiveness and NO emanations Hydro carbon, Carbon Monoxide are surveyed and broke down.

Predicting infusion pressure during pars plana vitrectomy: a physically based model

Purpose: Intraocular pressure (IOP) during pars plana vitrectomy (PPV) decreases as aspiration generates flow, a phenomenon known as head loss. Since direct measurement of the IOP during surgery is impractical, currently, available compensating systems infer IOP by measuring infusion flow rate and estimating corresponding pressure drop. The purpose of the present paper is to propose and validate a physically based algorithm of the infusion pressure drop as a function of flow. Methods: Complete infusion lines (20G, 23G, 25G and 27G) were set up and primed. The infusion bottle was set at incremental heights and flow rate measured 10 times and recorded as mean Å} SD. Overall head loss (OHL) was defined, according to hydraulics laws, as the sum of frictional head loss (FHL; i.e., pressure drop due to friction along tubing) and exit head loss (EHL). The latter is equal to the kinetic energy of the exiting flow through the trocar (FKE = V2/2g). A 2nd degree polynomial equation (i.e., ΔP = aQ2 + bQ, where ΔP is the pressure drop, or OHL, and Q is the volumetric flow) was derived for each gauge and compared to experimental data 2nd order polynomial best-fit curve. Results: Ninety-seven percent of the pressure values for all gauges predicted using the derived equation fell within 2 SD of the mean difference yielding a Bland-Altman statistical significance when compared to 91% of best fit curve. Conclusion: The derived equations accurately predicted the head loss for each given infusion line gauge and can help infer IOP during PPV.

In Vivo Intraocular Pressure Monitoring during Microincision Vitrectomy with and without Active Control of Infusion Pressure

Purpose To evaluate intraocular pressure (IOP) fluctuation during vitrectomy, we directly monitored IOP in vivo using 2 vitrectomy machines with or without constant infusion pressure monitoring and control. Methods Among 61 eyes of 61 consecutive patients, 32 were assigned to the Accurus system (group 1) and 29 were assigned to the Constellation system (group 2) in this prospective case series. The IOP fluctuations were evaluated during routine vitrectomy procedures. Results The initial IOP before vitrectomy was 20.3 ± 2.4 mm Hg in group 1 using a conventional vented gas forced infusion system and 20.0 ± 0.0 mm Hg in group 2 using active IOP control at 20 mm Hg (p = 0.532). However, the average IOP change during core vitrectomy was -8.6 ± 4.3 mm Hg in group 1 and -0.8 ± 1.1 in group 2 (p<00.001). Maximum IOP was significantly decreased in group 1 (-17.0 ± 2.6 mm Hg) compared with that in group 2 (-4.1 ± 2.2 mm Hg) (p<00.001). Partial ocular collapse was observed during vitrectomy only in group 1 (78.1%). Peak IOP significantly increased during scleral compression and gas and fluid injection but was not significantly different between the groups (all p≥0.147). The IOP fluctuation range was 50-70 mm Hg in both groups. Conclusions The IOP fluctuated significantly during routine vitrectomy using both systems. Hypotony and partial ocular collapse were more frequently observed during vitrectomy with the Accurus system than with the Constellation system. Both systems were vulnerable to IOP surge during indentation and intravitreal injection.

Management of Traumatic Cataract with Posterior Capsular Rupture: A Case Report and In Vitro Model Study

Purpose. To investigate the optimal strategy for surgical management of traumatic cataract with posterior capsular rupture. Methods. We describe four cases of traumatic cataract with posterior capsular rupture and an in vitro model built to evaluate the optimal infusion pressure during surgery. Results. All patients underwent cataract surgery. By using an anterior chamber maintainer to elevate infusion pressure, we safely performed cataract extraction without phacoemulsification. At 3 days after surgery, visual acuity was greater than 20/25 in all patients, without any complications. Phacoemulsification would also be feasible under anterior chamber maintainer infusion in a similar case of traumatic cataract with posterior capsular rupture during intravitreal injection. In addition, an in vitro model that we established using pig’s eyes revealed that the anterior chamber remained stable when the height of infusion bottle was 50–90 mmHg, whereas shallowing of the anterior chamber occurred when the height of infusion bottle was reduced to 40 mmHg, and corneal edema occurred when the height of infusion bottle was raised to 100 mmHg. Conclusions. During management of traumatic cataract with posterior capsular rupture, using an anterior chamber maintainer to maintain optimal infusion pressure may reduce the risk of anterior hyaloid membrane breakup and vitreous loss.

The correlation between pulsatile intracranial pressure and indices of intracranial pressure-volume reserve capacity: results from ventricular infusion testing

OBJECTIVE The objective of this study was to examine how pulsatile and static intracranial pressure (ICP) scores correlate with indices of intracranial pressure-volume reserve capacity, i.e., intracranial elastance (ICE) and intracranial compliance (ICC), as determined during ventricular infusion testing. METHODS All patients undergoing ventricular infusion testing and overnight ICP monitoring during the 6-year period from 2007 to 2012 were included in the study. Clinical data were retrieved from a quality registry, and the ventricular infusion pressure data and ICP scores were retrieved from a pressure database. The ICE and ICC (= 1/ICE) were computed during the infusion phase of the infusion test. RESULTS During the period from 2007 to 2012, 82 patients with possible treatment-dependent hydrocephalus underwent ventricular infusion testing within the department of neurosurgery. The infusion tests revealed a highly significant positive correlation between ICE and the pulsatile ICP scores mean wave amplitude (MWA) and rise-time coefficient (RTC), and the static ICP score mean ICP. The ICE was negatively associated with linear measures of ventricular size. The overnight ICP recordings revealed significantly increased MWA (> 4 mm Hg) and RTC (> 20 mm Hg/sec) values in patients with impaired ICC (< 0.5 ml/mm Hg). CONCLUSIONS In this study cohort, there was a significant positive correlation between pulsatile ICP and ICE measured during ventricular infusion testing. In patients with impaired ICC during infusion testing (ICC < 0.5 ml/mm Hg), overnight ICP recordings showed increased pulsatile ICP (MWA > 4 mm Hg, RTC > 20 mm Hg/sec), but not increased mean ICP (< 10–15 mm Hg). The present data support the assumption that pulsatile ICP (MWA and RTC) may serve as substitute markers of pressure-volume reserve capacity, i.e., ICE and ICC.