Combined Procedure Research Articles

Safety and efficacy profile of irrigating trabeculectomy (Trabectome®) in a Latin American population with moderate and advanced glaucoma.

To describe the mid-term safety and efficacy profile of Trabectome® in a Latin American cohort with moderate and advanced glaucoma. We conducted a retrospective consecutive case series of 42 eyes of 39 patients treated with Trabectome® ab interno irrigating trabeculectomy. A total of 29% were treated as combined procedures with cataract surgery. A total of 71% were categorized as moderate/advanced glaucoma. Success criteria A was defined as an intraocular pressure (IOP) reduction > 20%, 5 < IOP < 21 mmHg, no reoperation, no severe complications. More restrictive definitions of success were also applied for further analysis: B (5mmHg < IOP ≤ 18 mmHg, no reoperation, IOP reduction > 20%, no severe complications); C (5 mmHg < IOP ≤ 15 mmHg, no reoperation, IOP reduction ≥ 40%, no severe complications). Mean IOP dropped from 22.2 ± 8.0 down to 15.2 ± 3.7 mmHg (20.5 ± 12.7-months follow up, 30% reduction) (P < .0001). Success rates in the overall group were 71% (A), 62% (B), and 19% (C). Complications included intraoperative arterial hemorrhages in 2 cases (4.8%) and late blood reflux in another 2 (4.8%). Six eyes (14%) required reoperation due to treatment failure. A total of 21 eyes (50%) had baseline IOP levels ≥ 22 mmHg. In this subgroup, IOP dropped from 28.3 ± 5.5 down to 16.6 ± 3.0 (40% reduction) (P < .0001) and success rates were 81% (A), 62% (B) and 29% (C). Trabectome® is an effective and safe technique to lower IOP in this Latin American cohort representing the whole spectrum of disease severity and miscellaneous clinical scenarios.

Surgical intervention patterns and long-term survival of bicuspid aortic valve patients: community-based versus tertiary-referral cohorts

Abstract Background Bicuspid aortic valve(BAV) disease carries a cumulative lifetime morbidity &amp;gt;80%. This morbidity includes surgery for aortic valve dysfunction, aortic dilatation, infective endocarditis, and aortic dissection. This study assessed surgical intervention patterns for BAV-related morbidity and long-term survival of these patients in a community-based cohort versus a tertiary referral cohort. Methods The tertiary-referral cohort included all patients with BAV-related surgeries across Mayo Clinic sites (Arizona, Florida, and Minnesota), from January 1990 to May 2024. The community-based cohort included all patients with BAV-related surgeries in Olmsted County, Minnesota, from January 1980 to May 2024. The tertiary-referral cohort comprised 2529 BAV patients of which 991(39%) [mean age 53±15 years, 76% males] underwent aortic valve surgery(AVR), aorta surgery, or a combination thereof, while the community-based cohort included 652 BAV patients of whom 262(40%) [mean age 43±20 year, 70% males] had the mentioned interventions. Cumulative survival was calculated by Kaplan-Meier method compared to the U.S population. Statistical significance was evaluated using one-sample log rank statistics. Results In the tertiary-referral cohort, 530/991(54%) patients underwent isolated AVR, 62/991(6%) had isolated aortic surgery, and 399(40%) underwent combined procedures. In the community-based cohort, 179/262(68%) patients underwent isolated AVR, 30/262(11%) underwent isolated aortic surgery, and 53(21%) had combined surgeries. In the tertiary-referral cohort, 940 patients underwent AVR; 57% for aortic stenosis(AS), 29% for aortic regurgitation(AR), 13% for mixed valvular disease, and 1% for endocarditis. In comparison, in the community-based cohort, 236 patients underwent AVR for AS in 71%, AR 20%, mixed valvular disease 7%, and endocarditis 2%. In the tertiary-referral cohort, 459 patients underwent aortic surgery; 21% for the root, 69% for the ascending aorta, 1% for the arch, &amp;lt;1% for aortic dissection, and 8% for coarctation repair. In comparison, 105 patients from the community-based cohort underwent aortic surgery; 33% for the root, 44% for the ascending aorta, 1% for the arch, 4% for aortic dissection and 18% coarctation repair. Compared to age- and sex-matched U.S. population, the relative risk for all cause death in the tertiary-referral cohort was 0.89 [95% CI: 0.70-1.11, p=0.35], whereas in the community-based cohort was 1.06 [95% CI: 0.85-1.32, p=0.57](Figure1). Conclusion Surgical intervention patterns were similar for community and tertiary BAV cohorts, with most patients undergoing isolated AVR or AVR plus aortic surgery, and isolated aortic surgery being uncommon. AVR indications were driven by AS, followed by AR and mixed valvular disease. Aortic surgery indications were driven by ascending aorta dilatation, followed by root dilatation and coarctation. Survival in both cohorts was similar to the U.S. general population.

Robotic Versus Open Placement of Hepatic Artery Infusion Pumps.

A growing number of centers offer hepatic artery infusion pump (HAIP) chemotherapy for advanced liver malignancies. While small series have demonstrated feasibility of robotic HAIP placement, comparison of outcomes with open placement is lacking. We compared outcomes after robotic versus open HAIP placement. We retrospectively reviewed HAIP placement without concurrent hepatectomy at Memorial Sloan Kettering Cancer Center from 1 January 2011 to 15 September 2022, and Duke Health from 1 November 2018 to 18 May 2023. Patients with prior liver surgery or who required catheterization of a non-standard vessel were excluded. Propensity score matching weights (PSMW) were calculated using age, sex, race, body mass index, American Society of Anesthesiologists class, neoadjuvant chemotherapy, colorectal procedure, and institution. Survey-weighted generalized linear models assessed the relationship between approach and outcomes. Of 2002 consecutive HAIP placements, 819 (645 open/174 robotic) met the inclusion criteria. A higher proportion of open procedures involved combined colorectal procedures; other patient characteristics were similar. Overall, 15% of patients experienced an HAIP-specific complication and 12% required re-intervention; 2.7% had HAIP failure ≤ 90 days. After PSMW, the robotic approach had a longer operative time (β=68min, 95% confidence interval [CI] 55-81, p<0.001) but shorter length of stay (β=- 1.8 days, 95% CI - 2.3 to 1.3, p<0.001). The robotic approach was associated with increased HAIP-specific complications (odds ratio [OR] 1.72, p=0.025) and re-intervention (OR 2.33, p<0.001), with no difference in time to initiation of HAIP chemotherapy or HAIP failure. Robotic HAIP placement was associated with increased postoperative complications and significantly shorter length of stay, with similar time to initiation of HAIP therapy. There was no difference in the rate of early HAIP failure versus the open approach. These results suggest robotic HAIP placement is feasible and effective.

Addition of anal encirclement to perineal proctosigmoidectomy: a retrospective review

BackgroundThe optimal approach for the surgical management of rectal prolapse is individualized based on anatomical, functional, and surgical factors. In patients with significant comorbidities, perineal approaches are often preferred even though they are associated with higher recurrence rates compared to an abdominal approach. Although anal encirclement was one of the first procedures described for this condition, it is seldom employed given its high recurrence rates. There is currently a lack of data addressing a combination surgery, wherein both a perineal proctosigmoidectomy and anal encirclement are performed simultaneously.AimsTo evaluate the efficacy of combining perineal proctosigmoidectomy with anal encirclement using Nylon sutures compared to perineal proctosigmoidectomy alone.MethodsThis was a single institution, non-randomized, retrospective study conducted at the Royal University Hospital, Saskatoon, Saskatchewan, Canada (July 2017 to October 2022). Patients over the age of 18 with full-thickness rectal prolapse who underwent either perineal proctosigmoidectomy alone or perineal proctosigmoidectomy with anal encirclement were included. There were 23 patients in the perineal proctosigmoidectomy group and 21 patients in the perineal proctosigmoidectomy with anal encirclement group. The primary outcome was prolapse recurrence. Secondary outcomes included operative time, length of hospital stay, and post-operative complications.ResultsPatients who received perineal proctosigmoidectomy with anal encirclement had significantly lower rates of recurrent prolapse (9.5%) compared to perineal proctosigmoidectomy alone (34.8%) (p = 0.02). Patients who underwent the combined procedure had a shorter length of stay by 2.3 days (p = 0.03). There was no difference in post-operative complications or operating time.ConclusionsRoutine anal encirclement in perineal proctosigmoidectomy reduces recurrence rates and length of stay without increasing operating time or complications.

Echocardiography evaluation of iatrogenic atrial septal defect after combined procedure of catheter ablation and left atrial appendage closure for atrial fibrillation

Using transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) to investigate the occurrence and related causes of iatrogenic atrial septal defect (iASD) after catheter ablation combined with left atrial appendage closure (LAAC) for atrial fibrillation (AF) and its impact on the right heart system. We retrospectively analyzed 330 patients that underwent combined procedure of catheter ablation for AF and LAAC at General Hospital of Northern Theater Command from January 2018 to March 2022. These patients were divided into iASD group and non-iASD group according to whether there was persistent iASD shown on TEE at 3 months after procedure. There were 96 (29.1%) patients with iASD and 234 patients without in the TEE follow up at 3 months post-operation. Patients with iASD had larger left atrial volumes (76.5 ± 35.2 ml vs. 61.1 ± 21.9 ml, p = 0.036) as well as higher occurrence of mitral regurgitation (MR) (32.3% vs. 12.8%, p = 0.018) and tricuspid regurgitation (TR) (27.1% vs. 7.3%, p = 0.002). Procedural features showed that patients with persistent iASD had longer procedure time (92.1 ± 36.3 vs. 69.1 ± 17.8 min, p = 0.003) and larger sheath sizes (4.1 ± 1.2 mm vs. 3.3 ± 1.2 mm, p = 0.022). The preoperative and postoperative right heart parameters of patients in the persistent iASD group were compared, and there were no significant differences on right atrial/ventricular diameter, right heart systolic/diastolic function and pulmonary artery pressure (P > 0.05). The occurrence of iASD 3 months after combined atrial fibrillation ablation and LAAC was 29.1%. The size of left atrium, the pressure of left atrium, the manipulation time within left atrium, the size of sheath, and the use of ICE during operation was related to the closure of iASD.

"MINIMIZING THIGHPLASTY COMPLICATIONS: A COMBINED APPROACH OF J MEDIAL PATTERN AND HELIUM-PLASMA ASSISTED LIPOSCULPTURE".

Thighplasty is a widely performed body contouring procedure, utilizing various surgical techniques for thigh lifting, including medial scar positioning, vertical and horizontal procedures, and liposuction. Despite its popularity, thighplasty is associated with high complication rates and suboptimal postoperative outcomes.This article presents a novel technique: the J medial thighplasty combined with helium plasma radiofrequency technology (HPRF) to address moderate skin and soft-tissue laxity and ptosis in the inner thighs. Between 2020 and 2023, 21 patients underwent this combined procedure. The surgical approach involved selective liposuction in targeted areas, skin resection, and preservation of deep tissue layers, coupled with the application of HPRF in the lower third of the medial thigh.Results demonstrated significant reductions in thigh laxity, correction of skin overhang, and fat reduction, yielding improved functional and aesthetic outcomes in the lower thigh region. By strategically avoiding lymphatic vessels in superficial areas, the risk of secondary lymphedema was minimized. Patient satisfaction was notably high, with both patients and surgeons reporting favorable results.In conclusion, the J medial thighplasty combined with HPRF offers an effective and straightforward method for enhancing the lower thigh area with minimal complications. This innovative technique provides a promising solution for patients seeking improved thigh contouring while ensuring high levels of patient satisfaction.

Lucia Keratoprosthesis in a Sclerocorneal Graft for Recurrent Graft Rejection Secondary to Herpetic Keratitis.

To report the surgical approach of a Lucia keratoprosthesis (KPro) on a sclerocorneal graft in the setting of recurrent graft rejection and perilimbal scleral thinning. A case report. We report the case of a 26-year-old man with a history of herpes simplex keratitis, 2 penetrating keratoplasties, graft failure, secondary glaucoma, and a conjunctival flap in the right eye who underwent a Lucia KPro, lens extraction, glaucoma drainage device, and pars plana vitrectomy. The surgery involved releasing the conjunctival flap, revealing severe perilimbal scleral thinning. The use of a sclerocorneal graft to mount the Lucia KPro allowed an effective combined procedure by providing a healthy sclera. At the last follow-up (34 months), the patient had retained the Lucia KPro and had a best-corrected visual acuity of 20/400. The Lucia KPro on a sclerocorneal graft may be a viable option to provide healthy sclera in patients requiring combined KPro surgery.

When a Road Traffic Accident Reveals an Intravitreal Cyst: A Case Report

Vitreous cysts, whether congenital or acquired, are rare ocular malformations. We report the case of a 70- year-old patient who sustained multiple traumas following a severe road traffic accident. Brain magnetic resonance imaging revealed an intravitreal cyst associated with intravitreal hemorrhage and a subluxated left lens. The remaining findings were unremarkable. Two months later, a combined procedure involving phacoemulsification, vitrectomy, and implantation of a posterior iris-claw intraocular lens was performed. Histopathological analysis of the cyst identified a ciliary epithelial cyst with no evidence of malignancy. Postoperatively, the patient’s visual acuity improved significantly, from hand motion to 10/10. Pigmented or non-pigmented vitreous cysts are exceptionally rare and originate from the pars ciliaris or the hyaloid system. They are often asymptomatic and incidentally discovered, requiring no specific treatment. Management of vitreous cysts should be undertaken with caution and tailored to the clinical indications.

CXL: Challenges and updates

Corneal cross‐linking (CXL) is a critical treatment for keratoconus that combines UVA light and riboflavin (vitamin B2). This procedure received FDA approval in 2016 based on studies by Sykakis et al. (2015) which indicated that CXL could stabilize keratoconus, prevent myopia progression, and improve uncorrected distance visual acuity (UDVA). Despite the promising results, the studies had potential biases and a low number of randomized controlled trials (RCTs).The two primary methods of CXL are epithelium‐off (epi‐off) and epithelium‐on (epi‐on or transepithelial). Epi‐off CXL involves removing the corneal epithelium to allow riboflavin penetration, whereas epi‐on CXL retains the epithelium, reducing patient discomfort but potentially being less effective. NG et al. (2021) found no significant difference in outcomes between these methods, though epi‐on showed fewer side effects such as corneal haze.Accelerated CXL protocols have been developed to increase efficiency. Karam et al. (2023) compared these protocols, revealing that a 10‐minute protocol with 9 mW/cm2 UVA exposure provided better outcomes than a 5‐minute protocol with 18 mW/cm2. Accelerated methods are becoming more common due to their reduced treatment time.In pediatric cases, both conventional and accelerated CXL are effective, although the transepithelial method had a lesser impact, as concluded by Mahdavi Fard et al. (2020). Additionally, combined procedures known as CXL+ integrate CXL with other treatments like laser ablation. The Athens Protocol, developed by Dr. Kanellopoulos, combines topography‐guided laser ablation with CXL to address irregular astigmatism and coma in keratoconus patients.New riboflavin formulations and delivery methods, such as isotonic riboflavin and iontophoresis, have been developed to enhance riboflavin penetration and effectiveness. Glaukos' (Avedro) Mosaic System and the "sub400" protocol for ultrathin corneas are notable advancements, offering customized treatments based on individual corneal characteristics.

Combined cardiac procedures and orthotopic liver transplant in the era of machine perfusion

Combined cardiac procedures and orthotopic liver transplant in the era of machine perfusion

A Combination of Conventional Transconjunctival Lower Blepharoplasty and Percutaneous Nanofat Grafting in a Young Chinese Population With Eyelid Bags and Tear Trough Deformities.

A simple and minimally invasive combined procedure, including transconjunctival orbital fat removal and transcutaneous resected orbital fat injection, was performed based on the anatomical characteristics of the lower eyelids in our young Chinese patients. Our study aimed to investigate the efficacy and safety of this procedure in our study population. In our retrospective study, a total of 183 consecutive patients underwent a combination of traditional transconjunctival blepharoplasty and nanofat grafting between February 2020 and June 2024. After transconjunctival septal fat removal, the resected orbital fat was processed into fat emulsion (nanofat) and then injected percutaneously into the depressed tear trough zone. The mean age of the 183 patients was 26.9 years old, and the average surgery time was 36.1 min. The mean volume of nanofat injected for bilateral lower eyelids in each patient was 1.1 mL. All the patients were followed for at least 6 months after surgery, and the subjective patient satisfaction was 96.6% (175/183) with fewer complications. In the objective assessment of the surgical outcomes according to the five anatomical elements of lower eyelids, orbital fat prolapse, tear trough depression and dark circles were all improved, orbicularis prominence was more evident, while skin elasticity did not vary significantly after operation. Our study provided a simple, effective, and safe combination of transconjunctival lower blepharoplasty and percutaneous nanofat grafting for the treatment of lower eyelid bags with high patient satisfaction, quick recovery and low complication rate. Thus, this combined application may be a promising alternative choice for the young Chinese with lower eyelid bags.

Recurrent anterior dislocation of radial head treated with ulnar distraction osteotomy and reconstruction of annular ligament using palmaris longus tendon with bioabsorbable screw anchoring: A case report

Introduction: Radial head dislocation in children may be either congenital, an isolated injury or more commonly part of a complex injury to the elbow. Isolated traumatic radial head dislocation in children is a rare and easily missed condition.The reported case shows various treatment and intervention with ulnar osteotomy and annular ligament reconstruction in order to reach the definitive reduction of recurrent dislocation of radial head. Case Presentation: Male 9 years old with anterior dislocation of the radial head, came with difficulty on flexing his elbow due to bony prominence on his anterior elbow. He had recurrent radial head dislocation with redundant annular ligament. From the physical examination there was a prominent radial head on anterior region of elbow. From x-ray examination we found anterior dislocation of ulnar head without any fracture or deformity of ulna. Patient underwent ulnar distraction osteotomy to achieve radial traction and allow stable reduction of radial head. After 5 months he had reconstruction of annular ligament with palmaris longus tendon graft and anchoring with bioabsorbable screw in order to reduce and stabilize the radial head. Conclusion: In this case we found ulnar osteotomy may gave improvement for the reduction of the radial head. But additional annular ligament reconstruction give stability of the radial head which will held in place with full range of motion of the elbow. So this combined procedures hopefully can gave best achievement and satisfactory results of the children and last a lifetime.

The effect of arthroscopic Bankart repair and remplissage procedure on joint range of motion and functional outcomes in anterior shoulder instability.

This study aimed to investigate the e!ect of arthroscopic Bankart repair (ABR) alone and ABR with an additional remplissage procedure on joint range of motion and functional results in patients with anterior shoulder instability. This retrospective study included patients treated 1 year ago with either ABR alone or the ABR additional remplissage procedure. The Bankart lesion was determined by magnetic resonance imaging, and the amount of glenoid bone loss was determined by computed tomography. Patients with glenoid bone loss <25% and on-track Hill-Sachs lesions (HSLs) were treated with ABR alone (22 females, 8 males; mean age=27.4 ± 6.4 years). Those with o!-track HSL were treated with both ABR and remplissage (20 females, 10 males; mean age=27.5 ± 5.3 years). One year after surgical treatment, the joint range of motion of the patients was determined by a universal goniometer, and functional status was evaluated using the Rowe score. Sixty shoulders of 60 patients were evaluated over an average period of 1 year. There was no di!erence between groups regarding age (P=.767) and gender (P=.779). There were 42 female and 18 male patients, with a mean age=27.5 ± 5.8 years. There was a significant di!erence between the groups in patients' external rotation with arm adduction (ER1) (P=.001), external rotation with arm abduction (ER2) (P=.001), forward flexion (P=.001), and abduction (P=.001) measurements between the groups (P < .05). No significant di!erence was found in internal rotation and Rowe scores between the groups (P=.057, P=.069). A greater improvement was seen in the Rowe score of the ABR+remplissage group (85.2 ± 8.8). No recurrence or complications were observed in any of the patients. The combined procedure of ABR with remplissage may limit joint mobility in patients with anterior shoulder instability. However, it provides satisfactory functional results, with patients in the ABR+remplissage group showing better overall outcomes. Level III, Therapeutic study.

3-Step Combined Technique for Correction of Involutional Lower Eyelid Ectropion: A Case Series

Background: Involutional lower eyelid ectropion is a common disorder of the elderly population. Several surgical approaches have been described in the literature to address the multifactorial nature of this condition, each targeting different factors contributing to its development. Nevertheless, no single procedure has proven to be superior to the others. This study aims to assess the safety and effectiveness of a new 3-step combined technique in treating involutional ectropion. Methods: The surgical technique consists of a combination of lateral lid-shortening with removal of a base-up triangle (modified Bick procedure), lower eyelid skin release, and transposition of a laterally based myocutaneous flap from the upper eyelid. A retrospective chart review was conducted for all patients treated with this procedure at our institution between 2012 and 2023 was performed. Self-reported patient satisfaction with functional and esthetic outcomes was evaluated three months after surgery. Results: A total of thirty-six patients (forty-five eyelids) were included in the study, with a mean follow-up period of 22 months (range 3–144). Minor surgical revision was performed in one case for early wound dehiscence following premature stitches removal. The overall success rate was 93.2%, with one case of undercorrection and two cases of recurrence recorded at three years postoperatively. No additional complications or recurrences were observed during the follow-up period. Conclusions: The 3-step combined procedure demonstrated high efficacy and safety, offering excellent functional and esthetic outcomes. This approach provides a reliable solution for treating involutional ectropion, making it a valuable addition to the surgical options for this condition.

Non-destructive inspection of interfacial debonding in concrete-filled steel tube bridges

ABSTRACT Concrete-filled steel tube (CFST) structures are widely used in the construction of large-scale structures owing to its exceptional load-bearing capacity. However, inadequate construction quality and improper maintenance may cause debonding defects at the steel-concrete interface. Two non-destructive testing methods, i.e. the ultrasonic phased array (UPA) method and the impact acoustic method, are developed for deboning detection. A combined inspection procedure is proposed to balance the detection accuracy and efficiency, where the impact acoustic method is utilised for a rapid preliminary inspection to pinpoint the suspected debonding areas, while the UPA method is sequentially applied to accurately evaluate the debonding rates in the suspected areas. The impact acoustic method analyzes the time-frequency spectrum from the echo signals using wavelet transform, and calculates the vibration energy ratio for debonding detection. The UPA method applies the total focusing method for image reconstruction, and extracts the reflection coefficient at the steel–concrete interface for debonding evaluation. The laboratory experimental results show that the combined method possesses a high accuracy and accurately delineates the range of the debonding defect while preserving the detection efficiency. Field tests conducted on an arch bridge in Foshan, China, verified the effectiveness of the proposed evaluation method.

Trifold technique for pupil reconstruction in large non-appositional iris defects.

Large iris defects are challenging to close due to shortage of tissue and opposite vector force. By using two pupilloplasty methods, we can close large iris defects with less tractional force or tethering. The trifold technique is a combination of trocar-assisted iris repair and single-pass four-throw (SFT) pupilloplasty for non-appositional large iris defects. The initial two trocar-assisted iris repair sutures oppose the unopposed iris ends and the subsequent SFT seals the defect. The combination procedure is less manipulative with no complications for the iris and pupil diaphragm.

The initial clinical application of standard PCNL combined with visual needle nephroscope in the treatment of complex renal calculi by holmium YAG laser: a retrospective case series study

This study aims to evaluate the feasibility, safety, and effectiveness of an optimized treatment approach for complex renal calculi, utilizing visual needle nephroscopy in conjunction with standard PCNL and holmium YAG laser. We collected data from 62 patients diagnosed with complex kidney stones who underwent this combined procedure using the visual needle nephroscope (Needle-perc®, Youcare Tech, Wuhan, China). The percutaneous nephroscopic working channel was established by visual needle nephroscope, and the primary channel was expanded to 20 F to treat most of the main body of the calculi with a 550 μm holmium laser fiber. Visual needle nephroscope was used to locate the renal calyx where the residual calculi were located for precise puncture as a secondary channel, and the residual stones were treated by a 200 μm holmium laser fiber. Clinical data were collected, and intraoperative variables, postoperative complications and outcomes were assessed. All 62 patients successfully completed the operation without severe complications. The S.T.O.N.E. score of 62 patients before operation was 10.5 ± 0.9 points and above, of which the N score was more than 2 points. The average operation time was (65.5 ± 12.7) minutes, and the average hospital stay was (7.3 ± 2.1) days. After operation, 2 patients developed a fever, which improved after symptomatic treatment by intravenous antibiotics. 4 patients had clinically significant residual fragments, and the stone-free rate of primary operation was 93.5% (58/62). The optimized operation for the treatment of complex renal calculi based on standard PCNL combined with visual needle nephroscope by holmium YAG laser has good feasibility, safety and effectiveness.

A Comparative Study of Planned and Unplanned Manual Small Incision Cataract Surgery (MSICS) Outcomes at Nan Hospital, Thailand: A Retrospective Study

Objective: To compare the visual outcomes and complications of planned and unplanned manual small incision cataract surgery (MSICS) using Ruit technique in cataract patients. Materials and Methods: The medical records of 3,107 eyes for 2,642 patients with cataracts who underwent MSICS using the Ruit technique at Nan Hospital between January 2016 and April 2023 were retrospectively reviewed. MSICS used a temporal scleral tunnel incision. All 3,107 surgeries were performed by a single surgeon. Out of these 908 eyes of 719 patients, 411 eyes missed the six-week follow-up, the data were incomplete on 195 eyes, 58 eyes underwent combined ocular procedures, and 244 eyes had preoperative vision impairing pathology or previous ocular surgeries. Medical records of 2,199 eyes from 1,923 patients were analyzed, including data on preoperative and postoperative uncorrected visual acuity (UCVA), operative time, intra- and postoperative complications, and astigmatism at the second and sixth weeks after surgery. Results: MSICS using Ruit technique was performed on 2,199 eyes of 1,923 patients. Both groups achieved excellent surgical outcomes with low complication. The postoperative UCVA at the sixth-week follow-up was 20/70 or better in 96.2% (1,467 out of 1,526 patients) in the planned group and 94.7% (637 out of 673 patients) in the unplanned group. At the sixth week after treatment, the median postoperative astigmatism of both groups were –1.0 (IQR –1.5 to –0.5) D. Hyphema was the most frequent intraoperative complication found in both groups, equating to 5.9% (90 out of 1,526 patients) in the planned group and 8.2% (55 out of 673 patients) in the unplanned group. There was no significant difference in the visual results and complication rates between the groups (p&lt;0.05). Conclusion: The present study demonstrates that cataract surgery in the unplanned group was safe, and the outcomes in terms of visual results and complications were comparable to those of the planned group. The findings revealed that favorable visual outcomes could be achieved with Ruit technique MSICS. Keywords: Ruit technique; Manual small incision cataract surgery

Preserflo MicroShunt Implantation: A Narrative Review of Its Standalone Benefits vs. Combined Use with Phacoemulsification in Managing Open-Angle Glaucoma.

Glaucoma and cataract often coexist. Patients with both conditions who qualify for surgical treatment may undergo either a combined surgical procedure or sequential treatments such as cataract surgery followed by an antiglaucoma procedure. A combined procedure with phacoemulsification is related to an increased risk of fibrosis of the filtering bleb; however, it is a rational approach for patients with high intraocular pressure and clinically significant lens opacification. Trabeculectomy has been a traditional filtration procedure for decades, effectively lowering intraocular pressure. It is highly effective; however, it may cause sight-threatening complications. The Preserflo MicroShunt, introduced less than a decade ago in the field of glaucoma surgery, has shown similar hypotensive efficacy to trabeculectomy, and is a less invasive procedure with a better safety profile. Despite their shared mechanism of action to reduce intraocular pressure, the two procedures differ in the extent of scleral incision and filtration bleb morphology, which may influence the extent of the post-surgery inflammation process. This review evaluated and compared reports on the efficacy and safety of Preserflo MicroShunt implantation as a standalone procedure versus combined with cataract removal in surgical treatment for patients with open-angle glaucoma and concomitant cataract.

Safety of Simultaneous Laparoscopic Cholecystectomy and Inguinal Hernia Repair: A Systematic Review.

Background: Cholelithiasis and inguinal hernias are common surgical conditions that often coexist. Laparoscopic techniques are increasingly used for both cholecystectomy and inguinal hernia repair. This study aimed to systematically review the available evidence on the safety and efficacy of simultaneous laparoscopic cholecystectomy (LC) and laparoscopic inguinal hernia repair (LIHR). Methods: A systematic search of the PubMed/MEDLINE and Google Scholar databases was performed for articles published until March 2024 using specific keywords. Studies meeting predetermined inclusion and exclusion criteria were analyzed. Results: Ten studies comprising 199 patients were included in the review. The mean operative time for combined LC and LIHR ranged from 55 to 157 minutes, with an average hospital stay between 1 and 4 days. The overall complication rate was 22%, with seroma/hematoma formation (6.5%) being most common. There were no reported mortalities or cases of mesh infection. Discussion: This review suggested that simultaneous LC and LIHR is a safe and effective option for patients with both conditions. The combined procedure offers potential benefits such as reduced hospital stay, faster recovery, and cost savings. Although the optimal sequence of surgical procedures for LIHR and LC remains debatable, the risk of mesh infection appears to be minimal.