Complete Success Rate Research Articles

The Impact of Unguided Trauma Simulation Practice on Novice Performance: A Randomized Controlled Trial.

The purpose of this investigation was to determine the impact of simulator practice on task completion time, radiation use, success rate, and overall quality in a simulation of placing a distal locking screw. This was a prospective, randomized control trial with one-to-one randomization and parallel group design. Twenty-eight volunteer novice trainees (medical and premedical students) participated. Using the TraumaVision Virtual Reality Simulator (Swemac, Sweden), subjects performed locking screw placement using the "perfect circle" technique. All subjects underwent a pretest and posttest on the simulator. The simulator group completed three additional simulator training sessions. The primary outcome variables were simulator-collected task completion time, success rate, radiation exposure time, and overall score. No notable difference existed between groups for pretest completion time, radiation use, success rate, or overall score. No notable difference in posttest radiation use or overall procedure score was found between groups. A significant difference existed in posttest total completion time (trained = 251.2 ± 103.4; control = 497.3 ± 223.1; P = 0.001) and success rate (64.3% versus 100%; P = 0.041) between groups. In addition, a significant difference existed in variance between groups for completion time (P = 0.029). These findings suggest that independent simulator practice leads to improved speed and success rates; however, radiation use and overall score do not improve in the same manner. The design of simulator-based curriculum must be tailored to specific educational objectives and ultimately validated in the clinical setting.

Intraocular pressure control after combined phacotrabeculectomy versus trabeculectomy alone.

We compared the efficacy and safety of trabeculectomy and phacotrabeculectomy in patients with glaucoma. We retrospectively analyzed consecutive patients who underwent trabeculectomy or phacotrabeculectomy. Patients in the trabeculectomy group were pseudophakic. We established three different intraocular pressure (IOP) thresholds (A: <21 mmHg, B: <18 mmHg, and C: <15 mmHg) to measure complete (without medication) and qualified (with medication) success. Success criteria were analyzed through Kaplan-Meier survival curves. Sixty-seven eyes were included (40 trabeculectomy, 27 phacotrabeculectomy). The mean follow-up period was 25.70 ± 14.439 months. The baseline characteristics were similar between the groups. The complete and qualified success rates according to criterion C were significantly higher in the trabeculectomy group (p = 0.033, p = 0.021, respectively); however, there was a trend toward a higher success rate for all criteria in favor of trabeculectomy. Bleb needling was more frequent in the phacotrabeculectomy group. The mean IOP significantly decreased from 26.46 ± 7.07 to 12.27 ± 4.06 at 12 months (p < 0.001). The final mean IOP was significantly lower in the trabeculectomy than in the phacotrabeculectomy group (10.95 ± 3.08 vs 13.00 ± 4.56, p = 0.0003). In pseudophakic eyes, trabeculectomy alone achieves a higher success rate, lower mean IOP, and less frequent bleb needlings. More frequent follow-up and prolonged postoperative use of high-dose topical steroids should be considered in patients undergoing phacotrabeculectomy.

Abstract P151: Remote Enrollment Practices for Acute Stroke Clinical Research Trials During a Pandemic

Introduction: Many clinical trials have suffered poor enrollment or have been placed on hold due to the COVID-19 pandemic. Limitations on in-person interaction with patients, legally authorized representatives, coordinators, and physician investigators disrupt research processes including screening, consent, randomization, and study interventions. Remote enrollment practices incorporating telemedicine and electronic consent may address these enrollment limitations. Methods: We retrospectively reviewed clinical trial enrollments in two pivotal phase-III acute stroke trials (NCT03735979, NCT03785678) at two high-volume stroke centers that routinely use remote enrollments in clinical research. Individual elements of acute clinical stroke trial enrollment, including: screening, consent, randomization, and intervention were reviewed. For each research phase, we compared the rate of successful completion and research protocol violations for in-person vs remote research via Fisher’s exact test. Results: Forty patients were reviewed (median age 72 [IQR 63-84], 50% female, median NIHSS 13 [IQR 7.5-19.5]; 35 patient were enrolled and 5 were screened and consented, but found ineligible on qualifying imaging. All research phases were completed successfully with the exception of one in-person study intervention. Fisher’s exact test revealed no differences in protocol violations between research elements conducted remotely (predominantly via telemedicine) versus in-person (see Table). Conclusion: Our study revealed no difference in successful completion of acute clinical trial research elements when conducted remotely or in-person. Incorporation of remote research, especially telemedicine, may enable stroke clinical trial enrollments both during the COVID 19 pandemic and beyond.

Safety and efficacy of transvenous lead extraction in octogenarians using powered extraction sheaths.

In the aging population equipped with cardiac implantable electronic devices, an increasing number of octogenarians require lead extractions. This patient population is often considered as a high-risk group for surgical procedures. We, therefore, investigated the safety and efficacy of transvenous lead extraction in octogenarians using powered extraction sheaths. Between January 2013 and March 2017, 403 patients underwent lead extraction at two high-volume lead extraction centers. A total of 71 octogenarians were treated with laser lead extraction and were included in this analysis. Primary extraction method was laser lead extraction, with additional use of mechanical rotational sheaths or femoral snares, if necessary. Patient-based and procedural data were collected and analyzed retrospectively. Mean age was 83.5 ± 3.3 years, 64.7% were males. A total of 152 leads were extracted. The mean lead dwell time of treated leads was 10.2 ± 5.2 years. Complete procedural success rate was 92.9%, while clinical success was achieved in 98.6%. Failure of extraction occurred in one patient (1.4%). In six (7.7%) patients, additional mechanical rotational sheaths or femoral snares were used. Overall complication rate was 4.2%, including one (1.4%) major (RA perforation) and two (2.8%) minor complications. No procedure-related mortality was observed in any of the patients. Transvenous lead extraction in octogenarians with old leads is safe and effective when performed in experienced centers. Patient's age should therefore not be considered as contraindication for lead extraction using powered extraction sheaths.

Comparison between sutureless scleral tunnel phacotrabeculectomy with and without placement of anterior capsule remnant.

To compare sutureless scleral tunnel phacotrabeculectomy with and without placement of anterior capsule remnant in the tunnel. In this comparative interventional case series, 41 eyes of 40 patients having open-angle glaucoma (OAG) underwent sutureless scleral tunnel phacotrabeculectomy (Group A) and 28 eyes of 24 patients underwent the same procedure with placement of anterior capsule remnant in the tunnel (Group B). Baseline intraocular pressure (IOP) and IOP at 1day, 1month and 6months after surgery were recorded. IOP < 21mmHg and 20% reduction in IOP from baseline without and with antiglaucoma medication(s) were considered as complete and qualified success, respectively. Any further procedures or complications that require returning the patient to the operating room or becoming no light perception (NLP) were defined as failure. Mean preoperative IOP was 26.6 ± 10.08 and 26.64 ± 6.31mmHg in group A and B, respectively (P-value = 0.984). Mean IOP at 1month was significantly lower in group B (14.24 ± 4.4 versus. 12.07 ± 3.1, P = 0.027) but at 6months there was no significant difference between groups (14.38 ± 3.56 versus. 14.8 ± 1.85, P = 0.590). The qualified success rate in group B was higher than group A (78.6 versus. 58.5%) at month 1, while the complete success rate was higher in group A than B (34.1% versus. 17.9%). Neither of any group had complete success at month 6. The qualified success rate was 94.7% and 100% in group A and B, respectively, at 6months. Placement of anterior capsule remnant in the ostomy during combined phacotrabeculectomy may improve the outcome of the procedure.

Combined Phacoemulsification and Ex-PRESS Implant with Everting Suture in Primary Angle-Closure Glaucoma: Survival Analysis and Predictive Factors.

The purpose of this study was to evaluate the efficacy and safety of combined phacoemulsification and Ex-PRESS implant with everting suture in primary angle-closure glaucoma (PACG) and to examine predictive factors of failure. Twenty-three eyes of 18 patients were enrolled. Data about time of removal of releasable sutures and traction of the everting suture and about changes in intraocular pressure (IOP) were collected, as well as comprehensive ophthalmic examinations. Success was defined by the following criteria: IOP ≤ 18 mmHg (criterion 1); IOP ≤ 15 mmHg (criterion 2); and IOP ≤ 12 mmHg (criterion 3). Success was categorized as complete or qualified, depending on whether it was reached without or with drugs, respectively. Success rate was assessed with Kaplan–Meier survival analysis with a Cox proportional hazard model to adjust for potential confounders. The lowering of IOP and the reduction of medications were statistically significant at every follow-up visit compared with the baseline (p < 0.05). The complete success rates were 87%, 70%, and 17% accordingly to criterion 1, 2, and 3; the qualified success rates were 93%, 70%, and 20%, respectively. Most of the complications resolved spontaneously and conservatively. In conclusion, combined phacoemulsification and Ex-PRESS Minishunt implant with everting suture is a safe and effective surgery, even in PACG, lowering IOP and number of medications.

CO2 Laser-Assisted Deep Sclerectomy Surgery Compared with Trabeculectomy in Primary Open-Angle Glaucoma: Two-Year Results.

Purpose To compare the effectiveness and safety of carbon dioxide (CO2) laser-assisted deep sclerectomy surgery (CLASS) and trabeculectomy (Trab) for treatment of primary open-angle glaucoma (POAG). Methods In this retrospective and comparative study, 77 eyes of 62 patients with POAG were studied and divided into the CLASS and Trab groups. The best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of medications, surgical success rate, and complications were analyzed. Results The mean follow-up periods were 27.89 ± 2.94 months and 26.11 ± 2.06 months in the CLASS and Trab groups, respectively. 30 eyes (24 patients) underwent CLASS and 47 eyes (38 patients) underwent Trab. The BCVA in the CLASS and Trab groups was recovered to baseline at postoperative 1 week and 1 month, respectively. At last follow-up visits, a remarkable reduction in the IOP and number of medications was observed in both groups, and no significant difference was found in those between the two groups. The complete success rates were 51.7% and 47.7% in postoperative 24 months in the CLASS and Trab groups, respectively (P > 0.05). There were higher rates of delayed anterior chamber formation (21.3%) and thin-wall filtrating blebs (10.6%) in the Trab group. Meanwhile, the peripheral anterior synechiae were only observed in the CLASS group, and the ratio was 30%. Conclusions CLASS is an effective and safe treatment modality for POAG, with fewer filtering bleb-related complications and quicker visual recovery in the early postoperative stage than trabeculectomy. The efficacy of lowering intraocular pressure was similar for both procedures.

Ahmed glaucoma valve implantation with and without subconjunctival bevacizumab in refractory glaucoma.

To evaluate the effects of subconjunctival bevacizumab injection on intraocular pressure (IOP), hypertensive phase, and failure and success rates of Ahmed Glaucoma Valve (AGV) implantation. A total of 63 eyes of 63 patients (30 cases in control and 33 cases in bevacizumab group) were included in this randomized masked prospective clinical trial. Pre- and postoperative BCVA, IOP, number of medications, complications and success rates were compared between AGV + bevacizumab and AGV alone group. Both groups showed statistically significant reductions in IOP in all their follow-up visits (P < 0.05). The mean IOP was lower in the AGV + Bevacizumab group than AGV group in all follow-up visits. However, the difference was only significant at the 3rd month (17.3 ± 6.2 vs. 20.7 ± 4.6, p = 0.04). The number of medications was not differed significantly between the two groups at their last visit (p value = 0.84) Complete success rate was higher in AGV + Bevacizumab. However, the difference was not significant (p = 0.73). The qualified and overall success rate, failure rate and the need for second tube were not statistically different between the two groups. The hypertensive phase was not statistically significant between the 2 groups (33.3% in AGV + Bevacizumab group and 50% in AGV group, p = 0.06) CONCLUSION: Adjunctive use of Bevacizumab during AGV implantation is beneficial in controlling hypertensive phase and IOP control and may lead to higher success rates and lower failure rates after AGV implantation. However, whether it's clearly beneficial or its exact role remains to be investigated.

Improving the Safety, Effectiveness, and Efficiency of Clinical Alarm Systems: Simulation-Based Usability Testing of Physiologic Monitors.

BackgroundClinical alarm system safety is a national patient safety goal in the United States. Physiologic monitors are associated with the highest number of device alarms and alarm-related deaths. However, research involving nurses’ use of physiologic monitors is rare. Hence, the identification of critical usability issues for monitors, especially those related to patient safety, is a nursing imperative.ObjectiveThis study examined nurses’ usability of physiologic monitors in intensive care units with respect to the effectiveness and efficiency of monitor use.MethodsIn total, 30 nurses from 4 adult intensive care units completed 40 tasks in a simulation environment. The tasks were common monitoring tasks that were crucial for appropriate monitoring and safe alarm management across four categories of competencies: admitting, transferring, and discharging patients using the monitors (7 tasks); managing measurements and monitor settings (23 tasks); performing electrocardiogram (ECG) analysis (7 tasks); and troubleshooting alarm conditions (3 tasks). The nurse-monitor interaction was video-recorded. The principal investigator and two expert intensive care units nurse educators identified, classified, and validated task success (effectiveness) and the time of task completion (efficiency).ResultsAmong the 40 tasks, only 2 (5%) were successfully completed by all the nurses. At least 1-27 (3%-90%) nurses abandoned or did not correctly perform 38 tasks. The task with the shortest completion time was “take monitor out of standby” (mean 0:02, SD 0:01 min:s), whereas the task “record a 25 mm/s ECG strip of any of the ECG leads” had the longest completion time (mean 1:14, SD 0:32 min:s). The total time to complete 37 navigation-related tasks ranged from a minimum of 3 min 57 s to a maximum of 32 min 42 s. Regression analysis showed that it took 6 s per click or step to successfully complete a task. To understand the nurses’ thought processes during monitor navigation, the authors analyzed the paths of the 2 tasks with the lowest successful completion rates, where only 13% (4/30) of the nurses correctly completed these 2 tasks. Although 30% (9/30) of the nurses accessed the correct screen first for task 1 and task 2, they could not find their way easily from there to successfully complete the 2 tasks.ConclusionsUsability testing of physiologic monitors revealed major ineffectiveness and inefficiencies in the current nurse-monitor interactions. The results indicate the potential for safety and productivity issues in completing routine tasks. Training on monitor use should include critical monitoring functions that are necessary for safe, effective, efficient, and appropriate monitoring to include knowledge of the shortest navigation path. It is imperative that vendors’ future monitor designs mimic clinicians’ thought processes for successful, safe, and efficient monitor navigation.

Hypertension Editors' Picks: Hyperaldosteronism.

Hypertension Editors' Picks: Hyperaldosteronism.

Outcomes of primary trabeculectomy with mitomycin-C for primary angle closure glaucoma among supervised trainees in a tertiary eye center in Manila.

To evaluate efficacy and safety of trabeculectomy with mitomycin C (trab-MMC) for primary angle closure glaucoma (PACG) performed by ophthalmology trainees. This was a six-year retrospective study of patients with primary trab-MMC with PACG performed by ophthalmology trainees in a tertiary urban eye center. Outcomes included intraocular pressure (IOP), number of medications, and complications. There were 120 PACG eyes that underwent trab-MMC performed by trainees. The mean follow-up duration was 28.6 ± 20.8 months. At 24 months, postoperative IOP decreased from 32.1 ± 12.0 mm Hg to 14.8 ± 6.9 mm Hg (p<0.0001) with decrease in glaucoma medications [0 (0), 0-2; p<0.0001]. Half of surgeries, 64/120 (53.8%) utilized MMC-onlay and the other half, 55/120(46.2%) received MMC sub-tenon injection. Half 60/120 (50.4%) utilized releasable sutures. Majority 55/120 (46.2%) utilized conjunctival closure near the corneal limbus while 34/120 (28.6%) used a conjunctival skirt. Cumulative complete surgical success rates were 63.3%, 55.83%, and 42.5% at 6, 12, and 24 months, respectively. Most complications were minor, including high IOP (25.0%), bleb leaks (13.3%), and cystic blebs (15.0%). Bleb needling was the most common (24.2%) post-op surgical intervention. Among supervised ophthalmology trainees in the Philippines, trab-MMC for PACG was effective in lowering IOP long term and decreasing glaucomamedications, and surgical success rates were generally comparable with trainee studies from first world nations. Complications were minor and not sight threatening.

The hospital admission profile of people presenting to specialist addiction services with problematic use of alcohol or opioids: A national retrospective cohort study in England.

BackgroundOver the past decade in England the rate of alcohol and opioid-related hospitalisation has increased alongside a simultaneous reduction in people accessing specialist addiction treatment. We aimed to determine the hospitalisation patterns of people presenting to addiction treatment with problematic use of alcohol or opioids, and estimate how individual sociodemographic characteristics and hospital admission diagnoses are associated with the rate of hospitalisation, death and successful completion of addiction treatment.MethodsA national record linkage between Hospital Episode Statistics (HES) and the National Drug Treatment Monitoring System (NDTMS) captured lifetime hospital admission profiles of people presenting to addiction services in England in 2018/19. Latent class analysis assigned individuals to clusters based on the ICD-10 diagnosis coded as primary reason for admission. Negative binomial, and multilevel logistic regression models determined if outcomes differed due to sociodemographic characteristics or assigned diagnostic clusters.FindingsInpatient data were available for 64,840 alcohol patients, and 107,296 opioid patients. The most common reasons for admission were alcohol withdrawal (n = 20,024 (5.3% of alcohol-cohort admissions)), and unspecified illness (n = 11,387 (2.1% of opioid-cohort admissions)). Seven diagnostic clusters were identified for each substance cohort. People with admissions predominantly relating to mental and behavioural disorders, and injuries or poisonings had significantly higher hospitalisation rates (adjusted IRR 7.06 (95%CI 6.72–7.42);p < 0.001), higher odds of death during addiction treatment (adjusted OR 2.71 (95%CI 2.29–3.20);p < 0.001) and lower odds of successful treatment completion (adjusted OR 0.72 (95%CI 0.68–0.76);p < 0.001).InterpretationThis is the first study to interrogate national hospitalisation patterns within people presenting to addiction services with problematic use of alcohol or opioids. Having identified high-risk, high-cost individuals with increased hospital usage, and increased odds of death, future work should focus on targeting appropriate interventions, to improve their health outcomes and prevent unnecessary hospital readmission.FundingThe work was funded by the Medical Research Council (MRC).

The characteristics of optic disc pit maculopathy and the efficacy of vitrectomy: a systematic review and meta-analysis.

To evaluate the basic characteristics of optic disc pit maculopathy (ODPM) and the efficacies of pars plana vitrectomy (PPV) treatment with different adjunctive strategies. The databases PubMed, EMBASE and Ovid up to April 2020 were searched to identify relevant studies. Statistical analyses were conducted with R software version 3.6.3. Fifty-nine studies were eventually included for different aspects of statistical analyses. The pooling results suggest the general incidence of maculopathy in optic disc pit (ODP) is 51%, and the rate of serous macular detachment and retinoschisis is 49% and 58%, respectively. The incidence of sub-retinal fluid (SRF) only is 10%, intra-retinal retinal (IRF) fluid only is 14%, and SRF plus IRF is 69%. A lamellar macular hole (LMH) is present in 53% of cases, and 58% have communication between the macula with the pit. The incidence of posterior vitreous detachment (PVD), vitreo-papillary traction and vitreomacular traction (VMT) is 7%, 28% and 13%, respectively. Besides, the rate of complete anatomic success and visual improvement after PPV are both around 85%. Subgroup analysis reveals the anatomic, and visual success rates of PPV alone are 89% and 100%, respectively. Gas tamponade, laser or internal limiting membrane peeling (ILMP) during vitrectomy are less promising, while PPV with ILM flap stuffing could achieve better outcomes than cases without it. Optic disc pit-associated maculopathy has different fundus characteristics. Based on the current evidence, PPV is effective for ODPM, and the combined application of gas tamponade, laser and ILMP should be used with caution.

Combined Phacoemulsification and 360-Degree Endocyclophotocoagulation with and without a Kahook Dual Blade in Patients with Primary Open-Angle Glaucoma.

PurposeThe present study aimed to compare the outcomes of combined phacoemulsification and 360-degree endocyclophotocoagulation with and without goniotomy using a Kahook Dual Blade in patients with glaucoma.Patients and MethodsWe enrolled 37 patients, 21 of whom underwent combined phacoemulsification with 360-degree endocyclophotocoagulation and goniotomy using a Kahook Dual Blade (tri-modal therapy (T-MT) group). The remaining 16 patients underwent phacoemulsification with endocyclophotocoagulation (bi-modal therapy (B-MT) group). Visual acuity, intraocular pressure, and number of glaucoma medications were recorded before the study and postoperatively on the first day, at week 1, and at 1, 3, 6, 9, and 12 months. Surgical success was defined as an IOP ≤12 mmHg and ≥6 mmHg or an at least 20% reduction in IOP from baseline with (qualified success) or without medications (complete success).ResultsForty-nine eyes were included. Baseline mean IOP was 16.96±3.66 mmHg and 15.64±4.88 mmHg in the T-MT and B-MT groups (p=0.122), respectively. At the 12-month follow-up, mean IOP values were 11.44±2.15 mmHg and 12.45±1.90 mmHg (p=0.031) in the T-MT and B-MT groups, respectively. Complete success rates were 37% in the T-MT group and 31% in the B-MT group, while qualified success rates were 74% and 50%, respectively. Glaucoma medications decreased from 2.0±1.4 to 0.8±1.0 (p<0.001) in the T-MT group and from 1.5±1.3 to 1.0±1.5 in the B-MT group (p=0.032). Similar improvements in visual acuity were observed in both groups. Complications were mild and resolved without intervention.ConclusionThe tri-modal treatment is safe and may be more effective in reducing IOP and glaucoma medication requirements than bi-modal treatment.

Combined small incision cataract surgery and trabeculectomy on intra ocular pressure outcome

Trabeculectomy is a gold standard filtration procedure in the management of glaucoma. However, small incision cataract surgery with trabeculectomy is the combined surgical procedure for the management of coexisting glaucoma and cataract. The final success rate related to minimizing intraocular pressure (IOP) depends on the follow-up duration and assessment criteria. This study was aimed to evaluate the long term control of intraocular pressure and morphology of bleb in cases undergoing small incision cataract surgery with trabeculectomy. One hundred cases diagnosed with moderate or severe glaucomatous damage with cataract above 32 years were recruited. Postoperative follow up was done from day 1 to 12 months, to evaluate the intraocular pressure (IOP), bleb morphology and postoperative complications. In PAOG, 61.3% cases had good control and 60% cases had poor control of postoperative IOP. In PACG, 32% cases had good control and 28% cases had poor postoperative IOP control. In the overall success, the qualified success rate was 63% and the complete success rate was 97%. Cases with early postoperative IOP of >10mmHg on 5th day or >13mmHg on 10th day is associated with poor control of intraocular IOP at the end of 12th month. Small incision cataract surgery with trabeculectomy is an effective procedure in reducing the intraocular pressure.

Retrospective analysis of the comparison between carbon dioxide laser-assisted deep sclerectomy combined with phacoemulsification and conventional trabeculectomy with phacoemulsification.

Purpose:To compare outcomes of laser assisted deep sclerectomy (LADS) and conventional trabeculectomy both combined with phacoemulsification.Methods:We divided 36 eyes into 2 groups, one group with LADS and the other Trabeculectomy. Patients were measured post operatively at 1, 3, 6, 9 months, 1, 2, 3 years for intraocular pressure (IOP), best corrected visual acuity (BCVA) and number of medications.Results:In the trabeculectomy group, after 3 year follow up, IOP was 14.67 ± 3.14, 15.27 ± 4.28 and 17.00 ± 7.79, BCVA improved to 0.17 ± 0.18, 0.24 ± 0.20 and 0.24 ± 0.27 and number of medications reduced to 0.6 ± 0.6, 1.1 ± 1.2, and 1.5 ± 1.5. Complete success rate after 3 years was 100%, 80.0% & 80.0% and Qualified success rate was 100%, 88.9% & 88.9%. In the LADS group, after 3 years follow up, IOP was 14.11 ± 3.91, 16.07 ± 5.51, 15.80 ± 6.07, BCVA improved to 0.13 ± 0.11, 0.10 ± 0.15, 0.11 ± 0.13 and medications reduced to 1 ± 1.1, 1.5 ± 1.0 and 1.8 ± 1.0. Complete success after 3 years was 85.7%, 57.1% & 57.1% whereas qualified success was 92.3%, 84.6% & 84.6%.Conclusion:Main limitations of our study were small sample size and lack of prospective comparison. However we were able to perfom the surgery comfortably due to the relatively shorter learning curve compared to conventional NPDS.

Relaxing retinotomies and retinectomies in case of proliferative diabetic vitreoretinopathies and tractional retinal detachment

IntroductionRadical anterior vitreous base dissection and lensectomy in combination with inferior 180° retinectomy will improve the anatomic success of complex proliferative diabetic vitreoretinopathies (PVR)-related retinal detachment. Our study aims to describe the anatomical and functional results of pars plana vitrectomy with retinotomies and relaxing retinectomies in patients with tractional retinal detachment in advanced PVR.Patients and methodsA case series study was conducted on 28 eyes of patients with tractional retinal detachment with severe PVR. Preoperative and postoperative complications and final visual outcomes were recorded. The follow-up period was 12 months.ResultsFull reattachment rate was reached intraoperatively in 26 (92.9%) eyes, with final complete reattachment success rate in 22 (78.5%) eyes at least 6 months of follow-up. A total of 17 (60.7%) eyes had their best-corrected visual acuity (BCVA) improved at 6 months postoperatively, and reaching a final BCVA of more than or equal to 2/60 at 6 months. The BCVA remained stable in six (21.4%) eyes and declined in five (17.9%) eyes. The complications postoperatively included secondary glaucoma (three eyes), retinal redetachment (four eyes), and hypotony (two eyes).ConclusionPars plana vitrectomy with relaxing retinotomies and retinectomies is an effective treatment method for complex PVR-related retinal detachment. Improved preoperative visual acuity, lower PVR extension, and silicone oil tamponade use during the early recovery period are essential factors for good anatomical and visual outcomes and a lower rate of complications.

Diagnostic yield and therapeutic outcome of hysteroscopy in women with infertility in a referral clinical setting: a Port Harcourt, Nigeria experience.

Introductionintrauterine pathologies were traditionally evaluated by blind dilatation and curettage along with hysterosalpingography. Hysteroscopy is a veritable tool for evaluation of uterine cavity pathologies with an increasing availability in Nigeria. The study aims to report the diagnostic yield and therapeutic outcome of hysteroscopy in women with infertility from a Nigerian metropolis.Methodsa retrospective cross-sectional study of consecutive cases of infertile women referred for hysteroscopy to an ambulatory care endoscopy facility in Port Harcourt, Nigeria. The variables collated included age, parity, past gynaecological history, indication, hysteroscopy findings and interventions. Statistical analysis was performed using SPSS version 25.Resultsincluded in study were 75 patients undergoing a total of 124 hysteroscopic procedures. The age range of patients was 25 to 56 years (mean 40.7 ± 5.9 years). A positive diagnostic yield of 93.3% with non-visualization of intracavitary uterine pathology in 5 patients was recorded. The most common pathologies were submucous myoma-25(31.3%), endometrial polyps- 18(22.5%) and intrauterine adhesions-18(22.5%). There was no statistical difference between the mean age of patients with or without polyp, myoma and intrauterine adhesions (P = 0.185, P = 0.510 and P = 0.619 respectively) but a non-linear relationship between age and polyp detection (Eta2 = 0.024). Operative hysteroscopies were all performed on out- patient basis but staged in 30(40.0%) patients.Conclusionbenign uterine growths and intrauterine adhesions are frequent causes of uterine factor infertility. A high successful completion rate of hysteroscopic interventions was achieved.

Cross-linked hyaluronic acid viscoelastic scleral implant in trabeculectomy.

Purpose:Patients with glaucoma undergoing trabeculectomy develop bleb cicatrix causing poor postoperative intraocular pressure (IOP) control and low success rates. Several approaches have been explored over the years for better outcomes. This study assesses the safety, efficacy, and outcome of trabeculectomy with HealaFlow® (Anteis S. A, Geneva, Switzerland), a high-molecular-weight cross-linked hyaluronic acid viscoelastic gel, and comparing it with the antimetabolite Mitomycin-C (MMC).Methods:A prospective, interventional, case-controlled study conducted at a tertiary care hospital in Southern India on 60 eyes of patients requiring trabeculectomy divided in two groups – HealaFlow scleral implant and adjuvant low-dose MMC (0.1 mg/mL). Postoperative IOP reduction along with bleb morphology was assessed over follow-up at 1 week, 1 month, 3 months, 6 months, and 12 months.Results:Preoperatively IOP in the two groups was statistically similar. Postoperative IOP on day 1 had statistically significant reduction in both groups with greater reduction in MMC group. However, by 12 months, the IOP reduction was statistically similar in both groups, i.e., 46.24% (to 11.04 ± 2.55 mmHg) and 54.47% (to 11.99 ± 3.37 mmHg) in HealaFlow® group and MMC group, respectively (P > 0.05). The bleb morphologies were similar and complications were seen equally, which resolved by 4 weeks. A complete success rate of 89.29% and a qualified success rate of 10.71% were observed equally in both groups.Conclusion:Absorbable biosynthetic cross-linked hyaluronic acid and low-dose MMC are equally safe and efficacious in trabeculectomy with significant IOP reduction and good bleb morphology. Therefore, it is a novel substitute for MMC.

Transvenous extraction of permanent pacemaker and defibrillator leads: Reduced procedural complexity and higher procedural success rates in patients with infective versus noninfective indications.

Transvenous lead extraction (TLE) is critical in the long-term management of patients with cardiac implanted electronic devices (CIEDs). The aim of the study is to evaluate the outcomes of TLE and to investigate the impact of infection. Data of patients undergoing extraction of permanent pacemaker and defibrillator leads during October 2014-September 2019 were prospectively analyzed. Overall, 242 consecutive patients (aged 71.0 ± 14.0 years, 31.4% female), underwent an equal number of TLE operations for the removal of 516 leads. Infection was the commonest indication (n = 201, 83.1%). Mean implant-to-extraction duration was 7.6 ± 5.4 years. Complete procedural success was recorded in 96.1%, and clinical procedural success was achieved in 97.1% of attempted lead extractions. Major complications occurred in two (0.8%) and minor complications in seven (2.9%) patients. Leads were removed exclusively by using locking stylets in 65.7% of the cases. In the subgroup of noninfective patients, advanced extraction tools were more frequently required compared to patients with CIED infections, to extract leads (success only with locking stylet: 55.8% vs. 67.8%, p = .032). In addition, patients without infection demonstrated lower complete procedural success rates (90.7% vs. 97.2%, p = .004), higher major complication rates (2.4% vs. 0.5%, p = .31) and longer procedural times (136 ± 13 vs. 111 ± 15 min, p = .001). Our data demonstrate high procedural efficacy and safety and indicate that in patients with noninfective indications, the procedure is more demanding, thus supporting the hypothesis that leads infection dissolves and/or prohibits the formation of fibrotic adherences.