Two-way adjustable double-knots intrascleral fixation and single sclerotomy looping technique: a novel minimal invasive adjustable intraocular lens fixation technique

BACKGROUND

IOL fixation without capsular support presents challenges for surgeons. Although innovative techniques were developed to address subluxated IOLs, adjustable IOL fixation methods are seldom reported. We introduce a novel two-way adjustable double-knots intrascleral fixation combined with single sclerotomy looping technique for fixing intraocular lenses (IOL) or IOL-capsular bags.

METHODS

A bent 30-gauge needle threaded with 8 - 0 polypropylene was introduced into the eye. A gripping forceps assisted the haptic looping. Two overhand knots were made with 8 - 0 polypropylene thread. The knots were incarcerated into a scleral tunnel made by a 30-gauge needle, with two ends of the thread left at each side of the tunnel. The IOL was adjusted to the premium position with adequate tension by pulling either end of the threads. The study included 19 eyes with aphakia, subluxated IOL-capsular bags, or subluxated crystalline lenses. The mean followed up period was 18.9 ± 7.1 months with evaluations of uncorrected visual acuity (UCVA), intraocular pressure, slit-lamp examination, and swept-source optical coherence tomography of the anterior segment.

RESULTS

UCVA increased from 1.28 ± 0.74 at baseline to 0.44 ± 0.51 (logMAR) at final visit (P < 0.001). All IOLs were fixed well-centered. The mean IOL tilt was 3.5°±1.1°. Postoperative complications included transient IOP elevation (15.8%), hypotony (10.5%), and cystoid edema (5.3%) which resolved within 4 weeks.

CONCLUSIONS

We presented a novel adjustable technique for IOL fixation, which stabilize IOLs by using an intrascleral double-knots structure. This technique minimized surgical manipulations by using a single sclerotomy looping technique without large conjunctival dissection and scleral flap creation. The technique offers a reliable and optimal IOL positioning and improved visual outcomes in patients undergoing scleral fixed IOL implantation.

Adjustable slings versus other surgical methods in female stress urinary incontinence: a systematic review and meta-analysis

INTRODUCTION AND HYPOTHESIS

The objective of this study was to evaluate the efficacy and safety of different adjustable slings compared to other surgical methods for the treatment of stress urinary incontinence (SUI) among women.

METHODS

The inclusion criteria were as follows: randomized controlled trials (RCTs) and non-RCTs assessing adult women with SUI. The exclusion criteria were as follows: other types of urinary incontinence, studies that combined conservative interventions and pharmacological treatment, pregnant and lactating patients. Databases were searched up to November 2022 to identify articles evaluating the effectiveness and safety of different adjustable slings compared to other surgical methods for the treatment of SUI among women. The systematic review was conducted in accordance with the PRISMA 2020 checklist and registered in PROSPERO. Risk-of-bias assessment tools recommended by the Cochrane Society were used to evaluate the risk of bias in the included studies.

RESULTS

Eighteen clinical trials were included in this systematic review, and 11 studies were included in the meta-analysis. Fourteen studies were RCTs, and four were retrospective studies. Only RCTs were included in the meta-analyses. There was no statistically significant difference in the objective cure rate, subjective cure rate, or long-term postoperative complication rate between Ajust single-incision mini-slings (SIMS) and standard mid-urethral slings (SMUS) or MiniArc SIMS. However, the operation time in the adjustable SIMS group was significantly shorter (RR = -4.20, 95% CI: [-7.51, -0.89], p = 0.01).

CONCLUSIONS

This systematic review and meta-analysis revealed that adjustable SIMS is equally effective when compared with SMUS for the treatment of SUI among women. Moreover, the operation time for the adjustable SIMS was shorter. However, additional well-designed studies with standard outcome measures and complete follow-up periods will help to increase confidence in the choice of different options for treating SUI among women.

Using paper clips to make simple, effective, and accessible auricular compression devices

PURPOSE

To investigate the early compression effects of adjustable pressure auricular clips, made of paper clips, during auricular surgery.

METHODS

24 patients who underwent auricular surgery between August 2021 and April 2022 were selected as the study participants. Doctors used ear clips made of paper clips to prevent postoperative complications in these patients.

RESULTS

In all 24 patients, the wounds healed by stage I. Except for one case of minor local hematoma, all wounds healed well with no postoperative complications, such as subcutaneous hematoma formation, ulceration, or infected skin necrosis. Moreover, doctors were able to operate in lesser time and more conveniently with the help of the paper-clip devices.

CONCLUSIONS

This study proposes, for the first time, the use of paper clips to make ear clips with adjustable pressure. This simple device is easy to manufacture, inexpensive to the user, reliable in performance, and remarkable in its clinical effects. As such, the present study provides substantial evidence to suggest that this device should be widely applied in the clinical setting.

Novel use of an adjustable single 8-0 polypropylene suture of scleral fixation without conjunctival dissection

Background

This report serves to describe the use of a novel adjustable single 8–0 polypropylene suture for scleral fixation without conjunctival dissection, and to describe related clinical outcomes associated with this approach.

Methods

In this study, we retrospectively reviewed 28 eyes from 27 patients that underwent scleral fixation of the intraocular lens (IOL) without conjunctival dissection using an adjustable single 8–0 polypropylene suture at the Beijing Tongren Eye Center between April 2018 and April 2019. For this surgical approach, a 23-gauge infusion cannula was set, after which two Hoffmann scleral pockets were created. Next, 8–0 polypropylene sutures were inserted into the eye guided by 10–0 polypropylene sutures of a long straight needle. The 8–0 suture was then used to fix the haptic IOs. Finally, these 8–0 polypropylene sutures were removed from the scleral pockets, and knots were tightened with the adjustable single suture. Primary outcomes included visual acuity and postoperative complication incidence.

Results

For this study, outcomes for 28 eyes from 27 patients (9 female, 18 male) were assessed. Patients had a mean age of 54 ± 15.11 years-old and were followed for an average of 10.18 ± 2.76 months postoperatively. Uncorrected visual acuity in these patients improved significantly from a preoperative value of 1.269 ± 0.464 logMAR to a 3-month postoperative value of 0.409 ± 0.413 logMAR (p = 0.000). The majority of postoperative complications in these patients were temporary and self-limiting, including corneal edema (35.71%), hypotony (14.29%), elevated intraocular pressure (28.58%), and mild hyphema (7.14%). No evidence of exposure or erosion of the trimmed suture end was detected in any patients. An ultrasound biomicroscope was able to readily detect the IOL and all sutures, and IOLs were found to be well-centered without any dislocation, tilting, or subluxation upon follow-up.

Conclusions

An adjustable single 8–0 polypropylene suture can reliably and effectively be used for scleral fixation without conjunctival dissection for the treatment of patients with aphakia or inadequate posterior capsule support. The novel procedure described herein may therefore be an effective means of minimizing the risk of suture-related complications in patients undergoing scleral-fixated IOL implantation.

Trial registration

Retrospective case series study, not applicable. NCT04476264.

Evaluation of prefabricated adjustable thermoplastic mandibular advancement devices (PAT-MADs) for obstructive sleep apnea: an Asian experience

OBJECTIVE

To evaluate the use of direct to consumer Prefabricated adjustable thermoplastic mandibular advancement devices (PAT-MADs) (MyTAP™, Airway Management Inc), its effectiveness in the treatment of OSA, feasibility and short-term adherence.

METHODS

In sum, 50 patients with diagnosed mild-moderate OSA on formal polysomnography (PSG) were fitted with a PAT-MAD (MyTAP™, Airway Management Inc). Sleep indices included the apnea-hypopnea index (AHI), hypopnea index (HI), apnea index (AI); oxygen desaturation index (ODI), and the lowest 0₂ saturation (Lsat) were measured with a Level 3 home sleep apnea test (HSAT) pre versus post treatment. Quality of life (QOL) surveys of Epworth sleepiness scale (ESS), Pittsburg sleep quality index (PSQI), Functional outcomes of sleep quality-10 (FOSQ10) and satisfaction surveys were administered.

RESULTS

Over three months, indices showed a trend towards improvement. Results were statistically significant when stratified into groups who achieved cure and success. Moreover, there was a mean improvement in AHI: -12.7 ± 9.3, AI: -5.7 ± 8.2, HI: -6.3 ± 3.7, ODI: -11.2 ± 8.6 for responders with a success rate of 41%. Out of QOL surveys, ESS showed a decrease of -1.41 [-2.52, -0.3] (p = 0.017) when controlled for age and body mass index (BMI). Up to 68.8% of patients found that the device was useful in alleviating snore symptoms. Adherence rate was reported at 59%.

CONCLUSION

Titratable PAT-MAD is an economical and effective option for a patient of Chinese descent. It has the potential to serve as a device for trial use and means of selection before proceeding with customized MADs. Further studies will be required to substantiate other factors which influence the recommendation of MADs for patients with this demographic.

Efficacy of Polytetrafluoroethylene/Polylactide-co-glycolide (PTFE/PLGA) Laminate and PTFE/PLGA Laminate Containing Slow-Releasing Thalidomide in Delayed Adjustable Strabismus Surgery in a Rabbit Model

Purpose: To evaluate the efficacy of polytetrafluoroethylene/polylactide-co-glycolide (PTFE/PLGA) laminate containing sustained-release thalidomide for delayed adjustable strabismus surgery. Methods: This is a prospective, masked-observer, controlled study using 50 eyes of 25 rabbits. After superior rectus muscle (SRM) recession, a PTFE/PLGA laminate containing thalidomide (group PT, 20 eyes), PTFE/PLGA laminate alone (group P, 20 eyes), or no barrier (group C, 10 eyes) were applied around the SRM. Delayed adjustment was performed at postoperative 3 or 5 weeks. Adjustability, adjustment lengths, adjustment forces, and degrees of adhesion were evaluated. Results: Both groups PT and P showed significantly better adjustability compared to group C at both 3 weeks (100%, 80%, and 0%, respectively) and 5 weeks (100%, 90%, and 0%, respectively). Between groups PT and P, adjustability, adjustment lengths, and forces were not significantly different at 3 and 5 weeks. Group PT showed a significantly lower grade of adhesion between SRM and sclera (SRM/S) compared to group C at both 3 weeks (p = 0.007) and 5 weeks (p = 0.001, respectively). Group P showed no significant difference in adhesion between SRM/S compared to group C at 3 weeks (p= 0.302) but had a lower grade of adhesion after 5 weeks (p = 0.007). There was no significant difference between groups PT and P at 3 weeks (p= 0.143) and 5 weeks (p= 0.716). Conclusions: PTFE/PLGA laminate containing sustained-release thalidomide was effective in reducing adhesion and allowed delayed adjustment in all eyes. However, PTFE/PLGA laminate alone was also equally effective in reducing adhesion compared to controls.

Outcomes of adjustable strabismus surgery in an Irish University Hospital

PURPOSE

Strabismus surgery aims to improve binocular vision, reduce diplopia, and enhance cosmesis. Adjustable strabismus procedures have been developed as a means of tackling unpredictability in some post-operative results. The purpose of the study was to compare the effectiveness of adjustable and non-adjustable squint procedures in the treatment of strabismus.

METHODS

We analyzed adjustable or non-adjustable squint surgery undergone in our Irish locality by retrospectively studying 27 consecutive patients at Mater Misericordiae University Hospital, Dublin.

RESULTS

There was no significant difference (p = 0.519) in the mean post-operative horizontal deviation between the adjustable group (mean = 11.6 PD) and the non-adjustable group (mean = 15.3 PD). We found that adjustable procedures resulted in a trend (p = 0.050) towards a greater mean horizontal effect per muscle (18.9 PD per muscle) than non-adjustable procedures (mean 9.7 PD). We went on to analyze the adjustable group in order to determine the impact on outcome in those patients in whom their adjustable sutures were manipulated postoperatively. Of the 11 patients who underwent adjustable procedures, 6 subsequently had adjustments made as planned and 5 did not require adjustment. Those patients who had their sutures adjusted demonstrated a smaller mean post-operative deviation (8.5 PD) than those patients in whom their suture was not adjusted (mean = 16.3 PD).

CONCLUSION

Our study displays a trend that adjustable procedures are more effective in terms of the mean horizontal effect per muscle operated, and is a novel way of reporting effectiveness of strabismus procedures.

Effect of "phase change" complex on postoperative adhesion prevention

BACKGROUND

Postsurgical peritoneal adhesion is a major clinical problem. Numerous anti-adhesion products have been studied, but none could be easily used to provide a physical barrier. In this study, we developed a "phase change" anti-adhesion barrier for reducing peritoneal adhesion by cross-linked copolymerization of O-carboxymethyl chitosan (CMC) and CaCl2 and addition of cyclosporin A (CsA).

MATERIALS AND METHODS

The CMC-CaCl2-CsA compound was characterized by equilibrium swelling rate, weight loss, releasing effect, and coagulation test, and its biosafety was characterized by acute oral toxicity, hemolysis, and cytotoxicity. Intestinal adhesion model was applied on 64 Sprague-Dawley rats, which received CMC, CMC-CaCl2, or CMC-CaCl2-CsA treatment. At postoperative days 7 and 14, the rats were euthanized, and adhesions were graded by an investigator blinded to the treatment groups, using a predetermined adhesion scoring system. The cecum and adhesion tissue were stained with hematoxylin and eosin and antibodies for matrix metalloproteinase-9 and TIMP-1 for further histopathologic examination.

RESULTS

The phase change anti-adhesive material exhibited effective blood clotting and were nontoxic in clotting experiments and acute toxicity test. The degradation rate could be adjusted using phosphate-buffered solution with varying pH. Adhesions were significantly reduced in the CMC-CaCl2-CsA treatment group compared with the control group (P < 0.001). Expression of matrix metalloproteinase-9 was stronger in CMC-CaCl2-CsA treatment group at 7 days after surgery.

CONCLUSIONS

"Phase-change" adhesive can undergo changes after application, and it inhibits the formation of abdominal adhesions after surgery. The material is convenient for using by surgeons and provides an effective tool for intestinal adhesion prevention.

Is there a difference?

Objectives

To determine whether there are any significant differences in complications and success rate between adjustable transobturator tape (TOA) and ordinary transobturator tape (TOT) in the treatment of female stress urinary incontinence (fSUI), as the TOA was recently introduced for the treatment of female SUI, its advantage being the ability to adjust the tape after surgery to address over- or under-correction.

Patients and methods

In all, 96 women with SUI (mean age 53 years, SD 10) were included in the study. Patients were randomised into two equal groups (group 1, TOA, vs. group 2, TOT). The operative duration, blood loss, intra- and post-operative complications, and the success rate, were compared between the groups.

Results

There was no statistically significant difference between the groups in cure rates (83% vs. 80%, groups 1 and 2, respectively) or in postoperative stay. The mean operative duration in group 2 was significantly shorter than in group 1. No intraoperative bleeding requiring a blood transfusion was recorded, and there were no bladder injuries. Postoperative adjustment of the tape was only required in three patients in group 1.

Conclusions

The TOA is a safe and accurate method for treating fSUI, but with experienced surgeons there was no difference in the cure rate and postoperative outcome between TOA and TOT.

Adjustable augmented rectus muscle transposition surgery with or without ciliary vessel sparing for abduction deficiencies

BACKGROUND

Vertical rectus transposition (VRT) is useful in abduction deficiencies. Posterior fixation sutures enhance the effect of VRT, but usually preclude the use of adjustable sutures. Augmentation of VRT by resection of the transposed muscles allows for an adjustable technique that can reduce induced vertical deviations and overcorrections.

METHODS

We retrospectively reviewed the records of all patients undergoing adjustable partial or full tendon VRT augmented by resection of the transposed muscles. Ciliary vessels were preserved in most of the patients by either splitting the transposed muscle or by dragging the transposed muscle without disrupting the muscle insertion.

RESULTS

Seven patients with abducens palsy and one with esotropic Duane syndrome were included. Both vertical rectus muscles were symmetrically resected by 3-5 mm. Preoperative central gaze esotropia of 30.6 ± 12.9Δ (range, 17-50Δ) decreased to 10.6 ± 8.8Δ (range, 0-25Δ) at the final visit (p = 0.003). Three patients required postoperative adjustment by recession of one of the transposed muscles due to an induced vertical deviation (mean 9.3Δ reduced to 0Δ), coupled with overcorrection (mean exotropia 11.3Δ reduced to 0 in two patients and exophoria 2Δ in one patient). At the final follow-up visit 3.8 ± 2.6 months postoperatively, one patient had a vertical deviation <4Δ, and none had overcorrection or anterior segment ischemia. Three patients required further surgery for recurrent esotropia.

CONCLUSIONS

Augmentation of VRT by resection of the transposed muscles can be performed with adjustable sutures and vessel-sparing technique. This allows for postoperative control of overcorrections and induced vertical deviations as well as less risk of anterior segment ischemia.