Glaucoma drainage device implantation and cyclophotocoagulation in the management of refractory glaucoma after Descemet-stripping automated endothelial keratoplasty

AIM:To compare the surgical outcomes of glaucoma drainage device implantation(GDI)and trans-scleral neodymium:YAG cyclophotocoagulation(CPC)in the management of refractory glaucoma after Descemetstripping automated endothelial keratoplasty(DSAEK).METHODS:This retrospective study on observational case series enrolled 29 patients who underwent DSAEK and posterior anti-glaucoma surgery(15 with GDI and 14 with CPC).The main outcome measures were intraocular pressure(IOP),glaucoma surgery success rate(defined as IOP of 6–21 mm Hg without additional anti-glaucoma operation),number of glaucoma medications,endothelial graft status,and best-corrected visual acuity(BCVA).RESULTS:The mean follow-up time was 34.1 and 21.0mo for DSAEK or glaucoma surgeries,both for the GDI and CPC groups.Both groups showed significant IOP reduction after glaucoma surgery.The GDI group presented a significantly higher success rate in IOP control than the CPC group(60%vs 21.4%,P=0.03).Both procedures significantly decreased the number of glaucoma medications(P=0.03).Forty percent and 57%of cases in the GDI and the CPC group,respectively,experienced endothelial graft failure during follow-up(P=0.36).Significantly worse BCVA after surgery was observed in the CPC group but not in the GDI group.CONCLUSION:Both GDI and CPC significantly decrease IOP in eyes with glaucoma after DSAEK.GDI is preferable to CPC in refractory glaucoma cases after DSAEK,as it manifests a significantly higher success rate for IOP control,similar endothelial graft failure rate,and relatively preserves BCVA than CPC.

Binocular disturbance after glaucoma drainage device implantation

Binocular vision disturbance is a well-described complication of glaucoma drainage device(GDD) implantation. The pathophysiology is not well-understood, but may involve bulk effects from the implant and surrounding bleb, as well as modulation of muscle function due to surgical trauma and post-operative inflammation, resulting in a combined resection/posterior fixation effect. Retrospective studies have found the risks of motility disorder and diplopia vary widely, estimated to be 56%-86% and 57%-75%, respectively. More recently, cross-sectional studies and prospective trials estimate post-GDD incidence to be approximately 1%-44%, with the incidence in newer generation of implants designed to limit bleb size likely lower at 1%-5%. Suggested methods of management strategies include prismatic spectacles, monocular occlusion, extreme monovision, and strabismus surgery.

Direct Synthesis of Layer-Tunable and Transfer-Free Graphene on Device-Compatible Substrates Using Ion Implantation Toward Versatile Applications

Direct synthesis of layer-tunable and transfer-free graphene on technologically important substrates is highly valued for various electronics and device applications.State of the art in the field is currently a two-step process:a high-quality graphene layer synthesis on metal substrate through chemical vapor deposition(CVD)followed by delicate layer transfer onto device-relevant substrates.Here,we report a novel synthesis approach combining ion implantation for a precise graphene layer control and dual-metal smart Janus substrate for a diffusion-limiting graphene formation to directly synthesize large area,high quality,and layer-tunable graphene films on arbitrary substrates without the post-synthesis layer transfer process.Carbon(C)ion implantation was performed on Cu-Ni film deposited on a variety of device-relevant substrates.A well-controlled number of layers of graphene,primarily monolayer and bilayer,is precisely controlled by the equivalent fluence of the implanted C-atoms(1 monolayer~4×10^(15)C-atoms/cm^(2)).Upon thermal annealing to promote Cu-Ni alloying,the pre-implanted C-atoms in the Ni layer are pushed toward the Ni/substrate interface by the top Cu layer due to the poor C-solubility in Cu.As a result,the expelled C-atoms precipitate into a graphene structure at the interface facilitated by the Cu-like alloy catalysis.After removing the alloyed Cu-like surface layer,the layer-tunable graphene on the desired substrate is directly realized.The layer-selectivity,high quality,and uniformity of the graphene films are not only confirmed with detailed characterizations using a suite of surface analysis techniques but more importantly are successfully demonstrated by the excellent properties and performance of several devices directly fabricated from these graphene films.Molecular dynamics(MD)simulations using the reactive force field(ReaxFF)were performed to elucidate the graphene formation mechanisms in this novel synthesis approach.With the wide use of ion implantation technology in the microelectronics industry,this novel graphene synthesis approach with precise layer-tunability and transfer-free processing has the promise to advance efficient graphene-device manufacturing and expedite their versatile applications in many fields.

Comparison of the efficacy and safety of ultrasonic cycloplasty vs valve implantation and anti-VEGF for the treatment of fundus disease-related neovascular glaucoma

·AIM: To compare the clinical efficacy and safety of ultrasonic cycloplasty(UCP) vs Ahmed glaucoma drainage valve implantation(ADV) in addition to intravitreal antivascular endothelial growth factor(VEGF) for treatment of fundus disease-related neovascular glaucoma(NVG).·METHODS: A total of 43 patients(45 eyes) with NVG secondary to fundus diseases underwent anti-VEGF combined with UCP or ADV from August 2020 to March 2022 were enrolled in this retrospective cohort study. Of them, 14 patients(15 eyes) were treated with both UCP and anti-VEGF as the UCP group and 29 patients(30 eyes) treated with both ADV and anti-VEGF as the ADV group. The success of the treatment was defined as intraocular pressure(IOP) between 11-20 mm Hg with or without using IOP-lowering drugs. IOP measurement, IOP lowering drugs at baseline and follow-ups period and complications were recorded.·RESULTS: The average age was 63.03±9.95 and 52.27±12.89y in ADV and UCP groups, respectively(P=1.947). The fundus pathology included proliferative diabetic retinopathy in 42 eyes and retinal vein occlusion in 3 eyes. All eyes in both groups achieved successful treatment at 3mo. While the success rate was 90.0%(27/30) in the ADV group and 86.7%(13/15) in the UCP group at the last follow-up of 6mo(P>0.05). IOP was significantly lower with reduction of drug use than the baseline in both groups(both P<0.05). And the ADV group needed fewer anti-glaucoma drops than the UCP group from 1d to 3mo. The comfort scores of patients in the ADV group were significantly lower than those in the UCP group in the first week after the operation(P<0.05).·CONCLUSION: UCP is an alternative to the ADV with the same efficacy but non-invasive for the treatment of NVG.

Intraocular pressure control of a novel glaucoma drainage device-in vitro and in vivo studies

AIM：To evaluate the intraocular pressure（IOP）control of an artificial trabeculum drainage system（ATDS）,a newly designed glaucoma drainage device,and postoperative complications in normal rabbit eyes.METHODS：Pressure drops in air and fluid of 30 ATDS were measured after being connected to a closed manometric system.Twenty of them were then chosen and implanted randomly into the eyes of 20 rabbits.Postoperative slitlamp,gonioscopic examination and IOP measurements were recorded periodically.Ultrasound biomicroscopy and B-scan ultrasonography were also used to observe the complications.Eyes were enucleated on day 60.RESULTS：Pressure drops of 4.6-9.4 mm Hg were obtained at physiological aqueous flow rates in the tests in vitro.The average postoperative IOP of the experimental eyes（11.6-12.8 mm Hg）was lower than the controls significantly（P〈0.05）at each time point.Complications of hemorrhage（n=1）,cellulosic exudation（two cases）and local iris congestion（two cases）were observed.The lumina of the devices were devoid of obstructions in all specimens examined and a thin fibrous capsule was found around the endplate.CONCLUSION：ATDS reduce IOP effectively.However,further studies on the structure are needed to reduce complications.

A feasibility study of using biodegradable magnesium alloy in glaucoma drainage device

Technological advances in glaucoma have challenged the traditional treatment paradigm. Historically incisional surgery has been used in cases of advanced disease and/or uncontrolled intraocular pressures resistant to medical or laser interventions. More recently, perhaps due to advancements in imaging, surgery has been suggested to be beneficial earlier in the treatment paradigm. Despite these trends, surgical manipulation of the tissues and unpredictability of wound healing continue to result in surgical failure. Magnesium is an essential element for human body and plays a critically important role in maintaining the functional and structural integrity of several tissues, including the eye. Due to several of its advantageous properties such as non-toxicity, biodegradability, and high biological compatibility, magnesium alloy has attracted great attention as a novel biomaterial. Biodegradable cardiovascular stents made of magnesium alloy have already been introduced into clinical practice. The purpose of this review is to determine if bioabsorbable magnesium alloys can be utilized as a promising candidate for the development of a new generation of glaucoma surgical assistive devices.

Dellen-like keratopathy associated with glaucoma drainage devices

To report the first case of dellen-like keratopathy with superior corneal thinning associated with implantation of glaucoma drainage devices. A 70-year-old male with a history of primary open angle glaucoma and dry eye disease underwent placement of glaucoma drainage devices with antimetabolite application in both eyes. Prior to placement, minimal refractive error was noted on manifest refraction. Several years later, the patient was referred for decreased vision and corneal irregularity. Examination showed pathologic corneal curvature, superior corneal thinning, and epithelial demarcation lines immediately anterior to the glaucoma drainage devices in both eyes. The epithelium remained intact with no evidence of limbal stem cell deficiency. Manifest refraction revealed a large change in both eyes. Topography was used to confirm the presence of irregular corneal curvature anterior to the glaucoma drainage devices. Dellen-like keratopathy with superior thinning is a rare sequela after implantation of a glaucoma drainage device that must be considered in elderly patients who undergo glaucoma surgery. It is likely related to a combination of tear film alteration related to previously large anterior blebs, antimetabolite application, and aqueous humor flow patterns around the drainage devices. Treatment should focus on lubrication.

A portable,economic drainage device to prevent pocket hematoma of pacemakers

Objective:To make up a portable,economic drainage device to prevent the development of pocket hematoma and avoid the additional therapies of pocket hematoma.Methods:Between 2003 and 2006,a total of 265 devices were implanted at our institution.The 89 high-risk patients were determined by the predictors of hematoma occurrence(marasmatic elder,inevitable oral antiplatelet/anticoagulation therapy,venous pressure increased by other comorbidity,the deficiency of the clotting mechanism for hepatic diseases,or incognizable severe intraoperative bleeding),and other 186 patients were included in non-high-risk group.The 89 high-risk patients were randomized into treatment and control subgroups by sortition.Surgical procedures differed only by the application of the portable,economic drainage device prior to wound closure in treatment subgroup.Results:The incidence of pocket hematoma was 4.3% in treatment subgroup,18.6% in control subgroup and 2.7% in non-high-risk group,leading to 2,6 and 3 patients' prolonged hospitalization,respectively.The additional cost due to pocket hematoma was lower(1.5 times) in the treatment group compared to the control group.There wasn't antidromic infection and delayed cure of the skin incision with the use of our drainage device within 6 months.Conclusion:Our portable drainage device was made up easily and quickly.It could decrease the total cost of hospitalization,did not increase the other adverse events and seemed to be suitable for such patients with a tendency to develop pocket hematoma undergoing the implantation of pectoral pacemakers,implantable cardioverter defibrillator,or cardiac resynchronization therapy.

Long-term Outcomes of Domestic Hunan Aqueous-Drainage Implantation in Refractory Glaucoma

Purpose:To evaluate the long-term outcomes of a non-valved,.Chinese-made Hunan aqueous drainage device(HAD) in patients with refractory glaucoma,.compared to trabeculectomy.Methods:This was a retrospective observational case series,including 27 patients with refractory glaucoma who either underwent HAD implantation (n=11) or trabeculectomy (n=16).The mean follow-up was 27.9±13.5 (mean±SD) months.Intraocular pressure(IOP),visual acuity and postoperative complications were measured.Results:IOP was significantly lower at the last follow-up in both two groups compared with the baseline IOP (HAD:58.4 to 19.0 mmHg,P<0.001;trabeculectomy:58.4 to 23.7 mmHg,P<0.001).One week,1 month and 1 year after the operation,the average IOP of the HAD group was significantly lower than that of trabeculectomy group(P<0.05 at all time points).However,the IOP did not differ significantly between the two groups at the time of last follow-up.Conclusion:HAD implantation serves as a good option to control IOP in refractory glaucoma.

Efficacy and safety of intravitreal ranibizumab with panretinal photocoagulation followed by trabeculectomy compared with Ahmed glaucoma valve implantation in neovascular glaucoma

AIM：To evaluate the efficacy and safety of intravitreal ranibizumab（IVR）with panretinal photocoagulation（PRP）followed by trabeculectomy compared with Ahmed glaucoma valve（AGV）implantation in neovascular glaucoma（NVG）.METHODS：This was a retrospective comparative study.We reviewed the cases of a total of 45 eyes from 45 NVG patients among which 23 eyes underwent AGV implantation and the other 22 underwent trabeculectomy. The causes of neovascular glaucoma included：diabetic retinopathy（25 eyes）,and retinal vein occlusion（20 eyes）.All patients received preoperative IVR combined with postoperative PRP. The mean best-corrected visual acuities（BCVA）were converted to the logarithms of the minimum angle of resolution（log MAR）for the statisitical analyses.Intraocular pressure（IOP）,the log MAR BCVA and surgical complications were evaluated before and after surgery.The follow-up period was 12 mo.RESULTS：A total of 39 cases showed complete regression of iris neovascularization at 7d after injection,and 6 cases showed a small amount of residual iris neovascularization. The success rates were 81.8% and 82.6% at 12 mo after trabeculectomy and AGV implantation,respectively. In the trabeculectomy group,the log MAR BCVA improved at the last follow-up in 14 eyes,remained stable in 6 eyes and decreased in 2 eyes. In 4 cases,slight hyphemas developed after trabeculectomy. A shallow anterior chamber developed in 2 cases and 2 vitreous hemorrhages. In the AGV group,the log MAR BCVA improved in 14 eyes,remained stable in 5 eyes and decreased in 4 eyes. Slight hyphemas developed in 3 cases,and a shallow anterior chamber in 3 cases. The mean postoperative IOP was significantly lower in both groups after surgery（F=545.468,P〈0.05）,and the mean postoperative log MAR BCVA was also significantly improved（F=10.964,P〈0.05）with no significant difference between two groups.CONCLUSION：It is safe and effective to treat NVG with this combined procedure,and we found similar results after IVR＋AGV implantation＋PRP and IVR＋trabeculectomy＋PRP in eyes with NVG.

XPS INVESTIGATION OF NITROGEN IONS IMPLANTED INTO ALUMINUM ALLOY BY PLASMA BASED ION IMPLANTATION

Aluminum alloy 2024 has been implanted with nitrogen ions at various doses by plasma based ion implantation. The introduction of energetic ions causes structural change within the near surface region of the solid. The samples have been characterized by X-ray Photoelectron Spectroscopy at various depths. The chemical states of Al and N were identified by deconvolution of the recorded XPS spectra. After plasma based ion implanted nitrogen into aluminum, not only the AlN precipitates but also super saturated solution of nitrogen forms. The presence of aluminum in different chemical states is corresponding to Al, AlN and Al2O3. The majority of nitrogen is in the form of the supersaturated solution. With the increase of nitrogen dose, the amount of AlN precipitates increases.

CIED implantation in elderly patients： a single-center experience

Thanks to the development of new medical technologies and improvement in medical care the last decades are characterized by the growth of elderly＇s number. The median age of the world＇s population is increasing because of a decline in birth rates and a 20-year increase in the average life span during the second half of the 20th century.

Optimizing Device Implantation in Patients with Atrial Fibrillation and Risk of Stroke

According to clinical studies,about a third of patients with atrial fibrillation will suffer a stroke during their lifetime.Between 70 and 90%of these strokes are caused by a thrombus formed in the left atrial appendage.The study was to develop tools based on biophysical models and interactive interfaces to optimize LAAO device therapies.

Optimized Axillary Vein Technique versus Subclavian Vein Technique in Cardiovascular Implantable Electronic Device Implantation： A Randomized Controlled Study

Background：The conventional venous access for cardiovascular implantable electronic device （CIED） is the subclavian vein,which is often accompanied by high complication rate.The aim of this study was to assess the efficacy and safety of optimized axillary vein technique.Methods：A total of 247 patients undergoing CIED implantation were included and assigned to the axillary vein group or the subclavian vein group randomly.Success rate of puncture and complications in the perioperative period and follow-ups were recorded.Results：The overall success rate （95.7% vs.96.0%） and one-time success rate （68.4% vs.66.1%） of punctures were similar between the two groups.In the subclavian vein group,pneumothorax occurred in three patients.The subclavian gaps of three patients were too tight to allow operation of the electrode lead.In contrast,there were no puncture-associated complications in the axillary vein group.In the patient follow-ups,two patients in the subclavian vein group had subclavian crush syndrome and both of them received lead replacement.The incidence of complications during the perioperative period and follow-ups of the axillary vein group and the subclavian vein group was 1.6% （2/125） and 8.2% （10/122）,respectively （χ^2=5.813,P =0.016）.Conclusion：Optimized axillary vein technique may be superior to the conventional subclavian vein technique for CIED lead placement.

Expert consensus on the clinical application of totally implantable venous access devices in the upper arm(2022 Edition)

With the widespread adoption of ultrasound guidance,Seldinger puncture techniques,and intracardiac electrical positioning technology for the placement of peripherally inserted central catheters in recent years,an increasing number of medical staff and patients now accept peripheral placement of totally implantable venous access devices(TIVADs)in the upper arm.This approach has the advantage of completely avoiding the risks of hemothorax,pneumothorax,and neck and chest scarring.Medical specialties presently engaged in this study in China include internal medicine,surgery,anesthesiology,and interventional departments.However,command over implantation techniques,treatment of complications,and proper use and maintenance of TIVAD remain uneven among different medical units.Moreover,currently,there are no established quality control standards for implantation techniques or specifications for handling complications.Thus,this expert consensus is proposed to improve the success rate of TIVAD implantation via the upper-arm approach,reduce complication rates,and ensure patient safety.This consensus elaborates on the technical indications and contraindications,procedures and technical points,treatment of complications,and the use and maintenance of upper-arm TIVAD,thus providing a practical reference for medical staff.

Effect of fluoroscopy frame rate on radiation exposure and in-hospital outcomes in cardiovascular implantable electronic device implantation procedures

Objective:To assess the radiation exposure in cardiovascular implantable electronic device(CIED)implantation procedures,the effect of fluoroscopy frame rate on various radiation exposure indices,and in-hospital outcomes.Methods:Data of CIED implantation procedures from September 2015 to December 2019 of all the CIED implantation procedures performed at our institute were retrospectively analyzed.The procedural data were divided into two groups:a)pre-group:procedures that were performed under fluoroscopy frame rate of 7.5 frames per second(fps);b)post-group:procedures that were performed under fluoroscopy frame rate of 3.75 fps.We compared procedure time,fluoroscopy time,Kerma air product,effective dose,and in-hospital outcomes between the two groups.Results:A total of 2,225 procedures were included in the analysis with mean age of(62±15)years.The procedures consisted of the implantation of single-chamber(n=1,436),double chamber(n=656),and biventricular devices(n=133).Procedure time and radiation indices showed a significant reduction over the study period(P<0.001).Reduction in the fluoroscopy frame rate was associated with a significant reduction in radiation exposure indices(P<0.001).In-hospital outcomes did not differ between the two groups.Conclusions:Reduction in the fluoroscopy frame rate from 7.5 to 3.75 fps significantly decreased the radiation exposure in CIED implantation procedures.A framerate lower than 3.75 fps should be the default setting during such procedures.

精细化管理在手术室骨科外来器械与植入物中的应用

目的探讨精细化管理在骨科外来器械与植入物管理中的应用效果。方法将2022年1月-3月进行的1275例骨科植入物手术设为对照组,将2022年4月-6月进行的骨科植入物手术1023例设为干预组,对照组采用常规的骨科手术配合管理模式,干预组采用精细化管理模式。结果干预组外来器械与植入物管理质量均明显高于对照组(均P<0.05),术中清点意外事件发生率显著低于对照组(P<0.05)。结论精细化管理能有效实施骨科外来器械与植入物的环节控制,显著提升外来器械与植入物管理质量,同时降低术中清点意外事件发生率。

运用5G通信技术远程程控心脏置入型电子设备的有效性及安全性评价

目的:探讨与技术服务人员术中现场程控、测试心脏置入型电子设备(cardiac implantable electrical devices,CIEDs)各项参数的常规方式相比,该非接触式远程程控系统在CIEDs置入过程中的的安全性和有效性。方法:本研究为回顾性研究。依照时间顺序,连续分析了自2020年8月至2021年3月,于我院接受CIEDs置入的110例患者,根据术中程控及测试方式,分为常规程控组及非接触组。入选患者中,59例常规组患者由技术服务人员术中现场程控,其余51例非接触组患者通过新型远程非接触系统程控。结果:常规组的开关门频率高于非接触组[(9.8±1.8)vs.(5.8±1.2),P<0.05]。在CIEDs置入期间和术后12个月时,常规组和非接触组之间的设备相关参数差异及手术相关不良事件差异无统计学意义。结论:基于5G通信传输技术的新型非接触性程控系统与传统的程控方法相比,是安全有效的。

基于Java的排涝泵站站内优化调度软件开发

【目的】针对安装全调节轴(混)流泵的排涝泵站开发计算软件确定运行中的最优开机台数组合和各机组的叶片角度,以获得最高装置效率或最大流量。【方法】根据实测的扬程和电动机输入功率等运行参数,结合水泵性能曲线推算水泵流量和流道阻力参数,研究装置效率随叶片角度变化规律。以平均装置效率最高或总流量最大为目标函数,建立动态规划模型进行站内运行优化调度,获得最优的开机组合和运行机组的叶片角度。在集成环境IntelliJ IDEA下,采用Java开发了通用的可视化的计算软件。【结果】对某排涝泵站,通过软件获得并分析了装置效率随叶片角度(或流量)的变化曲线,给出了在Hsy=5.3 m条件下不同需要流量下的优化运行方案。当需要流量为32 m^(3)/s时,与各机组均以+1.0°叶片角度的简单决策方案相比,软件给出的优化方案装置效率提高了0.76%。【结论】实际工程应用表明所开发的软件性能稳定,计算精确,实用性强。

消毒供应中心外来器械及植入物应用信息化追溯系统管理的效果观察

目的:探讨消毒供应中心外来器械及植入物应用信息化追溯系统管理的效果。方法:选取2021年1—12月绵阳市中心医院消毒供应中心纳入的15919包次的外来器械及植入物为研究样本,结合开展信息化追溯系统前后时间差异将其分为对照组(2021年1—6月)7919包次和观察组(2021年7—12月)8000包次。比较两组物品包装、清洗、消毒达标率。结果:观察组清洗、消毒、包装合格率均高于对照组,差异有统计学意义(P<0.05)。结论:信息化追溯系统管理用于消毒供应中心外来器械及植入物管理的效果确切。