Irrigation Aspiration Research Articles

Outcomes and Complications of Tibiotalocalcaneal Arthrodesis

Category: Ankle Arthritis; Hindfoot Introduction/Purpose: Tibio-talo-calcaneal (TTC) arthrodesis is usually a salvage procedure to address several hindfoot and ankle conditions. Non-union rate after TTC fusion is variably reported 3.4% - 48%. The aims of this study were to describe the outcomes and complications of this procedure and to determine potential risk factors associated with non-union. Methods: In this IRB-approved retrospective cohort study, we used the following codes (28705,28725 and 27870) to search the medical records for all patients who underwent TTC fusion between 2006-2022. All relevant demographic data, surgical indications, surgery details (type of the graft, type of the implant, and surgical approach, associated procedures), post-operative course (complications and union rate) and follow-up duration were extracted. Descriptive statistics were performed, and continuous variables were described using median (interquartile range) and categorical variables were described using frequency (%) and mean (standard deviation, SD). Patients and surgery characteristics were compared between united and non-united cases using Wilcoxon Rank Sum Tests for continuous variables and Chi-squared or exact tests, as appropriate, for categorical variables. Analyses were performed using SAS statistical software version 9.4 (SAS Institute Inc., Cary, NC). Results: Fifty-one patients (53 feet) were included in the study. Long hindfoot fusion nails were used in 51 cases.Ten cases were routinely dynamized 8-10 weeks after surgery. In 24 (45.3%) patients, morselized allograft was combined with infuseTM and reamer irrigation aspiration autograft (RIA). In 20 (37.7%) patients, morselized allograft was combined with infuseTM only. There were 6 non-union cases (11.3%). When comparing patients and surgery characteristics between non-union versus union group, smoking (P = 0.0150) and routine dynamization (P= 0.0297) were higher in the non-union group. No difference in union rates between different types of graft. Frequency of other complications is listed in (Figure 1). Follow up duration was 27.2 months (range 4-108 months). Conclusion: TTC fusion achieves good union rate (88.68%), however it carries a relatively high risk of complications. Routine dynamization of the TTC nail at 8-10 weeks could be a risk factor for non-union. Smoking was also associated with a high non- union rate.

Effect of Modified Peristaltic Phacoemulsification Device on Efficiency and Post-Occlusion Pressure Surge.

To evaluate efficiency of grooving, nuclear fragment removal, and changes in pressure control in the Oertli Faros using traditional peristaltic and Speed and Precision (SPEEP) features. The SPEEP mode uses novel peristaltic technology permitting independent control of flow and vacuum. A porcine lens model was used with an enclosed chamber simulating the anterior segment. Grooving efficiency is evaluated with flow rates of 10, 30, and 50 mL/min using whole lenses. Lens cubes were emulsified at 20, 40, 60, 80, and 100% power with both SPEEP and non-SPEEP modes. Surge was evaluated with pressure gauges placed on the irrigation tubing and aspiration tubing. Pressure readings were recorded per the following: fluid and vacuum were initiated for 15 seconds, vacuum tubing was occluded for 5 seconds, tubing patency was then re-introduced for 15 seconds. Differences between sensors were recorded. No significant increase in efficiency was seen with increasing flow rate from 30 to 50 mL/min using SPEEP. No significant differences were shown in lens fragment removal in SPEEP and non-SPEEP modes at any power tested. Pressure difference measurements were not significantly different with SPEEP and non-SPEEP modes. We showed that lower flow rates show comparable efficiency of grooving when using the SPEEP mode. The SPEEP function did not show increased efficiency in nuclear fragment removal when compared to traditional mode. Surge control was also comparable with both SPEEP and non-SPEEP modes. We suggest that the SPEEP function included in the Oertli Faros may have some advantages.

CORNEAL EDEMA AFTER CATARACT SURGERY - CHANGES IN CORNEAL ENDOTHELIUM CELL CHARACTERISTICS


 Corneal edema is a common complication of cataract surgery, although tremendous improvements have been made in the surgical techniques, which decreased surgical eye trauma and complication rates. Normal endothelial cell density is 2000-3000 cells/mm2 in older individuals, which maintains the corneal clarity. Even ‘perfect’ cataract surgery does some damage to the endothelium. A significant postoperative endothelium density decrease can impair its ability to maintain corneal clarity, resulting in corneal edema, blurring of vision and ocular pain. Aggressive topical treatment in the first month after surgery may lead to recovery of the endothelial cells. Our aim was to establish the effects of cataract surgery on the characteristics of the corneal endothelium. We performed a prospective interventional clinical study of 30 patients, mean age 65±12 years, with senile cataract. Over 80% were hard cataracts: 18% hypermature, 66% grade 4 (brunescent) and 16% grade 3 cataracts. Uneventful phacoemulsification with IOL implantation was performed by one experienced phaco-surgeon in an outpatient setting. Preoperative parameters included: best-corrected visual acuity (BCVA) in Snellen decimal units, IOP, cataract density (slit lamp examination), corneal endothelium cell density (ECD) and hexagonality measured with a specular microscope. Intraoperative parameters included: phacoemulsification time and energy, irrigation–aspiration suction time. Standard phacoemulsification cataract surgery was performed with in-the-bag IOL implantation. Mean baseline parameters were: BCVA=0.1±0.13, IOP=15.7±2.7 mmHg, ECD=2,497±290 cells/mm2, cell hexagonality was 54.3±9.4%. Mean surgical parameters were: surgical time=9,3±2.9 minutes, phacoemulsification time=35.6±26.1 seconds, phacoemulsification energy=13.3±10.9J, irrigation–aspiration suction time=81.3±45.9 seconds. Acute postoperative corneal edema occurred in 4 eyes (13.3%). After one-week BCVA was 0.5±0.2. 9 eyes (30%) had visual acuity ≤0.5. They were treated aggressively with antibiotics (moxifloxacine), corticosteroid (dexamethasone) and hypertonic eye drops (sodium chloride (5%) and mannitol (20%)), every hour during the first week and gradually tapered in the 1 month. Antiglaucomatose eyedrops (timolol, brinzolamide) were used to control the IOP below 20 mmHg. After 1 month mean BCVA increased to 0.85±0.15 and all eyes reached BCVA higher than 0.6. IOP was stable at 15.4±2.0 mmHg. The mean endothelial cell loss was 19,1%. None of the eyes progressed to chronic edema. Corneal edema is a common complication after surgery of difficult cataracts. Even though the cataract density directly influences the postoperative condition of the corneal endothelium, surgical trauma is still considered the most common cause of corneal endothelial decompensation. Preoperative specular microscopy is very important to predict possible postoperative complications of the corneal endothelium and apply appropriate surgical techniques and materials. Modern phaco-techniques (low phaco-energy, small incision site, new irrigation solutions and OVDs) can significantly reduce endothelial cell loss after cataract surgery. It is recommended to treat postoperative corneal edema and inflammation with topical corticosteroids, topical hypertonic agents and to maintain intraocular pressure below 20 mmHg.

Real-time corneal thickness changes during phacoemulsification cataract surgery.

To observe the changes in corneal thickness during phacoemulsification cataract surgery and to analyze the influencing factors. One hundred two patients (102 eyes) with cataracts undergoing phacoemulsification cataract surgery at Shandong Eye Hospital between July and October 2021 were included. Intraoperative OCT was applied to capture real-time images preoperatively, before and after ultrasonic emulsification, at the end of irrigation aspiration and the end of surgery. Then, the corneal thickness at the above time points was measured using Photoshop software. The corneal thickness of 102 cataract patients was 511.79 ± 31.46μm before operation and 512.71 ± 31.51μm at the beginning of phacoemulsification, which increased by 0.91 ± 1.48μm (0.2%). At the end of ultrasonic emulsification, the corneal thickness was 521.58 ± 32.75μm and 8.87 ± 8.71μm (1.7%) thicker than that before the procedure. After irrigation aspiration, the corneal thickness reached 528.09 ± 33.87μm, which increased by 6.52 ± 6.38μm (1.3%) compared with that of the previous step. At the end of the operation, the corneal thickness was 539.19 ± 33.88μm, 11.09 ± 10.92μm, and 27.37 ± 13.64μm thicker than that of the previous step and the preoperative thickness, respectively, with an overall increase of 5.3%. The differences were statistically significant at all time points (all P < 0.001). Correlation analysis showed that postoperative corneal thickness changes were correlated with age, cataract lens nuclear grade, actual phacoemulsification time (APT), effective phacoemulsification time (EPT), average phacoemulsification energy (APE), total surgery time (TST), cell density (CD), maximum cell area (MAX), and cell area standard deviation (SD) (all P < 0.05), while the changes in thickness were not correlated with gender, cell area coefficient of variation (CV), percentage of hexagonal cells (6A), average cell area (AVE), or minimum cell area (MIN) (all P > 0.05). During phacoemulsification cataract surgery, corneal thickness gradually increases in real time with the increase of perfusion pressure and intraocular manipulation time. The real-time magnitude of intraoperative corneal thickness change is closely related to lens nucleus hardness, corneal endothelial cell density, ultrasound energy, and time for emulsification.

Masquelet's induced membrane technique associated with Reamer Irrigation Aspiration grafting and intramedullary Nailing (MaRIAN) for chronic diaphyseal osteomyelitis of the lower limb

IntroductionMasquelet's induced membrane technique offers a definitive contribution to the treatment of diaphyseal osteomyelitis. To overcome its drawbacks while maintaining its principles, technical modifications have been proposed: antibiotic cement, femoral intramedullary autograft harvested by RIA (Reamer Irrigation Aspiration) and interlocking nails. Material and methodThis retrospective study gathered patients with chronic osteomyelitis of the femur or tibia. The first surgical stage consisted of bone resection in the healthy zone and use of a gentamicin cement spacer to fill the bone defect. The second stage consisted of the placement of a statically locked intramedullary nail associated with a bone autograft using the RIA technique. ResultsAmong this group of 12 men with diaphyseal osteomyelitis; 9 tibial and 2 femoral, and 1 knee nonunion, the mean bone defect was 7.3cm (±6.7). The mean time between the 2 stages was 2.7months (±3) with a mean antibiotic period of 3.25weeks (±3). There was a femoral diaphyseal fracture at the donor site, and a wrong trajectory intraoperatively during the RIA. Two patients with tibial nonunion presented with nail rupture without septic recurrence. A septic recurrence was healed by removal of the nail. At a minimum follow-up of 18months, with an average of 5years, consolidation was complete without infectious recurrence. Despite the statistical weakness related to the size of the cohort, the resumption of early weight bearing (OR=−7.68 95% CI [−13.33 to −2.08] (p=0.01)) and nail dynamization seemed to have an impact on the formation of complete consolidation (OR=−0.86 95% CI [−1.39 to −0.33] (p=0.007)). Discussion and conclusionThis short series, compared to the literature, demonstrated that the proposed technical modifications improved the overall management of this rare and challenging condition while maintaining the reliability of the original technique. Dynamization was also seen to be of particular interest. Level of evidenceIV, retrospective study.

ISCHEMIC PRIAPISM: A STARTLING THROMBOEMBOLIC COMPLICATION OF COVID-19

TYPE: Case Report TOPIC: Chest Infections INTRODUCTION: The coronavirus disease-2019 (COVID-19) is known to cause severe systemic inflammation leading to thrombotic complications. Deep vein venous thrombosis, pulmonary embolism and stroke are some of the most commonly reported. However, ischemic priapism has been rarely documented as a thromboembolic consequence. CASE PRESENTATION: A 39-year-old man with a history of hypertension and type 2 diabetes mellitus presented with a painful irreducible erection of six-hour duration. Physical exam revealed tachycardia and a tender, rigid penile shaft, with an engorged glans and corpus spongiosum. He denied prior episodes or penile trauma. Laboratory-work revealed an elevated D-Dimer and inflammatory markers, as well as a positive COVID PCR test. Further investigations showed no previous hematological diseases or medications with an elevated thromboembolic risk. He received epinephrine irrigation and cavernosal blood aspiration which resolved the priapism. Nonetheless, the erection recurred a few hours later and a heparin infusion was started. Despite being on heparin for 24 hours, the erection persisted, requiring surgical intervention via a corpora cavernosa - penis glans fistula. The erection resolved and he was discharged home. DISCUSSION: Priapism is a prolonged penile erection of more than four hours without sexual stimulation. Interestingly, COVID-19 induces thrombosis by the hypercoagulability, hyperviscosity, and endothelial dysfunction after the massive inflammatory response and free radical damage. Ischemic priapism is a medical emergency that prompts treatment with a-agonists and corporal blood aspiration if needed. Detumescence can be achieved surgically if the initial measures fail. CONCLUSIONS: This case highlights a rare complication of COVID-19. Early recognition and medical treatment can prevent irreversible complications. DISCLOSURE: Nothing to declare. KEYWORD: COVID-19 Ischemic Priapism

“Egg in the eye appearance” of traumatic pre-existing posterior capsular defect presenting as near-total cataract

A 10-year-old girl was brought by her parents with complaints of a sudden drop in vision in the left eye (LE) with the appearance of a white reflex for a 1-month duration. There was a history of needle stick injury to the LE 5 years ago which was conservatively managed elsewhere. Previously, she had a vision of 6/9, N6 LE, with glasses as per her old records. The best corrected visual acuity (BCVA) was 6/6, N6 right eye (RE), hand motion (HM), and <N36 LE at the time of presentation. There was a small corneal scar at the 3 o'clock position in the peripheral cornea of the LE. Dilated examination of LE revealed near-total cataract, an intact anterior lens capsule, and a large elliptical area of pre-existing posterior capsular defect (PPCD) resembling an “egg in the eye appearance” [Figure 1]. Ultrasonography (USG) B scan of the LE showed the characteristic “fishtail sign” and confirmed the herniation of the lens matter through posterior capsular dehiscence into the anterior vitreous cavity [Figures 2 and 3] with an intact retina.Figure 1: Intra-operative picture of the LE taken after nicking the anterior capsule showing the fibrosed edges of the large elliptical posterior capsular dehiscenceFigure 2: Ultrasound B scan of the LE showing conical protrusion of the breached posterior lens capsuleFigure 3: Ultrasound B scan of the LE showing “fishtail sign” with herniation of the lens matter into the anterior vitreous cavity through the posterior capsular dehiscenceThe patient underwent a careful continuous curvilinear capsulorhexis (CCC), bimanual irrigation–aspiration of the lens matter, and anterior vitrectomy with reduced parameters of low bottle height, low irrigation, and aspiration, taking care to avoid hydro-dissection and shallowing of the anterior chamber. Intra-operatively, the large posterior capsular dehiscence [Figure 4] was carefully evaluated and cleared off any vitreous incarceration. A foldable three-piece intraocular lens (IOL) was implanted in the ciliary sulcus [Figure 5]. Post-operatively, the patient did well and regained 6/6, N6 vision in the LE, and remained the same until the last follow-up after 1 year [Figure 6].Figure 4: Intra-operative picture of the LE showing the large elliptical posterior capsular defect after lens aspirationFigure 5: Intra-operative picture after intraocular lens implantation into the LEFigure 6: Clear visual axis on follow-up after 1 yearDISCUSSION The history of past needle stick injury in our patient with sudden transformation into near mature cataract later points toward the presence of a PPCD which gradually caused microleakage and rapid maturation of the cataract. A dilated examination using a slit lamp and under an operating microscope helped to identify the thick, well-demarcated, elliptical borders of the PPCD, through the near-total cataract simulating an “egg in the eye” appearance. The thickened and fibrosed margins of the PPCD have been attributed to the migration of the hyperplastic epithelial cells to this region.[1] USG B scan confirmed the PPCD with lenticular matter hanging in the vitreous cavity (fishtail sign).[2] Other clinical signs which have been described in the literature include white demarcation lines and white crystalline particles floating in the vitreous, but they may not be evident in all white cataracts with PPCDs.[2] A relatively smaller CCC, closed-chamber bimanual irrigation–aspiration with reduced parameters (low bottle height, irrigation, and aspiration), avoiding hydro-dissection and shallowing of AC, controlled anterior vitrectomy, and switching between the cut and aspiration modes to remove the prolapsed lens matter and vitreous are essential to ensure a clear visual axis and safe IOL implantation.[2] CLINICAL SIGNIFICANCE All total cataracts are not the same, and surgery without a thorough history, careful examination, and proper planning could be catastrophic to the patient. Surgical management in pediatric cataracts with PPCD remains a challenge due to the increased risk of lens matter drop in the vitreous cavity. Identifying the PPCD, explaining the potential risks to the patient, and taking adequate precautions to avoid lens matter drop are vital steps to a successful outcome. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient and her parents have given their consent for images and other clinical information to be reported in the journal. The patient and her parents understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Acknowledgements The patient and her parents are acknowledged.

Evaluation of flow field in the anterior segment during irrigation and aspiration in cataract surgery with three-dimensional computational simulation

IntroductionTo quantitatively analyze the flow field and fluid pressure contour in the anterior segment during the irrigation and aspiration (I/A) procedure by means of computational fluid dynamics (CFD) simulation. MethodsFour different models were established combining the irrigation sleeve, aspiration cannula, anterior chamber, and capsule to simulate various scenarios during the coaxial I/A procedure. Commercial CFX software was applied to perform the steady-state simulation with the k-ε turbulence model. The inlet boundary condition was a balanced salt solution with a 100 cm height of pressure, and the mass flow rate boundary condition set at 40 cc/min was applied at the outlet. ResultsThe four models included the I/A tip located in the middle of the pupillary plane, the capsule equator, and the middle of the posterior capsule. The inlet/outlet pressure at the tip of the I/A cannula was almost the same in the four models. Following ejection into the anterior chamber and capsule bag, the streamline speed rapidly decreased. The pressure in the anterior chamber and capsule bag was approximately 60–70 mmHg. The area on the cornea and capsule closer to the initial streamline of the inlet irrigation possessed larger pressure. The differential pressure on the cornea and capsule was greater when the irrigation orifice directly facing the wall. ConclusionThe pressure varies at different positions in the anterior segment during the I/A procedure. The study suggests that specific precautions are required when the tip moves closer to the wall and the irrigation orifice is directed toward the opposite wall.

Removing residual cortical material during cataract surgery: Visco polishing and the grindstone effect as a new surgical technique.

To describe a new technique for removing residual cortical material adjacent to posterior lens capsule during cataract surgery with the help of cohesive ophthalmic viscosurgical devices. In this technique, if there are still cortical remnants and lens epithelial cells left after the routine irrigation-aspiration and polishing at the final steps of cataract surgery, the capsule is filled to about one-third with a highly viscous cohesive ophthalmic viscosurgical device. Rinsing is performed from the anterior chamber with the water jet directed tangentially to the ophthalmic viscosurgical device bolus and towards the posterior capsule, which creates a turbulence creating a "grindstone effect". The ophthalmic viscosurgical device bolus transforms into a ball and starts to rotate very quickly within the capsule, grinding away the cortical remnants. In the first series of 62 cases, there were no intra-operative or post-operative complications. At day 1 there was no corneal oedema and no hypertension of intraocular pressure. Visual outcomes were good with a mean best corrected distance visual acuity of -0.01 ± 0.11 logMAR. This technique appears to be effective and fast in removing persistent cortical remnants from the surface of the posterior capsule, while minimising risks such as capsule aspiration during irrigation/aspiration. There is limited pressure and mechanical force applied on the capsule; the anterior chamber and the corneal endothelium remain safe since the ophthalmic viscosurgical device stays inside the capsular bag to its high cohesiveness and molecular weight. More data on a larger cohort of patients is planned to confirm these results and evaluate long-term effects on posterior capsule opacification.

KARAKTERISTIK DAN PENANGANAN PENDERITA SINDROM RUBELA KONGENITAL DI PUSAT MATA NASIONAL RUMAH SAKIT MATA CICENDO

Introduction : Congenital rubella syndrome is a collection of symptoms caused by rubella virus infection during pregnancy. Congenital rubella syndrome often associated with ocular and systemic disease that are important for early diagnosis and management to prevent visual deprivation. Purpose : To determine the characteristic, clinical manifestation and management associated with congenital rubella syndrome in Cicendo Eye Hospital National Eye Center during January 2017 – December 2020. Methods :This was retrospective observational study and conducted from January 2017 – December 2020. The medical records of patients diagnosed with laboratory confirmed congenital rubella syndrome were included. We studied the demographic profile, associated ocular and systemic manifestation, and the management. Results : The study included 137 eyes of 84 patients with congenital rubella syndrome. Median duration of postoperative follow up was 9 months. Most patients were below 6 months of age and most patients were presented with bilateral manifestation. Ocular manifestations were congenital cataract, congenital glaucoma and pigmentary retinopathy. Non ocular manifestations were congenital heart disease, hearing impairment, microcephaly and developmental delay. Irrigation aspiration with primary posterior capsulotomy and anterior vitrectomy without intraocular lens implantation was the most frequent technique. Visual axisopacity was complication that were found after surgery. Conclusions :There were various ocular and systemic manifestation of congenital rubella syndrome. Surgical management were performed in all cases with irrigation aspiration with primary posterior capsulotomy and anterior vitrectomy was the most frequent technique. Keywords : Congenital rubella syndrome, ocular and non ocular manifestation, cataract and glaucoma surgery

Preserving posterior capsular integrity in post-endothelial keratoplasty posterior capsular opacification.

Endothelial keratoplasty (EK) with pseudophakia often presents with late-onset proliferative after-cataract with posterior capsule distension. We performed a modified technique of capsular bag lavage in 11 eyes with late-onset PCO after EK (4 cases: post-DSAEK, 7 cases: post-DMEK). Anterior capsular rim was separated from the underlying IOL optic using MVR blade. Circumferential relaxing radial nicks were made on the capsular rim to create space for the passage of irrigation-aspiration (IA) probes behind the IOL. Bimanual IA of the flocculent cortical material was performed without damaging the posterior capsule. Air was injected at end of surgery to ensure graft apposition. All cases gained 1-3 lines of Snellen’s acuity and no case developed graft failure, rejection, or endothelial decompensation. An intact posterior capsule is associated with better outcomes post a repeat graft, if required. Our technique helps avoid complications related to a disturbed anterior hyaloid phase and minimizes postoperative inflammation.

Quantitative Assessment of Rectal Washout With Irrigation and Aspiration

Abstract Local recurrence of rectal cancer is defined as any evidence of relapse within the small pelvis after surgical resection of the primary tumor. After removal of a rectal tumor, necrotic cellular debris and viable exfoliated cancer cells are present in the rectal lumen; using saline or povidone-iodine solution, many surgeons perform rectal washout beyond an occlusive clamp to remove these exfoliated malignant cells, which may lead to local recurrence. A meta-analysis showed that intraoperative rectal washout at the surgical anastomosis site can reduce the risk of local recurrence after rectal cancer resection. Therefore, intraluminal lavage is useful to prevent local recurrence. Although intraoperative rectal washing is considered to be important, there is probably room for improvement on this method. We described the idea of a new transanal irrigation and aspiration system for small rectal contents. The aim of this research was to investigate the effect of a new rectal washout system using a chemiluminescent imaging system. We attempted to evaluate and compare the washout efficiency between this new system and the conventional irrigation system using a cylindrical rectum model. Our results implied that, at the same volume of solution, the irrigation–aspiration rectal washout system was more effective than the irrigation washout system. This new rectal washout system was easy to use and allowed a good washout. To the best of our knowledge, this was the first report that evaluated the efficacy of a rectal washout system using quantitative data.

Clinical Investigation into Posterior Capsule Rupture in Phacoemulsification Operations Performed by Surgery Trainees.

This retrospective cohort study investigated the occurrence rate, correlative factors, and prognosis of posterior capsule rupture (PCR) in phacoemulsification operations conducted by surgery trainees. This study assessed the first 200 phacoemulsification surgeries performed by six surgery trainees between August 2016 and December 2018. Cases were divided into two groups depending on whether they fell within the first 100 surgeries performed by a trainee (first 100 cases group) or the last 100 surgeries (last 100 cases group). The following clinical data were analyzed: the occurrence rate of PCR, whether this complication arose in the phaco or irrigation/aspiration (IA) phase, the occurrence of vitreous loss, retinal detachment, and dropped nucleus, the site of intraocular lens (IOL) implantation, and postoperative visual acuity. Thirty-nine of the 1200 cases (3.25%) experienced PCR. The occurrence rates of PCR and vitreous loss were higher in the first 100 cases group than in the last 100 cases group (P=0.015 and P=0.017). PCR occurred more frequently in the phaco phase in the first 100 cases group and in the IA phase in the last 100 cases group (P=0.012). There was no difference between the two groups in terms of site of IOL implantation, the occurrence of retinal detachment or dropped nucleus, and postoperative visual acuity. With a supervising surgeon and the selection of suitable cases, the occurrence rate of PCR in phacoemulsification operations performed by surgery trainees could be controlled to the desired level. The phase in which PCR most frequently occurred and the likelihood of vitreous loss differed depending on the level of surgical experience of the trainees. It is a lengthy process for surgery trainees to reach the stage at which they can manage PCR and complex cataract surgery independently.

A Simple, Novel Approach to Capsulorhexis Formation in the Setting of A Mature Cataract and Miotic Pupil.

PurposeTo report a simple, effective technique for surgeons creating a capsulorhexis in patients with pupillary miosis and a dense, mature cataract.MethodsA single center, two-year retrospective chart review examined 1408 phacoemulsification cataract surgeries. The criteria for inclusion involved a dense, mature cataract and a pupil that was unresponsive to pharmacologic dilation preoperatively. A standardized technique was used for all cases consisting of a 1mm corneal paracentesis and 2.4mm temporal clear corneal incision. Synecholysis was performed if present, followed by the insertion of a 6.25mm malyugin ring under cohesive viscoelastic. The cohesive viscoelastic was removed via the irrigation aspiration tip. The paracentesis was sealed with a small amount of viscoelastic and an air bubble was placed in the anterior chamber. The anterior capsule was then painted with trypan blue. The air bubble and trypan blue were then replaced by a dispersive viscoelastic. Curvolinear capsulorrhexis was performed followed by standard phacoemulsion.ResultsNine patients ranging from 76 ± 12 years (mean ± standard deviation) met the criteria with a 4+ NS (n=5), white mature (n=3), or deep brunescent (n=1) cataract and 3mm pupil preoperatively. Pupillary miosis was caused by posterior synechia in 44.5% of the cases followed by pharmacologic interactions from tamsulosin and donepezil in 22.25% of cases respectively. One case involved idiopathic miosis likely from aging. Capsulorhexis formation was successful in all cases with no capsular tear, vitreous loss, or conversion to extracapsular cataract extraction (ECCE). However, one case had cortex retention requiring a second procedure for removal.ConclusionDense, mature cataracts and small pupils both compromise the view for the surgeon and may be significant risk factors for training ophthalmologists. Thus, good visualization of the anterior capsule and peripheral nucleus with our simple technique facilitates a reliable capsulorhexis, potentially limiting the risk of complications for ophthalmic surgeons.

The Masquelet technique in the treatment of a non-infected open complex fracture of the distal tibia with severe bone and soft tissue loss: A case report

The treatment of open distal tibia fractures remains challenging, particularly when the fracture involves severe soft tissue damage and segmental bone loss.We present the case of a 33-year-old woman who sustained an open distal tibia fracture type 43-A3.3, with segmental bone loss, and a closed bifocal fibular fracture.The fractures were initially fixed with a temporary external fixator. The open distal tibial fracture underwent an intramedullary nailing on day six post-trauma, while the segmental bone loss was refilled with a temporary cement spacer, in order to create a biologic chamber, according to the technique by Masquelet et al.At three months post-trauma, the temporary cement spacer was removed and the bone loss was filled with an autologous bone graft obtained with the Reaming Irrigation Aspiration (RIA) system. The fracture successfully healed at 13 months post-trauma.Masquelet technique, in association with the RIA system, represents a valid strategy in the treatment of non-infected open complex fracture of the distal tibia with severe bone and soft tissue loss.

Surgical efficiency in femtosecond laser cataract surgery compared with phacoemulsification cataract surgery: a case–control study

ObjectivesTo investigate differences in surgical time, the distance the surgical instrument travelled and number of movements required to complete manual phacoemulsification cataract surgery versus femtosecond laser cataract surgery.DesignNon-randomised comparative case...

Influence of an intentionally induced posterior lens capsule rupture on the real-time intraocular pressure during phacoemulsification in canine ex vivo eyes.

To evaluate the changes in the intraocular pressure (IOP) following an intentionally induced posterior lens capsule rupture (PLCR) during phacoemulsification in enucleated canine eyes. Furthermore, to compare the IOPs between different stages of phacoemulsification for two different bottle heights (BH). Coaxial phacoemulsification was performed using a venturi-based machine at a 60 or 90 cm BH. A pressure transducer, inserted into the anterior chamber through the peripheral cornea, monitored real-time IOP. For one half of the lens, the sculpt-segment removal (SS) was followed by irrigation/aspiration (IA). The PLCR was intentionally created, and the SS and IA were repeated on the residual lens fragments. For the 60 cm BH, the mean IOP following the PLCR was significantly higher than before the PLCR during SS (28.30 ± 12.56 and 38.71 ± 9.43 mmHg before and after PLCR, respectively) and IA (42.76 ± 12.46 and 47.88 ± 7.10 mmHg before and after PLCR, respectively) stages (P < 0.001). For the 90 cm BH, the mean IOP following the PLCR was also significantly higher than before the PLCR during SS (33.39 ± 11.09 and 58.17 ± 6.89 mmHg before and after PLCR, respectively) and IA (62.39 ± 12.46 and 72.04 ± 8.59 mmHg before and after PLCR, respectively) stages (P < 0.001). The occurrence of a PLCR led to an increase in IOP during both the SS and IA stages. The elevated IOP after the PLCR might be one of the most important factors for ocular tissue damage, as it reduces ocular perfusion. Additionally, the BH should be reduced following PLCR to prevent complications stemming from the raised IOP.

The comparative effectiveness and safety of three activated irrigation techniques in the isthmus area using a transparent tooth model.

To compare the effectiveness and safety of three activated irrigation techniques when removing pulp tissue from the isthmus of a transparent tooth model. The three techniques assessed were: the EndoVac (EV), passive ultrasonic irrigation (PUI) and ultrasonic wave aspiration (TUWA). Conventional syringe irrigation (CSI) was used as a control. A transparent tooth model was created using the mesial root of an extracted mandibular first molar that had an isthmus and two independent mesial canals. An artificial 0.3-mL cylindrical chamber was created below the apical foramen. The tooth was then cleared. After preparation, the root canals were filled with fuchsine-stained bovine pulp tissue. The irrigation protocols were compared in respect of their effectiveness at removing pulp tissue from the isthmus and their safety with regard to irrigant extrusion. For all four groups, 5.25% sodium hypochlorite solution was used as the irrigant. Photographs were taken and analysed using an imaging software. A Kruskal-Wallis test was used to detect the differences between groups (statistical significance was set at P<0.05). No group was associated with extrusion of irrigant beyond the apex. Significant differences were observed between the groups: TUWA was the most effective technique at removing pulp tissue from the isthmus (3.39mm2 ; standard deviation (SD)=0.67; range=1.25-3.69), followed by PUI (2.16mm2; SD=0.38; range=1.37-2.96), EV (0.73mm2 ; SD=0.14; range=0.49-0.98) and CSI (0.27mm2 ; SD=0.01; range=0.26-0.28). Ultrasonic wave aspiration was the most effective technique at removing artificial pulp tissue from the isthmus of a transparent tooth model. None of the techniques extruded irrigant.

Evaluation of intraocular inflammation after intracameral injection of triamcinolone acetonide during pediatric cataract surgery

Purpose The aim of this study was to evaluate the efficacy and safety of intracameral triamcinolone acetonide (TA) to control inflammation in pediatric cataract eyes undergoing cataract extraction. Patients and methods This prospective clinical study included 60 eyes of 47 patients who underwent elective cataract extraction with irrigation–aspiration under general anesthesia and were randomized to three groups. Eyes in group A were injected with 0.1 ml of 2 mg TA into the anterior chamber. Eyes in group B were injected with 0.05 ml of 1 mg TA into the anterior chamber, and eyes in group C were not administered TA. Postoperatively, in group C, topical prednisolone acetate 1% eye drops were administered six times per day for 7 days, followed by four times per day for 3 weeks, to control postoperative inflammation. In groups A and B, topical corticosteroids were not used. To evaluate the efficacy of intracameral TA, anterior chamber cells were measured on postoperative days 1, 7, and 30 using slit-lamp biomicroscopy. Results Both treatments were equally effective in controlling postoperative inflammation following irrigation–aspiration in congenital cataract. No statistically significant differences between groups were observed. Conclusion This study concluded that the use of TA as an intracameral injection during pediatric cataract surgery reduces aqueous cells, the main clinical findings in postsurgical inflammation.

ASSESSMENT OF EFFICACY OF THE METHOD OF PROGRAMMED IRRIGATION ASPIRATION SANATION IN COMPLEX TREATMENT OF PATIENTS WITH CHRONIC POSTTRAUMATIC OSTEOMYELITIS OF THE LONG BONES

The analysis of treatment results of 128 patients aged from 21 to 62 years old with chronic posttraumatic osteomyelitis of the long bones was made at the period from 2006 to 2013. The main group included 67 patients and the method of programmed irrigation aspiration sanation was applied for them. The comparison group consisted of 61 patients and drainage was performed for these patients using the conventional ways. The authors noted good immediate results in the main group in 56 (83,58%) out of 67 patients and in the comparison group - in 43 (70,49%) out of 61 patients. The long-term results were analyzed in 116 (90,6%) out of 128 patients in terms from two to five years after treatment. The rate of recurrences such as formation of purulent fistula were twice less in patients of the main group, than in the comparison group. According to the results of questionnaire SF-36, there was noticed, that patients of the main group got better mean indices of quality of life on all 8 scales compared with the other group.