Conjunctival flap advancement with or without scleral graft for hypotony maculopathy after trabeculectomy

AIM: To investigate the outcomes of adaptive conjunctival flap advancement surgical techniques with or without scleral graft for patients undergoing revision surgery after trabeculectomy.METHODS: This retrospective study included 28 eyes of 28 subjects from December 2015 to April 2018. A group of 15 eyes underwent conjunctival advancement only while the other 13 eyes did conjunctival advancement with partial thickness scleral graft. In both study groups, we considered the intraocular pressure(IOP) as our primary outcome and visual acuity(VA) as our secondary outcome. Both were assessed pre-and post-operatively till the last followup possible point. Additionally, we classified the patients according to complete and qualified success criteria.RESULTS: The mean age of the conjunctival advancement group was 36.87±19.25 y, while it was 44.08±18.04 in the other group. In both study groups, the mean IOP significantly increased after revision surgery at 1, 2, 3 mo and the last follow-up visit when compared to prior the surgery(P<0.001). Moreover, VA was significantly improved(P=0.03) in the final follow-up for both surgical techniques. When we compared the change from baseline in both groups, there was no significant difference between IOP improvement in 1 mo(P=0.263), while the difference was significant in 2 mo(P=0.03), 3 mo(P=0.02) and in the final follow-up visit postoperatively. However, this difference was not significant regarding VA(P=0.5).CONCLUSION: The both adaptive techniques of conjunctival advancement and conjunctival advancement with scleral graft are effective for treating patients with lateonset hypotony. Yet, more prospective studies are needed to assert upon these results.

Modified malleable prosthesis with a fixed mesh:case series for the Ghattas technique

Penile prosthetic implantation represents a cornerstone for patients with organic erectile dysfunction(ED)that is refractory,unsatisfactory,or contra-indicated for other approved medical or mechanical options.In this study,we introduce the“Ghattas technique,”wherein we constructed a polypropylene mesh sheath that surrounds and is fixed to a 13-mm malleable prosthesis cylinder,which can increase the cylinder diameter for cases that need a larger prosthesis.All patients underwent preoperative evaluation and completed the five-item International Index of Erectile Function questionnaire(IIEF-5).Postoperative outcomes were evaluated by IIEF-5 and Erectile Dysfunction Inventory of Treatment Satisfaction(EDITS)questionnaires at final follow-up.The mean age of the 23 included patients was 57.9(standard deviation[s.d.]:11.4)years and the mean duration of ED was 8.5(s.d.:7.9)years.Erection improvement was determined by comparing mean preoperative and postoperative IIEF-5 scores(8.3[s.d.:3.9]vs 24.6[s.d.:0.6],P<0.001).High treatment satisfaction was determined according to a mean EDITS score of 94.9(s.d.:9.9).The proposed Ghattas technique was safe and effective in our patients,and provides opportunity for cases that need a diameter larger than 13 mm.Further studies are needed to confirm these results.