Predictable Surgical Results Research Articles

A modified protocol merging two published techniques for computer guided zygomatic implants surgery: a technical note

ObjectivesZygomatic implant surgery can be difficult due to the limited intraoperative visibility of the surgical field and the complex anatomy of the zygomatic bone, which could lead to serious complications. This study aims to assess the accuracy of zygomatic implants placement using computer-guided surgical templates.Materials and methodsA total of 13 zygomatic implants were placed in four participants. Double-sleeve drill guides were used with the help of computer-guided surgical templates designed with a lateral window. The accuracy was evaluated by measuring the linear deviations regarding the implants’ platforms and apices’ positions in addition to the angular deviations. Moreover, deviations of both implants from three fixed planes of space were measured.ResultsThe mean linear deviation at platforms was 2.44 mm ± 1.57 and at the apices 2.32 mm ± 1 while the mean angular deviation was 3.6˚ ± 1.92. Differences at the entry points were 0.43 ± 1.79 mm, 0.39 ± 1.12 mm, and − 0.54 ± 2.00 mm from the mid-sagittal, horizontal, and coronal planes respectively. Differences at the exit points were − 0.75 ± 1.25 mm, -0.06 ± 1.09 mm, and 0.63 ± 1.24 mm from the same planes respectively. Within all planes, there was no statistically significant difference.ConclusionGiven the limitations of this study, the use of the computer-guided surgical templates augmented by the double sleeve drill guides allowed favorable control over the tip of the long surgical drill away from vital structures during the zygomatic implant osteotomy. It also allowed control over alveolar crest osteotomy and its placement in a favorable prosthetic position. Overall, this protocol should be considered for further research and improvement to allow more predictable surgical outcomes while preventing the occurrence of complications. Before conducting this study, the protocol was reviewed and approved by the Research Ethical Committee of Faculty of Dentistry, Ain Shams University in meeting no. (105), on 15th of July 2020 with the application no.: (FDASU-RecD072029).

Digital planning for two-implant-supported overdenture and bone reduction guide using cone-beam computed tomography: Simple features for predictable outcomes.

The two-implant-supported mandibular overdenture is considered a reliable treatment option to restore masticatory function. Digital planning has been shown to improve the precision and accuracy of the surgical procedure. The outcomes are indeed pertinent to the ideal three-dimentionalpositioning of the implant placement. Recently, the uses of cone-beam computed tomography (CBCT) and intraoral scan have improved greatly the workflow of digital planning; however, the sophisticated technology caused confusion among clinicians. The purpose of this case series was to exhibit the efficacy of a bone-supported guide in applying simultaneous implant placement and bone reduction, solely based on CBCT data. The bone reduction can therefore be determined accordingly, by adding windows to the guide, allowing the clinician to decide the amount of bone reduction as well as the location for implant placement. This novel surgical guide would not only fit properly on the bone but also providethe benefits of less-invasive surgery and the opportunity to place implants parallel. The digital workflow described not only simplifies the fabrication process but also yields predictable surgical outcomes.

Thermal damage and excision time of micro and super pulsed diode lasers: A comparative ex vivo analysis.

The primary aim of this ex vivo study was to evaluate thermal damage and cutting efficiency of micro and super pulsed diode lasers. The secondary aim was to suggest a guideline to perform simple surgical excisions adequate for histopathological evaluation. Ten groups of 10 specimens of pig tongues were excised using a blade (G1), a micro pulsed (G2-G9), and a super pulsed diode (G10) lasers. Different output power, pulse duration, pulse interval, and duty cycle were tested. Quantitative measures of thermal damage and excision times were recorded. Statistical analysis was performed at a significance level of 5%. The control group (G1) presented no thermal damage. Within the laser groups (G2-G10), no statistically significant differences in depth of thermal damage (µm) were noted. G3 showed significantly less area of thermal damage (mm2 ) when compared with G7 and G9 (p < .05). The median excision time of the control group and super pulsed diode laser group were significantly lower (p < .001) than the micro pulsed diode laser groups. The cutting efficiency of the super pulsed diode laser is comparable to traditional blade, and with appropriate parameters, these lasers can produce predictable surgical outcomes with less collateral damage.

Clinical Validation of a Novel Musculoskeletal Modeling Framework to Predict Postoperative Sagittal Alignment.

A retrospective radiographic and biomechanical analysis of 108 thoracolumbar fusion patients from two clinical centers. This study aimed to determine the validity of a computational framework for predicting postoperative patient posture based on preoperative imaging and surgical data in a large clinical sample. Short-term and long-term studies on thoracolumbar fusion patients have discussed that a preoperative predictive model would benefit surgical planning and improve patient outcomes. Clinical studies have shown that postoperative alignment changes at the pelvis and intact spine levels may negatively affect postural balance and quality of life. However, it remains challenging to predict such changes preoperatively because of confounding surgical and patient factors. Patient-specific musculoskeletal models incorporated weight, height, body mass index, age, pathology-associated muscle strength, preoperative sagittal alignment, and surgical treatment details. The sagittal alignment parameters predicted by the simulations were compared with those observed radiographically at a minimum of three months after surgery. Pearson correlation coefficients ranged from r=0.86 to 0.95, and mean errors ranged from 4.1° to 5.6°. The predictive accuracies for postoperative spinopelvic malalignment (pelvic incidence minus lumbar lordosis>10°) and sagittal imbalance parameters (TPA>14°, T9PA>7.4°, or LPA>7.2°) were between 81% and 94%. Patients treated with long fusion (greater than five segments) had relatively lower prediction errors for lumbar lordosis and spinopelvic mismatch than those in the local and short groups. The overall model performance with long constructs was superior to those of the local (one to two segments) and short (three to four segments) fusion cases. The clinical framework is a promising tool in development to enhance clinical judgment and to help design treatment strategies for predictable surgical outcomes. 3.

Surgical - orthodontic planning of complex cases through the use of 3D models: A case report

Stereolithographic models are three-dimensional reproductions of digital data, created using CAD-CAM software. In recent years, the use of these three-dimensional models has increased as an aid in orthodontic diagnostics and in the planning of oral and maxillofacial surgery [1]. Unlike conventional diagnostic imaging techniques, such as Orthopanoramic radiographs and Cone-Beam CT (CBCT), which provide valuable digital information on bone size and geometry, stereolithographic models exhibit a physical three-dimensional reproduction of the anatomical area of interest with maximum accuracy. These truly guide both the diagnosis process and the surgical operation itself, in order to improve preoperative planning and minimize operative and postoperative morbidity. For the reproduction of these models, a CBCT scan is necessary. Through a 3D printing software, the data is converted into a stereolithographic model in scale. It is produced with transparent resin for better visualization of the bone structures and internal anatomical structures involved, such as the path of the inferior alveolar nerve or, as in this case report, the presence of dental elements totally impacted in the bone [2,3]. The use of these three-dimensional models has demonstrated a series of advantages such as a more accurate planning both orthodontic and surgical treatment, a significant reduction of operating times, a reduction in the time of exposure of the wound, better communication with colleagues and patients and more predictable surgical results [1]. Toothimpaction is defined as the failed eruption of a tooth, which remains embedded in the maxillary or mandibular bone after its period of physiological eruption. It can be partial or total and it most commonly happensto third molars, especially mandibular wisdom teeth, followed by the maxillary canines. Unlike the third molars, the maxillary canines constitute dental elements of great functional importance. They play agreat role of control in the movements of mandibular excursion. According to the classification of included maxillary canines by Yamamoto et al. there are 7 types (Figure 1), with the first three types showing more predictable results in the surgical orthodontic treatment and the following four types considered untreatable with orthodontic anchorage [4].

Patient-Related Risk Factors for Maxillary Sinus Augmentation Procedures: A Systematic Literature Review.

The posterior maxilla has traditionally presented a challenge for successful placement of dental implants due to a combination of poor bone quality, ridge atrophy, and pneumatization of the sinus floor following tooth extraction. However, with the successful and predictable surgical outcomes reported in the literature, more clinicians and patients are choosing an implant-supported restoration in the edentulous posterior maxilla. Consequently, sinus elevation and augmentation have gained more popularity. Extensive research has been conducted on types of bone graft materials and implants, less-invasive techniques to perform sinus augmentation, and timing for implant placement for sinus grafting. Despite the predictability of the techniques and biomaterials employed in sinus grafting procedures, intra- and postoperative complications are common. Much of the current literature discusses the local risk factors related to sinus augmentation, with few studies focusing on the patient-related risk factors. The purpose of this review is to identify, evaluate, and discuss the possible management of patient-related risk factors to allow for more predictable maxillary sinus floor augmentation outcomes.

Long-term surgical outcomes of levator resection in patients with Marcus-Gunn jaw-winking ptosis

ABSTRACT Purpose To report long-term surgical outcomes of a series of MGJWS patients with moderate ptosis who underwent levator resection. Materials and Methods A retrospective review of medical records of 10 MGJWS patients with moderate ptosis who underwent levator resection was performed in two major eye centers in Riyadh, Saudi Arabia from January 1987 to December 2019. Clinical features, pre-operative and post-operative data of the 10 patients were recorded. Outcome Measures Long-term upper eyelid position. Results The mean patient age at presentation was 5.4 years. Seven patients were female and three were male. All patients had moderate ptosis with marginal reflex distance ranged from 1 to 2 mm. The mean age at surgery was 9.5 years. After initial good ptosis correction for all patients, seven of them had a recurrence of ptosis several months after levator resection. Conclusions Levator resection in MGJWS patients with moderate ptosis and good levator function is associated with a high rate of ptosis recurrence and less predictable surgical results.

High-Frequency Hubs of the Ictal Cross-Frequency Coupling Network Predict Surgical Outcome in Epilepsy Patients.

Seizure generation is thought to be a process driven by epileptogenic networks; thus, network analysis tools can help determine the efficacy of epilepsy treatment. Studies have suggested that low-frequency (LF) to high-frequency (HF) cross-frequency coupling (CFC) is a useful biomarker for localizing epileptogenic tissues. However, it remains unclear whether the LF or HF coordinated CFC network hubs are more critical in determining the treatment outcome. We hypothesize that HF hubs are primarily responsible for seizure dynamics. Stereo-electroencephalography (SEEG) recordings of 36 seizures from 16 intractable epilepsy patients were analyzed. We propose a new approach to model the temporal-spatial-spectral dynamics of CFC networks. Graph measures are then used to characterize the HF and LF hubs. In the patient group with Engel Class (EC) I outcome, the strength of HF hubs was significantly higher inside the resected regions during the early and middle stages of seizure, while such a significant difference was not observed in the EC III group and only for the early stage in the EC II group. For the LF hubs, a significant difference was identified at the late stage and only in the EC I group. Our findings suggest that HF hubs increase at early and middle stages of the ictal interval while LF hubs increase activity at the late stages. In addition, HF hubs can predict treatment outcomes more precisely, compared to the LF hubs of the CFC network. The proposed method promises to identify more accurate targets for surgical interventions or neuromodulation therapies.

Evaluation of Bone Remodeling After Simultaneous Sagittal Split Ramus Osteotomy and Mandibular Angle Ostectomy in Patients With Mandibular Prognathism

The present study assessed the postoperative bone remodeling after simultaneous sagittal split ramus osteotomy (SSRO) and mandibular angle ostectomy using a 3-dimensional analysis of computed tomography (CT) data. We designed and implemented a retrospective study that included patients who had undergone SSRO with (study group) or without (control group) mandibular angle ostectomy. Using CT data taken immediately after (T1) and 6months (T2) after surgery, the vertical and horizontal morphologic changes of the mandibular angle were evaluated and compared between the 2 groups. In the study group, the volumetric changes of the mandibular angle were assessed, and the bone regeneration rate was calculated. A total of 58 mandibular angles were evaluated (32 in the study group and 26 in the control group). The study group exhibited significantly greater vertical bone regrowth at the middle and posterior regions of the mandibular angle ostectomy line compared with that in the control group (middle, P<.001; posterior, P<.001). Both groups showed significant horizontal bone regrowth at 6months postoperatively (P<.01). In the study group, the postoperative vertical bone regrowth was significantly associated with the extent of exposed bone below the angle ostectomy line at T1 for all regions (P<.001). The percentage of postoperative regenerated bone volume relative to the volume of bone removed intraoperatively was 41.8%. The present findings suggest that significant bone regrowth could occur after mandibular angle ostectomy with simultaneous SSRO. Therefore, it is necessary to consider bone remodeling patterns in the treatment planning stage for better and more predictable surgical outcomes.

A Novel Prosthetically Driven Workflow Using Zygomatic Implants: The Restoratively Aimed Zygomatic Implant Routine

Zygomatic implants present a unique treatment option for patients with severe resorption of the maxilla; however, palatally positioned zygomatic implant platforms will result in a significant buccopalatal cantilever, speech disturbances, and unhygienic prosthesis contours. The purpose of the present study was to introduce a novel preoperative workflow to help attain predictable surgical and prosthetic outcomes with zygomatic implants. To minimize prosthetic complications, an appropriate preoperative workup is imperative. A restoratively driven approach commonly used in traditional intra-alveolar implant dentistry has been adapted for zygomatic implant rehabilitation and described in the present report. With zygomatic implants, applying a prosthetically driven approach is possible. However, it involves a unique application of traditional biomechanical and soft tissue principles of implant dentistry and digital integration of the prosthetic and surgical treatment plans. Striving to attain zygomatic implant platforms as close as possible to the central fossae and cingulum of prosthetic teeth should be the goal when placing zygomatic implants. The restoratively aimed zygomatic implant routine introduced in the present report is a progressive and modern approach to prosthetically driven implant rehabilitation.

“Three-dimensional evaluation of breast volume changes following autologous free flap breast reconstruction over six months”

ObjectivesTo date, little is known about postoperative changes in breast volume after autologous breast reconstruction. The purpose of this retrospective study was to investigate breast volume changes following autologous free flap reconstruction and the factors affecting flap volume. Materials and methodsPatients who underwent deep inferior epigastric perforator, superficial inferior epigastric artery and profunda artery perforator flaps between December 2016 and January 2019 were included. Exclusion criteria were breast complications requiring surgical debridement, and the absence of at least two suitable three-dimensional images postoperatively. Three-dimensional stereophotogrammetry volume measurements were performed at the time of standard surgical check-ups. Changes in breast volume were modeled using a quartic polynomial curve function in a nested mixed effects model. Results136 breasts in 101 patients were included. An average decrease of predicted breast volume was found from 637.8 cc (95%-CI [624.4, 651.1]) at two weeks to 566.6 cc (95%-CI [535.1, 598.0]) after three and 567.6 cc (95%-CI [515.9, 617.6]) after six months postoperatively. Reconstruction timing and first postoperatively measured breast volume showed a statistically significant difference in initial reconstructed breast volume and in the shape of the relationship between time and breast volume, whereas autologous technique and BMI only showed a statistically significant difference in initial reconstructed volume and mastectomy indication in the shape of the relationship. ConclusionThe final overall flap volume decreased to 88.9% of its original volume after six months. Gaining more insight into the factors influencing flap volume is of crucial importance to facilitate predictable surgical outcomes.

Intraocular correction of ametropia in patients with keratoconus

This review was conducted due to the growing number of patients with keratoconus requiring cataract surgery and the complexity of surgical planning. The article reviews preoperative planning, intraoperative options, and postoperative management, which can help obtain high functional results. Treatment of cataracts in keratoconic eyes requires a multifaceted approach. In some cases, in the preoperative period, interventions such as crosslinking and implantation of intrastromal segments or corneal ring may be required to ensure stable keratometry values for accurate intraocular lens (IOL) calculations. The use of stabilizing procedures prior to optical biometrics can assist in preoperative lens selection and provide predictable surgical outcomes. To achieve targeted refraction and reduce unwanted optical effects, it is necessary to take a critical approach when choosing the type of lens (toric, monofocal). This is due to the appearance of aberrations of different order after preliminary surgical interventions on the cornea. The intraoperative decision plays important role in choosing the position of the corneal incisions, how to use sutures for wound adaptation, choosing scleral approaches to minimize possible postoperative complications. In the postoperative period, the degree of irregular astigmatism and the need for rigid gas-permeable or scleral lenses should be assessed.

Bone Augmentation Techniques for Horizontal and Vertical Alveolar Ridge Deficiency in Oral Implantology.

Bone deficiency is the major obstacle in implant dentistry. Guided bone regeneration (GBR) with particulate bone and barrier membranes has been the primary surgical technique used to regenerate alveolar bone for dental implant therapy. This procedure has been used in implant dentistry for more than 30years and continues to be developed and refined for more predictable surgical outcomes. This article reviews GBR and alternative ride expansion procedures and reviews the use of various particulate graft materials. Alveolar distraction osteogenesis, used as an augmentation technique, is also presented.

Treatment Planning for Periimplant Mucositis and Periimplantitis.

A literature search was performed in a number of health care databases for articles published until January 2018. A number of anatomical factors, risk indicators, possible aesthetic complications, and financial implications have to be taken into consideration before treatment commences. When diagnosed early, periimplant mucositis is a problem that can be easily managed as long as the patient is motivated and maintains good levels of oral hygiene. Periimplantitis is more difficult to treat and results can be unpredictable. Nonsurgical therapy has limited effectiveness on the treatment of periimplantitis, but it should always precede a surgical intervention. Clinically predictable surgical outcomes seem to rely mainly on the configuration of the bone defect, the position of the affected implant, and the patient's ability to perform good oral hygiene. Thorough treatment planning of periimplant diseases is paramount for the success of the treatment that follows. Local and general factors as well as patients' expectations have to be considered before proceeding, but treatment planning should also allow for a degree of flexibility, which will accommodate the unknown parameters.

Cataract surgery in eyes with keratoconus: a review of the current literature.

There are an increasing number of keratoconic eyes, requiring cataract surgery. We review the preoperative planning, intraoperative options, and postoperative management that aid in successful outcomes. Management of keratoconic eyes requiring cataract surgery requires a multifaceted approach. Preoperatively, corneal crosslinking and intrastromal corneal ring segments can be considered in order to provide stable keratometry values for intraocular lens (IOL) calculations. Deciding between toric and monofocal IOLs requires a thorough evaluation. Intraoperatively, the decision of clear corneal incisions with or without sutures versus scleral incisions is important to mitigate postoperative complications. Postoperatively, irregular astigmatism should be evaluated and updated rigid gas permeable or scleral lenses provided. Patients needing irregular astigmatism correction postoperatively should not have toric IOL implantation; however, in select cases of keratoconus, it is an option. The use of stabilizing procedures prior to optical biometry can aid in preoperative lens selection and provide predictable surgical outcomes. Decisions on intraoperative wound construction and toric versus monofocal lenses should be based on the severity, regularity, and central nature of the keratoconus. Postoperative use of rigid gas permeable or scleral lenses can help patients achieve their best visual potential.

Physiology-Based Modeling May Predict Surgical Treatment Outcome for Obstructive Sleep Apnea.

To test whether the integration of both anatomical and nonanatomical parameters (ventilatory control, arousal threshold, muscle responsiveness) in a physiology-based model will improve the ability to predict outcomes after upper airway surgery for obstructive sleep apnea (OSA). In 31 patients who underwent upper airway surgery for OSA, loop gain and arousal threshold were calculated from preoperative polysomnography (PSG). Three models were compared: (1) a multiple regression based on an extensive list of PSG parameters alone; (2) a multivariate regression using PSG parameters plus PSG-derived estimates of loop gain, arousal threshold, and other trait surrogates; (3) a physiological model incorporating selected variables as surrogates of anatomical and nonanatomical traits important for OSA pathogenesis. Although preoperative loop gain was positively correlated with postoperative apnea-hypopnea index (AHI) (P = .008) and arousal threshold was negatively correlated (P = .011), in both model 1 and 2, the only significant variable was preoperative AHI, which explained 42% of the variance in postoperative AHI. In contrast, the physiological model (model 3), which included AHIREM (anatomy term), fraction of events that were hypopnea (arousal term), the ratio of AHIREM and AHINREM (muscle responsiveness term), loop gain, and central/mixed apnea index (control of breathing terms), was able to explain 61% of the variance in postoperative AHI. Although loop gain and arousal threshold are associated with residual AHI after surgery, only preoperative AHI was predictive using multivariate regression modeling. Instead, incorporating selected surrogates of physiological traits on the basis of OSA pathophysiology created a model that has more association with actual residual AHI. A commentary on this article appears in this issue on page 1023. ClinicalTrials.Gov; Title: The Impact of Sleep Apnea Treatment on Physiology Traits in Chinese Patients With Obstructive Sleep Apnea; Identifier: NCT02696629; URL: https://clinicaltrials.gov/show/NCT02696629.

Superiorly based nasolabial island flap for reconstruction of the lateral lower eyelid

Background/aim: Various flap procedures have been described and used for the lower eyelids; however, the nasolabial flap is rarely employed. We herein aimed to present the clinical results of using the superiorly based nasolabial island flap for repair of surgical defects extending to the lateral lower eyelid. Materials and methods: Nine patients with a mean age of 62 +- 6 years underwent surgery for reconstruction of the lower eyelid.Results: The diagnosis of lesions was nodular basal-cell carcinoma (n = 5), superficial basal-cell carcinoma (n = 1), well-differentiated squamous-cell carcinoma (n = 1), and basosquamous-cell carcinoma (n = 2). According to the classification reported by Spinelli and Jelks, 6 surgical defects were located at zones II and IV, while 3 were at zones II and V. Five patients required posterior lamellar reconstruction. Lagopthalmos (n = 1), ectropion (n = 1), and transient numbness of the ipsilateral upper lip (n = 1) were noted as postoperative complications. Conclusion: Despite the low number of patients, the present series demonstrated that lower eyelid defects involving zone IV or zone V can be repaired safely and reliably with the superiorly based nasolabial island flap, along with its use shown in the literature for zone II or zone III defects. The technique for raising the flap is fairly simple, with predictable surgical results. In addition, the superiorly based nasolabial island flap provides a reliable means of obtaining good wound healing with acceptable aesthetics, as well as functional results of both the donor site and reconstructed area.

SUVmax and Tumor Size Predict Surgical Outcome of Synchronous Multiple Primary Lung Cancers.

To assess surgical outcomes in synchronous multiple primary lung cancer (SMPLC) and correlations with clinicopathological features and prognostic/predictive factors.We retrospectively reviewed patients diagnosed with early-stage nonsmall cell lung cancer (NSCLC) between January 2006 and June 2012. In total, 564 patients with resectable NSCLC underwent a preoperative positron emission tomography-computed tomography scan followed by anatomic resection. We reviewed the clinical features of 35 SMPLC patients. Surgical outcomes, prognosis, and tumor imaging features were evaluated (median follow-up = 44 months).In total, 35 eligible SMPLC patients (6.21%) were identified (11 men [31%], 24 women [69%], mean age = 65 years]). The tumors were bilateral in 17 patients (49%) and in different lobes of the ipsilateral lung in 18 patients (51%). Most patients (26/35, 74%) had 2 primary tumors, and 26% (9/35) had more than 2 tumors (6 with 3 tumors; 3 with 4 tumors). The median size of the most advanced tumor was 3.0 cm (range 0.9–54). The median standard uptake value (SUV) of the largest tumor was 3.1 (range 1.0–13.3). The patients were treated as follows: 30 lobectomies, 2 sublobar resections, 2 sequential bilateral lobectomies, and 1 bi-lobectomy. Twenty-four patients (69%) received adjuvant therapy. The overall cumulative 5-year survival was 91.5% (median overall survival = 45.5 months). Patients with a reference tumor ≤ 3 cm and SUV ≤ 3.1 had an expected 5-year survival of 100%. Patients with a reference tumor > 3 cm and SUV > 3.1 had an expected 5-year survival rate of 53.3%.SMPLC patients can benefit from aggressive surgery. The size and SUVmax of the reference tumor may predict postoperative outcomes.

Standardization of surgical techniques used in facial bone contouring

Since the introduction of facial bone contouring surgery for cosmetic purposes, various surgical methods have been used to improve the aesthetics of facial contours. In general, by standardizing the surgical techniques, it is possible to decrease complication rates and achieve more predictable surgical outcomes, thereby increasing patient satisfaction. The technical strategies used by the author to standardize facial bone contouring procedures are introduced here. The author uses various pre-manufactured surgical tools and hardware for facial bone contouring. During a reduction malarplasty or genioplasty procedure, double-bladed reciprocating saws and pre-bent titanium plates customized for the zygomatic body, arch and chin are used. Various guarded oscillating saws are used for mandibular angloplasty. The use of double-bladed saws and pre-bent plates to perform reduction malarplasty reduces the chances of post-operative asymmetry or under- or overcorrection of the zygoma contours due to technical faults. Inferior alveolar nerve injury and post-operative jawline asymmetry or irregularity can be reduced by using a guarded saw during mandibular angloplasty. For genioplasty, final placement of the chin in accordance with preoperative quantitative analysis can be easily performed with pre-bent plates, and a double-bladed saw allows more procedural accuracy during osteotomies. Efforts by the surgeon to avoid unintentional faults are key to achieving satisfactory results and reducing the incidence of complications. The surgical techniques described in this study in conjunction with various in-house surgical tools and modified hardware can be used to standardize techniques to achieve aesthetically gratifying outcomes.

Femtosecond laser will not be a standard method for cataract extraction ten years from now

The femtosecond laser was recently introduced to cataract surgery in order to replace several highly successful and low risk manual surgical techniques with automated laser techniques. Despite the hope that femtosecond laser-assisted cataract surgery (FLACS) would lead to safer and more predictable surgical outcomes, the literature consistently demonstrates that FLACS has provided no advantage over standard phacoemulsification cataract surgery (SP). Yet, the disadvantages of FLACS as compared to SP are clear. FLACS is more expensive and time-consuming, may increase surgical complications during the surgeon's initial learning period, introduces unique risks due to the additional steps of laser docking and treatment, and is limited in its scope of use as compared to SP due to factors including small pupils and orbital anatomy. While FLACS may one day prove to be advantageous for a small subset of patients, such as those with corneal endothelial cell dysfunction or zonular instability, these patients have not been the targets of this technology, and FLACS will not become the standard technique for cataract extraction in the coming decade.