Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART)

BACKGROUND

Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery.

METHODS

A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed.

RESULTS

Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011).

CONCLUSION

The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years.

REGISTRATION NUMBER

ISRCTN25616490 (http://www.controlled-trials.com).

349 Improving Surgical Teaching for Junior Trainees Internationally in Light of Covid-19

Aim

During the Covid-19 pandemic there has been a gross effect on surgical training at all grades. A cohort that has been affected but reported less frequently are medical students and foundation doctors (junior trainees), whose interest in the field and clinical skills may have been affected by reduced service provision.

Method

A survey of junior trainees was conducted to analyse their perceived adequacy of surgical teaching in light of the effect of Covid-19. An online teaching course was then designed to target areas of weakness identified in the survey. The content was designed with the Imperial College London surgery curriculum and was vetted by a consultant surgeon.

Results

Of the 713 people surveyed, 393 (55%) had received little or no surgical teaching and 496 (70%) respondents said they were “not” or “slightly” confident in managing common and emergency surgical presentations. A free text box highlighted that deteriorating patients, clinical decision-making, and initiating management were the greatest concerns. This was used to design an international online teaching course for junior trainees, that focused explicitly on clinical care. The sessions were run live on MindTheBleep via Facebook live, to answer questions in real time and examine cases with live audience participation, receiving feedback after every session. This model has reached trainees in >30 countries with >200 feedback responses and an average rating of 4.5/5.

Conclusions

Junior trainees are a key cohort whose interest and education in surgery has suffered due to the pandemic. An innovative, online, clinically orientated course is assisting to re-engage trainees internationally.

Systematic analysis of authorship demographics in global surgery

Background

Global surgery has recently gained prominence as an academic discipline within global health. Authorship inequity has been a consistent feature of global health publications, with over-representation of authors from high-income countries (HICs), and disenfranchisement of researchers from low-income and middle-income countries (LMICs). In this study, we investigated authorship demographics within recently published global surgery literature.

Methods

We performed a systematic analysis of author characteristics, including gender, seniority and institutional affiliation, for global surgery studies published between 2016 and 2020 and indexed in the PubMed database. We compared the distribution of author gender and seniority across studies related to different topics; between authors affiliated with HICs and LMICs; and across studies with different authorship networks.

Results

1240 articles were included for analysis. Most authors were male (60%), affiliated only with HICs (51%) and of high seniority (55% were fully qualified specialist or generalist clinicians, Principal Investigators, or in senior leadership or management roles). The proportion of male authors increased with increasing seniority for last and middle authors. Studies related to Obstetrics and Gynaecology had similar numbers of male and female authors, whereas there were more male authors in studies related to surgery (69% male) and Anaesthesia and Critical care (65% male). Compared with HIC authors, LMIC authors had a lower proportion of female authors at every seniority grade. This gender gap among LMIC middle authors was reduced in studies where all authors were affiliated only with LMICs.

Conclusion

Authorship disparities are evident within global surgery academia. Remedial actions to address the lack of authorship opportunities for LMIC authors and female authors are required.

Implementation of a clinical pathway for the surgical treatment of colorectal cancer during the COVID-19 pandemic

AIM

This report summarizes the early experience of implementing elective colorectal cancer surgery during the COVID-19 pandemic.

METHODS

A pathway to minimize the risk of including COVID-19-positive patients for elective surgery was established. Prioritization and additional safety measures were introduced into clinical practice. Minimal invasive surgery was used where appropriate.

RESULTS

Thirty-eight patients were prioritized, and 23 patients underwent surgery (eight colon, 14 rectal and one anal cancer). The minimal invasive surgery rate was 78%. There were no major postoperative complications or patients diagnosed with COVID-19. Histopathological outcomes were similar to normal practice.

CONCLUSION

A safe pathway to offer standard high-quality surgery to colorectal cancer patients during the COVID-19 pandemic is feasible.

Assessment of collateral hand circulation by modified Allen's test in normal Indian subjects

BACKGROUND

Allen's test (AT) and Modified Allen's Test (MAT) are used as screening methods for assessment of the hand circulation. Few people lack the dual blood supply of hand and are at risk of hand ischemia after any intervention on radial artery. The Purpose of the study was to assess the collateral circulation of hand using MAT in normal Indian subjects and in elderly population to know the prevalence of positivity of Allen's test.

METHODS

900 participants (1800 hands) were divided in two groups. Group I had participants with age <50 years and group II had participants with age ≥50 years. MAT was performed in all participants and results were compared between the two groups.

RESULTS

In group I (n = 450, 900 hands), 313 were males and 137 were females, with mean age of 35.04 years. The relative percentages of a normal, equivocal, borderline and abnormal MAT were 77.8%, 16.6%, 3.7% and 1.6%, respectively. In group II (n = 450, 900 hands), 248 were males and 202 were females, with mean age of 60.4 years. The relative percentages of a normal, equivocal, borderline and abnormal MAT were 69.0%, 18.6%, 6.60% and 5.66%, respectively. A positive/abnormal test was significantly more common (5.66% Vs 1.66%, P < 0.00001) in older group.

CONCLUSION

MAT is simple, time tested and non invasive test to assess collateral circulation of the hand. A negative MAT safely selects patients for radial artery harvest; however, if the test is positive and in older patients then a second objective test may be needed.

Trans Fatty Acid Analysis of Frying Oil Using ATR-FTIR Spectroscopy: A Study on Indian Traditional Snack Foods

Background: Trans Fatty Acid (TFA) content in oil is an important quality parameter due to its adverse health effect. This study was aimed to examine the TFA content in the frying oil used by street food vendors in India for two traditional snack foods. Methods: Totally, 143 oil samples were collected at different frying times (0, 2, and 4 h) from five different vendors for Samosa and Jalebi. TFA levels of the oil samples were analyzed by Attenuated Total Reflection-Fourier Transform Infrared Spectroscopy (ATRFTIR). Statistical analyses were carried out using SPSS software version 23.0. Results: ATR-FTIR spectra exhibited an increase in peak intensity at 966 cm-1 with different frying time in both frying oil samples, indicating the formation of TFA. The TFA content in oils fried at 4 h was significantly higher than the ones at 0 and 2 intervals. It was found that 3 out of 74 (4%) Samosa fried oils and 12 out of 69 (17.4%) Jalebi fried oils were over the maximum allowed regulatory limit of TFA (5%). Jalebi fried oils had significantly higher TFA content than Samosa fried oils. Conclusion: The increase in frying time decreased the peroxide values and increased saturated fatty acids and TFA values of oils used for both food items. The local vendors and consumers should be educated by national authorities regarding health risk of TFA in street fried snacks.

Molecular Modeling and Docking Study to Elucidate Novel Chikungunya Virus nsP2 Protease Inhibitors

Chikungunya is one of the tropical viral infections that severely affect the Asian and African countries. Absence of any suitable drugs or vaccines against Chikungunya virus till date makes it essential to identify and develop novel leads for the same. Recently, nsP2 cysteine protease has been classified as a crucial drug target to combat infections caused by Alphaviruses including Chikungunya virus due to its involvement viral replication. Here in, we investigated the structural aspects of the nsP2 protease through homology modeling based on nsP2 protease from Venezuelan equine encephalitis virus. Further, the ligands were virtually screened based on various pharmacological, ADME/Tox filters and subjected to docking with the modeled Chikungunya nsP2 protease using AutoDock4.2. The interaction profiling of ligand with the protein was carried out using LigPlot⁺. The results demonstrated that the ligand with PubChem Id (CID_5808891) possessed highest binding affinity towards Chikungunya nsP2 protease with a good interaction profile with the active site residues. We hereby propose that these compounds could inhibit the nsP2 protease by binding to its active site. Moreover, they may provide structural scaffold for the design of novel leads with better efficacy and specificity for the nsP2 protease.

Nickel doped nanohydroxyapatite: vascular endothelial growth factor inducing biomaterial for bone tissue engineering

Biomaterial induced activation of vascular endothelial growth factor (VEGF) pathway for angiogenesis is now gaining recognition as an effective option for tissue engineering.

Molecular docking and interactions of pueraria tuberosa with vascular endothelial growth factor receptors

Pueraria tuberosa is known for its therapeutic potentials in cardiovascular disorders, but its effect in angiogenesis has not been studied so far. In this study, a computational approach has been applied to elucidate the role of the phytochemicals in inhibition of angiogenesis through modulation of vascular endothelial growth factor receptors: Vascular endothelial growth factor receptor-1 and vascular endothelial growth factor receptor-2, major factors responsible for angiogenesis. Metabolite structures retrieved from PubChem and KNApSAcK – 3D databases, were docked using AutoDock4.2 tool. Hydrogen bond and molecular docking, absorption, distribution, metabolism and excretion and toxicity predictions were carried out using UCSF Chimera, LigPlot⁺ and PreADMET server, respectively. From the docking analysis, it was observed that puerarone and tuberostan had significant binding affinity for the intracellular kinase domain of vascular endothelial growth factor receptors-1 and vascular endothelial growth factor receptor-2 respectively. It is important to mention that both the phytochemicals shared similar interaction profile as that of standard inhibitors of vascular endothelial growth factor receptors. Also, both puerarone and tuberostan interacted with Lys861/Lys868 (adenosine 5’-triphosphate binding site of vascular endothelial growth factor receptors-1/vascular endothelial growth factor receptors-2), thus providing a clue that they may enforce their inhibitory effect by blocking the adenosine 5’-triphosphate binding domain of vascular endothelial growth factor receptors. Moreover, these molecules exhibited good drug-likeness, absorption, distribution, metabolism and excretion properties without any carcinogenic and toxic effects. The interaction pattern of the puerarone and tuberostan may provide a hint for a novel drug design for vascular endothelial growth factor tyrosine kinase receptors with better specificity to treat angiogenic disorders.

Management of perianal abscess and fistula-in-ano in children

INTRODUCTION

Perianal abscess (PA) and fistula-in-ano (FIA) are common acquired anorectal disorders in children, but their management is still controversial. This study was performed to evaluate our experience with the treatment of PA and FIA in children of different age groups.

MATERIAL AND METHODS

A retrospective study was conducted of children below 16 years of age treated for PA/FIA in a pediatric surgery center between January 2002 and April 2006. The standard treatment for PA was incision and drainage (I&D). Judicious probing for fistulae was only performed in recurrent abscess or if a discharge of pus was identified from the anal verge at surgery. Fistulotomy was routinely performed in low fistulae not associated with inflammatory bowel disease (IBD). IBD associated fistulae were treated with topical tacrolimus in the absence of deep seated infection. Patients were divided into 3 age groups: <2 years, 2-8 years and >8 years. Mode of treatment, microbial organisms, recurrence, associated FIA and association with IBD were recorded. The median follow-up period was 6 months (8 weeks-3 years). Fisher's exact test was used for the analysis of categorical variables.

RESULTS

A total of 78 (39 [<2 years]; 17 [2-8 years]; 22 [>8 years]) patients were treated for PA/FIA during the four year period. In children aged <2 years, 33 (85%) had I&D of PA and the other 6 (15%) had fistulotomy. Recurrence was seen in 9 (23%) children, of which 3 (8%) had FIA. In children aged 2-8 years, 13 (76%) had PA and 4 (24%) had a FIA and there were no recurrences. In children >8 years, 12 (55%) had I&D, 1 (4%) had a fistulotomy and 9 (41%) were treated non-surgically. Six of 7 patients with IBD associated FIA were treated successfully with topical tacrolimus. The recurrence rate after primary surgery was significantly higher for <2 years and >8 years age groups compared to the 2-8 years age group. The incidence of FIA identified either at primary operation or during exploration for recurrence was highest (50%) in >8 years age group and lowest (21%) in the <2 years age group. Lactose fermenting coliforms were the most common organisms isolated from pus. The presence of intestinal organisms in pus was associated with significantly higher recurrence rates in children aged <2 years.

CONCLUSIONS

Surgery for PA/FIA in children aged <2 years resulted in low recurrence rates and should be considered as the primary treatment. Topical tacrolimus was found to be an effective treatment for IBD associated FIA.

A nontransfusional perioperative management regimen for patients with sickle cell disease undergoing laparoscopic cholecystectomy

BACKGROUND

Patients with sickle cell disease (SCD) are at increased risk for cholelithiasis. Laparoscopic cholecystectomy is the most frequent general surgical operation performed for this group of patients. Acute chest syndrome (ACS) is the most common cause of postoperative death among SCD patients. This study aimed to evaluate the impact of a novel perioperative management regimen involving prophylactic continuous positive airways pressure (CPAP) ventilation and avoidance of preoperative blood transfusion on postoperative SCD-related complications after laparoscopic cholecystectomy.

METHODS

A retrospective study included all SCD patients who underwent laparoscopic cholecystectomy since 1997 at our institution. Medical notes were analyzed to assess the rates of postoperative complications in relation to the severity of SCD.

RESULTS

A total of 13 patients were identified. There were no recorded episodes of acute painful crises and only one patient experienced an episode of ACS requiring protracted CPAP.

CONCLUSION

Laparoscopic cholecystectomy can be safely performed for SCD patients without prior blood transfusion. A defined perioperative regimen including the use of routine postoperative prophylactic CPAP for these patients helps to reduce SCD-related postoperative complications such as ACS and painful vaso-occlusive crises.

Sentinel node biopsy can replace four-node-sampling in staging early breast cancer

AIM

Four-node axillary sampling for breast cancer is an established method of staging the axilla in the United Kingdom. We report the sensitivity of sentinel node (SN) biopsy and compare it with that of four-node sampling.

METHODS

SN identification was attempted in 234 consecutive patients with unifocal breast cancers up to 25 mm in diameter on pre-operative ultrasound. A combination of isotope-labelled nanocolloid and patent blue dye techniques were used and SN were identified in 221 (94.5%). All patients underwent back-up four-node sampling and those with positive sentinel nodes on frozen section (FS) underwent immediate full axillary clearance.

RESULTS

Among those patients who had SN successfully identified, an average of 1.38 SN were identified per patient. Histological examination of the SN alone would have identified all node-positive patients that the four-node sample identified.

CONCLUSION

In patients who have SN identified, four-node axillary sampling does not provide any additional information.

Ultrasound biomicroscopy in lens "coloboma"

PURPOSE

To study the morphology of the Lens "Coloboma" using the technique of ultrasound biomicroscopy.

METHODS

We used the Paradigm 40 Ultrasound biomicroscope to study the morphology of the lens "Coloboma".

RESULTS

Ultrasound biomicroscopy of the lens "Coloboma" revealed a greatly increased sphericity of the lens and the deficiency of zonules in the "colobomatous" area.

CONCLUSIONS

Ultrasound biomicroscopy has helped in elucidating the pathology of the lens "Coloboma".

Core biopsy versus FNAC for palpable breast cancers. Is image guidance necessary?

The aim of this study was to assess the efficacy of free-hand percutaneous core biopsy (FHCB) and to determine the role of fine needle aspiration cytology (FNAC) as diagnostic tools for palpable radiologically-suspicious breast lumps. This retrospective study was based on reviewing the clinical records of all patients diagnosed as having breast cancer between January 1999 and December 2000 and patients who had benign lesions, but suspicious breast imaging at triple assessment. Absolute sensitivity of FHCB for diagnosing cancer in palpable lesions was 98.7% compared with 51.3% for FNAC. The difference in the sensitivity of FHCB and FNAC was statistically significant (P<0.005, Wilcoxon matched pair test). Since 94.8% of radiologically-suspicious lumps were shown to be cancers, we advocate FHCB for all patients presenting with radiologically suspicious palpable lumps to our breast clinic. We also conclude that the sensitivity of FHCB for the diagnosis of malignancy in palpable radiologically-suspicious breast lesions is so high that image-guidance is unnecessary.

Image-guided surgery for anal fistula in a 0.5T interventional MRI unit

PURPOSE

To determine whether MR-guided anorectal surgery is feasible, and to develop techniques for MR-guided anal fistula surgery.

MATERIALS AND METHODS

Six patients with pilonidal sinus (PNS), and 21 with suspected anal fistulae were operated on in the GE Signa SPIO 0.5T interventional MRI unit. Procedures were performed with magnet-safe Lockhart-Mummery fistula probes. Preprocedural and intra-operative MRI (IOMRI) techniques were used to identify the extent of the fistula tracts and septic foci, and to ensure the adequacy of the surgical procedure.

RESULTS

IOMRI demonstrated the PNS lesions and the adequacy of excision. Imaging failed to demonstrate a fistula in two patients, as confirmed by surgical examination. No images were obtained in one patient due to his size (weight in excess of 100 kg). In 18 patients a fistula tract or abscess was demonstrated and IOMRI was used to assess the adequacy of the surgical procedure. In three patients this demonstrated incomplete drainage of septic foci, which was not obvious on inspection of the surgical field. We believe that in these patients IOMRI prevented an incomplete procedure and the potential requirement for a second operation. Further surgery was performed to rectify this situation. The fistula tract was laid open in 13 patients, and a Seton drain was inserted in five.

CONCLUSION

MRI-guided surgery for anal fistula is feasible. IOMRI demonstrates the exact anatomy of the tracts and abscesses, and confirms that all have been adequately treated. We believe it may become particularly useful in surgery for recurrent and complex anal fistulae, and may lead to fewer recurrences.

The 'Tellytubby Tummy', a novel technique for laparostomy management

Images

Laser in situ keratomileusis for residual myopia after primary LASIK

PURPOSE

To analyze the results of secondary laser in situ keratomileusis (LASIK) for residual myopia after primary LASIK.

SETTING

Dr. Agarwal's Eye Hospital, Chennai, India.

METHODS

A retrospective study of 50 eyes of 29 patients who had a secondary LASIK procedure was carried out. After a mean follow-up of 5.84 months +/- 3.24 (SD) after the primary procedure, the mean myopic residual refraction was -4.30 +/- 1.83 diopters (D). In 10 eyes, the primary corneal flap was lifted by blunt dissection. In 40 eyes, the flap was made with a second cut. The secondary LASIK was performed using the Chiron Technolas Keracor 217 excimer laser and the Automated Corneal Shaper microkeratome (Bausch & Lomb).

RESULTS

The mean follow-up was 16.58 +/- 3.06 months. At 12 months, the mean spherical equivalent was -0.45 +/- 0.68 D (P <.05). Thirty-one eyes were emmetropic, 13 eyes were within +/-1.00 D of emmetropia, and 5 eyes were within +/-2.00 D. The mean uncorrected visual acuity improved from 20/80 (range 20/60 to 20/200) to 20/40 (range 20/20 to 20/200) (P <.005). Seventeen eyes gained 1 line of best spectacle-corrected visual acuity; 1 eye lost 1 line because of a decentered ablation with an induced postoperative astigmatism of -3.50 D cylinder. No sight-threatening complications such as a free cap, flap irregularity, corneal ectasia, or retinal complication occurred postoperatively. Epithelial ingrowth developed in 5 eyes and corneal thinning, in 1 eye. Three eyes had night glare.

CONCLUSION

Secondary LASIK was a safe, stable, and effective method for the treatment of residual myopia after primary LASIK.

Laser in situ keratomileusis for residual myopia after radial keratotomy and photorefractive keratectomy

PURPOSE

To evaluate the visual outcome, stability, and complications of laser in situ keratomileusis (LASIK) for residual myopia after radial keratotomy (RK) and photorefractive keratectomy (PRK).

SETTING

Dr. Agarwal's Eye Hospital, Chennai, India.

METHODS

Twenty eyes that had LASIK treatment for residual myopia after RK (10 eyes) or PRK (10 eyes) were retrospectively analyzed. Laser in situ keratomileusis was performed after a mean period of 24.3 months +/- 0.75 (SD) in the RK group and 22.0 +/- 1.07 months in the PRK group.

RESULTS

At the last follow-up, the mean spherical equivalent was reduced from -6.05 +/- 1.98 diopters (D) to -1.26 +/- 0.32 D (P <.05) in the RK group and from -3.38 +/- 1.30 D to -0.55 +/- 0.40 D (P <.005) in the PRK group. The mean uncorrected visual acuity improved from 20/300 (range 20/600 to 20/200) to 20/40 (range 20/60 to 20/20) (P <.05) and from 20/200 (range 20/800 to 20/80) to 20/25 (range 20/40 to 20/20) (P <.05), respectively. Two eyes in the RK group and 3 in the PRK group gained 1 line of best corrected visual acuity, and 2 eyes in the RK group lost 1 line. No sight-threatening complications such as a free flap, corneal ectasia, or a retinal complication occurred. There was no statistically significant difference in corneal haze before and after LASIK. Two eyes in the RK group required repositioning of the flap because of irregular apposition to the stromal bed.

CONCLUSION

Laser in situ keratomileusis was safe, effective, and stable in the treatment of residual myopia after RK and PRK.

Fine needle aspiration of bone tumors

Fine needle aspiration cytology (FNAC) was performed in 226 cases of bone tumors and the cytohistologic correlation was calculated to assess the technique's diagnostic efficacy aided by immunocytochemistry, considering histopathology as the gold standard. Of the 226 cases, 136 were malignant and 72 cases were benign tumors. In the remaining 18 cases, cytohistopathologic examination revealed no bony lesion. There were 178 evaluable cases, but the specific morphologic diagnosis on FNAC was possible only in 159 cases with one false positive and 29 false negatives. Giant cell tumor (32%) and Ewing's sarcoma (22%) were the most common bony tumors encountered in this series. The diagnostic indices were calculated by a decision matrix comparison. The overall sensitivity and specificity were 86.0 (confidence interval [CI], 80.3-90.3) and 94.7 (CI, 71.9-99.7), respectively. The positive predictive value (PPV) was as high as 99.4 (CI, 96.5-100), while the negative predictive value (NPV) was 38.3 (CI, 24.9-53.6) with positive and negative likelihood ratios of 16.338 and 0.147, respectively. Diagnosis of malignant tumors was more accurate with a PPV of 99.2 (CI, 94.8-100.0) and specificity of 94.7 (CI, 71.9-99.7), while the sensitivity was 89.0 (CI, 82.2-93.5) and NPV was 54.5 (CI, 36.6-71.5). This study highlights the usefulness of FNAC along with the use of immunocytochemistry in the rapid diagnosis of bone tumors.

Results of pediatric laser in situ keratomileusis

PURPOSE

To evaluate the results of laser in situ keratomileusis (LASIK) for uniocular high myopia in pediatric eyes.

SETTING

Dr. Agarwal's Eye Hospital, Chennai (Madras), India.

METHODS

Sixteen eyes that were treated by LASIK for uniocular high myopia were retrospectively analyzed. The mean patient age was 8.4 years +/- 1.83 (SD) (range 5 to 11 years). Laser in situ keratomileusis was performed using the Technolas Keracor 217 excimer laser and the Automated Corneal Shaper microkeratome, which created a 160 microm corneal lamellar flap. Postoperatively, patients were reviewed at 1 day, 1 week, and 1, 6, and 12 months. The examination included uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction, anterior segment evaluation, grading of haze based on a 5-point scale, intraocular pressure, corneal topography, and fundus evaluation. The Student t test was used for statistical analysis.

RESULTS

The charts of all patients were analyzed at the 12 month visit. The mean preoperative spherical equivalent (SE) was -14.88 +/- 3.69 diopters (D) (range -9.00 to -23.00 D) and the mean postoperative SE, -1.44 +/- 1.14 D (range 0 to -2.50 D) (P < .05). The safety index was 1.01 (mean postoperative BCVA 0.54 and mean preoperative BCVA 0.53; P = .77). The efficacy index was 0.53 (mean postoperative UCVA 0.28 and mean preoperative BCVA 0.53). None of the eyes had an induced astigmatism of more than 0.5 D. Twelve eyes regained their BCVA, 2 lost 1 line of BCVA, and 2 gained 1 line. Three eyes had grade 2 haze. No retinal complications were observed.

CONCLUSION

In this study, LASIK for uniocular high myopia in pediatric eyes provided encouraging results in the management of select cases of anisometropic amblyopia when other measures failed. A larger study with a longer follow-up is necessary to determine the long-term effects.

Vitrectomy for intra ocular foreign body removal

Ten consecutive cases of perforating ocular injuries with retained intraocular foreign bodies over a period of 2 years were reviewed retrospectively in this study. All cases were operated upon by a 3 port pars plana vitrectomy and if necessary endolaser done. All ten cases (100%) were successful in terms of intraocular foreign body removal through the pars plana sclerotomy but ultimately we lost three [3] [30%] cases of which two had retinal detachments with P.V.R. D-3 preoperatively and the other had endophthalmitis. Of the seven (70%) successful cases four eyes (40%) had a post-operative vision of 6/12 or better while 2 [20%] had 6/24 and the last had 6/60 [10%]. Nine cases [90%] had a magnetic Intraocular foreign body. Various complications of Intraocular foreign bodies like vitreous haemorrhage, retinal incarceration, cataract and retinal detachment were noted preoperatively. Silicone oil was used in three (30%) cases. Sulfur Hexafluoride was used in 5 cases (50%). Endolaser photocoagulation was done in 7 cases (70%).