Complete Success Rate Research Articles

One tube for all: 1-year outcomes after transition to Paul glaucoma implant at a tertiary centre.

To evaluate the intraocular pressure (IOP) lowering effect and success rate of Paul glaucoma implant (PGI) in refractory glaucoma after changing practice pattern from Ahmed and Baerveldt tubes to PGI. A prospective observational study of the first 50 consecutive PGI surgeries at a single Danish tertiary centre from January 2022 to October 2023. Primary endpoints were IOP and success rates after 12 months. Secondary endpoints were the use of IOP-lowering medications and complications. All cases had a risk of failure for traditional glaucoma surgery (neovascular glaucoma, oil-filled eye or uveitis). Preoperative IOP was 29.9 ± 8.6 mmHg and the mean number of topical IOP-lowering medications used was 3.4 ± 0.76 with 14 cases of systemic acetazolamide. Twelve months after surgery IOP was reduced to 11.4 ± 3.1 mmHg and complete success rate with (a) IOP≤21 mmHg was achieved in 43%, (b) IOP≤18 mmHg in 43%, (c) IOP≤15 mmHg in 41% and (d) IOP≤12 mmHg in 33%. Qualified success rate (on topical glaucoma medications) was achieved in (a) 96%, (b) 94%, (c) 86% and (d) 71% of the cases. The number of topical IOP-lowering medications was 0.9 ± 0.9 after surgery and 47% were medication free. Early (<3 months) and late (>3 months) complications were observed in 22% and 16% of patients respectively. This study indicates that PGI provides a good IOP-lowering effect after 12 months in a population with risk factors for failure for traditional glaucoma surgery.

Two-year randomized controlled trial of circumferential versus segmental ab externo angle surgery in patients with primary open angle glaucoma.

To compare the surgical outcomes of visco-circumferential-suture-trabeculotomy (VCST) and rigid probe segmental viscotrabeculotomy (VT) in primary open-angle glaucoma (POAG). A prospective randomized controlled study. Patients presenting with POAG and operated upon in Mansoura Ophthalmic Center in Mansoura, Egypt between February 2017 and September 2021 were enrolled. Study eyes were randomized to either VCST or VT and follow up extended for 24 months. Success was defined as an intra ocular pressure (IOP)≤18 mmHg with a 40% reduction from baseline. Complications were noted. The study enrolled 166 (82 in the circumferential group) eyes of 107 patients. There were no statistically significant differences between both groups in any demographic or preoperative clinical characteristics. The IOP trend demonstrated marked initial reduction (from 32.3±2.4 and 31.8±2.6 mmHg preoperatively in VCST and VT groups respectively) followed by a slow gradual rise over subsequent follow-up settling at lower IOP values in the circumferential (12.4±1.2 mmHg) than in the segmental group (15.5±0.9 mmHg) (p<0.001), both settling at significantly lower levels than preoperative values. The survival curve demonstrates complete success rates at 12, 15, 18, and 24 months were 98.8%, 96.4%, 95.1%, and 85.4% in the circumferential group and 98.8%, 92.9%, 91.7%, 79.8% in the segmental group respectively. Minimal self-limiting hyphema was universal in all study eyes. Angle procedures -segmental and circumferential- are effective in lowering the IOP for at least 2 years in eyes with POAG, with circumferential angle surgery providing a greater reduction of IOP and requiring fewer subsequent glaucoma procedures.

Short-term efficacy and safety of PreserFlo MicroShunt in Japanese patients with medically treated primary open-angle glaucoma.

To assess the efficacy and safety of PreserFlo MicroShunt (PMS) combined with mitomycin C in patients with medically treated primary open-angle glaucoma (POAG). A retrospective observational study. The study examined 83 eyes from 83 patients with medically treated glaucoma surgery naive POAG. Preoperative intraocular pressure (IOP) was stratified into three groups: IOP < 15 mmHg (group 1), 15 ≤ IOP < 21 mmHg (group 2), and IOP ≥ 21 mmHg (group 3). IOP levels at week 1, month 1, month 3, and month 6 were evaluated using a linear mixed model, and Kaplan-Meier survival analysis was employed to assess the complete success rate (30% IOP reduction without any medications or interventions) of IOP management. The postoperative complications and interventions were also evaluated. Overall, the mean IOP decreased from 19.2 ± 7.4 mmHg to 11.3 ± 3.1 mmHg, representing a 41% IOP reduction. Especially, in group 1 (mean IOP of 12.8 mmHg), IOP decreased to 10.3 mmHg, achieving a reduction rate of 20%. Overall, 51% (95% confidence interval [CI] 41-62%) of the patients maintained a ≥ 30% IOP reduction (complete success). Minor complications included hypotony (n = 10) and hyphema (n = 30). Needling was performed in 12 eyes, bleb revision in 2, tube re-insertion in 2, and insertion of a second tube in 1. PMS demonstrated significant efficacy in reducing IOP in patients with POAG reagrdless of its preoperative IOP levels. No serious complications affecting the VA were observed.

Short-Term Safety and Efficacy of PreserFlo™ Microshunt in Patients with Refractory Intraocular Pressure Elevation After Dexamethasone Implant Intravitreal Injection.

Background: The PreserFlo™ MicroShunt (PFMS) is a bleb-forming device considered to be less invasive than traditional glaucoma surgery such as trabeculectomy. This study evaluates the 1-year success rates as well as safety profile of PFMS in patients having high intraocular pressure (IOP) and/or glaucoma refractory to drop therapy with a history of prior intravitreal dexamethasone therapy. Methods: A total of 16 eyes after PFMS implantation due to elevated IOP after intravitreal dexamethasone implant (DEX-I) administration were included in this retrospective cohort study. Success rates and secondary outcomes were evaluated. Results: Qualified and complete success rates at 12 months, respectively, were 14/16 and 12/16 eyes for criterion A, 13/16 and 11/16 eyes for B, 13/16 and 11/16 eyes for C, and 6/16 and 6/16 eyes for D. The overall mean (range) preoperative IOP decreased from 27 (16-38) mmHg to 13 (10-17) mmHg at 12 months. BCVA was not significantly different up to 12 months (p = 0.63). The preoperative mean (range) number of medications decreased from 3.56 (2-4) to 0.31 (0-3) at 12 months. One eye underwent needling twice, and two eyes were revised surgically. One patient needed replacement of the PFMS. There were no hypotony-related complications. Conclusions: The PFMS is an effective surgical option for patients with steroid-induced IOP elevation. It demonstrates satisfactory short-term success rates, a reduced need for pressure-lowering eye drops, an excellent safety profile with minimal postoperative care, and a low complication rate. Additional interventions such as needling or revisions were infrequently necessary. However, PFMS may not be the ideal choice for cases requiring a low target pressure (≤12 mmHg).

Evaluation of Femoston and Dydrogesterone therapy for incomplete abortion: a retrospective cohort study

Purpose This study aimed to compare the efficacies of Femoston and Dydrogesterone therapy in patients with incomplete abortions. Methods Patients with incomplete abortions were included if they preferred medication over surgical intervention. The participants were categorized into three groups: the Femoston group received Femoston, the Dydrogesterone group was administered Dydrogesterone, and the control group was followed up without treatment. Basic clinical information, complete abortion success rate, and menstrual recovery rate were collected to evaluate the efficacy of Femoston and Dydrogesterone in patients with incomplete abortions. Results We analyzed 332 patients with incomplete abortions. The success rate of complete abortion was significantly higher in the Femoston group than in the control group (relative risk (RR)=1.708, 95% CI 1.304–2.237, p = .001) and the Dydrogesterone group (RR = 1.200, 95% CI 1.015–1.418, p = .023). The effectiveness of Dydrogesterone was also significantly higher than that in the control group (RR = 1.439, 95% CI 1.068–1.938, p = .015). After 60 days, the rate of menstrual recovery in the Femoston group was significantly higher than that in the control group (RR =1.322, 95% CI 1.103–1.609, p = .001), while the rate in the Dydrogesterone group was significantly lower than that in the Femoston group (RR =1.200, 95% CI 1.035–1.391, p = .009). Conclusions Femoston and Dydrogesterone were effective in treating incomplete abortions, with Femoston being more effective. Patients receiving Femoston had shorter menstrual recovery times than those receiving dydrogesterone. Therefore, Femoston and Dydrogesterone are potential treatment options for incomplete abortion, with Femoston being the more effective.

Comparison of efficacy and safety between gonioscopy-assisted transluminal trabeculotomy and trabeculectomy for primary open-angle glaucoma treatment: a retrospective cohort study

BackgroundTrabeculectomy (TRAB) traditionally has been the gold-standard surgical treatment for primary open-angle glaucoma (POAG), while gonioscopy-assisted transluminal trabeculotomy (GATT) is an emerging minimally invasive surgery used for the treatment of various open-angle glaucoma (OAG) types. In this study, we aimed to compare the efficacy and safety between GATT and TRAB for the treatment of POAG.MethodsThis cohort study included eyes with POAG that underwent a single GATT (30 eyes) or TRAB (34 eyes). Follow-up was conducted at 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. Intraocular pressure (IOP), the numbers of glaucoma medication, visual field mean deviation, peripapillary retinal nerve fiber layer thickness, surgical time, and complications were analyzed. Success criteria were defined as IOP ≤ 21 mmHg and ≥ 20% IOP reduction from baseline. Qualified and complete surgical success rates were also compared.ResultsIOP and antiglaucoma drug use decreased significantly at 12 months postoperatively in the both groups (P < 0.001), with no significant differences between the two groups pre- and postoperatively (P > 0.05). The success rates at 12 months were 70% (95% confidence interval [CI] = 52.6–87.4%) in the GATT group and 76.5% (95% CI = 61.4–91.5%) in the TRAB group (P = 0.559).Visual field loss remained unchanged at 12 months postoperatively compared with preoperative levels in both groups (P > 0.05); however, peripapillary retinal nerve fiber layer thickness decreased significantly at 12 months postoperatively compared with preoperative levels in the GATT group (P < 0.001). The most frequent complications after TRAB and GATT were bleb-related complications and hyphema, respectively.ConclusionsGATT demonstrated an efficacy comparable to that of TRAB for the treatment of POAG with regards to lowering IOP, reducing medication use, and preserving visual fields. Thus, GATT is a minimally invasive technique that enables an effective and safe decrease in IOP.

Outcomes of Second Trabeculectomy Versus Glaucoma Drainage Device in Juvenile Open-angle Glaucoma After Primary Trabeculectomy Failure.

Second trabeculectomy and glaucoma drainage device implantation offer similar success rates for juvenile open angle glaucoma after initial trabeculectomy failure. However, second trabeculectomies required fewer medications. A quarter of patients in both groups required a third operation after 2.5±2.3 years. To compare outcomes between second trabeculectomy surgery versus glaucoma drainage device (GDD) insertion in juvenile open-angle glaucoma (JOAG) patients after primary trabeculectomy failure. A retrospective review was performed on all JOAG patients who underwent a second glaucoma surgery after primary trabeculectomy failure across two tertiary hospitals in Bangkok, Thailand between 2009 and 2020. Demographics, intraoperative reports, and clinical findings were collected. The primary outcomes were complete and qualified success rates at 5 years; secondary outcomes included differences in intraocular pressures and number of glaucoma medications post-operatively. Fifty-two eyes of 38 patients underwent a second glaucoma surgery after primary trabeculectomy: 30 had a second trabeculectomy, 17 received a GDD (10 valved, 7 non-valved), and 5 underwent cyclophotocoagulation. Prior to surgery, there were no significant differences except in mean refractive error. Average follow-up length was 66.9±53.7 months. Qualified success rates were 81.5% and 63.2% at 3 and 5 years (complete success: 55.6% and 42.1%) for the second trabeculectomy group and 80.0% and 70.0% (complete success: 53.3% and 50.0%) for the GDD group, respectively. There were no significant differences in group success or IOP post-operatively. The GDD group required more medications at 5 years (1.3±1.9 vs. 2.3±1.5, P=0.03). Two cases of tube exposure in the GDD group resulted in implant removal. About a quarter of patients in both groups required a third operation after 2.5±2.3 years. Both second trabeculectomy and GDD insertion are effective treatments for JOAG after trabeculectomy failure. Second trabeculectomy required fewer medications for IOP control.

Preserflo MicroShunt Implantation for Glaucoma Secondary to Viral and Juvenile Idiopathic Arthritis-Related Anterior Uveitis

ABSTRACT Purpose To investigate the efficacy and safety of the Preserflo MicroShunt (PMS) in treating glaucoma secondary to different uveitic glaucoma (UG) types in a European population. Methods This study evaluated consecutive eyes with UG that received the PMS. The primary outcome measure was 12-month surgical success (≥20% IOP reduction, target IOP of 6–21 mmHg). Complete success was considered without IOP-lowering medication or additional surgery other than needling. Qualified success A was considered regardless of medication use, and qualified success B regardless of medication and/or incisional bleb revision. The secondary outcome measures included revision and complication rates. Results Twenty-five eyes (viral group: 10 with Fuchs uveitis syndrome and six with herpetic uveitis; juvenile idiopathic arthritis (JIA) group: nine with JIA-related uveitis) were included. The 12-month complete success rate was significantly higher in the viral group than in the JIA group (69% vs 11%; p = 0.0059, log-rank test). The qualified success rates in the viral and JIA groups were 75% and 22% for category A (p = 0.029) and 94% and 56% for category B (p = 0.0237), respectively. Among the viral and JIA groups, 13% and 11% required medication, respectively. Incisional bleb revisions were conducted within 12 months in 25% and 78%, respectively (p = 0.0131, log-rank test). Complications were self-limiting, with no uveitic activity observed. Conclusion The PMS is safe and effective for glaucoma secondary to viral anterior uveitis. Conversely, it is moderately effective in eyes with JIA-related UG, with a high probability of bleb fibrosis development.

Five-Year Outcomes of Deep Sclerectomy in Pseudoexfoliation Glaucoma Compared to Primary Open-Angle Glaucoma.

Objectives: This study aimed to investigate the five-year outcomes of deep sclerectomy (DS) in patients with pseudoexfoliation glaucoma (PEXG) and primary open-angle glaucoma (POAG). Methods: This retrospective, observational, unicentric study analyzed POAG and PEXG patients. Intraocular pressure (IOP), the number of IOP-lowering medications, peripapillary retinal nerve fiber layer (RNFL) thickness, the number of postoperative interventions, surgical success rates, and secondary surgery rates were evaluated at baseline and during follow-up appointments. Results: A total of 109 POAG and 153 PEXG eyes were included. Over the 5-year follow-up, IOP decreased in both groups (p = 0.17), from 22.8 ± 0.7 to 13.3 ± 0.6 mmHg (p < 0.001; POAG) and from 24.3 ± 0.8 to 16.6 ± 1.2 mmHg (p < 0.001; PEXG). The number of IOP-lowering medications decreased comparably (p = 0.99), from 3.1 ± 0.1 to 1.7 ± 0.3 (p = 0.001; POAG) and from 3.4 ± 0.1 to 1.7 ± 0.2 (p < 0.001; PEXG). Peripapillary RNFL thickness decreased in both groups (p = 0.31), from 60.6 ± 1.9 to 54.2 ± 2.4 µm (p < 0.001; POAG) and from 63.1 ± 1.7 to 58.0 ± 2.3 µm (p < 0.001; PEXG). The 5-year complete success rates were 33% and 12% for the POAG and PEXG groups, respectively (p = 0.01). The qualified success rates were 63% and 40% (p = 0.03). Secondary glaucoma surgery was required in 8% of POAG eyes and 21% of PEXG eyes (p = 0.04). Conclusions: DS resulted in comparable results for IOP, medications, and RNFL development in the PEXG and POAG groups but in less favorable outcomes concerning surgical success and further necessary repeated glaucoma surgery in patients with PEXG over the 5-year follow-up period.

One-Year Comparison of Efficacy and Safety of PreserFlo MicroShunt with Mitomycin C Applied by Sub-Tenon Injection Versus Sponge.

This study was performed to compare the efficacy and safety of PreserFlo MicroShunt (PMS) implantation with mitomycin C (MMC) applied by sub-tenon injection versus conventional application by MMC-soaked sponges. This retrospective, 1-year cohort study included 100 eyes of 100 patients with glaucoma who underwent PMS implantation with MMC (0.4mg/ml) delivered either by sub-tenon injection (50 eyes) or via soaked sponges (50 eyes). The primary outcome measure at 1year was intraocular pressure (IOP) reduction, with complete success defined as an IOP reduction of ≥ 20% and achieving a target IOP of ≤ 21 or 18mmHg without the use of medication. Secondary outcomes, including corneal endothelial cell density (CECD) loss, the number of medications, and complications, were assessed and compared between the groups. Sustained reductions in mean IOP were observed in both groups over the 1-year follow-up, with no significant differences between the groups. The complete success rate, with a target IOP of ≤ 21mmHg after 1year, was 19.3% in the sponge group and 26.4% in the injection group. The qualified success rate was 59.0% and 87.4% in the sponge and injection groups, respectively. A longer survival rate was observed in the injection group than in the sponge group when IOP was below 21mmHg. The mean CECD significantly decreased (P < 0.01) from baseline to each postoperative follow-up time point in both groups. At 1year postoperatively, the percentage of total CECD loss was 8.1% in the sponge group and 8.0% in the injection group. However, no significant differences in mean CECD values, the number of medications, or adverse events were found between the groups. PMS implantation with sub-tenon injection of MMC was comparable in terms of efficacy and safety to traditional MMC delivery via soaked sponges. However, the injection group demonstrated a significantly higher success rate than the sponge group.

Two-year outcomes of Xen 45 gel stent implantation in patients with open-angle glaucoma: real-world data from the Fight Glaucoma Blindness registry

ObjectiveTo evaluate efficacy and safety outcomes of the Xen 45 gel stent implant over 24 months of follow-up.MethodsA retrospective analysis of prospectively collected data from the Fight Glaucoma Blindness observational...

The Application of Sleep Deprivation Combined With Chloral Hydrate on Pediatric Dermatological Surgery.

In small dermatological surgeries for infant and child patients, it is required that the child be in a quiet state. However, general anesthesia not only requires the participation of professional anesthesiologists for surgery but also has a high cost and anesthesia risks. Parents have a low acceptance rate. At present, chloral hydrate combined with local anesthesia for sedation has been widely used in various pediatric examination and treatment projects. To retrospectively analyze the impact of sleep deprivation on pediatric dermatological surgery performed under local anesthesia following chloral hydrate enema. A retrospective review was conducted on 280 pediatric patients who underwent dermatological surgery or tissue pathology biopsy from September 2022 to March 2023. The study analyzed the success rate of local anesthesia following chloral hydrate enema under different states of wakefulness and whether the surgical processes for infants and toddlers were conducted smoothly. Among the 215 patients who underwent sleep deprivation, the successful completion rate of the surgery reached 87%. By contrast, only 29.2% of the 65 patients who did not experience sleep deprivation completed the surgery. The patients' vital signs remained stable throughout the surgery, and no adverse reactions occurred when the patients were awakened 30 minutes to 1 hour after the surgery. Sleep deprivation in infants and toddlers can enhance the anesthetic and immobilization effects in dermatological surgery, significantly reducing the patients' negative emotions, such as crying and fear, increasing the patient's cooperation during the surgery, and improving parental satisfaction. The clinical operation is convenient and thus worth promoting extensively.

Quality Evaluation Tools for Learning Objects: A Case of Engineering Tuition in an ODL Setting

This research investigates the application of Learning Objects (LOs) in enhancing the delivery of educational content through multimedia approaches, particularly within the contexts of Open Distance Learning (ODL) and engineering education. The quality of LOs employed in these settings is critical, as it can significantly impact student comprehension, influencing both successful qualification completion rates and attrition rates within specific fields of study. The study aims to evaluate whether the current criteria used to assess LOs are sufficient and appropriate for the teaching and learning (T&amp;L) of engineering disciplines. A technology scorecard for various LO technologies is developed, and the assessment is conducted using the Learning Object Review Instrument (LORI) criteria. The findings from this assessment are then analysed against the Engineering Council of South Africa (ECSA) module outcome criteria to determine whether the existing LORI criteria are suitable for measuring the acceptable quality levels of LOs in engineering T&amp;L. The research adopts a qualitative methodology, with the establishment of a technology scorecard being a key component. The study's outcomes will reveal whether the LORI criteria are adequate and appropriate for assessing the quality of LOs in engineering education. If inadequacies are identified, the research will highlight these gaps and propose recommendations for addressing them. Ultimately, the study aims to establish a new, refined framework for assessing the quality of LOs in engineering T&amp;L contexts.

Controlled Study of Tanito Microhook (TMH) ab interno trabeculotomy combined with phacoemulsification for POAG/ PACG

Abstract. To evaluate the efficacy of Tanito Microhook (TMH) ab interno trabeculotomy combinated with phacoemulsification in treating primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). A retrospective comparative study was conducted to analyze 16 patients with primary open-angle glaucoma (POAG) who underwent phacoemulsification and TMH at the Second People's Hospital of Changshu from December 2021 to December 2022, along with 19 patients with primary angle-closure glaucoma (PACG) who underwent phacoemulsification, goniosynechialysis, and TMH. The follow-up period ranged from 12 to 24 months. The average preoperative IOP in the POAG group was (26.504.52) mmHg, and the average IOP was (18.001.67) mmHg at 12 months postoperatively, which was significantly lower than the preoperative value (P&lt;0.05). The average preoperative IOP in the PACG group was (34.1114.90) mmHg, and the average IOP was (18.670.87) mmHg at 12 months postoperatively, which was lower than the preoperative value (P&lt;0.05). The average number of anti-glaucoma drugs used by the POAG group before surgery was (2.060.21) types, and the average number of types was (0.180.10) at 12 months postoperatively, which was significantly reduced compared with the preoperative value (P&lt;0.05). The PACG group used an average of (1.890.15) kinds of anti-glaucoma drugs preoperatively, (0.680.17) kinds of drugs postoperatively, and the difference in the number of drugs used between preoperative and postoperative periods was not statistically significant (P&gt;0.05). The complete success rate of the POAG group was 81.3% (13/16), and the conditional success rate was 18.7% (3/16). The complete success rate of the PACG group was 47.4% (9/19), and the conditional success rate was 52.6% (10/19). The intraoperative and postoperative complications in the POAG group mainly included one case of hyphema in the anterior chamber and one case of transient intraocular pressure elevation, while the intraoperative and postoperative complications in the PACG group included one case of shallow anterior chamber after surgery, four cases of hyphema in the anterior chamber, and three cases of transient intraocular pressure elevation. No serious complications occurred in either group. The combination of TMH with cataract phacoemulsification and intraocular lens implantation demonstrates a safe and effective approach for treating POAG. Additionally, when combined with goniosynechialysis (GSL), it may be a safe and effective treatment for PACG. However, the long-term efficacy still requires further investigation through large-scale prospective controlled studies.

The competency of the novel through-the-scope suture device for gastric mucosal defects: In vivo study in a porcine model (with video).

Endoscopic closures of mucosal defects following endoscopic resection can be challenging and time-consuming. The novel through-the-scope suture device has demonstrated acceptable closure times, but its learning curve is still unknown. This study aims to evaluate the number of cases required to achieve competency in this device. Two endoscopists participated; a novice with less than 400 experiences in upper gastrointestinal endoscopy and an expert with over 500 experiences in endoscopic submucosal dissection. Neither endoscopist had previous exposure to the device. In four porcine models, 24 gastric mucosal defects, each 2-4 cm in diameter, were created by endoscopic mucosal resection with ligation. Each endoscopist performed endoscopic closure for 12 mucosal defects with a single through-the-scope suture device per lesion. The primary endpoint was the number of cases needed to reach competency, defined as achieving a procedure time below the average closure time reported in the literature. Secondary endpoints included procedure time, complete closure success rates, and incidence of adverse events. The mean defect size was 2.9 (±0.2) cm. Competency was achieved after six cases in the expert and seven cases in the novice. The median closure time was 9.0 (interquartile range [IQR]: 6.0-11.0) min for the expert and 8.0 (IQR: 6.2-9.7) min for the novice (p = 0.862). Complete closure success rates were 75.0% (n = 9) for the expert and 83.3% (n = 10) for the novice. No adverse events were reported. A small number of cases were required for both expert and novice endoscopists to reach competency in the novel through-the-scope suture device.

Pancreatoscopy-Guided Lithotripsy for Pancreatic Duct Stones: A Systematic Review and Meta-Analysis.

Pancreatic duct stones (PDS) are one of the leading complications of chronic pancreatitis, causing intractable upper abdominal pain, aggravating the underlying disease, and even increasing the risk of pancreatic cancer. At present, pancreatoscopyguided lithotripsy is considered the second-line endoscopic treatment for pancreatic duct stones. In this systematic review and metaanalysis, we evaluated the efficacy and safety of pancreatoscopy-guided lithotripsy. A systematic search was conducted across several medical electronic databases, including PubMed, Web of Science, Medline, and Embase, encompassing publications up to December 2022. Studies reporting complete stone clearance rate, clinical success rate, and adverse event rate were included for analysis. We further aimed to compare the outcomes between electrohydraulic lithotripsy and laser lithotripsy treatment groups. A total of 17 studies (5 prospective studies and 12 retrospective studies) with 441 patients were included in the meta-analysis. Pooled complete stone clearance rate was 81% (95% CI, 0.74-0.88), pooled clinical success rate was 90% (95% CI, 0.84-0.95), while the pooled adverse event rate was 12% (95% CI, 0.07-0.19). Pancreatoscopy-guided lithotripsy is a safe and effective treatment for pancreatic duct stones. This is evidenced by high pooled rates of complete stone clearance and clinical success, combined with a relatively low incidence of adverse events.

Factors influencing the outcomes of trabeculectomy, conventional canaloplasty, and mitomycin C augmented canaloplasty.

To compare the efficacy, safety, and factors influencing the outcomes of trabeculectomy (TE), conventional canaloplasty (cCP), and mitomycin C augmented canaloplasty (mCP) in glaucoma patients. Intraocular pressure (IOP), the number of IOP-lowering eye drops, and surgery-related complications were evaluated at baseline and through 18months postoperatively. Correlations between patients' demographic data, ophthalmic and non-ophthalmic conditions, outcomes and complications were evaluated. 171 patients were included. IOP and IOP-lowering eye drops were significantly (p < 0.001) reduced 18months after TE, cCP, and mCP. At the 18-month follow-up, IOP and IOP-lowering eye drops were significantly lower following TE than cCP (p < 0.001, p = 0.010, respectively) and mCP (p = 0.010, p = 0.014). At the 18-month follow-up, complete success rates were significantly higher after TE compared to cCP and mCP for IOP ≤ 21, 18, and 16mmHg (p < 0.001). Qualified success rates for IOP ≤ 16mmHg were higher following TE than cCP and mCP (p = 0.023). In the TE group, clinical hypotony at any postoperative follow-up was positively correlated with previous intravitreal anti-vascular endothelial growth factor (VEGF)-therapy (p < 0.001), leukaemia (p = 0.002), and a spherical equivalent < -3 dioptres (p < 0.001). There were no significant correlations in the cCP and mCP groups. TE, cCP, and mCP led to a significant reduction in IOP and IOP-lowering eye drops during 18months of follow-up. At 18months of follow-up, IOP and IOP-lowering eye drops were significantly lower following TE compared to cCP and mCP. Anti-VEGF-therapy, cystostatic therapy in leukaemia, and a spherical equivalent < -3 dioptres were significantly correlated with postoperative hypotony, macular folds, and choroidal detachment in the TE group. What is known • Trabeculectomy (TE) is considered the gold standard in the surgical management of glaucoma. However, TE involves extensive postoperative management and might be associated with severe surgery-related complications. What is new • In this study, intraocular pressure (IOP) and IOP-lowering eye drops were significantly lower following TE compared to conventional canaloplasty (cCP) and mitomycin C augmented canaloplasty (mCP) at a follow-up of 18months. • In patients undergoing TE, anti-VEGF-therapy, cystostatic therapy in leukaemia, and a spherical equivalent < -3 dioptres were significantly correlated with postoperative hypotony, macular folds, and choroidal detachment.

Measurement-Based Care in a Remote Intensive Outpatient Program: Pilot Implementation Initiative.

The ongoing mental health crisis, especially among youth, has led to a greater demand for intensive treatment at the intermediate level, such as intensive outpatient programs (IOPs). Defining best practices in remote IOPs more broadly is critical to understanding the impact of these offerings for individuals with high-acuity mental health service needs in the outpatient setting. Measurement-based care (MBC), or the routine and systematic collection of patient-reported data throughout the course of care to make meaningful changes to treatment, is one such practice that has been shown to improve patient outcomes in mental health treatment. Despite the literature linking MBC to beneficial clinical outcomes, the adoption of MBC in clinical practice has been slow and inconsistent, and more research is needed around MBC in youth-serving settings. The aim of this paper is to help bridge these gaps, illustrating the implementation of MBC within an organization that provides remote-first, youth-oriented IOP for individuals with high-acuity psychiatric needs. A series of 2 quality improvement pilot studies were conducted with select clinicians and their clients at Charlie Health, a remote IOP program that treats high-acuity teenagers and young adults who present with a range of mental health disorders. Both studies were carefully designed, including thorough preparation and planning, clinician training, feedback collection, and data analysis. Using process evaluation data, MBC deployment was repeatedly refined to enhance the clinical workflow and clinician experience. The survey completion rate was 80.08% (3216/4016) and 86.01% (4218/4904) for study 1 and study 2, respectively. Quantitative clinician feedback showed marked improvement from study 1 to study 2. Rates of successful treatment completion were 22% and 29% higher for MBC pilot clients in study 1 and study 2, respectively. Depression, anxiety, and psychological well-being symptom reduction were statistically significantly greater for MBC pilot clients (P<.05). Our findings support the feasibility and clinician acceptability of a rigorous MBC process in a real-world, youth-serving, remote-first, intermediate care setting. High survey completion data across both studies and improved clinician feedback over time suggest strong clinician buy-in. Client outcomes data suggest MBC is positively correlated with increased treatment completion and symptom reduction. This paper provides practical guidance for MBC implementation in IOPs and can extend to other mental health care settings.

Evaluation of remote check in children with cochlear implants

ObjectiveThis study evaluates the feasibility of reducing in-person appointments by utilizing Remote Check (RC) in pediatric cochlear implant (CI) recipients and investigates the most suitable age range for implementing RC. MethodsFifty-eight pediatric CI recipients, aged 1–17 years, were evaluated using a web-based RC application by audiologists. Most (84.5 %) used verbal communication. Inclusion criteria required stable map status, caregiver tech proficiency, and a compatible phone. ResultsRemote assessments were beneficial, with 89.7 % of participants successfully completing RC. Aided threshold tests (ATT) were completed in 73.2 % of participants, while speech-in-noise tests (Digit Triplet Test, DTT) were completed in 47.3 %. Children as young as 4 successfully completed ATT, while a minimum age of 7 was required for DTT. A significant relationship between age and test success was demonstrated. Verbally communicative children had higher completion success rates. Parental education was significantly correlated with DTT success, with higher success rates in children whose parents had undergraduate degrees. With RC use, 69 % of children did not need clinic visits, emphasizing the need for personalized and remote support for optimal cochlear implant performance. In-person appointments were primarily required due to concerns about the duration of device usage. ConclusionThe study confirms the effectiveness and feasibility of using RC in pediatric CI users, even as young as one year old with stable aided hearing. The findings advocate for the integration of RC into routine follow-up protocols, offering a more accessible option for enhanced patient care.

Transvenous extraction of conduction system and lumenless pacing leads.

Conduction system pacing (CSP), often accomplished with lumenless pacing leads, is increasingly employed to achieve physiologic ventricular activation. There are limited data on the extraction of these leads. The objective of this study was to describe the safety and efficacy of extraction of CSP pacing leads and compare outcomes with extraction of non-CSP lumenless leads. Patients undergoing CSP/non-CSP lumenless lead removal were included. Outcomes of interest included rates of complete procedural success, complications, and successful reimplantation. Overall, 23 patients were included (n = 14 with CSP and n = 9 with non-CSP lumenless leads implanted in the right atrium, right ventricle, or septum). The mean age was 52.7 ± 24.0 years, 30% were female, and the mean lead age was 4.5 ± 4.4 years. The complete procedural success rate was 100%. One serious complication occurred in the non-CSP group but was unrelated to the lead of interest. Manual traction alone was successful in 57% of CSP cases (mean lead age 2.4 ± 1.7 years) and in 11% of non-CSP cases (mean lead age 7.9 ± 5.3 years). Laser sheaths were used in 43% of CSP cases and 89% of non-CSP cases; rotational cutting tools were used in no CSP cases and in 33% of non-CSP cases. Reimplantation in the conduction system was attempted with a left bundle branch pacing lead and successful in 80% (n = 4/5). Extraction of CSP and non-CSP lumenless leads is feasible with a high success rate and a good safety profile. CSP reimplantation after extraction is also feasible with good electrical performance.