Patch Graft Research Articles

Results of an Adaptive Surgical Approach for Managing Late Onset Hypotony After Trabeculectomy With Mitomycin C.

The objective of this study is to investigate the results of an adaptive approach of bleb revision surgery for late onset hypotony after trabeculectomy with mitomycin C because of bleb leakage and/or scleral melting. A total of 29 eyes of 27 patients, aged 63.8±11.7 years with hypotony maculopathy [intraocular pressure (IOP), ≤6 mm Hg] because of late onset bleb leakage and/or scleral melting after trabeculectomy with mitomycin C in which minimally invasive transconjunctival suturing of the scleral flap was impossible were enrolled in this retrospective interventional case series. External bleb leakage was seen in 16 eyes, 11 eyes suffered from scleral melting. Because of the intraoperative findings regarding appearance of conjunctiva and sclera 4 different surgical approaches were used: (1) bleb excision (in case of external leakage) and conjunctival reapproximation, (2) bleb excision and free conjunctival autografting, (3) human donor scleral patch grafting (in case of scleral flap defect) with conjunctiva reapproximation and (4) combined conjunctival and scleral patch grafting. Outcome measures were IOP and visual acuity (VA) development over time. Data analysis comparing changes in the parameters (IOP and VA) before and after bleb revision surgery was carried out using the paired t test. Changes in IOP and VA were analyzed over 9.3±8.3 months (range, 1.1 to 36.5 mo). IOP increased from 4.0±1.8 mm Hg, (P<0.001) before revision surgery to 13.1±4.1 mm Hg at 3 months after revision and 12.6±3.8 mm Hg at last follow-up visit, showing no significant difference in IOP between 3 months post revision and at the last documented patients' follow-up visit (P=0.28). The VA before revision surgery (0.42±0.28 logMAR) significantly increased (P=0.05) 3 months after revision (0.32±0.23 logMAR) and remained stable (P=0.65) until the last follow-up visit (9.3±8.3 mo; range, 1.1 to 36.5) (0.35±0.32 logMAR). In patients with hypotony an adaptive approach of bleb management shows good results both in terms of IOP control and improvement in VA.

Optical and Tectonic Corneal Transplant Outcomes in a Tertiary Hospital in Singapore within the Singapore Corneal Transplant Registry

This study aimed to describe and compare corneal graft survival and optical outcomes following deep anterior lamellar keratoplasty (DALK) and Descemet's stripping automated endothelial keratoplasty (DSAEK) with penetrating keratoplasty (PK), and to document tectonic success of patch grafts. This was a retrospective, non-randomised, comparative and descriptive cohort study. A total of 139 eyes that underwent primary keratoplasty between 2000 and 2016 were included, and the following data was extracted: demographics, clinical diagnosis and primary indication, pre- and intraoperative risk factors, postkeratoplasty outcomes, and complications. Optical success was defined as good graft clarity and best corrected visual acuity (BCVA) of 6/12 or better. Graft failure was defined as irreversible corneal oedema and loss of clarity. Tectonic success in patch grafts was defined as tectonic integrity with no repeat tectonic surgical procedure required in the postoperative period. The mean follow-up duration was 3.24 ± 3.47 years in the PK group (n = 16), 1.89 ± 0.86 years in the DALK group (n = 37), 2.36 ± 1.24 years in the DSAEK group (n = 53), and 2.17 ± 1.09 years in the patch graft group (n = 33). The 3-year probabilties of survival for PK, DALK, DSAEK and patch graft were 60.9%, 94.1%, 89.9%, and 67.1%, respectively. The overall percentage of complications was significantly higher for PK (81.3%), compared to DALK (48.6%), DSAEK (49.1%), and patch graft (21.2%). In the PK and DALK groups, 100% achieved DSAEK (49.1%), and patch graft (21.2%). In the PK and DALK groups, 100% achieved BCVA of 6/12 or better, while in the DSAEK group, 96.43% achieved BCVA of 6/12 or better. From a similar study cohort of Asian eyes, graft survival was superior and complications were reduced for DALK and DSAEK compared to PK, but optical outcomes were comparable. Graft survival for patch graft was expectedly lower, but the incidence of complications was low.

Surgical Management of Aortic Coarctation from Infant to Adult

In the present study, we aimed to retrospectively investigate the early and late results of different surgical treatment techniques applied in different age groups with coarctation of the aorta (CoA). Between January 2007 and February 2017, 26 patients (12 males, 14 females; mean age: 12.2±12.4 years; range: 29 days-34 years) who underwent surgery with the diagnosis of CoA were evaluated. Overall, 11 of these patients (42.3%) were in the infantile period, whereas 15 patients (57.7%) aged between 6 and 34 years. Resection and end-to-end anastomosis were performed in 13 patients (50%). Bypass grafting was performed in six patients (23.1%), and patch plasty was performed in seven patients (26.9%). A patient (3.8%) who was operated on during the infantile period died early, whereas another patient (3.8%) died 2 years after the surgery. Recoarctation was detected in two patients. A patient underwent balloon dilatation, whereas another patient underwent balloon dilatation and stenting. In patients who underwent re-section and end-to-end anastomosis based on postoperative echocardiography results during follow-up, a lower statistically significant gradient was observed compared with the preoperative period. Despite the decrease in the left ventricular systolic diameter (LVSD) and the increase in the ejection fraction (EF) the decrease in LVSD and increase in EF were not statistically significant. In patients who underwent patch plasty or graft interposition, the low values of the gradient and left ventricular diastolic diameter in the postoperative follow-up were statistically significant. However, the decrease in LVSD and increase in EF were not statistically significant. Our clinical experience suggests that repairing with resection and end-to-end anastomosis is a more appropriate treatment option during the infancy, whereas patch plasty or bypass grafting may be preferred in advanced ages.

Invited commentary

Computational studies of carotid artery hemodynamics have been performed for almost three decades. We now know that the localized arterial dilation found exclusively in the carotid bulb produces disturbed flow patterns with low and oscillatory shear stress that can alter endothelial function and activate atherogenic cellular phenotypes. Intensified by the deleterious effects of systemic risk factors and high intramural stresses and strains, these hemodynamic conditions can stimulate arterial wall stiffening and thickening that can further perturb normal physiology. This vicious circle of abnormal hemodynamics and pathologic remodeling may produce plaques that can become unstable, presenting vascular surgeons with opportunities to intervene. Two of the most commonly used variations on the technique of carotid endarterectomy are primary closure and patch angioplasty. Whereas clinical evidence has historically advocated for patch use,1Brott T.G. Halperin J.L. Abbara S. Bacharach J.M. Barr J.D. Bush R.L. et al.2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: a report of the American College of Cardiology Foundation/American Heart Association Task F.Circulation. 2011; 124: e54-e130Crossref PubMed Scopus (453) Google Scholar recent data suggest that benefits are only of borderline significance2Rerkasem K. Rothwell P.M. Systematic review of randomized controlled trials of patch angioplasty versus primary closure and different types of patch materials during carotid endarterectomy.Asian J Surg. 2011; 34: 32-40Crossref PubMed Scopus (68) Google Scholar or may not even be significant at all.3Avgerinos E.D. Chaer R.A. Naddaf A. El-Shazly O.M. Marone L. Makaroun M.S. Primary closure after carotid endarterectomy is not inferior to other closure techniques.J Vasc Surg. 2016; 64: 678-683.e1Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar This poses a question of whether increased clamp time, higher risk of cerebral ischemia, potential infectious issues, and patch-associated aneurysmal dilation are justified for every patient. In this study by Domanin et al, this argument is explored from a hemodynamic perspective whereby the authors compare flow characteristics in carotid arteries virtually repaired with primary closure and patch angioplasty. Because addition of the patch widened the carotid bifurcation, patch angioplasty was found to be associated with less favorable hemodynamics compared with primary closure. The authors conclude that patch use should be elective and performed with the purpose of re-creating the original shape of the carotid bifurcation rather than enlarging it. We arrived at similar conclusions in our computational analysis of carotid artery reconstruction, demonstrating more favorable flow patterns and lower intramural mechanical stresses for the artery repaired without a patch.4Kamenskiy A.V. Pipinos I.I. Dzenis Y.A. Gupta P.K. Jaffar Kazmi S.A. MacTaggart J.N. A mathematical evaluation of hemodynamic parameters after carotid eversion and conventional patch angioplasty.Am J Physiol Heart Circ Physiol. 2013; 305: H716-H724Crossref PubMed Scopus (19) Google Scholar To produce favorable hemodynamics with patching, our analysis demonstrated that the patch should be tailored to ensure smooth transition in arterial diameter, be placed anteriorly (as opposed to laterally), and be made of material that most closely matches the compliance of the recipient artery.5Kamenskiy A.V. MacTaggart J.N. Pipinos I.I. Gupta P.K. Dzenis Y.A. Hemodynamically motivated choice of patch angioplasty for the performance of carotid endarterectomy.Ann Biomed Eng. 2012; 41: 263-278Crossref PubMed Scopus (17) Google Scholar Patch compliance was particularly important as the mismatch in stiffness between synthetic patches and the host wall resulted in high stress and strain concentrations at the suture-artery interface, causing the posterior aspect of the artery to bulge out and to perturb flow and intramural stresses. Whereas these findings are merely suggestions offered by computational modeling, they have the potential to help clinicians choose the optimal type of repair material and geometry based on patient-specific arterial characteristics. Computational modeling of vascular physiology is frequently met by clinicians with skepticism as it is still in its infancy in describing complex mechanobiologic phenomena. There is much to be learned to improve fidelity of these models, and prospective validation in patients is a difficult next step to make these techniques clinically relevant. This cannot be achieved without synergistic collaborations between engineers and vascular surgeons. Sparking and nurturing these collaborations is the best way to make meaningful progress in making computational models useful to clinicians, as even the best of tools are only as good as the hands that use them. The opinions or views expressed in this commentary are those of the authors and do not necessarily reflect the opinions or recommendations of the Journal of Vascular Surgery or the Society for Vascular Surgery. Computational fluid dynamic comparison between patch-based and primary closure techniques after carotid endarterectomyJournal of Vascular SurgeryVol. 67Issue 3PreviewThe aim of the study was to provide, by means of computational fluid dynamics, a comparative analysis after carotid endarterectomy (CEA) between patch graft (PG) and primary closure (PC) techniques performed in real carotid geometries to identify disturbed flow conditions potentially involved in the development of restenosis. Full-Text PDF Open Archive

330 Residual Curvature after Penile Prosthesis: The Role of Peyronie's Patch Grafts

Peyronie's disease (PD) and erectile dysfunction (ED) can both be treated by placement of a penile prosthesis (PP). After PP placement, persistent penile curvature may be addressed with maneuvers such as penile modeling or PD plaque incision/excision with or without patch grafts. Outcomes data regarding the use of patch grafts during the same operation as penile prostheses is sparse. The purpose of this study is to analyze and present our institution's experience using patch grafts to correct residual penile curvature after PP placement. The study aims to verify that these procedures can be safely and efficiently conducted at the same operation. After IRB approval, all patients who underwent PP surgery from October 2011 through April 2017 at our university were identified. All surgeries that concurrently involved a patch graft procedure to correct residual PD curvature at the time of IPP were then isolated. The pre- and post-operative demographics, as well as intra-operative findings, were collected for each patient.

What to expect with major vascular reconstruction during Whipple procedures: a single institution experience and literature review.

Major vascular reconstruction during a pancreaticoduodenectomy (PD), also known as a Whipple procedure, leads to controversial postoperative outcomes compared to conventional Whipple. Discussion with the patient regarding postoperative expectations is a crucial component of holistic surgical healthcare. The aim of this study was to report our 8-year experience of Whipple procedures involving vascular reconstruction and to review relevant literature to further evaluate expectant outcomes, therefore leading to more accurate discussion. A retrospective review of patients undergoing Whipple procedures from January 2010, through December 2017 was performed. Patch, graft, and primary anastomosis during Whipple procedures were considered major vascular reconstruction. Literature on the current understanding of the outcomes associated with vascular reconstruction during Whipple procedures was reviewed. Twenty-nine from a total of 405 patients that met inclusion criteria had a Whipple procedure that involved major vascular reconstruction. Twelve patients were male and 17 were female (mean age, 65.2 years). Median hospital and intensive care unit (ICU) stay [range] of patients with vascular reconstruction was 12 [5-92] days and 3 [0-59] days, respectively. Thirty-day survival and 1-year survival of patients with vascular reconstruction was 93.1% and 55.2%, respectively, compared to non-vascular reconstruction patients 96.0% and 83.5%, respectively (P=0.35, P<0.001). Ninety-day readmission for vascular reconstruction patients was 31.0% compared to 14.6% in non-vascular reconstruction patients (P=0.03). The 1-year survival of those who had patch reconstruction, graft reconstruction, and primary anastomosis was 50.0%, 62.5%, 53.8%, respectively. Compared to conventional Whipple procedures, those requiring major vascular reconstruction are associated with decreased survival. When vascular reconstruction is a valid option patients should be well aware of the associated outcomes.

117 Non-degloving Technique for Peyronie's Disease with Penile Prosthesis Implantation and Double Dorsal-ventral Patch Graft

117 Non-degloving Technique for Peyronie's Disease with Penile Prosthesis Implantation and Double Dorsal-ventral Patch Graft

Combined use of bulbar conjunctival pedicle flap and labial mucous membrane graft for porous orbital implant exposure: Long-term outcome

ABSTRACTImplant exposure is the most common serious complication of porous orbital implants, and often requires surgical repair. This study aims to describe a new repair technique using a bulbar conjunctival pedicle flap and a labial mucous membrane patch graft, as well as to report its long-term results. A retrospective chart review was performed on all patients whose porous orbital implant exposures were repaired using this technique from 1995 to 2014. Twenty-three patients were included. The maximal defect dimension ranged from 2 to 18 mm. Sixteen patients (70%) also received a banked human scleral patch graft during their repair. The mean follow-up was 130 months (range 29–267 months). Eighteen patients (78%) were successfully treated with one repair surgery. At the final follow-up, 21 patients (91%) could comfortably wear a prosthetic eye, and 18 patients (78%) reported satisfactory cosmesis. Two patients (9%) developed small conjunctival cysts that were successfully excised. The combination of a bulbar conjunctival pedicle flap and a labial mucous membrane patch graft is a simple but effective technique in salvaging exposed porous orbital implants. Its long-term results are promising.

First Aid for Skin Tears by Mini Patch Grafting from the Flap Edge

BackgroundTraumatic skin tears often occur in patients with dystrophic skin. Closing them with adhesive skin closures is useful for patients with a healthy flap, but occasionally fails to cover the entire defect. We describe a simple technique to perform mini patch grafting on the remaining raw surface without damaging healthy skin. DiscussionThe skin flap is spread out and fixed with adhesive skin strips to minimize defects first. Small pieces of skin are obtained by trimming the edges of the skin flap with curved tip scissors. They are placed on the defect with free spaces of 3 to 5 mm between each of the grafts. Then the whole wound is covered with a dressing and gauze pads. Healing of the ulcer could be markedly promoted with little enlargement of the skin defect. ConclusionsSmall pieces of skin trimmed out from the edge of skin flap can be used as a mini patch graft that remarkably enhances healing of remaining open surface.

Pilot Study Assessing the Use of High-density Polyethylene (Su-Por) for Tube Shunt Patch Grafts.

To assess the viability of a manufactured high-density polyethylene patch graft material (Su-Por) for prevention of tube shunt exposure. Retrospective review of the first 11 patients from the Wills Eye Hospital Glaucoma Service to receive the high-density polyethylene patch graft during tube shunt surgery. Four patients (36.3%) experienced an extrusion of the Su-Por patch without a leak within 2.5 months of postoperative follow-up. All 4 patients developed either symptomatic or progressive extrusion. Operative repair was completed with Su-Por removal and replacement with a new human donor patch graft. No patient developed any sign of infection despite the extrusions. The remaining 7 patients had an uneventful postoperative course and continue to have no complications from the Su-Por patch with 9 months of follow-up. Given the high rate of extrusion of the Su-Por graft, this material seems to be an inadequate alternative for covering tube shunts. Harvested human tissue or other more flexible, manufactured grafts remain the standard of care for covering tube shunts.

Application of polycaprolactone nanofibers as patch graft in ophthalmology.

Purpose:The purpose of the study was to evaluate tissue reaction to polycaprolactone (PCL) nanofiber patches in the cornea, conjunctiva, and anterior chamber (AC) in rabbit eyes and to assess their biocompatibility for use as patch grafts.Methods:Two 100 μ PCL patches were implanted under the conjunctiva and in the corneal stroma of one albino New Zealand rabbit, and pathologic evaluation was done after 3 weeks. In the next step, two PCL patches were implanted; one in the corneal stroma and the other in the AC of two rabbits followed by pathologic evaluation after 3 months.Results:On slit-lamp examination, there was minimum inflammation in all cases. Pathologic examination showed that the contact and probably merging between the host tissue and PCL fibers were achieved with minimal tissue reaction.Conclusion:As a biocompatible material, PCL nanofibers seem to be a promising modality for the repair of different tissue defects including melting, thinning, and perforation. They may also be a suitable material for manufacturing keratoprostheses.

Serum amyloid A as a marker of inflammation in xenotransplantation

Increasing evidence indicates that inflammation plays a role in pig-to-baboon organ xenotransplantation. We have evaluated serum amyloid A (SAA) as a marker of inflammation in baboons with various pig xenografts. We measured SAA levels in recipient baboons with pig artery patch (n = 5), life-supporting kidney (n = 5), heterotopic heart (n = 2), or hepatocyte (n = 1) grafts and using an OmniChek-SAA for Inflammation &amp; Infection kit. C-reactive protein (CRP), another marker of inflammation (e.g. D-dimer), was also measured.SAA indicated increased inflammation when baboons developed consumptive coagulopathy (CC; e.g. thrombocytopenia) or infection. SAA also indicated that treatment of the recipient with tocilizumab reduced inflammation. There was significant positive correlation between SAA with changes in CRP (r = 0.6, P &lt; 0.05) and with D-dimer (r = 0.8, P &lt; 0.01), but SAA appeared at times to more accurately reflect the clinical state of the baboon. In sum, measurement of SAA proved simple and quick, and indicated (1) significant inflammation when CC or infection was present, and (2) reduced inflammation when treatment with tocilizumab was administered.

Patch graft for pterygium surgery: stitch it or stick it?

Pterygia are an extremely common ocular condition believed to be occurring due to proliferation and overgrowth of abnormal epithelial and fibrovascular tissue onto the cornea.

Antineutrophil cytoplasmic antibody-positive scleritis: Clinical profile of patients from a tuberculosis-endemic region.

Purpose:To report the clinical profile of a series of antineutrophil cytoplasmic antibody (ANCA)-associated scleritis in Indian population.Methods:We conducted a retrospective review of medical records of 33 eyes of 26 consecutive patients with scleritis, who tested positive for either antibody to proteinase 3 [anti-PR3/cytoplasmic antineutrophil cytoplasmic antibody (cANCA)] or myeloperoxidase [anti-MPO/perinuclear anti-neutrophil cytoplasmic antibody (pANCA)] between 2006 and 2015.Results:The mean age at presentation was 54.1 (11.1) years and 61.5% of the patients were female. Underlying systemic disorder was found in 46.2% of patients and includes granulomatosis with polyangitis (30.8%) and tuberculosis (15.4%). Necrotizing scleritis (48.5%) was the most common scleritis observed, followed by diffuse anterior scleritis (42.4%). Positive cANCA was found in 65.4% of patients and 34.6% was found positive for pANCA. Four of the six patients with positive Mantoux test were started on anti-tuberculosis treatment (ATT) by pulmonologist. Cyclophosphamide was the most common immunosuppressive and 11.5% of the patients required combination of two immunosuppressives. Seventeen eyes developed cataract and four eyes required patch graft. Female gender was more frequently associated with pANCA-associated scleritis than cANCA (P = 0.037). Incidence of necrotizing scleritis was higher in patients with positive cANCA, but this difference was not statistically significant (P = 0.806). cANCA-positive patients had statistically significant higher association with systemic rheumatic diseases (P = 0.021).Conclusion:Necrotizing scleritis is the most common subtype of scleritis in ANCA-positive individuals and even in the absence of systemic involvement. All patients with ANCA positivity should be thoroughly screened to rule out any evidence of tuberculosis, especially in tuberculosis-endemic region before planning aggressive immunomodulatory therapy.

Factors Associated with Conjunctival Erosions after Ahmed Glaucoma Valve Implantation.

Purpose:To investigate the frequency of conjunctival erosions in a series of patients who underwent Ahmed valve implantation in a tertiary referral center and to study risk factors associated with the conjunctival erosions.Methods:This is a single-center, retrospective case-control study of all patients who underwent Ahmed valve implantation between October 2006 and July 2016 at the Kresge Eye Institute in Detroit, Michigan. The series consisted of 306 eyes (277 patients) that underwent Ahmed valve implantation. The rate of conjunctival erosions was determined. Univariate, bivariate, and Cox-proportional hazard analyses were performed to identify factors associated with conjunctival erosions.Results:During the study period, 23 erosions occurred in 306 eyes (7.52%). Aphakia was significantly more common in eyes with erosions (P < 0.05). Aphakia (P = 0.02), uveitic glaucoma (P = 0.03), and longer post-operative use of topical steroids (P < 0.04) significantly increased the risk of erosions based on the Cox model. There were similar rates of erosions with each type of patch graft. No conjunctival erosion was observed after using the modified scleral tunnel method (n = 10).Conclusions:The overall erosion rate was 7.52% in our series. Uveitic glaucoma, aphakia, and longer post-operative use of topical steroids were significantly associated with conjunctival erosions.

Scleral necrosis in patients with posterior uveal melanomas evaluated by transcleral fine needle aspiration biopsy and treated by 125I plaque.

To evaluate the incidence, potential correlation with transcleral fine needle aspiration biopsy, and treatment of scleral necrosis in patients with posterior uveal melanomas treated by 125I plaque radiotherapy and assessed by transcleral fine needle aspiration biopsy. We per-formed a retrospective review of posterior uveal melanoma treated by 125I plaque radiotherapy at a single academic institution between July 2006 and July 2013. Consecutive patients diagnosed with a posterior uveal melanoma during the study period that had an anterior margin at or anterior to the equator who were evaluated by transcleral fine needle aspiration biopsy prior to 125I plaque radiotherapy were included. The main outcome measure was development of scleral necrosis, and the secondary outcome was treatment of this complication. Statistical analysis included computation of conventional descriptive statistics, cross-tabulation and chi-square tests of potential factors related to the development of scleral necrosis, and summarizing of treatment approaches and results. The incidence of treatment of scleral necrosis was calculated using the Kaplan-Meier method. During the 7-year study period, 87 posterior uveal melanomas were evaluated by transcleral fine needle aspiration biopsy and treated by 125I plaque radiotherapy. The median largest basal diameter of the tumor was 13.3 mm, and the median thickness was 6.8 mm. Eight patients (9.2%) developed scleral necrosis during follow-up. Thicker tumors (> 6.5 mm) were more likely to develop scleral necrosis (n=7) than thinner tumors (p=0.05). The median interval between 125I plaque radiotherapy and detection of scleral necrosis was 19.1 months. The overall cumulative probability of scleral necrosis was 6.2% at 6 months and 14.3% at 24 months, subsequently remaining stable. For thicker tumors, the probability of scleral necrosis was 23.5% at 45.4 months. Five patients were treated by scleral patch graft (62.5%) and three by observation (37.5%). One patient underwent enucleation after two failed scleral patch attempts and recurrent scleral necrosis. The mean follow-up period for patients with scleral necrosis was 34.5 months. Thicker posterior uveal melanomas are more likely to develop scleral necrosis after 125I plaque radiotherapy and transcleral fine needle aspiration biopsy. While observation is sufficient for managing limited scleral necrosis, scleral patch graft is a viable alternative for eye preservation in extensive scleral necrosis.

Ring graft technique for microvascular decompression.

Various nerve compression syndromes, such as trigeminal neuralgia (TN), glossopharyngeal neuralgia (GN), and hemifacial spasm (HFS), are caused by compression of the concerned nerve by the adjacent vessel. Patients who do not respond to medical management are usually treated by "microvascular decompression (MVD) of the nerve." Teflon patch graft is the most commonly used material for MVD. This graft has been used in various shapes like a patch, in the shredded form, or as a sling. This is done to prevent recurrence because of graft failure. We used a teflon ring graft to perform a successful MVD in 10 patients. Out of 10 cases, 6 cases were of TN, 2 of HFS, 1 of GN, and 1 case was of cochleovestibular nerve compression syndrome (CNCS). After MVD, every patient underwent a follow up assessment for 5 years. There was no major postoperative complication, except in the patient with CNCS who suffered from a temporary episode of facial palsy. All cases were symptom free at a follow-up duration of equal to or more than 5 years. Ring teflon graft may be used as an alternative as well as a safe method to perform MVD and has a good success rate.

Short-term observation of management of sclera patch grafts used in the scleral defects

Background: To explore the safety and effectiveness of Sclera patch grafts in the management of scleral defects. Methods: This is a retrospective uncontrolled study. Medical records were retrospectively reviewed for 8 eyes of 8 patients with sclera patch grafts. Two patients had necrotizing scleritis, 2 patients had scleral melting/perforation secondary to thermal burns, 4 patients had scleral staphyloma secondary to surgery. Sclera was reconstructed with allogenic sclera patch grafts, 6 in 8 patients combined autologous conjunctival pedicle flap, 1 patient combined partial medial rectus translocation, 1 patient combined autologous pedicle tenon graft, simultaneously. Treatment outcomes were evaluated using structural integrity, best corrected visual acuity (BCVA), scleritis remission, sclera rejection and melt, and ocular symptoms. Results: Eight patients were reviewed. In all of these cases, satisfactory anatomic and functional outcomes were achieved. In the at least half a year follow-up, the BCVA of all the eight patients were no worse than that of preoperative. No eye pain, foreign body sensation and other discomforts showed in all the patients, except one woman, who showed sclera rejection and melt 1 month postoperative. In addition, one patient showed high intraocular pressure (28 mmHg), which can be controlled by a kind of medicine. Conclusions: In this series, sclera patch grafts is an effective method for management scleral defects in the at least half a year following-up. Attention should be paid to the sclera patch rejection and melt post operatively.

Computational fluid dynamic comparison between patch-based and primary closure techniques after carotid endarterectomy

ObjectiveThe aim of the study was to provide, by means of computational fluid dynamics, a comparative analysis after carotid endarterectomy (CEA) between patch graft (PG) and primary closure (PC) techniques performed in real carotid geometries to identify disturbed flow conditions potentially involved in the development of restenosis. MethodsEight carotid geometries in seven asymptomatic patients who underwent CEA were analyzed. In six cases (A-F), CEA was performed using PG closure; in two cases (G and H), PC was performed. Three-dimensional carotid geometries, derived from postoperative magnetic resonance angiography, were reconstructed, and a computational fluid dynamics analysis was performed. A virtual scenario with PC closure was designed in patients in whom PG was originally inserted and vice versa. This allowed us to compare for each patient hemodynamic effects in the PG and PC scenarios in terms of oscillatory shear index (OSI) and relative residence time (RRT), considered indicators of disturbed flow. ResultsFor the six original PG cases, the mean averaged-in-space OSI was 0.07 ± 0.01 for PG and 0.03 ± 0.02 for virtual-PC (difference, 0.04 ± 0.01; P = .0016). The mean of the percentage of area (%A) with OSI >0.2 resulted in 10.08% ± 3.38% for PG and 3.80% ± 3.22% for virtual-PC (difference, 6.28 ± 1.91; P = .008). For the same cases, the mean of the averaged-in-space RRT resulted in 5.48 ± 3.40 1/Pa for PG and 2.62 ± 1.12 1/Pa for virtual-PC (difference, 2.87 ± 1.46; P = .097). The mean of %A RRT >4.0 1/Pa resulted in 26.53% ± 12.98% for PG and 9.95% ± 6.53% for virtual-PC (difference, 16.58 ± 5.93; P = .025). For the two original PC cases, the averaged-in-space OSIs were 0.02 and 0.04 for PC and 0.03 and 0.02 for virtual-PG; the %A OSIs >0.2 were 0.9% and 7.6% for PC and 3.0% and 2.2% for virtual-PG; the averaged-in-space RRTs were 1.8 and 2.0 1/Pa for PC and 2.9 and 1.9 1/Pa for virtual-PG; the %A RRTs >4.0 1/Pa were 6.8% and 9.8% for PC and 9.4% and 6.2% for virtual-PG. These results revealed generally higher disturbed flows in the PG configurations with respect to the PC ones. ConclusionsOSI and RRT values were generally higher in PG cases with respect to PC, especially for high carotids or when the arteriotomy is mainly at the bulb region. Thus, an elective use of patch should be considered to prevent disturbed flows.

Aqueous Drainage Device Erosion: A Review of Rates, Risks, Prevention, and Repair

ABSTRACT Aqueous drainage device tube erosions require prompt intervention to prevent endophthalmitis. As the use of drainage devices in glaucoma surgery continues to increase, recognizing and managing tube erosions is a pertinent issue. This review provides a comprehensive overview of tube erosions, including the rates of erosion with various types of patch grafts, the risk factors associated with erosion, and approaches to repair in order to counsel and treat our patients to prevent endophthalmitis.