Clinical evaluation of surgery-induced astigmatism in cataract surgery using 2.2 mm or 1.8 mm clear corneal micro-incisions

AIM： To evaluate corneal astigmatism after phacoemulsification using 2.2 mm or 1.8 mm clear corneal micro-incisions and its effects on visual function.METHODS： Sixty cases （60 eyes） with cataract were randomly divided into groups A （n=30） and B （n=30） respectively underwent 2.2 mm and 1.8 mm clear corneal tunnel incision phacoemulsification combined with folding intraocular lens implantation from the time direction of 11：00. On day 1 and at 1, 4, and 6wk after operation, patients’ vision was measured and both the corneal curvature and corneal thickness （CT） were recorded using Pentacam.RESULTS： The measured surgery-induced astigmatism （SIA） in both groups A and B peaked on day 1 after operation, and then gradually decreased and eventually stabilized in week 4. No statistically significant difference was found in corneal astigmatism between two groups （P〉0.05）. The measured corneal astigmatism at 4wk and 6wk postoperatively were 0.28±0.09 D and 0.27±0.10 D for groups A and 0.27±0.09 D and 0.25±0.10 D for groups B without statistically significant difference （P〉0.05）. In addition, no significant differences in visual acuity and CT were found between groups A and B before or after operation.CONCLUSION： Both 2.2 mm and 1.8 mm micro-incision cataract surgeries result in relatively small SIA with no difference in visual function and corneal astigmatism between two surgery approaches. Thus, the two types of surgical systems are safe and efficient for cataract treatment, by which satisfactory uncorrected visual acuity can be regained early postoperatively.

Is anoplasty superior to scar revision surgery for posthemorrhoidectomy anal stenosis?Six years of experience

BACKGROUND Anal stenosis is a rare but frustrating condition that usually occurs as a complication of hemorrhoidectomy.The severity of anal stenosis can be classified into three categories:mild,moderate,and severe.There are two main surgical treatments for this condition:scar revision surgery and anoplasty;however,no studies have compared these two approaches,and it remains unclear which is preferrable for stenoses of different severities.AIM To compare the outcomes of scar revision surgery and double diamond-shaped flap anoplasty.METHODS Patients with mild,moderate,or severe anal stenosis following hemorrhoidectomy procedures who were treated with either scar revision surgery or double diamond-shaped flap anoplasty at our institution between January 2010 and December 2015 were investigated and compared.The severity of stenosis was determined via anal examination performed digitally or using a Hill-Ferguson retractor.The explored patient characteristics included age,sex,preoperative severity of anal stenosis,preoperative symptoms,and preoperative adjuvant therapy;moreover,their postoperative quality of life was measured using a 10-point scale.Patients underwent proctologic follow-up examinations one,two,and four weeks after surgery.RESULTS We analyzed 60 consecutive patients,including 36 men(60%)and 24 women(40%).The mean operative time for scar revision surgery was significantly shorter than that for double diamondshaped flap anoplasty(10.14±2.31[range:7-15]min vs 21.62±4.68[range:15-31]min;P<0.001).The average of length of hospital stay was also significantly shorter after scar revision surgery than after anoplasty(2.1±0.3 vs 2.9±0.4 d;P<0.001).Postoperative satisfaction was categorized into four groups:45 patients(75%)reported excellent satisfaction(scores of 8-10),13(21.7%)reported good satisfaction(scores of 6-7),two(3.3%)had no change in satisfaction(scores of 3-5),and none(0%)had scores indicating poor satisfaction(1-2).As such,most patients were satisfied with their quality of life after surgery other than the two who noticed no difference due owing to the fact that they experienced recurrences.CONCLUSION Scar revision surgery may be preferable for mild anal stenosis upon conservative treatment failure.Anoplasty is unavoidable for moderate or severe stenosis,where cicatrized tissue is extensive.