A sutureless technique for securing leaking sclerotomies with viscoelastic substances in 23-gauge microincision vitrectomy surgery

AIM:To introduce and evaluate the clinical efficacy of a new technique,the use of viscoelastic substances(VS)to close leaking sclerotomy in 23G microincision vitrectomy,and to observe its effect on the visual acuity and intraocular pressure(IOP)of patients.METHODS:Patients who underwent 23G vitrectomy in Ningbo Eye Hospital before the use of VS technique(June 2019 to September 2020)and after the use of VS technique(October 2020 to December 2021)were selected as the subjects of this study.The above cases underwent operation by the same surgeon and were retrospectively analyzed.VS technique was used as the alternative to suturing,in which a small amount of VS was injected at the leaking sclerotomy and then gently massaged to confirm leaking sclerotomy closure.RESULTS:A total of 174 eyes were covered in the study,including 84 eyes in the control group(before the use of VS technique)and 90 eyes in the VS technique group.The number of eyes that needed to be sutured decreased considerably from 42.9%in the control group to 3.3%in the VS technique group,and the proportion of subconjunctival hemorrhage at 1-2d after surgery decreased remarkably from 35.7%in the control group to 2.2%in the VS technique group.No substantial differences in the incidence of mean IOP and low IOP were found between 1-2 and 3-20d after surgery in the VS technique group.No major complications associated with VS technique were identified during the study.CONCLUSION:In 23G microincision vitrectomy,VS technique is a safe,simple,and effective method to close leaking sclerotomy.

Pupillary capture following sutureless scleral-fixated intraocular lens in children with Marfan syndrome

AIM:To compare the clinical outcomes between two approaches for sutureless scleral-fixated intraocular lens(SFIOL)in children with Marfan syndrome(MFS).METHODS:The study included 15 children(26 eyes)with lens subluxation due to MFS.These children underwent lensectomy,anterior vitrectomy,and sutureless SFIOL.According to the position of placement of intraocular lens(IOL)haptics,two study groups were reviewed for best corrected visual acuity(BCVA)and postoperative complications:group A,14 eyes with haptics fixated at 2.0 mm from the limbus;group B,12 eyes with the haptics fixated at 2.5 mm from the limbus.RESULTS:The mean axial length for all patients was 25.66±2.35 mm.Postoperative BCVA in logMAR were significant improved in both groups(0.77±0.32 to 0.17±0.12 in group A,0.66±0.25 to 0.24±0.12 in group B,both P<0.001)while no significant difference between two groups(P>0.05).Pupillary capture was main postoperative complication,occurring between 3d and 18mo.It occurred in 7 eyes in group A and one eye in group B(P=0.02).CONCLUSION:Sutureless SFIOL is an effective treatment approach for lens subluxation in children with MFS.Pupillary capture is the main postoperative complication.Fixated IOL haptics at 2.5 mm from the limbus can reduce the occurrence of pupillary capture.

Sutureless技术矫治新生儿完全性肺静脉异位引流42例护理配合

目的:探讨Sutureless技术治疗新生儿完全性肺静脉异位引流(TAPVC)的护理配合方法。方法:对42例TAPVC新生儿应用Sutureless技术矫治,术前控制缺氧发作,注意温度及皮肤的管理,全程严密观察病情,积极配合医生处理肺动脉高压,熟悉本病解剖特点及手术步骤,充分正确的用物准备,术中密切配合,术后安全转运患儿。结果:42例患儿均顺利完成手术,安返监护室,1例患儿因多脏器功能衰竭,肺动脉高压危象术后死亡。结论:对TAPVC新生儿应用Sutureless技术矫治,在术前对患儿进行综合管理,全程严密观察病情,配合医生处理肺动脉高压,熟悉本病解剖特点及手术步骤,密切配合,灵活应对,是手术顺利完成的重要保障。

Primary sutureless技术在全肺静脉异位引流矫治中应用

目的:全肺静脉异位引流(TAPVC)是最常见的先天性心脏病之一,术后肺静脉梗阻(PVO)是发生率高,明显影响TAPVC预后。Sutureless技术是将肺静脉共汇或部分肺静脉与后心包直接吻合的一种技术,在TAPVC术后PVO治疗中获得良好临床效果。但Sutureless技术初次应用于TAPVC矫治(Primary sutureless)的效果目前尚有争议。

Combined 23-gauge sutureless vitrectomy and clear corneal phacoemulsification for rhegmatogenous retinal detachment repair

AIM: To assess the outcomes of combined 23-gauge sutureless vitrectomy and clear corneal phacoemulsification with intraocular lens implantation for rhegmatogenous retinal detachment(RRD) repair.METHODS: This was a retrospective, consecutive,noncomparative, interventional case series of 30 eyes of30 patients who underwent combined sutureless vitrectomy and clear corneal cataract surgery for the repair of RRD. The principal outcome measures were primary anatomical success rate, reasons for redetachment, final visual acuity, and surgical complications.RESULTS: Primary reattachment was achieved in 27eyes(90.0%). The reasons for redetachment(3 eyes, 10%)were incomplete laser retinopexy, persistent chronic subretinal fluid, and proliferative vitreoretinopathy,respectively. The logarithm of the minimum angle of resolution visual acuity(mean±SD) improved from 0.76±0.74 preoperatively to 0. 21 ± 0. 37 6 months’ postoperatively(P 【0.0001). Postoperative hypotony was not detected,but 1 eye( 3. 3 %) had increased intraocular pressure(30 mm Hg) with spontaneous resolution. No endophthalmitis developed during follow-up. Macular pucker was detected in 3 eyes(10.0%).· CONCLUSION: Combined 23-gauge sutureless vitrectomy and clear corneal phacoemulsification with intraocular lens implantation for RRD repair was proven safe and effective. It may provide not only the known advantages of conventional combined surgery, but also additional advantages such as less conjunctival fibrosis and the maintenance of stable intraocular pressure with low risks of postoperative hypotony and intraocular pressure elevation.

Evaluation of functional outcome and stability of sutureless scleral tunnel fixated IOLs in children with ectopia lentis

AIM:To evaluate functional outcome of sutureless scleral tunnel intraocular lens(SSTIOL)in children with crystalline lens subluxation of more than 7 clock hours.METHODS:A prospective interventional study was conducted consisting of 45 eyes of 44 children in age group 6-18 y having>7 clock hours of lens subluxation who underwent lensectomy-vitrectomy followed by SSTIOL implantation.Primary outcome was improvement in best corrected visual acuity(BCVA)and secondary outcomes were assessment of intraocular lens(IOL)tilt using ultrasound biomicroscopy(UBM),mean change in astigmatism at last follow-up of 1 y and associated complications.RESULTS:The mean preoperative and postoperative BCVA was 1.05±0.28 and 0.64±0.45(log MAR)respectively(P=0.001)at last follow-up.The mean astigmatism preoperatively and postoperatively was-4.17±2.69 D and-1.86±1.25 D respectively(P=0.011).Significant IOL tilt(>5 degrees)was present in 5 cases.The mean percentage endothelial loss was 3.65%±1.92%.The most serious complication encountered was retinal detachment seen in 2 cases.CONCLUSION:SSTIOL implantation provides efficient visual rehabilitation in children provided there is stringent case selection.We recommend caution in children having white-to-white distance>12 mm and presence of peripheral retinal degenerations.

A sutureless subconjunctival M-shaped limbus incision for hard cataracts

Dear Editor,Iam Dr.Ping-Hong Lai,from the Jiangxi Eye Center,Jiangxi Provincial People＇s Hospital,Nanchang,Jiangxi Province,China.I would like to present the technique of subconjunctival M-shaped limbus incision for a series of cases with hard cataracts.

Sutureless amniotic membrane transplantation following excision of ocular surface neoplasia

【正】Dear Sir,S uccess of surgical management of conjunctival neoplasias primarily depends on the complete excision of the mass and eradication of tumor cells from the ocular surface[1-3].Especially in cases that extensive resections are required,primary closure may not be feasible;so ocular surface reconstruction can be a challenging problem for the surgeons.For conjunctival tissue defects different surgical

Biomechanical characterization of a novel ring connector for sutureless aortic anastomosis

The surgical treatment for aortic diseases remains a challenge for any cardiac surgeon. The use of sutureless ring connector in aortic anastomosis can simplify the procedure and shorten anastomosis time. Therefore, we developed a novel device for sutureless aortic anastomosis. A series of experiments were carried out for tensile and leakproofcapacity assessments to verify the feasibility of the ring connector by using fresh swine aorta samples. In in vivo test,the ring connector was implanted in 6 swine with follow-up of 6 months. Radiographic and pathological studies of the aorta were performed. In the tensile tests, the strength was 32.7±5.9 Newton(N) in the sutureless anastomosis group,compared with 73.3±12.5 N in the control group by traditional manual suture. In the leakproof-capacity assessment,no sign of either leakage or bursting was evident at 280 mmHg of internal pressure in the aorta samples. In in vivo tests,it took 9.47±0.3 minutes for the sutureless anastomosis, compared with 15.58± 1.39 minutes for hand-sewn suturing. Insertion was easy and rapid. Radiographic and pathological studies were performed at first month, third month and sixth month after surgery, each time obtained from the two swine, showed patency of the anastomosis and no signs of stenosis, blood leakage, migration or pseudoaneurysm formation, except one paralyzed swine developed of thrombo-occlusion at the site of the sutureless anastomosis. The result indicates that this novel ring connector offers considerable promise for sutureless aortic anastomosis.

Off-Pump Multilayered Sutureless Repair for a Left Ventricular Blowout Rupture after Aortic Dissection Repair

A left ventricular (LV) free wall rupture is a highly lethal condition. A 75-year-old female who experienced chest pain was diagnosed as having an acute aortic dissection Stanford type A and underwent emergent surgery. Under cardiopulmonary bypass with LV venting through the right superior pulmonary vein, a proximal aortic stamp was formed. The patient was cooled, selective antegrade brain perfusion was performed, and a hemiarch repair was performed. After the patient was transferred to the intensive care unit, her blood pressure suddenly fell to 50 mmHg. She had a blowout rupture in the left ventricular anterolateral free wall. Since the bleeding hall was not large and the damage to the surrounding left ventricular tissue was not very wide, an off-pump multilayered sutureless repair was performed by using three layers of collagen fleece squares with fibrinogen-based impregnation (TachoComb;CSL Behring, Tokyo, Japan) and three layers of gelatin-resorcin-formalin glue reinforced by an equine pericardial patch (Xenomedica;Edwards Lifesciences, LLC, Irvine, CA). The blow-out rupture seemed to be caused by perioperative myocardial infarction generated by the compression of the left ventricular vent to the LV lateral wall. The patient was free from re-rupture or aneurysm enlargement. The thickness of the hemostatic material seemed to help control the bulging of the aneurysm and to prevent further LV aneurysm enlargement and re-rupture.

Novel sutureless transplantation for primary pterygium associated with cysts

AIM: To evaluate the efficacy and safety of a novel sutureless AMT (amniotic membrane transplantation) or CAT (conjunctivolimbal autograft transplantation) using fibrin glue for reconstructing corneoconjunctival surfaces for primary pterygium associated with cysts. METHODS: A prospective descriptive study was made of the period 1 January 2006-1 May 2009. Nine patients with primary pterygium associated with cysts underwent pterygium and cyst excision followed by sutureless AMT or CAT using fibrin glue. RESULTS: During a mean follow-up of 8.00 +/- 0.67 months, all eyes maintained a smooth and stable corneal epithelial surface without recurrent erosion or persistent epithelial defect. The limbal donor site showed the presence of mild depressions without the formation of pseudopterygium. All eyes have good tear secretion function, tear film stability and ocular motility. CONCLUSION: Sutureless transplantation using fibrin glue is safe and effective for restoring a stable corneoconjunctival epithelium in primary pterygium associated with cysts.

Aortic valve replacement with sutureless and rapid deployment aortic valve prostheses

大动脉的阀门狭窄是在西方的世界上的最普通的阀门疾病。在过去几年干预与尽管有增加病人的年龄和 comorbidities 的增加的负担，被改进了的结果增加了的大动脉的阀门代替(AVR ) 的数字。尽管有如此的优秀结果和它的生长得很好的位置，然而，常规 AVR 在以前的二十年经历了大开发。这进行，通过新技术的不太侵略的切口和使用，包括 transcatheter 大动脉的阀门培植和无缝术的阀门 prostheses ，被打算减少外科的过程的创伤的影响，因此圆满的更低的风险病人期望在一方面，并且在其它上向逐渐地高风险的病人扩大操作性。大动脉的阀门是的无缝术、快速的推广生物、心囊的 prostheses 在没有超过三缝术的大动脉的体环以内的那个锚。无缝术的 prostheses 由避免经过并且系住缝术，显著地减少起作用的时间并且可以改进结果。然而，仍然有无缝术的 AVR 的角色和表演上的柔韧的、基于证据的数据的少量。因此，最强壮的长期的数据，使随机化的研究和注册表数据被要求足够地估计耐久性和无缝术的大动脉的阀门代替的长期的结果。

A“T.E.S.T.”hydrogel bioadhesive assisted by corneal cross-linking for in situ sutureless corneal repair

Corneal transplantation is an effective clinical treatment for corneal diseases,which,however,is limited by donor corneas.It is of great clinical value to develop bioadhesive corneal patches with functions of“Transparency”and“Epithelium&Stroma generation”,as well as“Suturelessness”and“Toughness”.To simultaneously meet the“T.E.S.T.”requirements,a light-curable hydrogel is designed based on methacryloylated gelatin(GelMA),Pluronic F127 diacrylate(F127DA)&Aldehyded Pluronic F127(AF127)co-assembled bi-functional micelles and collagen type I(COL I),combined with clinically applied corneal cross-linking(CXL)technology for repairing damaged cornea.The patch formed after 5 min of ultraviolet irradiation possesses transparent,highly tough,and strongly bio-adhesive performance.Multiple cross-linking makes the patch withstand deformation near 600%and exhibit a burst pressure larger than 400 mmHg,significantly higher than normal intraocular pressure(10-21 mmHg).Besides,the slower degradation than GelMA-F127DA&AF127 hydrogel without COL I makes hydrogel patch stable on stromal beds in vivo,supporting the regrowth of corneal epithelium and stroma.The hydrogel patch can replace deep corneal stromal defects and well bio-integrate into the corneal tissue in rabbit models within 4 weeks,showing great potential in surgeries for keratoconus and other corneal diseases by combining with CXL.

Dual-crosslinked regenerative hydrogel for sutureless long-term repair of corneal defect

Corneal transplantation is the most effective clinical treatment for corneal defects,but it requires precise size of donor corneas,surgical sutures,and overcoming other technical challenges.Postoperative patients may suffer graft rejection and complications caused by sutures.Ophthalmic glues that can long-term integrate with the corneal tissue and effectively repair the focal corneal damage are highly desirable.Herein,a hybrid hydrogel consisting of porcine decellularized corneal stroma matrix(pDCSM)and methacrylated hyaluronic acid(HAMA)was developed through a non-competitive dual-crosslinking process.It can be directly filled into corneal defects with various shapes.More importantly,through formation of interpenetrating network and stable amide bonds between the hydrogel and adjacent tissue,the hydrogel manifested excellent adhesion properties to achieve suture-free repair.Meanwhile,the hybrid hydrogel not only preserved bioactive components from pDCSM,but also exhibited cornea-matching transparency,low swelling ratio,slow degradation,and enhanced mechanical properties,which was capable of withstanding superhigh intraocular pressure.The combinatorial hydrogel greatly improved the poor cell adhesion performance of HAMA,supported the viability,proliferation of corneal cells,and preservation of keratocyte phenotype.In a rabbit corneal stromal defect model,the experimental eyes treated with the hybrid hydrogel remained transparent and adhered intimately to the stroma bed with long-term retention,accelerated corneal re-epithelialization and wound healing.Giving the advantages of high bioactivity,low-cost,and good practicality,the dual-crosslinked hybrid hydrogel served effectively for long-term suture-free treatment and tissue regeneration after corneal defect.

In situ Injectable Tetra-PEG Hydrogel Bioadhesive for Sutureless Repair of Gastrointestinal Perforation

Hydrogel bioadhesives represent promising and efficient alternatives to sutures or staples for gastrointestinal(GI)perforation management.However,several concerns remain for the existing bioadhesives including slow and/or weak adhesive,poor mechanical strength,low biocompatibility,and poor biodegradability,which largely limit their clinical application in GI perforation repair.In this work,we introduce an in situ injectable Tetra-PEG hydrogel bioadhesive(SS)composed of tetra-armed poly(ethylene glycol)amine(Tetra-PEG-NH2)and tetra-armed poly(ethylene glycol)succinimidyl succinate(Tetra-PEG-SS)for the sutureless repair of GI defects.The SS hydrogel exhibits rapid gelation behavior and high burst pressure and is capable of providing instant robust adhesion and fluid-tight sealing in the ex vivo porcine intestinal and gastric models.Importantly,the succinyl ester linkers in the SS hydrogel endow the bioadhesive with suitable in vivo degradability to match the new GI tissue formation.The in vivo evaluation in the rat GI injured model further demonstrates the successful sutureless sealing and repair of the intestine and stomach by the SS hydrogel with the advantages of neglectable postsurgical adhesion,suppressed inflammation,and enhanced angiogenesis.Together,our results support potential clinical applications of the SS bioadhesive for the high-efficient repair of GI perforation.

Sutureless技术在新生儿完全性肺静脉异位引流中的应用

目的回顾性评价Sutureless技术在新生儿完全性肺静脉异位引流(total anomalous pulmonary venous connection,TAPVC)的单中心外科矫治情况。方法纳入2002年9月至2015年12月在我院行心上、心下型完全性肺静脉异位引流外科矫治的新生儿患者71例,男57例(80.3%),女14例(19.7%);中位手术年龄是8(1,29)d,中位体重3.3(2.1,4.7)kg。根据Darling分型,其中心上型45例(63.4%),心下型26例(36.6%)。根据手术方式将患者分为传统手术组(29例)和Sutureless技术组(42例),采用倾向性评分匹配两组资料。结果采用倾向性评分匹配后两组术前资料差异无统计学意义。死亡18例(25.4%),其中术后早期死亡11例(15.5%),晚期死亡7例(9.6%)。传统手术组死亡率(58.6%,17/29)高于Sutureless技术组(2.4%,1/42),差异有统计学意义(P=0.000)。Kaplan-Meier生存曲线示两组死亡率差异有统计学意义(P=0.005)。随访25.5(1.0~130.0)个月。随访时发生吻合口狭窄12例,其中传统手术组11例(37.9%),Sutureless技术组1例(2.4%),两组差异有统计学意义(P=0.000)。术后发生吻合口狭窄12例,其中8例患儿死亡,其死亡率高于术后吻合口通畅患儿[66.7%(8/12)vs.16.9%(10/59),P=0.001],差异有统计学意义。结论在新生儿TAPVC的矫治中,患者术后死亡与TAPVC术后吻合口狭窄明显相关,与传统手术方式相比,Sutureless技术可有效降低新生儿TAPVC术后吻合口狭窄发生率及死亡率。

初次手术应用sutureless技术治疗婴幼儿完全性肺静脉异位引流的效果

目的 回顾性分析初次手术中应用sutureless技术治疗婴幼儿完全性肺静脉异位引流（TAPVC）的早、中期效果.方法 2007年7月1日至2012年12月31日,126例行外科矫治术的心上型、心下型和混合型TAPVC患儿（婴）入选,其中sutureless手术方式组54例,传统手术方式组72例,收集术前术后临床资料并随访至2013年4月.结果 Sutureless技术组的体外循环时间和主动脉阻断时间均低于传统手术组（分别为Z=1 296.000、P=0.001和Z=1 181.500、P=0.000）.Sutureless技术组和传统手术组相比,院内死亡比例差异无统计学意义（3.7％对11.1％,x2 =1.414,P=0.234）,术后总死亡比例低（5.6％对23.6％,x2=7.533,P=0.006）,术后肺静脉梗阻发生率低（1.9％对16.7％,x2=7.319,P=0.007）.校正术前肺静脉狭窄、混合型、新生儿以及体质量等因素后,术后死亡与传统手术方式（HR =4.53,95％置信区间1.31～ 15.72,P=0.017）和术后肺静脉梗阻的发生（HR=10.42,95％置信区间1.32～ 82.02,P=0.026）显著相关.结论 对于心上型、心下型及昆合型TAPVC患儿,初次矫治手术采用sutureless技术可以明显缩短体外循环和主动脉阻断时间,降低术后死亡比例和肺静脉梗阻发生率.

结膜无缝合玻璃体切割系统联合微切口白内障超声乳化在白内障合并增殖型糖尿病视网膜病变患者中的应用效果

目的探讨结膜无缝合玻璃体切割系统联合微切口白内障超声乳化在白内障合并增殖型糖尿病视网膜病变患者中的应用效果。方法选取2020年1月至2022年12月南昌大学第二附属医院收治的40例(80眼)白内障合并增殖型糖尿病视网膜病变患者作为研究对象,所有患者均为双眼病变,按照随机数字表法将其分为观察组(20例,40眼)与对照组(20例,40眼)。对照组采用常规玻璃体切割术与白内障超声乳化吸除术,观察组采用结膜无缝合玻璃体切割系统联合微切口白内障超声乳化吸除术。比较两组手术前,术后7 d,术后1、3个月视力水平、眼压水平及内皮细胞数目以及两组术后并发症发生情况。结果两组患者术后7 d,术后1、3个月视力水平高于手术前,差异有统计学意义(P<0.05);手术前、术后7 d、术后1个月,两组患者的视力水平比较,差异无统计学意义(P>0.05);术后3个月,观察组患者的视力水平高于对照组,差异有统计学意义(P<0.05)。术后7 d及术后1、3个月,两组患者的眼压水平低于手术前,差异有统计学意义(P<0.05);手术前,术后7 d,术后1、3个月,两组患者的眼压水平比较,差异无统计学意义(P>0.05)。术后7 d及术后1、3个月,两组患者的内皮细胞数目低于手术前,差异有统计学意义(P<0.05);术后1、3个月,两组患者的内皮细胞数目均高于术后7 d,差异有统计学意义(P<0.05);术后7 d及术后1、3个月,观察组患者的内皮细胞数高于对照组,差异有统计学意义(P<0.05)。观察组患者的并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论结膜无缝合玻璃体切割系统联合微切口白内障超声乳化治疗白内障合并增殖型糖尿病视网膜病变效果显著,可改善患者视力水平,不增加患者术后眼压,且可减少术后内皮细胞的丢失,术后并发症发生率较低。

改良Sutureless技术治疗完全性肺静脉异位引流

目的介绍一种改良Sutureless技术及其治疗完全性肺静脉异位引流的手术效果。方法回顾性分析阜外医院小儿心外科2014—2019年行改良Sutureless技术治疗11例完全性肺静脉异位引流患者的临床资料,其中男4例、女7例,中位手术年龄1.4(0.3,27.0)个月,中位体重4.3(3.5,8.5)kg。心上型6例(54.5%)、心下型5例(45.5%)。术前重度肺动脉高压5例(45.5%),术前肺静脉梗阻3例(27.3%)。并将其手术治疗结果与同期行传统手术方法治疗的10例患儿进行比较。结果中位随访时间12(1~65)个月。随访期间,改良Sutureless组未出现死亡及术后肺静脉梗阻事件,在围术期资料及免除再梗阻等方面均较传统手术组显示出优势,但差异无统计学意义(P>0.05)。改良Sutureless组术后生存优于传统手术组(P=0.049)。结论包括“先部分缝合再切开”及“肺静脉内膜外翻扩大开口”等创新点的改良Sutureless技术,是一种治疗完全性肺静脉异位引流的安全可靠的方法,术后近期效果良好。