Individual idea about the micro-invasive aspiration and drainage of intracranial hematoma

AIM： This study aimed to expound the individual idea of micro-invasive surgery from pre-operative preparation, intra-operative processing and post-operative management. METHODS： Pre-operative preparation was improved by analyzing pathological factors and hematoma property, and considering patients＇ age, basic disease, blood pressure control, with persistent haemorrhagia/rehaemorrhagia or not, operative occasion choice, positioning and other procedures. In the surgery, positioner was used. Initial aspiration volume was cautiously controlled. After operation, vital signs of patients were kept stable by cautiously using hematoma liquefacient and combining with free radical scavenger. RESULTS： The core content of individual micro-invasive surgery was mainly to relieve intracranial pressure. Under the condition of sufficient pre-operative preparation known by patients＇ family members, precise positioning was determined and individual therapeutic regimen was made. Meanwhile, caution should be taken in hematoma aspiration. Liquefaction and drainage should be paid more attention, and complications were processed actively. CONCLUSION： During the process of micro-invasive evacuation of intracranial hematoma for treating cerebral hemorrhage, attention should be paid to analyzing cerebral hematoma etiology and pathophysiological mechanism, and individual idea should be considered in surgical treatment aiming at patients＇ concrete disease condition.

Effectiveness of intravitreal ranibizumab for diabetic macular edema in vitrectomized versus non-vitrectomized eyes:a Meta-analysis

AIM:To evaluate the effectiveness and safety of intravitreal ranibizumab(IVR)for diabetic macular edema(DME)in vitrectomized versus non-vitrectomized eyes.METHODS:The PubMed,EMBASE,Web of Science,Cochrane,EBSCO were comprehensively searched for studies comparing vitrectomized and non-vitrectomized eyes with DME.Clinical outcomes of best-corrected visual acuity(BCVA),central macular thickness(CMT),the mean number of intravitreal injection and adverse events were extracted and analyzed.RESULTS:Six studies involving 641 eyes were included.Final visual gain significantly improved and CMT significantly reduced in vitrectomized eyes at 6mo and 12mo visits(P<0.05).Although the mean reduction in CMT among non-vitrectomized eyes was significantly greater than in vitrectomized eyes at the 6mo[mean difference(MD)=53.57,95%confidence interval(CI):28.03 to 78.72,P<0.0001]and 12mo(MD=49.65,95%CI:19.58 to 79.72,P=0.01),no significant difference was detected in improvement in BCVA at either 6mo(MD=0.05,95%CI:-0.02 to 0.13,P=0.14)or 12mo(MD=0.03,95%CI:-0.04 to 0.09,P=0.43).Injection number of ranibizumab in non-vitrectomized eyes was significantly less than that in vitrectomized eyes during 6-month period(MD=0.60,95%CI:0.16 to 1.04,P=0.008),while there was no statistically significant difference between the two groups during 12mo of follow-up.CONCLUSION:Evidence from current study suggests that IVR was useful for both vitrectomized group and nonvitrectomized group with DME.Although less reduction in macular thickness is found in vitrectomized group,visual improvement between two groups is similar.

Surgical cardiac synchronization therapy for the cardiomyopathy heart failure with micro-invasive thoracoscopy techniques

Objective The cardiac synchronization therapy (CRT) was proven to have good treatment for the cardiacconduction disorders patients with serious heart failure. But many disadvantages were gradually be noticed,such as difficulty of sinus electrode implantation,coronary sinus injury and bleeding,still one third

Safety and effectiveness of an iris hook assisted phacoemulsification in vitrectomized eyes

AIM:To introduce a simple iris hook assisted phacoemulsification(PE)procedure and evaluate the safety and efficacy of it in completely vitrectomized eyes.METHODS:A single centre study which included 65 previously completely vitrectomized eyes of 62 patients who underwent cataract surgery.Patients were randomly divided into 3 groups.Patients received PE,and intraocular lens(IOL)implantation with the assistance of iris hook(SynergetiesTM)as group A(25 eyes);patients who received PE assisted with a 25 G pars plana irrigation as group B(20 eyes),and patients who received PE performed without the help of any instrument as group C(20 eyes).Main outcome measures were surgery duration,Ultrasound(U/S)total time,endothelial cell density(ECD),cumulative dissipated energy(CDE)and complications of the procedures.RESULTS:With the help of iris hook,the patients in group A had the lowest ECD loss rate(0.07±0.03,0.09±0.03,and 0.10±0.03,P<0.05),shortest CDE(12.2±4.1,15.8±6.0,and 16.0±6.0,P<0.05)and U/S total time(36.6±13.0 s,46.3±16.4 s,and 47.6±16.1 s,P<0.05),and minimal incidence of complications.The longest surgery duration was in group B(19.4±1.6 min)and maximum complications rate in group C(20%miosis,10%posterior capsular tears,5%zonular dialysis,5%cystoid macular edema).While best-corrected visual acuity(BCVA),intraocular pressure(IOP)and ECD did not show a significant difference among the three groups.CONCLUSION:Without prolonged surgery duration,the iris hook assistant method can minimize heat generation during surgery and incidence of complications,which transfer the challenged PE in vitrectomized eyes into a regular surgery.It does not need any change in the hydrodynamic parameters and in the bag PE technique,easy to operate even for junior surgeons.

A reasonable option in vitrectomized eyes: manual small incision cataract surgery

Dear Sir,It is known that cataract surgery is challenging in vitrectomized eyes.Cataract surgeons may have encountered with posterior capsular complications and nucleus drop events even with minimal ocular manipulations and low irrigation bottle height.Inadvertent damage to the zonular fibers,posterior or peripheral lens capsule with ocutome or microvitreoretinal(MVR)blade in previous

Retinal injury following intravitreal injection of a dexamethasone implant in a vitrectomized eye

Lee SM, Jung JW, Park SW, Lee JE, Byon IS. Retinal injury following intravitreal injection of a dexamethasone implant in a vitrectomized eye. Int J Ophthalmo12017; 10（6）： 1019-1020

Coreoplasty and Artisan Intraocular Lens Implantation for Mydriasis and Aphakic Correction in Post-traumatic Vitrectomized Eyes

Purpose:.To evaluate the efficacy and safety of using coreoplasty,.and an iris-supported Artisan intraocular lens (IOL), for mydriasis and aphakic correction in post-traumatic vitrectomized eyes. Methods:.A total of 17 aphakic patients were admitted between April 2009 and April 2010 to the ophthalmologic department of Xiamen Eye Centre..All eyes had previously received lens removal and vitrectomy. After the retina stabilized and corrected visual acuity improved,.the iris was sutured. The Artisan IOL was fixated onto the iris surface..Patients were followed-up at one day, one week,.one month and three months postoperatively..The following outcomes were assessed: symptoms of photophobia and glare, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), intraocular pressure (IOP), endothelial cell density (ECD). The diameter of pupil and the anterior chamber depth (ACD) were measured by the anterior segment optical coherence tomography (OCT). Results:.Artisan IOLs were successfully implanted in all aphakic eyes. Postoperatively, improvement was observed in photophobia and glare symptoms..UCVA was enhanced in all patients.(six eyes had better UCVA postoperatively than BCVA preoperatively)..However,.there were no significant changes in IOP. Mean loss of ECD was 336.06/mm2. Mean postoperative pupil diameter was 3.67±0.41 mm, compared with 5.67±0.57 mm preoperatively(P<0.05). Mean ACD was reduced by 0.88 mm.(3.38±0.33 mm preoperatively vs 2.50±0.35 mm postoperatively, P<0.05). Conclusion:.Surgery that combined coreoplasty and Artisan IOL implantation was a safe and effective treatment for correcting aphakia and mydriasis in post-traumatic vitrectomized eyes.

玻璃体切除治疗非严重性PVR视网膜脱离

目的探讨PPV在治疗非严重性PVR视网膜脱离中的作用。方法研究15眼有裂孔边缘卷曲的PVR-B级网脱，11眼裂孔在赤道后的PVR-C1或C2级网脱及28眼眼底可视度差的网脱共54眼。结果一次手术成功率为76％。总的成功率是96％。术后视力提高43眼（79．6％）。不变9眼（16．7％），下降2眼（3．7％）。结论PPV是治疗非严重性PVR视网膜脱离的有效方法。

后巩膜加固术在高度近视性黄斑病变手术中的应用

近视性黄斑病变致盲率高,常用治疗手段为玻璃体切割术,然而单纯玻璃体切割术对于已出现严重后巩膜葡萄肿的超高度近视患者疗效欠佳。近年来临床应用玻璃体切割术联合后巩膜加固术治疗高度近视继发眼底病变,特别在黄斑劈裂及黄斑裂孔病例中,疗效肯定,前景可期。我们针对近年来后巩膜加固术的材料与术式变迁作一全面综述,并进一步讨论其应用于眼底手术中的发展远景。

Micro-invasive glaucoma surgery – an interventional glaucoma revolution

The glaucoma surgical landscape has changed dramatically over the last decade with the introduction and integration of micro-invasive glaucoma surgery(MIGS)techniques.These modalities target physiologic outflow pathways or optimize previously utilized glaucoma surgical methods in order to deliver safety,efficacy,and individualized care to the patient.MIGS techniques can be classified based on anatomical location as well as method of intraocular pressure(IOP)reduction.This review will focus on MIGS optimizing the conventional outflow pathway via intervention at Schlemm’s canal,MIGS optimizing the uveoscleral outflow pathway via suprachoroidal shunting,and MIGS optimizing the transscleral or subconjunctival outflow pathway which has long been utilized by glaucoma surgeons performing traditional filtration procedures.The wide array of currently available MIGS modalities can be staggering to the glaucoma care provider,but an understanding of the landscape and the large classes of interventional strategies can allow for clinical decision making based on the specifics of the patient’s needs and the pathophysiology of their disease.

Oral Administration and External Application of Chinese Drugs Combined with Micro-invasive Operation for the Treatment of Varicose Ulcers in the Lower Extremities

Objective:To evaluate the clinical therapeutic effects of oral administration and external application of Chinese drugs combined with micro-invasive surgery for the treatment of varicose ulcers in the lower extremities(ecthyma).Methods:A total of 152 patients(163 limbs) suffering from varicose ulcers on the lower limbs were assigned to two groups according to the patients willingness.The 102 cases(109 limbs) in the treatment group underwent the method of endovenous microwave closure of communicating veins ...

硅油填充眼手法小切口与超声乳化白内障手术的并发症（英文）

目的:比较超声乳化联合硅油取出术与硅油填充眼手法小切口白内障手术(MSICS)的安全性。方法:回顾性对比研究。162例患者162眼接受白内障手术,超声乳化联合硅油取出术与硅油填充眼手法小切口白内障手术均行玻璃体切除。结果:超声乳化白内障手术组术后低眼压21眼(18.91%)MSICS组术后低眼压8眼(15.68%),两组间无明显统计学差异(P=0.666)。术后1mo两组间视网膜复位率无明显统计学意义;超声乳化白内障手术组8例患者(7.2%)复发,硅油填充眼手法小切口白内障手术组9例(17.64%)复发,两组复发率比较,差异无统计学意义(P=0.055)。结论:硅油填充眼手法小切口白内障手术相较于超声乳化联合硅取出术在低眼压、渗漏、脉络膜脱离、视网膜复位率方面结果无劣效性。

超声乳化术中25G玻璃体腔灌注的应用效果

目的 评价25G玻璃体腔灌注在玻璃体切除术后的白内障超声乳化手术中的应用效果.方法 采用预置25G玻璃体腔灌注的方法对41例（42只眼）玻璃体切除术后的白内障施行超声乳化联合人工晶状体植入术,观察并记录术后视力、眼压、患者自觉症状、巩膜穿刺口情况及术中、术后并发症.结果 所有手术均顺利完成.术后3个月时,40只眼最佳矫正视力较术前有不同程度提高,最佳矫正视力＞0.1者30只眼,手术前后比较,差别有统计学意义（x2=13.77,P＜0.01）,其中最佳矫正视力≥0.3者20只眼,手术前后比较,差别有统计学意义（x2=12.81,P＜0.01）.2只眼因原有的眼底病复发导致玻璃体积血,视力再度下降.术后1d、1周、末次随访时平均眼压分别为（14.62±0.56） mmHg、（14.82±0.54） mmHg和（14.83±0.57） mmHg,与术前平均眼压（14.86±0.59） mmHg（1 mmHg=0.133 kPa）比较,差别均无统计学意义（t=1.70,0.19,0.40,P＞0.05）.所有患者眼部刺激症状轻微,巩膜穿刺口愈合良好,术中及术后均未见严重并发症发生.结论 在玻璃体切除术后的白内障超声乳化术中,应用25G玻璃体腔灌注有利于维持眼压、稳定前房、减少手术并发症,是一种安全有效的辅助措施.

微创玻璃体切除术对手术切口的影响及护理观察

目的探讨微创玻璃体切除术对手术切口、手术并发症及手术时间的影响，并观察术后手术切口的变化。方法将2012年1～7月在天津市眼科医院就诊的120例患者分为A组和B组各60例，年龄18—65岁（平均年龄50．5岁）。病情诊断包括牵拉性视网膜脱离，特发性黄斑裂孔，糖尿病视网膜病变继发玻璃体积血，孔源性视网膜脱离，单纯玻璃体积血。两组患者年龄，性别，病情诊断等比较差异无统计学意义（P〉0．05），具有可比性。A组接受微创玻璃体切割术，B组接受20G玻璃体切割术。记录手术时间，手术切口渗漏、手术并发症、切口炎性反应、术后疼痛、住院时间，对相关记录指标进行统计学分析比较。结果A组和B组的手术时间分别为（55．2±9．8）min，（64．8±11．2）min，差异有统计学意义（P〈0．05）。切口炎性反应分别为7例和16例（P〈0．05）具有统计学意义。其余项目两组间无统计学意义（P〉0．05）。结论微创玻璃体切除手术，手术时间明显缩短，术后伤口局部炎性刺激症状轻微，眼内异物感较轻。术后视功能恢复快。而术前的充分准备，如术前应用抗生素，局部用聚维酮碘冲洗结膜囊，则最大限度的避免术后切口渗漏引起的低眼压和眼内炎的发生。术后护理则加强病情及切口的观察，对出现眼压升高的患者及时发现，及时处理，控制了眼压的持续性升高，减少了并发症的发生。

Ab externo implantation of the MicroShunt, a poly (styrene-block-isobutylene-blockstyrene) surgical device for the treatment of primary open-angle glaucoma: a review

Trabeculectomy remains the‘gold standard’intraocular pressure(IOP)-lowering procedure for moderate-to-severe glaucoma;however,this approach is associated with the need for substantial post-operative management.Microinvasive glaucoma surgery(MIGS)procedures aim to reduce the need for intra-and post-operative management and provide a less invasive means of lowering IOP.Generally,MIGS procedures are associated with only modest reductions in IOP and are targeted at patients with mild-to-moderate glaucoma,highlighting an unmet need for a less invasive treatment of advanced and refractory glaucoma.The PRESERFLO®MicroShunt(formerly known as InnFocus MicroShunt)is an 8.5 mm-long(outer diameter 350μm;internal lumen diameter 70μm)glaucoma drainage device made from a highly biocompatible,bioinert material called poly(styrene-block-isobutylene-blockstyrene),or SIBS.The lumen size is sufficiently small that at normal aqueous flow hypotony is avoided,but large enough to avoid being blocked by sloughed cells or pigment.The MicroShunt achieves the desired pressure range in the eye by draining aqueous humor from the anterior chamber to a bleb formed under the conjunctiva and Tenon’s capsule.The device is implanted ab externo with intraoperative Mitomycin C via a minimally invasive(relative to incisional surgery)surgical procedure,enabling precise control of placement without the need for gonioscopy,suture tension control,or suture lysis.The implantation procedure can be performed in combination with cataract surgery or as a standalone procedure.The MicroShunt received ConformitéEuropéenne(CE)marking in 2012 and is intended for the reduction of IOP in eyes of patients with primary open-angle glaucoma in which IOP remains uncontrolled while on maximum tolerated medical therapy and/or in which glaucoma progression warrants surgery.Three clinical studies assessing the long-term safety and efficacy of the MicroShunt have been completed;a Phase 3 multicenter,randomized clinical study comparing the MicroShunt to primary trabeculectomy is underway.In preliminary studies,the MicroShunt effectively reduced IOP and use of glaucoma medications up to 3 years after implantation,with an acceptable safety profile.This article summarizes current literature on the unique properties of the MicroShunt,the preliminary efficacy and safety findings,and discusses its potential use as an alternative to trabeculectomy for glaucoma surgery.

iStent inject trabecular microbypass stent implantation with cataract extraction in open-angle glaucoma:early clinical experience

Background:Retrospective,consecutive case series to evaluate the implantation of two second-generation trabecular microbypass stents in combination with cataract surgery in a real-world,clinical setting.Methods:The series included 56 eyes implanted with the iStent inject device with phacoemulsification.The series consisted of eyes with primary open-angle glaucoma(n=52)and pseudoexfoliative glaucoma(n=4).Primary outcome measures included intraocular pressure(IOP)and number of glaucoma medications.Safety outcomes included the need for secondary surgical intervention and the incidence of IOP spikes≥10 mmHg and≥15 mmHg.Results:IOP was reduced by 21%to 14.7±2.9 mmHg(p<0.01)at 6 months postoperative from 18.7±5.8 mmHg at baseline.Preoperatively,the mean number of glaucoma medications was 1.5±0.9 and reduced by 39%to 0.9±1.2(p<0.01)at 6 months.At 6 months,68%of eyes had an IOP≤15 mmHg,increased from 30%at baseline.55%of eyes were medication-free at 6 months,up from 18%at baseline.There were no severe postoperative complications.No eyes underwent an additional glaucoma procedure.Conclusions:Implantation of the iStent inject device with concomitant cataract surgery effectively provides a sustained reduction in IOP with a markedly improved medication burden out to 6 months postoperative.The safety profile is excellent.

iStent inject trabecular microbypass stent implantation with cataract extraction in open-angle glaucoma:early clinical experience

Background:Retrospective,consecutive case series to evaluate the implantation of two sec on d-generation trabecular microbypass stents in combination with cataract surgery in a real-world,clinical setting.Methods:The series in eluded 56 eyes implanted with the iSte nt inject device with phacoemulsification.The series consisted of eyes with primary open-angle glaucoma(n=52)and pseudoexfoliative glaucoma(n=4).Primary outcome measures included intraocular pressure(IOP)and number of glaucoma medications.Safety outcomes included the need for secondary surgical intervention and the incidence of IOP spikes>10 mmHg and>15 mmHg.Results:IOP was reduced by 21%to 14.7±2.9 mmHg(P<0.01)at 6 months postoperative from 18.7±5.8 mmHg at baseline.Preoperatively,the mean number of glaucoma medications was 1.5±0.9 and reduced by 39% to 0.9±1.2(P<0.01)at 6 months.At 6 months,68%of eyes had an IOP<15 mmHg,increased from 30%at baseline.55%of eyes were medicati on-free at 6 months,up from 18%at baseline.There were no severe postoperative complications.No eyes underwent an additional glaucoma procedure.Conclusions:Implantation of the iStent inject device with concomitant cataract surgery effectively provides a sustained reduction in IOP with a markedly improved medication burden out to 6 months postoperative.The safety profile is excellent.