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.

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.

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。

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。

微创人工晶状体缝线固定技术的要点

随着白内障超声乳化术和人工晶状体(IOL)植入术的广泛开展,IOL脱位已成为眼科常见病。对于IOL脱位的病例,微创、简便且可靠地固定脱位的IOL是IOL固定术的发展方向。本文将就微创IOL固定术的发展进行梳理,并结合笔者临床实践的心得和体会,对微创无巩膜瓣IOL缝线固定技术进行介绍。

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。

微血管无缝线吻合技术的研究进展和应用前景

血管损伤尤其是微血管损伤是外科创伤中常见的类型,血管吻合是创伤外科中重要的操作技术,在器官移植、创伤修复和肢体再植等领域具有广泛的应用。缝线吻合是血管吻合操作的金标准,但吻合直径<3 mm的微血管对外科医师经验和技术依赖性较强,同时血管缝线吻合本身可能引入新的创伤,在微血管吻合中该损伤更为显著。为降低操作难度,缩短手术时间,避免额外的内膜损伤,无缝线血管吻合技术作为缝线血管吻合的补充技术被逐步开发并应用于微血管吻合。本文综述了粘合吻合、激光辅助吻合、血管内支架辅助吻合、血管吻合器四个技术中应用于微血管的研究,探讨不同无缝线吻合技术在针对微血管吻合时的优劣,旨在为临床应用提供参考,并对未来的研究方向进行展望。

免缝拉合技术在山区门诊术后延迟愈合伤口护理中的应用价值

目的探究免缝拉合技术在山区门诊术后延迟愈合伤口护理中的应用价值。方法选取2018年8月至2020年8月在本院门诊就诊、接受过外科手术治疗的80例伤口延迟愈合患者为研究对象,根据就诊时间将其分为对照组(39例)和研究组(41例)。对照组采用常规护理,研究组采用免缝拉合技术。比较两组的干预效果。结果研究组的治疗总有效率高于对照组(P<0.05)。干预2、4周后,两组的创面面积均小于干预前,且研究组小于对照组(P<0.05);研究组的温哥华瘢痕量表(VSS)评分、换药费用低于对照组(P<0.05)。干预4周后,两组的伤口面积、渗液量及创面组织类型评分均低于干预前,且研究组低于对照组(P<0.05)。结论免缝拉合技术应用于山区门诊术后延迟愈合伤口患者中,具有简单、方便等优势,可以减少瘢痕,缩短伤口愈合时间,降低医疗费用。

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.

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.

Aortic valve replacement with sutureless and rapid deployment aortic valve prostheses

Aortic valve stenosis is the most common valve disease in the western world. Over the past few years the number of aortic valve replacement （AVR） interventions has increased with outcomes that have been improved despite increasing age of patients and increasing bur- den of comorbidities. However, despite such excellent results and its well-established position, conventional AVR has undergone great de- velopment over the previous two decades. Such progress, by way of less irtvasive incisions and use of new technologies, including tran- scatheter aortic valve implantation and sutureless valve prostheses, is intended to reduce the traumatic impact of the surgical procedure, thus fulfilling lower risk patients＇ expectations on the one hand, and extending the operability toward increasingly high-risk patients on the other. Sutureless and rapid deployment aortic valves are biological, pericardial prostheses that anchor within the aortic annulus with no more than three sutures. The sutureless prostheses, by avoiding the passage and the tying of the sutures, significantly reduce operative times and may improve outcomes. However, there is still a paucity of robust, evidence-based data on the role and performance of sutureless AVR. Therefore, strongest long-term data, randomized studies and registry data are required to adequately assess the durability and long-term outcomes of sutureless aortic valve replacement.

两种术式固定后房型人工晶状体治疗晶状体脱位的疗效

目的:对比25G玻璃体切割联合人工晶状体经睫状沟巩膜缝线固定术和无缝线巩膜隧道层间固定术治疗晶状体完全脱位的疗效。方法:回顾性病例对照研究。选取2015-05/2021-09在我院确诊为晶状体完全脱位于玻璃体腔的患者40例40眼,其中行25G玻璃体切割联合人工晶状体经睫状沟巩膜缝线固定术者21眼(缝线组),行25G玻璃体切割联合人工晶状体无缝线巩膜隧道层间固定术者19眼(无缝线组)。随访至术后3mo,观察两组患者手术时间、最佳矫正视力(BCVA)、角膜内皮细胞计数(CECC)、中央角膜厚度(CCT)及术后并发症情况。结果:无缝线组手术用时显著短于缝线组(31.79±6.01min vs 45.38±8.04min,P<0.001)。两组患者术后BCVA均较术前显著改善(均P<0.05),术后1wk无缝线组BCVA(LogMAR)显著优于缝线组(0.32±0.14 vs 0.57±0.25,P<0.001)。术后3mo,两组患者CECC均低于术前(均P<0.01)。缝线组术后1wk CCT大于术前和术后3mo(均P<0.01),无缝线组手术前后CCT无显著变化。随访期间,无缝线组并发症总发生率低于缝线组(26%vs 38%,P>0.05)。结论:25G玻璃体切割联合人工晶状体无缝线巩膜隧道层间固定术治疗晶状体完全脱位手术时间短,术后视力提升快,术后并发症少。

零阻断免缝合技术在腹腔镜下肾部分切除术中的临床应用研究

目的通过后腹腔镜零阻断免缝合肾部分切除术(ZS-RLPN)用于局限性肾肿瘤的临床治疗,分析该项技术对肾功能保护方面的治疗效果及安全性。方法通过对武汉科技大学附属孝感医院泌尿外科从2020年7月到2022年1月收治的25例局限性肾肿瘤患者病例资料进行回顾性分析,其中A组12例患者行阻断肾动脉的后腹腔镜肾部分切除术(RAO-RLPN),B组13例患者行ZS-RLPN,通过对比两组在术中手术时长、热缺血时间、术中出血量、术前、术后24 h内血肌酐值及血尿素氮值,术后24 h引流量、术后住院时长、术后并发症发生率(出血、感染、漏尿等)、病理切缘阳性率、输血率、术后3个月肾动态显像测定术肾肾小球滤过率(GFR),短期随访复发率、转移率等方面的整理数据,进行比较分析。结果两组术后24 h血肌酐[(84.66±4.64)μmol/L vs.(78.00±8.76)μmol/L)]、术后24 h血尿素氮[(8.06±1.18)mmol/L vs.(6.33±2.14)mmol/L)]、术中出血量[(93.25±23.65)mL vs.(138.21±13.77)mL],差异有统计学意义(P<0.05),其中术后术肾GFR[(40.06±4.67)mL/min vs.(43.22±6.15)mL/min)]差异无统计学意义(P>0.05)。结论后腹腔镜下零阻断免缝合肾部分切除术效果确切,可以最大限度保护肾功能,具有较好的临床可行性。

改良式23G免缝合切口与传统23G缝合切口硅油取出手术对比观察

目的对比观察改良式23G免缝合切口硅油取出手术的临床疗效及安全性。方法前瞻性随机对照研究。将28例(28只眼)随机分成两组,改良式23G免缝合切口硅油取出手术组为实验组(n=11),传统23G缝合切口硅油取出手术组为对照组(n=17),术前患者视网膜均完全复位。对比观察两组手术时间、术前,术后1 d、2个月眼压、角膜散光、最佳矫正视力、术后1 d结膜充血水肿程度,术后相关并发症发生情况,并通过眼表疾病指数(OSDI)量表调查评估患眼术后1周反应情况。结果两组在手术时间上差异无统计学意义(P>0.05)。术后1 d、2个月眼压、最佳矫正视力均无统计学意义(P>0.05);术后1 d角膜散光,实验组平均值远低于对照组,差异有统计学意义(P<0.05),术后2个月实验组的角膜散光平均值虽仍低于对照组,但无统计学意义(P>0.05);术后1 d,对照组结膜充血水肿程度较实验组明显。术后1周,眼表疾病指数(OSDI)量表调查结果有统计学意义(P>0.05);随访期间,实验组和对照组术后1 d各有1例(1只眼)患者发生一过性低眼压、对照组有1例(1只眼)视网膜再脱离,两组术后均未有眼内炎的发生。结论改良式23G免缝合切口硅油取出术可以安全有效地取出硅油,同时降低术后早期角膜散光,减轻结膜充血水肿程度,对于减轻患者术后的眼部不适,提高患眼术后舒适度具有明显优势。