Modified Technique Group Research Articles

Modified hook‐wire placement technique for localizing multiple pulmonary nodules

The localization of multiple pulmonary nodules is challenging due to a high incidence of pneumothorax after each needle insertion into lung parenchyma. The aim of the current study is to verify the safety and effectiveness of a modified technique utilizing simultaneous Hookwire placement to localize multiple lesions. The proposed method comprises a row of metal wires, perpendicular insertion, simultaneous release of Hookwire, and a lateral position to modify a conventional localizing technique. From January 2015 to August 2016, 23 patients were subjected to the modified technique group (Group A), while 53 patients in the conventional group (Group B). Success rates, procedural parameters, and complications were recorded and analyzed. Compared with Group B, Group A had higher success rate of lesion (96.7% vs 83.5%, P = 0.009), lower numbers of CT scans (2.91 vs 5.59, P < 0.001), shorter procedure duration (13.83 minutes vs 22.68 minutes, P < 0.001), and shorter distance between localizers and lesions (4.88 vs 6.29, P = 0.006). The incidence of pneumothorax in Group A was lower (21.8% vs 54.7%, P = 0.008), while lung hemorrhage was not significantly different ( P = 0.735). Lesion number and pneumothorax were risk factors for failure in multiple localizations. The modified Hookwire placement technique was feasible and successful, which was associated with fewer computed tomography scans, shorter procedure duration, and a lower incidence of pneumothorax.

Modified C-H flap for simultaneous nipple reconstruction during autologous breast reconstruction: Surgical tips for safety and cosmesis.

Background:Reconstruction of the nipple–areolar complex is the final stage of breast reconstruction. Nipple reconstruction is usually performed several months after breast reconstruction, because simultaneous reconstruction is thought to be risky. Here, we introduce our experiences of 1-stage procedures with immediate reconstruction of the nipple–areolar complex during autologous breast reconstruction.Methods:Between 2008 and 2015, 51 mastectomy patients underwent 1-stage breast and nipple reconstruction. All cases were reconstructed immediately with autologous tissue for the breast mound. The patients were divided into 2 groups according to the method of nipple–areolar complex reconstruction. In group A, 23 cases were reconstructed with a classical C-H flap, also known as the Hammond flap. In group B, 28 cases were reconstructed with a modified C-H flap, which is the evolved form of the classical Hammond flap. The nipple–areolar complex was evaluated preoperatively, immediately postoperatively, and 1 year postoperatively. Postoperative complications were also evaluated.Results:The mean projection of the reconstructed nipple decreased by approximately 50% in group A and 38% in group B during the postoperative 1 year. However, the reconstructed nipple width and areolar diameter did not show a significant change in either group. Group A showed 26% of complication rate and 17% of revision rate, whereas group B showed 11% of complication rate and 4% of revision rate. However, no major complications such as complete necrosis of the reconstructed nipple, were observed in any patients.Conclusion:The modified technique group showed superior results in terms of safety and cosmesis. With our modified C-H flap method, simultaneous breast and nipple reconstruction is safe and has satisfactory results.

Development of the Modified Lenticule Edge Dissection Technique for Small Incision Lenticule Extraction.

To identify and develop an efficient technique to separate the lenticule edge in small incision lenticule extraction (SMILE). Four hundred eyes of 400 consecutive patients with myopia assigned to receive SMILE were included in the study. Eyes with poor-quality laser treatment were excluded, and the second eye of the same patient was included. Two skilled surgeons performed SMILE in the Zhongshan Ophthalmic Center. Each surgeon was allotted 200 patients. One surgeon used the modified technique, whereas the other surgeon used the conventional technique to identify and separate the lenticule edge. All intraoperative complications associated with lenticule edge dissection and the duration of lenticule dissection were recorded. There were 200 eyes each in the modified technique group (group A) and the conventional technique group (group B). The mean lenticule dissection time was 49 ± 10 seconds in group A and 59 ± 43 seconds in group B (P = 0.002). Within 70 seconds, lenticule dissection was completely finished in 96.5% of eyes in group A and 86.0% in group B. Difficult lenticule dissection was experienced in 3.5% (7/200) of cases in group A and in 14.0% (28/200) of cases in group B. The modified lenticule edge dissection technique of SMILE is simpler and faster in identifying the correct dissection plane. It is efficient in reducing surgical manipulation, shortening the learning curve required for lenticule dissection, and allows surgeons to perform SMILE more safely and efficiently.

A Modification to the Nasal Septal Chain Suture Which Improves Its Application.

A novel modification to the nasal septal chain suture which makes its application easier and faster without using any special surgical instrument has been described in this study. The advantage of the modification was evaluated in terms of the suture application time. A total of 40 patients with a mean age of 30.1 ± 10.6 (18-58) years were evaluated in 2 groups. A nasal septal chain suture was applied with the previously described technique and the new modification for each group after the patients underwent septoplasty. The suture application time for all of the patients was recorded. The mean suture application time was 455.2 ± 36.5 (380-530) seconds in the previous technique group and 404.7 ± 29.4 (340-450) seconds in the modified technique group. The use of new modification of the technique was found to shorten the suture application time significantly (P < 0.001). The modified nasal septal chain suture that has been described in this study can be an option to nasal septal suturation since it can be used with absorbable or nonabsorbable materials, is easy to remove, and does not cause pain during suture removal.

Comparison of curative effects from arthroscopic modified suture bridge and single-row modified Mason-Allen suture in repair of supraspinatus tendon tears

Objective To compare the early curative effects of arthroscopic modified suture bridge and single-row modified Mason-Allen suture in repair of supraspinatus tendon tears. Methods A retrospective case-control analysis was made on 28 patients with supraspinatus tendon tears admitted between June 2012 and June 2015. There were 16 males and 12 females, aged 43-63 years (mean, 54.2 years). Thirteen patients (13 shoulders) were repaired using the arthroscopic modified suture bridge technique (Group A), and 15 patients (15 shoulders) were treated using the single-row modified Mason-Allen technique (Group B). Operation time and intraoperative blood loss were recorded. American shoulder and elbow surgeons (ASES) score, Constant score and visual analogue score (VAS) were used to evaluate the function and subjective outcomes preoperatively. Meanwhile, MRI was used for analysis of tendon integrity postoperatively. Results The operation time of Group A and B were (56.1±23.2)minutes and (36.1±15.6)minutes, respectively (P 0.05). The average follow-up time for Groups A and B were 12 months and 12.6 months, respectively. The symptoms of 28 cases were alleviated after surgery, and the functions were obviously recovered. In Group A, the VAS was decreased significantly from (7.0±0.8)points preoperatively to (0.8±0.8)points at final follow-up, ASES score was improved from (39.8±3.1)points to (88.1±4.8)points, and Constant score was improved from (54.8±2.7)points to (88.2±3.1)points (all P 0.05). The retear rate in Group B was 20% (3/15), while no retear was presented in Group A (P<0.05). Conclusion Arthroscopic modified suture bridge technique and single-row modified Mason-Allen technique are both clinically effective for function recovery and pain relief in patients with supraspinatus tendon tears, but the former associated with lower incidence of tendon re-tear is preferred for moderate to large rotator cuff injury or rotator cuff injury with large insertion avulsion. Key words: Shoulder joint; Suture techniques; Arthroscopies; Rotator cuff tear

Modified technique of ureteral stent placement during transurethral resection of bladder cancer invading the ureteral orifice

Objective To evaluate the efficacy and safety of modified technique of ureteral stent placement during transurethral resection of bladder tumor. Methods Seventeen patients with muscle invasive bladder cancer invading the ureteral orifice from March 2014 to June 2016 in Beijing Friendship Hospital were randomly divided into two groups. In the modified technique group (group A, n= 10), tumor was resected until the ureteral orifice was exposed. Then, a guide wire was placed through the tunnel of Electrode loop and the ureteral stent was placed along the guide wire. In control group (group B, 7 cases), after ureteral orifice exposed, the guide wire and ureteral stent was placed with cystoscopy. The demographic, oncological baseline and operative factors were evaluated between two groups. Results There was no difference in tumor grade and maximum diameter between two groups (P>0.05). The operation time in group A was significantly shorter than that in group B[(39.5±14.8)min vs (59.3±16.2) min, P=0.020], and the intraoperative vision clarity score was better in group A as well[(7.7±1.3) vs (5.9±1.2), P=0.010]. There was no statistical difference between the two groups in the complication. Conclusions The modified technique can improve the efficiency of ureteral stent placement during transurethral resection of bladder tumor without any risk enhancement. Key words: Urinary bladder neoplasms; Ureteral orifice invading; Uretera; Stent; Technique improvement

Modified Core Biopsy Technique to Increase Diagnostic Yields for Well-Circumscribed Indeterminate Thyroid Nodules: A Retrospective Analysis.

The results of conventional core biopsy for some thyroid nodules with indeterminate cytology have still remained indeterminate. The aim of this study was to evaluate whether the ultrasonography-guided core needle biopsy technique containing the nodule, capsular portion, and surrounding parenchyma was more effective than a conventional method in enhancing diagnostic yield for circumscribed solid thyroid nodules without malignant sonographic features. This retrospective comparative study evaluated 26 thyroid nodules in 26 consecutive patients between 2006 and 2010. They were biopsied by using a conventional method, and 61 nodules from 60 patients were biopsied by using a modified ultrasonography-guided core needle biopsy technique in 2013. The patients enrolled in this study presented with circumscribed solid thyroid nodules without malignant sonographic features, classified as nondiagnostic or atypia/follicular lesions of undetermined significance at previous cytology. The ultrasonography-guided core needle biopsy results of the 2 groups were compared. The rate of inconclusive ultrasonography-guided core needle biopsy results was 34.6% (9/26) in the conventional group and 11.4% (7/61) in the modified technique group (P = .018). There was no significant difference in the mean size of the nodules between the 2 groups (P = .134). The malignancy rate was 33% (3/9) for the conventional group and 52% (27/52) for the modified technique group (P = .473). The most common malignant pathology was a follicular variant of papillary thyroid carcinoma and follicular adenoma was the most common benign lesion. For circumscribed solid nodules without malignant sonographic features with indeterminate cytology, the ultrasonography-guided core needle biopsy technique containing the nodule, capsular portion, and surrounding parenchyma is more effective in diagnostic yield compared with a conventional method that biopsies the intranodular portion.

Efficacy and complications associated with a modified inferior alveolar nerve block technique. A randomized, triple-blind clinical trial

Objectives: To compare the efficacy and complication rates of two different techniques for inferior alveolar nerve blocks (IANB). Study Design: A randomized, triple-blind clinical trial comprising 109 patients who required lower third molar removal was performed. In the control group, all patients received an IANB using the conventional Halsted technique, whereas in the experimental group, a modified technique using a more inferior injection point was performed. Results: A total of 100 patients were randomized. The modified technique group showed a significantly higher onset time in the lower lip and chin area, and was frequently associated to a lingual electric discharge sensation. Three failures were recorded, 2 of them in the experimental group. No relevant local or systemic complications were registered. Conclusions: Both IANB techniques used in this trial are suitable for lower third molar removal. However, performing an inferior alveolar nerve block in a more inferior position (modified technique) extends the onset time, does not seem to reduce the risk of intravascular injections and might increase the risk of lingual nerve injuries. Key words:Dental anesthesia, inferior alveolar nerve block, lidocaine, third molar, intravascular injection.

Efficacy of a modified technique for TVT-O positioning: a twelve-month, randomized, single-blind, multicenter, non-inferiority study

To evaluate the impact of a more limited paraurethral dissection, avoidance of perforating the obturator membrane with scissors or guide, and a more medial trajectory of the trocar in positioning the TVT-O device on stress urinary incontinence cure rates. One hundred and ten patients were recruited for this randomized, single blind, multicenter, non-inferiority study, with a 1:1 ratio to undergo the traditional (n=55) or the modified (n=55) technique. Preoperatively, patients underwent POP-Q staging, Q-tip test, challenge stress test and urodynamics, and completed the I-QoL, PISQ-12, and PGI-S questionnaires. During the post-operative period, patients attributed a pain VAS score 1, 3, 6, 12 and 24h after the procedure and were followed up at 12 months, undergoing the same baseline evaluations. The primary outcome was the cure rate (absence of urine leaks at the challenge stress test or urodynamic testing) one year after the procedure. The primary outcome was evaluated using a non-inferiority test. No differences were observed in cure rates (traditional technique 92.3% vs. modified technique 88.8% and non-inferiority P<0.05) and in questionnaire scores between the two groups. Post-operative pain was significantly lower in the modified technique group at each time point assessed, with the exception of 12h post-operatively. No differences between the two groups were observed in the number of analgesic vials administered. The modified technique does not seem to reduce the efficacy of TVT-O, but induces a reduction of post-operative pain.

Insertion of LMA Classic™ with and without digital intraoral manipulation in anesthetized unparalyzed patients

Background:The standard recommended insertion technique for LMA Classic™ requires the insertion of index finger into the oral cavity. Several anesthesiologists are reluctant to do this. We conducted this study to evaluate the modified technique of insertion of LMA Classic™ (not requiring insertion of fingers into the patient's mouth) against the standard index finger insertion technique.Materials and Methods:This prospective, randomized, comparative study was conducted on 200 consenting patients. Patients suitable for anesthetic with LMA Classic™ were randomized to standard technique group (standard insertion technique) and modified technique group (technique not requiring digital intraoral manipulation). Laryngeal mask airway (LMA) was inserted by five designated anesthesiologists. Anesthetic protocol was standardized. Time taken to achieve an effective airway, ease of insertion, glottic view obtained through LMA, and incidence of sore throat were assessed.Results:Patient characteristics and duration of surgery were comparable between the groups. Time to achieve an effective airway was comparable [18.5 (8) s with standard technique and 19.7 (10) s with modified technique; data are mean (standard deviation)]. Ease of insertion (92 easy with standard technique and 91 easy with modified technique), success rate (99% in both the groups), glottic view with fiberoptic bronchoscope, and sore throat incidence (six patients with standard technique and eight patients with modified technique) were comparable. The first attempt success rate was significantly higher with the standard technique (98 patients in the standard technique group and 91 patients in the modified technique group).Conclusions:LMA Classic™ can be inserted successfully without the need to insert index finger into patient's mouth, though the first attempt success rate is higher with the standard technique.

Anterior Cruciate Ligament Reconstruction Using 4-Strand Hamstring Autograft: Conventional Single-Bundle Technique Versus Oval-Footprint Technique

The purpose of this study was to compare short-term results of conventional anterior cruciate ligament (ACL) reconstruction with oval-footprint (modified) single-tunnel ACL reconstruction with 4-strand hamstring autograft. A prospective comparative study was performed in 74 consecutive subjects who underwent ACL reconstruction with the conventional technique (group I, 40 cases) or the modified technique (group II, 34 cases), in which the entrances of the femoral and tibial tunnels were more elongated, by use of 4-strand hamstring tendon. The Lachman test, pivot-shift test, range of motion, International Knee Documentation Committee classification, Lysholm score, and side-to-side differences were evaluated preoperatively and at the last follow-up. The Tegner activity scale was evaluated before injury and at the last follow-up. There were 38 patients in group I and 32 in group II who were followed up for at least 2 years (mean follow-up, 32.4 months). At the last follow-up, Lachman test results were negative in 34 in group I and 30 in group II (P = .624) and the pivot-shift test was negative in 32 in group I and 30 in group II (P = .397). Mean range of motion of the injured knee was 142.2° in group I and 141.9° in group II (P = .771). The International Knee Documentation Committee classification was A or B in 37 in group I and 31 in group II (P = .872). The median Lysholm score was 94 in group I and 96 in group II (P = .048). The mean side-to-side difference averaged 2.08 mm in group I and 2.07 mm in group II (P = .943). The median score on the Tegner activity scale was 6 in group I and 6 in group II (P = .968). The Lysholm score in the modified-technique group at the last follow-up was better than that in the conventional-technique group in terms of statistical significance, but this may not be clinically significant. Level II, prospective comparative study.

Subcutaneous Fixation of Gastrostomy Tube Is Superior to Temporary Fixation

The placement of gastrostomy tubes (GTs) in infants and children to provide enteral access over the past decade has shifted toward a minimally invasive, safer direction with the development of various new techniques. We have developed a modified technique, utilizing subcutaneous (S.C.) tunneling stay sutures to prevent complications, such as GT dislodgment and wound infection. The aim of this study was to identify and describe complications of the modified procedure and compare it with the standard laparoscopic GT placement. A retrospective 4-year review of 153 patients who underwent laparoscopic GT placement was conducted. Eighty-nine patients underwent the modified S.C. tunneled technique, and 64 patients had standard U-stitch with temporary fixation. The overall complication rate was significantly higher with the temporary fixation group (20%) versus the modified technique group (2.5%). Six patients from the temporary group and 2 patients from the modified group developed cellulitis. Seven patients underwent reoperation secondary to GT dislodgment in the temporary group. No patients were identified with tube-related pressure necrosis or procedure-related deaths. S.C. placement of stay sutures in the modified technique is associated with a lower complication rate than temporary fixation. The modified technique should be the preferred approach when performing laparoscopic GT insertion.

Modified retractor plication technique in lower lid entropion repair: a 4-Year follow-up study

Background: Lower eyelid entropion is an eyelid malposition characterized by inward rotation of the eyelid margin associated with potentially significant discomfort and, occasionally, keratopathy. In this study we evaluated and compared the efficacy of two surgical techniques of retractor plication for involutional lower lid entropion repair.Methods: Sixty-two consecutive patients (62 eyes) with involutional lower lid entropion were included. Of the 62, 34 underwent the Jones retractor plication technique, and 28 underwent a modification of this technique that simplifies the procedure.We evaluated horizontal lid laxity, medial canthal tendon laxity and lower lid excursion before and after surgery, and determined the rate of entropion recurrence in the two groups. All measures were obtained before and I month, 6 months, I year, 2 years, 3 years and 4 years after surgery.Results: Preoperatively, there was no statistically significant difference between the two groups in any of the measures studied. Postoperatively, the mean amount of horizontal lid laxity was significantly less in the modified technique group than in the Jones technique group (6.86 mm [standard deviation (SD) 0.41 mm] vs. 7.30 mm [SD 0.64 mm]) (p < 0.05). Similarly, the mean amount of medial canthal tendon laxity in the resting position was significantly less in the modified technique group than in the Jones technique group (1.90 mm [SD 0.56 mm] vs. 1.25 mm [SID 0.43 mm]) (p < 0.05).The rate of entropion recurrence was significantly lower in the modified technique group (7. 1%) than in the Jones technique group (14.7%) (p < 0.05).Interpretation: The modified retractor plication technique showed encouraging results in terms of successful and long-lasting lower lid entropion repair.

A quantitative portal imaging assessment of set-up discrepancies during radiation therapy for spinal metastases

At PMH, radiation therapy (RT) for spinal metastases constitutes 15% of the palliative workload. A retrospective analysis of imaging data for posterior direct spinal R.T.(with patients in a supine position) revealed that 55% of 60 cases reviewed required lateral adjustment prior to treatment. The introduction of a modified technique incorporating lateral set-up tattoos improved the rate of required adjustment to 17% of the 60 patients accrued to the study. The adjustments required were made by the treatment therapist, after daily pretreatment portal imaging. All portal images were captured and saved for further review. A quantitative assessment of the magnitude of adjustment required was undertaken by utilizing image- matching technology available within the imaging systems. Each rejected image was analyzed for both groups of 60 patients. The magnitude of each shift required was measured accurately to the nearest millimeter. Patient information was collected at the time of simulation. The mental state and ECOG performance status of each patient was assessed. A questionnaire was completed for Pain Score and Body Mass Index. This data was collated to produce profiles for each patient. The data on the required shifts statistically verifies the validity of the modified technique with respect to the patient population in which set-up discrepancies occur. In the retrospective group the range of lateral adjustment was 7mm to 30mm, with an average of 14mm. For the modified technique group of patients the range was 6mm to 15mm, with an average of 9mm. The patient profile information collected will be correlated with the data on required shifts. Use of this technique has improved reproducibility and reduced the magnitude of potential set-up error significantly. For this RT technique lateral set-up tattoos should be incorporated as a standard requirement. Daily pre-portal imaging of this patient population is extremely desirable. If pre-portal imaging is unavailable, a wider treatment field (current standard is 8.0cm) may merit consideration for patients whose assessed profile establishes an increased risk of set-up discrepancy

A quantitative portal imaging assessment of set-up discrepancies during radiation therapy for spinal metastases

At PMH, radiation therapy (RT) for spinal metastases constitutes 15% of the palliative workload. A retrospective analysis of imaging data for posterior direct spinal R.T.(with patients in a supine position) revealed that 55% of 60 cases reviewed required lateral adjustment prior to treatment. The introduction of a modified technique incorporating lateral set-up tattoos improved the rate of required adjustment to 17% of the 60 patients accrued to the study. The adjustments required were made by the treatment therapist, after daily pretreatment portal imaging. All portal images were captured and saved for further review. A quantitative assessment of the magnitude of adjustment required was undertaken by utilizing image- matching technology available within the imaging systems. Each rejected image was analyzed for both groups of 60 patients. The magnitude of each shift required was measured accurately to the nearest millimeter. Patient information was collected at the time of simulation. The mental state and ECOG performance status of each patient was assessed. A questionnaire was completed for Pain Score and Body Mass Index. This data was collated to produce profiles for each patient. The data on the required shifts statistically verifies the validity of the modified technique with respect to the patient population in which set-up discrepancies occur. In the retrospective group the range of lateral adjustment was 7mm to 30mm, with an average of 14mm. For the modified technique group of patients the range was 6mm to 15mm, with an average of 9mm. The patient profile information collected will be correlated with the data on required shifts. Use of this technique has improved reproducibility and reduced the magnitude of potential set-up error significantly. For this RT technique lateral set-up tattoos should be incorporated as a standard requirement. Daily pre-portal imaging of this patient population is extremely desirable. If pre-portal imaging is unavailable, a wider treatment field (current standard is 8.0cm) may merit consideration for patients whose assessed profile establishes an increased risk of set-up discrepancy

Towards conformal radiotherapy: an audit of technique accuracy

Introduction: Conformal radiotherapy demands an accurate and reproducible treatment set up technique therefore the purpose of this study was to determine whether the current techniques were suitable for use with conformal treatment plans and to establish whether the current verification procedure was adequate.Method: 30 patients undergoing radical radiotherapy were recruited to each technique to be studied. Megavoltage images (MVI's) were taken twice during week one and then at weekly intervals. All study images were assessed after the patient had completed the treatment course using Masthead PIPS software. Field placement errors were recorded in x, y and z directions where appropriate. Patient characteristics were recorded to establish whether there was any relationship between reproducibility and patient size.Results: Head and neck: 26.6% patients had one or more errors &gt;5 mm, 3.3% had consistent errors &gt;5 mm throughout treatment. Poor fit of the beam direction shell was associated with errors &gt;5 mm. Chest and abdomen: The technique was modified after 20 patients due to the large number of errors exceeding 10 mm. A significant (p &lt; 0.01) reduction in the number of errors was in the modified technique group, this group also had a significantly (p &lt; 0.01) reduced range of errors in the y direction. Pelvis: Significantly more errors were seen in the y and z directions using the sinmed kneeblock. A link between field placement errors and patient size was found.Conclusion: Imaging on the first fraction is not sufficient to determine whether a set up error is likely to occur consistently during treatment, at least two sets of images are required. The study has shown that technique development is necessary for the chest, abdomen and pelvis prior to the introduction of conformal radiotherapy.

Is lymphocele in renal transplantation an avoidable complication?

Background: This study evaluated the impact of surgery in the incidence of lymphocele after kidney transplantation (KTx). Methods: A prospective randomized study was conducted during a 6-year period on a group of patients undergoing KTx and operated on by the same surgeon (CVS). A total of 280 patients undergoing KTx were randomly allocated into two groups: (1) group C (control group) was 140 patients who were submitted to KTx with standard technique: implantation of the kidney in the controlateral iliac fossa with vascular anastomoses on the external iliac vessels; and (2) group M (modified technique group) was 140 patients who underwent a modified technique with a cephalad implantation of the graft in the ipsilateral iliac fossa and vascular anastomoses in the common iliac vessels. Both groups were comparable for age, cold ischemia time, incidence of rejection episodes, presence of adult polycystic kidney disease, and source of donor graft. Results: Group M showed an incidence of lymphocele production (3 patients, 2.1%) significantly lower than group C (12 patients, 8.5%). Eight patients (1 in group M and 7 in group C) required surgical treatment by peritoneal fenestration. No allograft or recipient was lost as a result of fluid collection but the hospitalization was shorter in group M than in group C. Conclusions: A cephalad implantation of the renal graft in the ipsilateral iliac fossa has been associated with a lower incidence of lymphocele, probably because vascular anastomoses on the common iliac vessels cause less lymphatic derangement than those performed on the external iliac vessels.

Pars Plana Lensectomy and Vitrectomy by Ultrasonic Fragmentation: Part III - Results in Eyes Without Other Ocular Pathology or an Implant

The records of 320 eyes without other ocular pathology undergoing pars plana lensectomy and vitrectomy by ultrasonic fragmentation for routine cataract extraction without an implant were reviewed retrospectively. Three hundred two (302/320-94.4%) had vision between 20/20-20/40. Reasons for vision less than 20/40 in 18/320 (5.6%) eyes included 5/320 (1.5%) with retinal detachments, 11/320 (3.4%) with clinically apparent cystoid maculopathy, 1/320 (0.3%) with a macular hole, and 1/320 (0.3%) with retained lens material. Comparison was made between 184 lensectomies performed by the original technique and 136 pars plana lensectomies performed by the modified technique. Vision between 20/20-20/40 was achieved by 168/184 (91.3%) of the original technique group versus 134/136 (98.5%) of the modified technique group. In the latter group, there was one retinal detachment (0.7%), one macular hole (0.7%) and no clinical cystoid maculopathy. Fluorescein angiography performed three months postoperatively in eyes having vision of 20/20-20/40 of the modified lensectomy group showed cystoid maculopathy in one eye which had undergone trauma-induced wound dehiscence.