Single incision laparoscopic surgery for hepatocellular carcinoma

Single incision laparoscopic liver resection(SILLR)is the most recent develop-ment in the laparoscopic approach to the liver.SILLR for hepatocellular carci-noma(HCC)has developed much more slowly than multiport LLR.So far,195 patients completed SILLR for HCC.In this paper,we reviewed all published papers about SILLR for HCC and discussed the feasibility of the SILLR,peri and postoperative findings,tricks of patient selection and whether SILLR compromise the oncological principles.

Management Measures for Preventing Postoperative Incision Infections in General Surgery at Primary Hospitals

Objective:To analyze the management measures and effects of preventing postoperative incision infections in the general surgery department of primary hospitals.Methods:Forty-nine surgical patients with 11 healthcare workers who were admitted to the general surgery department of the primary hospital between August 2021 and August 2022 were selected as the routine group for routine incision infection management.Forty-nine surgical patients with 11 healthcare workers admitted to the same department between September 2022 and September 2023 were selected as the prevention group for prophylactic management of postoperative incision infections.The incision infection rate,knowledge,attitude,and practice(KAP)scores,and management satisfaction of the patients as well as the management skill scores of healthcare workers were compared between the two groups.Results:The rate of postoperative incision infection in the prevention group was lower than that in the routine group;after implementing management measures,patients in the prevention group had higher KAP scores than those in the routine group;patients in the prevention group were more satisfied with the management than those in the routine group;and healthcare workers in the prevention group had higher scores than those in the routine group,with P<0.05 for the comparison between the groups.Conclusion:The implementation of preventive management for general surgery patients in primary hospitals can reduce the incidence of postoperative incision infection and improve the KAP of patients,with higher management satisfaction.It can also enhance the management skills of healthcare workers,thus improving their overall management level.

Phacoemulsification versus small incision cataract surgery in patients with uveitis

AIMTo compare the safety and efficacy of phacoemulsification and small incision cataract surgery (SICS) in patients with uveitic cataract.METHODSIn a prospective, randomized multi-centric study, consecutive patients with uveitic cataract were randomized to receive phacoemulsification or manual SICS by either of two surgeons well versed with both the techniques. A minimum inflammation free period of 3mo (defined as less than 5 cells per high power field in anterior chamber) was a pre-requisite for eligibility for surgery. Superior scleral tunnel incisions were used for both techniques. Improvement in visual acuity post-operatively was the primary outcome measure and the rate of post-operative complications and surgical time were secondary outcome measures, respectively. Means of groups were compared using t-tests. One way analysis of variance (ANOVA) was used when there were more than two groups. Chi-square tests were used for proportions. Kaplan Meyer survival analysis was done and means for survival time was estimated at 95% confidence interval (CI). A P value of &#x0003c;0.05 was considered statistically significant.RESULTSOne hundred and twenty-six of 139 patients (90.6%) completed the 6-month follow-up. Seven patients were lost in follow up and another six excluded due to either follow-up less than six months (n=1) or inability implant an intraocular lens (IOL) because of insufficient capsular support following posterior capsule rupture (n=5). There was significant improvement in vision after both the procedures (paired t-test; P&#x0003c;0.001). On first postoperative day, uncorrected distance visual acuity (UDVA) was 20/63 or better in 31 (47%) patients in Phaco group and 26 (43.3%) patients in SICS group (P=0.384). The mean surgically induced astigmatism (SIA) was 0.86&#x000b1;0.34 dioptres (D) in the phacoemulsification group and 1.16&#x000b1;0.28 D in SICS group. The difference between the groups was significant (t-test, P=0.002). At 6mo, corrected distance visual acuity (CDVA) was 20/60 or better in 60 (90.9%) patients in Phaco group and 53 (88.3%) in the manual SICS group (P=0.478). The mean surgical time was significantly shorter in the manual SICS group (10.8&#x000b1;2.9 versus 13.2&#x000b1;2.6min) (P&#x0003c;0.001). Oral prednisolone, 1 mg/kg body weight was given 7d prior to surgery, continued post-operatively and tapered according to the inflammatory response over 4-6wk in patients with previously documented macular edema, recurrent uveitis, chronic anterior uveitis and intermediate uveitis. Rate of complications like macular edema (Chi-square, P=0.459), persistent uveitis (Chi-square, P=0.289) and posterior capsule opacification (Chi-square, P=0.474) were comparable between both the groups.CONCLUSIONManual SICS and phacoemulsification do not differ significantly in complication rates and final CDVA outcomes. However, manual SICS is significantly faster. It may be the preferred technique in settings where surgical volume is high and access to phacoemulsification is limited, such as in eye camps. It may also be the appropriate technique for uveitic cataract under such circumstances.

Healing time of incision infection after hepatobiliary surgery treated by needle-free incision suture closure

AIM: To compare the effectiveness of needle-free incision suture closure with butterfly tape and traditional secondary suturing techniques in treating incision infection. METHODS: Two hundred and twenty-three patients with incision infection following hepatobiliary surgery at a tertiary hospital were randomly divided into three groups: 90 patients were closed by needle-free incision suture closure, which gradually closed the incision wound when drainage from incision infection was visibly decreased and healthy granulation tissues had grown; 79 patients were closed by butterfly bandage; another 54 patients were closed by traditional secondary suturing technique. Healing time of incision infection was calculated from the beginning of dressing change to the healing of the incision. RESULTS: Healing time in the needle-free incision suture closure group (24.2 +/- 7.2 d) was significantly shorter than that in the butterfly bandage group (33.3 +/- 11.2 d) and the traditional secondary suturing group (36.2 +/- 15.3 d) (P < 0.05). Healing time in the butterfly bandage group appeared to be slightly shorter than that in the secondary suture group, but the difference was not statistically significant (P > 0.05). CONCLUSION: Needle-free incision suture closure could gradually close the infection wound at the same time of drainage and dressing change, thereby shortening the healing time. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

Comparison of surgically induced astigmatism in various incisions in manual small incision cataract surgery

AIMTo determine the surgically induced astigmatism (SIA) in Straight, Frown and Inverted V shape (Chevron) incisions in manual small incision cataract surgery (SICS).

Optimal incision sites to reduce corneal aberration variations after small incision phacoemulsification cataract surgery

AIM： To analyze the effect of steep meridian small incision phacoemulsification cataract surgery on anterior,posterior and total corneal wavefront aberration.· METHODS： Steep meridian small incision phacoemulsification cataract surgery was performed in age-related cataract patients which were divided into three groups according to the incision site： 12 o＇clock, 9o＇clock and between 9 and 12 o＇clock（BENT） incision groups. The preoperative and 3-month postoperative root mean square（RMS） values of anterior, posterior and total corneal wavefront aberration including coma,spherical aberration, and total higher-order aberrations（HOAs）, were measured by Pentacam scheimpflug imaging. The mean preoperative and postoperative corneal wavefront aberrations were documented.·RESULTS： Total corneal aberration and total lower-order aberrations decreased significantly in three groups after operation. RMS value of total HOAs decreased significantly postoperatively in the 12 o＇clock incision group（P 〈0.001）. Corneal spherical aberration was statistically significantly lower after steep meridian small incision phacoemulsification cataract surgery in BENT incision group（P 〈0.05） and Pearson correlation analysisindicated that spherical aberration changes had no significant relationship with total astigmatism changes in all three corneal incision location.·CONCLUSION： Corneal incision of phacoemulsification cataract surgery can affect corneal wavefront aberration.The 12 o＇clock corneal incision eliminated more HOAs and the spherical aberrations decreased in BENT incision group obviously when we selected steep meridian small incision. Cataract lens replacement using wavefront-corrected intraocular lens combined with optimized corneal incision site would improve ocular aberration results.

Single incision laparoscopic surgery

As a complement to standard laparoscopic surgery and a safe alternative to natural orifice transluminal endoscopic surgery,single incision laparoscopic surgery is gaining popularity.There are expensive ports,disposable hand instruments and flexible endoscopes that have been suggested to do this surgery and would increase the cost of operation.For a simple surgery like laparoscopic cholecystectomy,these extras are not needed and the surgery can be performed using standard ports,instruments and telescopes.Triangular port insertion and use of instruments by the "chop stick method" are recommended to successfully do the procedure as we have done in our so far small series of 40 cases.

Review of 500 single incision laparoscopic colorectalsurgery cases-Lessons learned

Single incision laparoscopic surgery(SILS) is a minimally invasive platform with specific benefits over traditional multiport laparoscopic surgery. The safety and feasibility of SILS has been proven, and the applications continue to grow with experience. After 500 cases at a high-volume, single-institution, we were able to standardize instrumentation and operative steps, as well as develop adaptations in technique to help overcome technical and ergonomic challenges. These technical adaptations have allowed the successful application of SILS to technically difficult patient populations, such as pelvic cases, inflammatory bowel disease cases, and high body mass index patients. This review is a frame of reference for the application and wider integration of the single incision laparoscopic platform in colorectal surgery.

Endoscopic radial incision and cutting method for adult congenital duodenal webs:A case report

BACKGROUND Congenital duodenal webs are rare in adults and can lead to various symptoms such as nausea,vomiting,and postprandial fullness.The treatment for this disease is mostly surgical.Endoscopic treatment techniques have been developed and attempted for this disease.Endoscopic radial incision and cutting(RIC)techniques are reportedly very effective in benign anastomotic stricture.This case report highlights the effectiveness and safety of endoscopic RIC as a minimally invasive treatment for adult congenital duodenal webs.CASE SUMMARY A 23-year-old female patient with indigestion was referred to a tertiary hospital.The patient complained of postprandial fullness in the epigastric region.Previous physical examinations or blood tests indicated no abnormalities.Computed tomography revealed an eccentric broad-based delayed-enhancing mass-like lesion in the second portion of the duodenum.Endoscopy showed an enlarged gastric cavity and a significantly dilated duodenal bulb;a very small hole was observed in the distal part of the second portion,and scope passage was not possible.Gastrografin upper gastrointestinal series was performed,revealing an intraduodenal barium contrast-filled sac with a curvilinear narrow radiolucent rim,a typical"windsock"sign.Endoscopic RIC was performed on the duodenal web.The patient recovered uneventfully.Follow-up endoscopy showed a patent duodenal lumen without any residual stenosis.The patient reported complete resolution of symptoms at the 18-month follow-up.CONCLUSION Endoscopic RIC may be an effective treatment for congenital duodenal webs in adults.

Single-incision laparoscopic surgery for colorectal cancer

AIM: To determine the effect of single-incision laparoscopic colectomy(SILC) for colorectal cancer on short-term clinical and oncological outcomes by comparison with multiport conventional laparoscopic colectomy(CLC).METHODS: A systematic review was performed using MEDLINE for the time period of 2008 to December 2014 to retrieve all relevant literature. The search terms were "laparoscopy", "single incision", "single port", "single site", "SILS", "LESS" and "colorectal cancer". Publications were included if they were randomized controlled trials, case-matched controlled studies, or comparative studies, in which patients underwent single-incision(SILS or LESS) laparoscopic colorectal surgery. Studies were excluded if they were non-comparative, or not including surgery involving the colon or rectum. A total of 15 studies with 589 patients who underwent SILC for colorectal cancer were selected.RESULTS: No significant differences between the groups were noted in terms of mortality or morbidity. The benefit of the SILC approach included reduction in conversion rate to laparotomy, but there were no significant differences in other short-term clinical outcomes between the groups. Satisfactory oncological surgical quality was also demonstrated for SILC for the treatment of colorectal cancer with a similar average lymph node harvest and proximal and distal resection margin length as multiport CLC.CONCLUSION: SILC can be performed safely with similar short-term clinical and oncological outcomes as multiport CLC.

Effect of femtosecond laser-assisted steepest-meridian clear corneal incisions on preexisting corneal regular astigmatism at the time of cataract surgery

AIM:To investigate the clinical efficacy and safety of femtosecond laser-assisted steepest-meridian clear corneal incisions for correcting preexisting corneal astigmatism performed at the time of cataract surgery.METHODS:This prospective case series study comprised consecutive age-related cataract patients with corneal regular astigmatism(range:+0.75 to+2.50 D)who had femtosecond laser-assisted steepest-meridian clear corneal incisions(single or paired).Corneal astigmatism was performed with the Pentacam preoperatively and 3 mo postoperatively.Total corneal astigmatism and steepestmeridian measured in the 3-mm central zone were used to guide the location,size and number of clear corneal incision.The vector analysis of astigmatic change was performed using the Alpins method.RESULTS:Totally 138 eyes of 138 patients were included.The mean preoperative corneal astigmatism was 1.31±0.41 D,and was significantly reduced to 0.69±0.34 D(equivalent to difference vector)after surgery(P<0.01).The surgically-induced astigmatism was 1.02±0.54 D.The correction index(ratio of target induced astigmatism and surgically-induced astigmatism:0.72±0.36)as well as the magnitude of error(difference between surgically-induced astigmatism and target induced astigmatism:-0.29±0.51)represented a slight under correction.For angle of error,the arithmetic mean was 1.11±13.70,indicating no significant systematic alignment errors.CONCLUSION:Femtosecond-assisted steepest-meridian clear corneal incision is a fast,customizable,adjustable,precise,and safe technique for the reduction of low to moderate corneal astigmatism during cataract surgery.

Single-incision laparoscopic surgery for biliary tract disease

Single-incision laparoscopic surgery(SILS), or laparoendoscopic single-site surgery, has been employed in various fields to minimize traumatic effects over the last two decades. Single-incision laparoscopic cholecystectomy(SILC) has been the most frequently studied SILS to date. Hundreds of studies on SILC have failed to present conclusive results. Most randomized controlled trials(RCTs) have been small in scale and have been conducted under ideal operative conditions. The role of SILC in complicated scenarios remains uncertain. As common bile duct exploration(CBDE) methods have been used for more than one hundred years, laparoscopic CBDE(LCBDE) has emerged as an effective, demanding, and infrequent technique employed during the laparoscopic era. Likewise, laparoscopic biliary-enteric anastomosis is difficult to carry out, with only a few studies have been published on the approach. The application of SILS to CBDE and biliary-enteric anastomosis is extremely rare, and such innovative procedures are only carried out by a number of specialized groups across the globe. Herein we present a thorough and detailed analysis of SILC in terms of operative techniques, training and learning curves, safety and efficacy levels, recovery trends, and costs by reviewing RCTs conducted over the past three years and two recently updated meta-analyses. All existing literature on single-incision LCBDE and singleincision laparoscopic hepaticojejunostomy has been reviewed to describe these two demanding techniques.

Bimanual microincision cataract surgery with implantation of the new Incise~? MJ14 intraocular lens through a 1.4 mm incision

AIM：To analyze the visual outcomes and the posterior capsule opacification（PCO）with the new Incise？MJ14intraocular lens（IOL）implanted through a 1.4 mm clear corneal incision（CCI）in patients who underwent bimanual microincision cataract surgery（B-MICS）.METHODS：Eighty eyes which underwent cataract surgery using B-MICS technique performed by the same experienced surgeon were included in the study：40 eyes were implanted with an Incise？MJ14 IOL through a 1.4 mm CCI（group A）without enlargement of the main CCI,while 40 eyes were implanted with an Akreos？MI60 IOL with enlargement of the main CCI to 1.8 mm（group B）.Best corrected visual acuity（BCVA）,astigmatism and endothelial cell loss were evaluated before and after surgery at 7,30d and 6mo.Anterior segment-optical coherence tomography（AS-OCT）of CCI was performed at 1,3,7,30d,6 and 18mo.PCO incidence was evaluated at 18mo using EPCO 2000 Software.RESULTS：Mean BCVA improvement and endothelial cell loss were statistically significant at 18mo in both groups with no difference between the two groups;no statistically significant difference in surgically induced astigmatism（SIA）was noticed in the two groups.At AS-OCT the only significant alterations in the CCI were endothelial gaping and local detachment of Descemet’s membrane at 1 and 7d after surgery;no statistically significant alterations were found at 1,6 and 18mo.PCO score at 18mo was 0.03±0.07for group A and 0.08±0.18 for group B（P=0.11）with no sign of central optic plate invasion in both groups.CONCLUSION：The implant of the new Incise？MJ14 IOL through a 1.4 mm CCI and B-MICS technique appeared to be a safe and effective procedure with rapid visual recovery.PCO rate resulted very low and the CCI presented few morphological alterations which were only detectable in the first days postoperatively and achieved fast corneal healing during the long-term follow-up.

Cataract surgery in aged patients:phacoemul-sification or small-incision extracapsular cataract surgery

AIM: To evaluate the effects and safety of phacoemulsification (Phaco) or small-incision extracapsular cataract surgery (SICS) and intraocular lens (IOL) implantation for aged patients. METHODS: Totally 137 aged patients (149 eyes) underwent cataract operation in the case of stable systemic condition, the blood pressure less than 160/95mmHg, blood glucose less than 8mmol/L, and under the help of electrocardiogram surveillance by anesthesiologists during the operation. 106 aged patients (114 eyes) underwent Phaco while 31 aged patients (35 eyes) underwent SICS. The postoperative visual acuity, corneal endothelial cell loss, surgery time and major complications were observed and analyzed retrospectively. RESULTS: The best-corrected visual acuity (BCVA) of >= 0.6 was achieved in 135 eyes (92.6%) at 1 month postoperatively (chi(2)=259.730, P<0.001). For aged patients, both Phaco and SICS could significantly improve visual acuity with no significant difference (chi(2)=4.535, P > 0.05). Postoperative corneal endothelial cell loss was 18.6%, in PHACO group, the rate was 18.5%; in SICS group, the rate was 19.0%, the difference of which was no significant (chi(2)=0.102, P>0.05). The surgery time was different in two groups. No severe complications occurred. CONCLUSION: Both Phaco and SICS combined with IOL implantation for aged patients are effective and safe. Before surgery, detailed physical examination should be performed. When the systemic condition is stable, cataract surgery for aged patients is safe.

Toric Intraocular Lens vs. Peripheral Corneal Relaxing Incisions to Correct Astigmatism in Eyes Undergoing Cataract Surgery

Purpose:.To compare toric intraocular lens implantation(ToricIOL).with peripheral corneal relaxing incisions(PCRIs) for astigmatism correction in patients undergoing cataract surgery.Methods: 54 patients(54 eyes) with more than 0.75 diopter(D).of preexisting corneal astigmatism were classified as group A(0.75-1.50D) or group B(1.75-2.50D). The patients were randomized to undergo Toric-IOL or PCRIs in the steep axis with spherical IOL implantation..Log MAR uncorrected visual acuity(Log MAR UCVA), Log MAR best corrected vi sual acuity.(Log MAR BCVA),.error of vector(|EV|), surgery induced refraction correction.(|SIRC |),.and correction rates(CR) were measured 1 month and 6 months postoperatively.Results: At 6 months postoperatively, all 54 eyes had LogMAR BCVA≤0.2. Patients who underwent PCRIs and ToricIOL with Log MAR BCVA≤0.1 showed no significant differences in group A(P=1.00) or in group B(P=0.59). Group A showed no significant differences in Log MAR UCVA(P =0.70), |EV|(P=0.13), |SIRC|(P=0.71), and CR(P=0.56)in patients underwent PCRIs and Toric-IOL. However, group B showed significant differences in Log MAR UCVA(P <0.01), |EV|(P<0.01)), |SIRC|(P<0.01), and CR(P<0.01).The Log MAR UCVA and |EV | between 1 and 6 months showed no significant differences in patients in group A. However, in group B, they are significant differences.Conclusion:.The efficacy and stability of Toric-IOL and PCRIs were equal in low astigmatic patients..Toric-IOL achieved an enhanced effect over PCRIs in higher astigmatic patients.PCRIs had the more refractive regression than Toric-IOL in 6months.

New approaches in laparoscopic surgery for colorectal diseases: The totally laparoscopic and single-incision approaches

More than 20 years have passed since the first report of laparoscopic colectomy in 1991. Thereafter, laparoscopic surgery for the management of colorectal diseases has been widely accepted as a prevailing option because of improved cosmetic outcomes, less postoperative pain, and shorter hospital stay in comparison with open surgery. To further the principle of minimally invasive surgery, two new approaches have been developed in this rapidly evolving field. The first is the totally laparoscopic approach. Currently most of standard techniques inevitably involve an abdominalincision for retrieval of the specimen and preparation for anastomosis, which might compromise the benefits of laparoscopic surgery. The totally laparoscopic approach dispenses with this incision by combining completely intraperitoneal anastomosis with retrieval of the specimen via a natural orifice, such as the anus or the vagina. Our new and reliable technique for intraperitoneal anastomosis is also described in detail in this article. The second is the single-incision approach. While three to six ports are needed in standard laparoscopic surgery, the single-incision approach uses the umbilicus as the sole access to the abdominal cavity. All of the laparoscopic procedures are performed entirely through the umbilicus, in which the surgical scar eventually becomes hidden, achieving virtually scarless surgery. This article reviews the current status of these two approaches and discusses the future of minimally invasive surgery for colorectal diseases.

2-Octyl Cyanoacrylate Skin Adhesive for Topical Skin Incision Closure in Female Pelvic Surgery

Background: 2-octyl cyanoacrylate (2OCA) high viscosity tissue adhesive (Medline Industries, Inc., Mundelein, IL) is a liquid topical skin adhesive. 2OCA offers the same design features and clinical utility in terms of flexibility, strength, and low complication rate as the commercially available 2OCA tissue adhesives. Additionally, 2OCA features high viscosity allowing for better control during the application process, polymerization without the use of an external activator, and a distinctive violet color for ease of application visualization. Objective: The aim of this prospective case series is to descriptively report clinical data with the application of 2OCA as a topical incision closure system in female pelvic surgery. The primary outcomes included: incisional pain, incisional dehiscence, and post-operative bleeding. The secondary outcome included drying times of the adhesive with regard to incision length. Methods: A prospective open-label observational case series study was conducted to evaluate the use of 2OCA in surgical wound closure of the topical skin in adult patients undergoing gynecologic surgical procedures. A total of 50 adult women undergoing gynecologic surgery were enrolled. 2OCA was applied only by surgeons who had undergone product training to the incisions in a standardized, protocol-defined fashion. Drying times for the adhesive and photography were recorded intraoperatively. Post treatment follow-up was conducted with queries of pain level, incisional dehiscence, and incisional bleeding immediately post-operatively, 48 hours, 5 - 10 days and 14 days post-treatment. Adverse events were documented. Results: 2OCA was applied to a total of 154 incisions from the 50 patients enrolled to the study. The procedures included: 16 laparoscopic total hysterectomies, 4 diagnostic laparoscopies, 2 laparoscopic myomectomies, 2 laparoscopic bilateral or unilateral salpingo-oophorectomies, 5 total robotic-assisted laparoscopic surgeries (2 total hysterectomies, 1 supracervical hysterectomy, 1 sacrocolpopexy, and one excision of endometriosis), 7 sacral neuromodulation procedures, and 18 midurethral slings. The overall rate of incisional dehiscence was 3% (4/154). The rate of reported incisional bleeding was 3% (4/154). There was 1 incisional infection. The pain reports based on a 10-point scale had a mean of 4.96 immediately post-operatively, which decreased to a mean score < 1 (0.2) by post-op day (POD) 14. The mean drying times for the various lengths of incisions included the following: 1.28 minutes for incisions ≤ 5 mm, 1.53 minutes for 6 - 8 mm, 1.66 minutes for 10 mm - 20 mm, and 1.57 minutes for the 40 - 50 mm incisions. In 23% (36/154) of incisions 2OCA was the sole method of skin closure. Conclusion: This study demonstrates that 2OCA is safe to use in gynecologic surgical incisions with low rates of post-operative incisional bleeding and incisional dehiscence. Post-operative reports of pain maintained expected levels for recovery. 2OCA is a practical alternative or augmentation to traditional suture closure of skin incisions at the time of gynecologic surgery.

The early change of corneal vertical coma and trefoil in 2.8-mm superior incision cataract surgery

Background: To investigate early change of corneal aberrations after 2.8-mm superior incision phacoemulsification.Methods: This study comprised 80 eyes of 75 patients. All the patients underwent phacoemulsification with monofocal foldable intraocular lens(IOLs) implanted through a 2.8-mm superior corneal incision. The anterior corneal wavefront aberrations for the 6.0-mm pupillary diameter was measured by i Trace wavefront aberrometer(Tracey Technologies, Inc.) preoperatively and 1 month postoperatively. Changes of root mean square(RMS) values of Z(3,-3), Z(3, 3), Z(3,-1), Z(3, 1), and Z(4, 0) and total high order aberration(HOA) were evaluated.Results: The uncorrected and corrected visual acuities improve significantly(P<0.001). No significant postoperative changes were observed in spherical aberration(P=0.652). Significant changes in vertical coma and vertical trefoil(0.005±0.214 vs.-0.049±0.242, P=0.037;-0.141±0.222 vs.-0.258±0.359, P=0.001; separately). However, the total HOAs increased after cataract surgery(0.567±0.161 vs. 0.688±0.343, P<0.001).Conclusions: Corneal vertical coma and vertical trefoil changes significantly in 2.8mm superior corneal incision phacoemulsification cataract surgery. In addition, those had a trend to negative direction.

Outcomes after combined excisional goniotomy and manual small incision cataract surgery

AIM: To report the long-term outcomes of combined excisional goniotomy and manual small incision cataract surgery(MSICS).METHODS: This is a retrospective case series of patients with open angle glaucoma and visually significant cataracts that underwent combined excisional goniotomy and MSICS with one-year follow-up. The medical history, demographic information, and clinical characteristics of each case were recorded. Data regarding changes in vision, intraocular pressure(IOP), the number of glaucoma medications, and the evolution of the disease after surgery were reported. RESULTS: Three patients, with open angle glaucoma and cataracts underwent combined excisional goniotomy and MSICS without adverse events. All patients had improvement in vision compared to baseline measurements. The range of IOP at baseline was from 14 to 18 mm Hg and decrease to a range of 10 to 14 mm Hg after one year of follow-up. Additionally, two patients also decreased their dependence on IOP-lowering medications at the last follow up visit with one patient maintaining baseline level of medication use.CONCLUSION: A combination of excisional goniotomy and MSICS illustrates both the safety and efficacy to treat patients with visually significant cataract and glaucoma. This procedure allows for a more cost-effective surgical approach that matches the needs of resource strained territories around the globe.

Incision Site in Manual Small Incision Cataract Surgery in Case of Preoperative Direct Astigmatism

We compared surgically induced astigmatism (SIA) by a superior incision with a temporal incision in manual small incision cataract surgery (MSICS), in patients with bilateral direct (regular) preoperative corneal astigmatisms. Patients and method: We carried out a prospective study from July 1st 2018 to September 30th 2019 in the department of ophthalmology at the University Hospital of Brazzaville. Keratometric readings were recorded before surgery to assess preoperative corneal astigmatisms. Keratometric evaluation was done 45 days post-operatively. Patients were followed 90 days after surgery in order to assess the healing of the surgical site. The surgically induced astigmatism (SIA) is the difference in the magnitude vectors between the preoperative and postoperative astigmatism. The result was positive if the postoperative astigmatism was greater than the preoperative astigmatism and negative if the postoperative astigmatism was less than the preoperative astigmatism. Results: Our study sample included 48 eyes from 24 patients, including 24 operated on temporal incision and 24 in superior incision. The average SIA for superior incisions was 0.33 ± 1.55 diopters (D), versus 0.33 ± 1.44 for temporal incisions. For superior incisions the SIA was 0.81 for astigmatisms lower than 2D, against 0.16D for the temporal incisions. On the other hand, for preoperative astigmatisms greater than 2D, the surgically induced astigmatism was &plusmn;0.62D, marking a decrease in preoperative astigmatism for the superior incisions against an increase of 0.5D for the temporal incisions. The healing was delayed for the temporal incisions responsible for discomfort persisting beyond 45 days. Conclusion: The temporal incision had better results than the superior incision for astigmatisms lower than 2D, and less good for astigmatisms higher than 2D. The temporal incision healed less well.