Trend of robot-assisted surgery system in gastrointestinal and liver surgery: A bibliometric analysis

BACKGROUND Robot-assisted gastrointestinal and liver surgery has been an important development direction in the field of surgery in recent years and it is also one of the fastest developing and most concerning fields in surgical operations.AIM To illustrate the major areas of research and forward-looking directions over the past twenty-six years.METHODS Using the Web of Science Core Collection database,a comprehensive review of scholarly articles pertaining to robot-assisted gastrointestinal and liver surgery was researched out between 2000 and 2023.We used Citespace(Version 6.2.4)and Bibliometrix package(Version 4.3.0)to visualize the analysis of all publications including country,institutional affiliations,authors,and keywords.RESULTS In total,346 articles were retrieved.Surgical Endoscopy had with the largest number of publications and was cited in this field.The United States was a core research country in this field.Yonsei University was the most productive institution.The current focus of this field is on rectal surgery,long-term prognosis,perioperative management,previous surgical experience,and the learning curve.CONCLUSION The scientific interest in robot-assisted gastrointestinal and liver surgery has experienced a significant rise since 1997.This study provides new perspectives and ideas for future research in this field.

Predictive visual field outcomes after optic chiasm decompressive surgery by retinal vessels parameters using optical coherence tomography angiography

AIM:To evaluate the predictive value of superficial retinal capillary plexus(SRCP)and radial peripapillary capillary(RPC)for visual field recovery after optic cross decompression and compare them with peripapillary nerve fiber layer(pRNFL)and ganglion cell complex(GCC).METHODS:This prospective longitudinal observational study included patients with chiasmal compression due to sellar region mass scheduled for decompressive surgery.Generalized estimating equations were used to compare retinal vessel density and retinal layer thickness preand post-operatively and with healthy controls.Logistic regression models were used to assess the relationship between preoperative GCC,pRNFL,SRCP,and RPC parameters and visual field recovery after surgery.RESULTS:The study included 43 eyes of 24 patients and 48 eyes of 24 healthy controls.Preoperative RPC and SRCP vessel density and pRNFL and GCC thickness were lower than healthy controls and higher than postoperative values.The best predictive GCC and pRNFL models were based on the superior GCC[area under the curve(AUC)=0.866]and the tempo-inferior pRNFL(AUC=0.824),and the best predictive SRCP and RPC models were based on the nasal SRCP(AUC=0.718)and tempo-inferior RPC(AUC=0.825).There was no statistical difference in the predictive value of the superior GCC,tempo-inferior pRNFL,and tempo-inferior RPC(all P>0.05).CONCLUSION:Compression of the optic chiasm by tumors in the saddle area can reduce retinal thickness and blood perfusion.This reduction persists despite the recovery of the visual field after decompression surgery.GCC,pRNFL,and RPC can be used as sensitive predictors of visual field recovery after decompression surgery.

Combining robot-assisted surgical system and 3D visualization system for teaching minimally invasive vitreoretinal surgery

AIM:To investigate the feasibility of teaching minimally invasive vitreoretinal surgery with a robot-assisted surgical system and a three-dimensional(3D) visualization system.METHODS:Enucleated porcine eyes were established as an animal model for removing foreign bodies.Forty medical students were recruited to remove foreign bodies to compare the traditional microscope and the 3D system.One junior resident performed the surgical task with manual and robot-assisted operations on 20 porcine eyes for each group.One senior surgeon evaluated the retinal invasion by a graded injury degree.The learning curve for minimally invasive vitreoretinal surgery was described.RESULTS:Compared with the robot-assisted group,the injury degree was higher in the manual group.For the first ten surgeries,the manual and robot-assisted groups had injuries of 2.60±1.35(4 to 0) and 1.80±1.62(4 to 0),respectively.For the last ten surgeries,the injury degrees were 1.90±1.20(3 to 0) and 0.80±0.42(1 to 0).Considering the manual and robot-assisted groups together,95%,75% and 60% of the students considered surgical manipulation with the 3D visualization system to be more comfortable,easier and clearer,respectively.CONCLUSION:The robot-assisted surgical system and 3D visualization system may have value in teaching minimally invasive vitreoretinal surgery.

Pars plana vitrectomy for retinal detachment using perfluoro-n-octane as intraoperative tamponade:a multicenter,randomized,non-inferiority trial

AIM:To evaluate the efficacy and safety of perfluoro-n-octane(PFO)for ophthalmic surgery versus F-Octane as an intraoperative tamponade in pars plana vitrectomy(PPV)in management of retinal detachment.METHODS:This multicenter,prospective,randomized,double-masked,parallel-controlled,non-inferiority trial was conducted in three ophthalmology clinical centers in China.Patients with retinal detachment,who were eligible for PPV were consecutively enrolled.Participants were assigned to PFO for ophthalmic surgery or F-Octane for intraocular tamponade in a 1:1 ratio.Best-corrected visual acuity(BCVA),intraocular pressure(IOP)measurement,and dilated fundus examination were performed preoperatively and at 1,7±1,28±3d postoperatively.The primary outcome was complete retinal reattachment rate at postoperative day one.The non-inferiority margin was set at 9.8%.The secondary outcomes included intraoperative retinal reattachment rate,and mean changes in IOP and BCVA from baseline to 1,7±1,28±3d postoperatively,respectively.Safety analyses were presented for all randomly assigned participates in this study.RESULTS:Totally 124 eligible patients completed the study between Mar.14,2016 and Jun.7,2017.Sixty of them were randomly assigned to the PFO for ophthalmic surgery group,and 64 were assigned to the F-Octane group.Baseline characteristics were comparable between the two groups.Both groups achieved 100%retinal reattachment at postoperative day one(difference 0,95%CI:-6.21%to 5.75%,P=1).The pre-defined noninferiority criterion was met.No significant difference was observed in intraoperative retinal reattachment rate(difference 1.77%,P=0.61),mean changes in IOP(difference 0.36,-0.09,2.22 mm Hg at 1,7±1,28±3d postoperatively,with all P>0.05)and BCVA(difference 0.04,-0.02,0.06 logMAR at 1,7±1,28±3d postoperatively,all P>0.05)between the two groups.No apparent adverse events related to the utilization of PFO were reported.CONCLUSION:In patients with retinal detachment undergoing PPV,PFO for ophthalmic surgery is non-inferior to F-Octane as an intraocular tamponade,and both are safe and well-tolerated.

Microstructural morphology and visual acuity outcome in eyes with epiretinal membrane before,during,and after membrane peeling in intraoperative optical coherence tomography assisted macular surgery

AIM:To measure the difference of intraoperative central macular thickness(CMT)before,during,and after membrane peeling and investigate the influence of intraoperative macular stretching on postoperative best corrected visual acuity(BCVA)outcome and postoperative CMT development.METHODS:A total of 59 eyes of 59 patients who underwent vitreoretinal surgery for epiretinal membrane was analyzed.Videos with intraoperative optical coherence tomography(OCT)were recorded.Difference of intraoperative CMT before,during,and after peeling was measured.Pre-and postoperatively obtained BCVA and spectral-domain OCT images were analyzed.RESULTS:Mean age of the patients was 70±8.13y(range 46-86y).Mean baseline BCVA was 0.49±0.27 log MAR(range 0.1-1.3).Three and six months postoperatively the mean BCVA was 0.36±0.25(P=0.01 vs baseline)and 0.38±0.35(P=0.08 vs baseline)log MAR respectively.Mean stretch of the macula during surgery was 29%from baseline(range 2%-159%).Intraoperative findings of macular stretching did not correlate with visual acuity outcome within 6mo after surgery(r=-0.06,P=0.72).However,extent of macular stretching during surgery significantly correlated with less reduction of CMT at the fovea centralis(r=-0.43,P<0.01)and 1 mm nasal and temporal from the fovea(r=-0.37,P=0.02 and r=-0.50,P<0.01 respectively)3mo postoperatively.CONCLUSION:The extent of retinal stretching during membrane peeling may predict the development of postoperative central retinal thickness,though there is no correlation with visual acuity development within the first 6mo postoperatively.

Impact of the Rapid Recovery Concept on Complications and Patient Quality of Life in the Perioperative Nursing of Robot-Assisted Radical Oesophageal Cancer

Aim: This study evaluates the impact of Enhanced Recovery After Surgery (ERAS) nursing on postoperative complications and quality of life in patients undergoing robot-assisted minimally invasive esophagectomy (RAMIE). Methods: A total of 150 patients who underwent RAMIE from January 2020 to January 2022 at our hospital were randomly assigned to either the observation group or the control group, with 75 patients in each. The control group received standard perioperative management and nursing care, while the observation group was treated with ERAS nursing strategies. Interventions continued until discharge, and outcomes such as postoperative complications, quality of life, and nutritional status were compared between the groups. Results: The observation group exhibited a significantly lower incidence of postoperative adverse reactions compared to the control group (P ionally, all dimension scores of the Short-Form 36 Health Survey (SF-36), including the total score, were higher in the observation group (P < 0.05). Furthermore, the Nutritional Risk Screening (NRS) scores for impaired nutritional status and disease severity, along with the total NRS score, were significantly lower in the observation group compared to the control group (P Conclusion: Implementing ERAS nursing in the perioperative care of patients undergoing RAMIE is associated with reduced postoperative complications and enhanced postoperative quality of life and nutritional status. .

Visual Outcomes and Risk of Rhegmatogenous Retinal Detachment Following Posterior Capsule Rupture during Cataract Surgery: With vs without Dropped Nuclear Lens Fragments

Background: Cataract surgery is the most frequently performed surgery worldwide. Posterior capsule rupture (PCR) remains one of the most common complications of cataract surgery and a major risk factor for poor visual outcomes. Cataract surgeries complicated by PCR and vitreous loss are managed with anterior vitrectomy at the time of surgery. However, the situation can be further complicated by dropping lens particles into the vitreous cavity necessitating a secondary pars plana vitrectomy (PPV). Purpose: To compare the visual outcomes and risk of rhegmatogenous retinal detachment (RRD) between eyes that required anterior vitrectomy (AV) alone for the management of vitreous loss and eyes that required AV and subsequent PPV for the management of dropped nuclear lens fragments (DNLF) following cataract surgery complicated by PCR in a tertiary care teaching hospital in Saudi Arabia. Methods: Medical records of patients in whom PCR occurred during phacoemulsification cataract surgery requiring AV or subsequent PPV for DNLF were retrospectively reviewed over a 6-year period from January 2016 to December 2021. Results: PCR occurred in 183 (2.3%) of 7757 consecutive eyes that underwent phacoemulsification cataract surgery during the study period. Seven eyes were excluded from analysis for missing data or short follow-up. Of the 176 eyes, 147 eyes (83.5%) were managed with AV alone, and the remaining 29 eyes (16.5%) underwent a secondary PPV for DNLF. After excluding eyes with pre-existing ocular pathology, final best-corrected visual acuity (BCVA) was similar in both groups with a mean of 0.32 logMAR (P = 0.99). Two of 147 eyes (1.4%) in the AV group developed RRD with poor final BCVA whereas none of the eyes in DNLF group developed RRD. Conclusion: The risk of RRD is lower in eyes that required PPV for DNLF than in eyes that were managed with AV alone following PCR during cataract surgery. The poor visual outcomes in eyes that suffered RRD underscore the importance of postoperative retinal examination and early detection of retinal breaks.

Current trends in three-dimensional visualization and real-time navigation as well as robot-assisted technologies in hepatobiliary surgery

With the continuous development of digital medicine,minimally invasive precision and safety have become the primary development trends in hepatobiliary surgery.Due to the specificity and complexity of hepatobiliary surgery,traditional preoperative imaging techniques such as computed tomography and magnetic resonance imaging cannot meet the need for identification of fine anatomical regions.Imaging-based three-dimensional(3D)reconstruction,virtual simulation of surgery and 3D printing optimize the surgical plan through preoperative assessment,improving the controllability and safety of intraoperative operations,and in difficult-to-reach areas of the posterior and superior liver,assistive robots reproduce the surgeon’s natural movements with stable cameras,reducing natural vibrations.Electromagnetic navigation in abdominal surgery solves the problem of conventional surgery still relying on direct visual observation or preoperative image assessment.We summarize and compare these recent trends in digital medical solutions for the future development and refinement of digital medicine in hepatobiliary surgery.

Primary 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment

AIM: To report the effectiveness and safety of primary 23-Gauge (G) vitreoretinal surgery for rhegmatogenous retinal detachment (RRD). · METHODS: In this retrospective study, 49 eyes of 49 consecutive patients who underwent primary 23-G transconjunctival sutureless vitrectomy (TSV) for RRD between January 2007 and July 2009 at our institution were evaluated. · RESULTS: Mean follow-up time was 8.9±7.7 months (1-28 months). Retinal reattachment was achieved with a single operation in 47(95.9%) of 49 eyes. In two eyes (4.1%), retinal redetachment due to new breaks was successfully treated with reoperation using the 23-G TSV system. Mean logMAR visual acuity was 2.01±0.47 preoperatively and 1.3±0.5 postoperatively (P <0.001, Paired t -test). Mean preoperative intraocular pressure (IOP) was 14.1±2.8mmHg. Mean postoperative IOP was 12.3±3.6mmHg at 1 day, 13.1±2.1mmHg at 1 week, 14.3±2.2mmHg at 1 month. Iatrogenic peripheral retinal break was observed in 1 eye(2.0%) intraoperatively. No sutures were required to close the scleral or conjunctival openings, and no eyes required convertion of surgery to 20-G vitrectomy. · CONCLUSION: Primary 23-G TSV system was observed to be effective and safe in the treatment of RRD.

Perfluorocarbon in vitreoretinal surgery and preoperative bevacizumab in diabetic tractional retinal detachment

AIM: To describe the en bloc perfluorodissection(EBPD) technique and to demonstrate the applicabilityof using preoperative intravitreal bevacizumab duringsmall-gauge vitreoretinal surgery(23-gauge transconjunctival sutureless vitrectomy) in eyes with advancedproliferative diabetic retinopathy(PDR) with tractionalretinal detachment(TRD).METHODS: This is a prospective, interventional caseseries. Participants included 114(eyes) with advancedproliferative diabetic retinopathy and TRD. EBPD wasperformed in 114 eyes(consecutive patients) during23-gauge vitrectomy with the utilization of preoperativebevacizumab(1.25 mg/-0.05 mL). Patients mean age was 45 years(range, 21-85 years). Surgical time had a mean of 55 min(Range, 25-85 min). Mean follow up of this group of patients was 24 mo(range, 12-32 mo). Main outcome measures included best-corrected visual acuity(BCVA), retinal reattachment, and complications.RESULTS: Anatomic success occurred in 100%(114/-114) of eyes. Significant visual improvement [≥ 2 Early Treatment Diabetic Retinopathy Study(ETDRS) lines] was obtained in 69.2%(79/-114), in 26 eyes(22.8%) BCVA remained stable, and in 8 eyes(7%) BCVA decreased(≥ 2 ETDRS lines). Final BCVA was 20/-50 or better in 24% of eyes, between 20/-60 and 20/-400 in 46% of eyes, and worse than 20/-400 in 30% of eyes. Complications included cataract in 32(28%) eyes, iatrogenic retinal breaks in 9(7.8%) eyes, vitreous hemorrhage requiring another procedure in 7(6.1%) eyes, and phthisis bulbi in 1(0.9%) eye.CONCLUSION: This study demonstrates the usefulne-ss of using preoperative intravitreal bevacizumab and EBPD during smallgauge vitreoretinal surgery in eyes with TRD in PDR.

Rhegmatogenous Retinal Detachment in One-Eyed Patients: Therapeutic and Prognostic Challenges

Background: Retinal detachment is a major ophthalmologic emergency. The rhegmatogenous form is the most common and its management is exclusively surgical as soon as possible. This urgency becomes major and absolute when it occurs in a particular monocular vision. Purpose: To analyze the clinical forms of rhegmatogenous retinal detachment (RRD), the results and the complications of their management in monophthalmic patients. Methodology: This was a retrospective and analytical study from June 2007 to December 2019. We included all patients who received a consultation for rhegmatogenous retinal detachment. All patients were seen by at least two posterior segment specialists and all were operated on by the same surgeon. Results: 57 files (57 eyes) were collected with an average age of 44.71 years and a sex ratio of 7.14. The average consultation time is 40.80 days. Patients complained of decreased visual acuity in 96.49% of cases. We had myopia in 49.12% of cases and 91.23% of patients were phakic. Retinal holes were found in 31.58% of our patients and giant tears in 17.54%. The mean retinal detachment extension was 2.52 quadrants and the macula was raised in 32 cases. The average time taken to take charge was 10 days. Detachment surgery was performed in 42 patients with 100% anatomical recovery. Conclusion: Retinal detachment in one-eyed patient is a major ophthalmic emergency. Its management must not suffer from any delay. Post-operative outcomes are relatively similar between the internal and external pathways. In one-eyed patient, silicone can be left alone in the absence of complications.

Retinal vascular diameter changes assessed with a computer-assisted software after strabismus surgery

AIM: To quantitatively investigate the retinal vascular diameter changes, analyzing the early and long-term effects on the retinal circulation, with 6-month follow-up. METHODS: Patients underwent horizontal strabismus surger y were enrolled prospectively. Retinal vessel diameters on color fundus photographs were assessed before and 1, 7 d, 6 mo after surgery, using a computerassisted quantitative assessment software. To evaluate the retinal vascular caliber changes, retinal vascular diameters were calculated by means of the Parr–Hubbard formula as the central retinal arteriolar equivalent(CRAE) and central retinal venular equivalent(CRVE). The arteriovenous ratio(AVR) was calculated as CRAE divided by CRVE. RESULTS: A total of 154 eyes of 104 consecutive patients were included. Compared with the data before surgery(121.55±24.67), the mean CRAE(131.18±28.29) significantly increased 1 d af ter surger y(P=0.003), but went back to baseline level at 7 d(118.89±30.35, P=0.15), and 6 mo(123.22±15.32, P=0.60), so did the AVR(P<0.001, P=0.08, P=0.07). As for the mean CRVE, there was no significant difference between those four time points(172.43±33.25, 175.57±36.98, 174.03±40.18, 174.86±20.46, P=1.00). CONCLUSION: Strabismus surgery on both lateral and media rectus muscles, or single media rectus muscle may increase retinal blood flow during the early postoperative period, but would return to normal later. The number of transected anterior ciliary arteries rather might be the main cause of retinal hemodynamic changes early after strabismus surgery.

Nursing Care of 13 Cases with Acute Retinal Necrosis Associated with HIV/AIDS during Day Surgery

Objective: Summarizing the nursing points from the treatment of the 13 cases of AIDS-related acute retinal necrosis syndrome (ARNS). Methods: Retrospective analysis of clinical nursing process of 13 cases (15 eyes) of AIDS-related ARNS patient treated in our hospital from January to December 2019. Results: The retina of all the patients were flat after operation. Postoperative visual acuity: bilateral visual acuity < 0.05 in 3 cases, >0.1 in 11 eyes, 0.01 - 0.1 in 3 eyes, >0.1 in 1 eye. No adverse events and nursing safety events occurred. Patients recovered well after operation during the follow-up after discharge. Conclusion: The focus of nursing care for patients with HIV/AIDS combined with acute retinal necrosis during daytime surgery is multifaceted, apart from the daily, perioperative nursing in day-care unit, continuous nursing, psychological counseling, disinfection and isolation should be paid attention to. At the same time, with the help of promotion and application of information education means, the treatment compliance of patients can be improved, which plays an essential role in the advance of the treatment effect.

An effective algorithm for needle tip displacement compensation in robot-assisted percutaneous surgery

This paper presents an automatic compensation algorithm for needle tip displacement in order to keep the needle tip always fixed at the skin entry point in the process of needle orientation in robot-assisted percutaneous surgery. The algorithm, based on a two-degree-of-freedom （2-DOF） robot wrist （not the mechanically constrained remote center of motion （RCM） mechanism） and a 3-DOF robot ann, firstly calculates the needle tip displacement caused by rotational motion of robot wrist in the arm coordinate frame using the robotic forward kinematics, and then inversely compensates for the needle tip displace- ment by real-time Cartesian motion of robot arm. The algorithm achieves the function of the RCM and eliminates many mechanical and virtual constraints caused by the RCM mechanism. Experimental result demonstrates that the needle tip displacement is within 1 inm in the process of needle orientation.

Robot-assisted lobectomy in a patient with poor lung function:Another advantage of robot-assisted thoracoscopic surgery

Patients with poor lung function have a high-risk for pulmonary complications following lobectomy.The development of minimally invasive thoracic surgical techniques allows sicker patients to safely undergo lung resection.Robotic lobectomy could benefit these higher risk patients.Here we present a case of a 58-year-old female patient with poor lung function presented with a 3-cm mass in her lower left pulmonary lobe,who successfully underwent lobectomy via robot-assisted thoracoscopic surgery.Her forced expiratory volume in one second was slightly improved compared to the preoperative value.Her forced vital capacity continued to improve in the follow-up period.There was no recorded recurrence during the three years follow-up period.

MARKER-BASED MAPPING BETWEEN MEDICAL IMAGE AND ROBOT SPACE IN ROBOT-ASSISTED SURGERY

This paper focuses on the problems of matching a virtual and a real environments by means of hardware and software tools. The real space is represented by a patient’s bone where a set of cuts by means of robot system is to be made. The virtual space is a 3D model of the bone reconstructed from a set of CT slices. Robot system is then not only to machine bones but also to perform the fundamental step of registration between the two spaces. An external force sensor is used to adjust robot stiffness in order to perform the tactile searching necessary for the registration. A simple but reliable software algorithm is used to control the robot for matching between medical image and robot space in robot-assisted surgery. The results show the system proposed is precise enough for application, and tests been made also clarify the way to improve it.

Risk Factors for Postoperative Retinal Detachment Following Cataract Surgery

Purpose: To determine the relation between patients’ age and degree of myopia on the risk of postoperative retinal detachment following cataract surgery. Setting: University-based cataract referral practice. Patients and methods: This is a retrospective study. The chart of all patients in the practice of 1 surgeon (K.M.M) who had cataract surgery by the Kelman phacoemulsification technique between 1991 and 2010, were reviewed to identify patients (those who had retinal detachment) was associated with 4-control who didn’t detach but had surgery around the same time. Result: Forty-three cases of retinal detachment were identified, the mean age at time of cataract surgery for the RD cases was 57.3 ± 14.7 years (range: 4 to 96 years) and for the control was 69.8 ± 12.9 years (range: 9 to 75 years), p Conclusion: The study shows that risk of retinal detachment and the degree of myopia is linear up to 12.00 diopters of myopia then starting to decline, and the risk of retinal detachment is the highest in age group between 50 to 59 years.

Miniature 6-axis force/torque sensor for force feedback in robot-assisted minimally invasive surgery

In order to restore force sensation to robot-assisted minimally invasive surgery(RMIS),design and performance evaluation of a miniature 6-axis force/torque sensor for force feedback is presented.Based on the resistive sensing method,a flexural-hinged Stewart platform is designed as the flexible structure,and a straightforward optimization method considering the force and sensitivity isotropy of the sensor is proposed to determine geometric parameters which are best suited for the given external loads.The accuracy of this method is preliminarily discussed by finite element methods(FEMs).The sensor prototype is fabricated with the development of the electronic system.Calibration and dynamic loading tests for this sensor prototype are carried out.The working ranges of this sensor prototype are 30 N and 300 N·mm,and resolutions are 0.08 N in radial directions,0.25 N in axial direction,and 2.4 N·mm in rotational directions.It also exhibits a good capability for a typical dynamic force sensing at a frequency close to the normal heart rate of an adult.The sensor is compatible with surgical instruments for force feedback in RMIS.

Effect of nepafenac 0.1% on retinal thickness after cataract surgery in patients without risk factors for cystoid macular edema

AIM:To evaluate the effect of topical preoperative nepafenac 0.1%treatment on postoperative macular edema using optical coherence tomography(OCT)after uncomplicated cataract surgery.METHODS:Ninety eyes of 90 patients without any risk factors were included in the study.The patients were assigned to three groups:group 1,treated with topical prednisolone acetate 1%;group 2,treated with topical nepafenac 0.1%in addition to prednisolone acetate(1%);and group 3,those who started receiving nepafenac 0.1%treatment 3 d prior to surgery and continued the treatment postoperatively in addition to prednisolone acetate(1%).Central retinal thickness(CRT)and macular volume values were recorded using OCT at weeks 3 and 6.RESULTS:The increases in macular volume in the central 1 mm area after 3 and 6 wk were significantly lower in patients who used prophylactic topical nepafenac preoperatively(group 3)compared with those in group 1(P=0.028 and 0.008,respectively).No significant differences in the increase in macular volume and CRT were noted between groups 2 and 3(P>0.05).In group 1,the increases in macular volume in the central 3 mm area at weeks 3 and 6 were significantly higher than that in group 2 and 3(3rd week,P=0.004;6th week,P=0.005).CONCLUSION:Nepafenac 0.1%treatment in addition to topical steroids after uncomplicated cataract surgery reduce the increase in macular volume in the early postoperative period.

Ratio of Primary Episcleral Buckling Surgery versus Primary Vitrectomy for Rhegmatogenous Retinal Detachment

Purpose: To assess the ratio of the frequency of primary scleral buckling procedures versus the frequency of vitrectomies performed as treatment for rhegmatogenous retinal detachments in a primary retinal surgical department.Methods: The study included all patients with rhegmatogenous retinal detachments who underwent retinal or vitreoretinal surgery in the study period from 2002 to 2006. The size of the retinal defect and the amount of proliferative vitreoretinopathy were not exclusion criteria. Patients with tractional retinal detachment due to proliferative ischemic retinopathies were excluded.Results: In the study period, 875 primary retinal and vitreoretinal surgeries were performed on 875 eyes. Among the surgeries, episcleral sponges(42.9%) formed the largest part,followed by pars plana vitrectomies(35.0%) and encircling bands(22.2%). Combining episcleral sponges and encircling bands into an episcleral surgery group revealed that two thirds(65%).of the surgeries were episcleral interventions. In the episcleral sponge group, the retinal re-detachment rate after the first surgery was 13%.Conclusion: In a university department as a primary referral unit for retinal detachments, episcleral retinal surgery can still outnumber vitreoretinal interventions, with retinal re-detachment rates which do not differ markedly from the re-detachment rates reported in randomized trials comparing vitreoretinal surgery with episcleral surgery.