Small Incision Group Research Articles

Efficacy and efficiency of a small-incision, minimal dissection procedure versus a traditional approach for correcting aponeurotic ptosis

To compare the efficacy and efficiency of a new small anterior incision, minimal dissection ptosis procedure with that of a traditional anterior aponeurotic approach for the correction of aponeurotic ptosis. Retrospective, comparative, interventional case series. Seventy-two patients with aponeurotic ptosis who had undergone ptosis correction surgery by 1 surgeon: 36 patients (49 ptotic eyelids) who had ptosis correction by a small-incision, minimal dissection procedure and 36 patients (49 ptotic eyelids) who had ptosis correction by a traditional aponeurotic approach. Charts and available photographs were reviewed for each patient. Postoperative upper eyelid height relative to the center of the pupil and relative to the opposite upper eyelid and the postoperative eyelid contour. Successful correction of the eyelid height and the rate of recommended reoperation were not significantly different for the 49 lids corrected in each arm of the study. The incidence of attaining good eyelid contour was significantly better in the small incision group, in which 41 of 42 lids (97.6%) evaluated by photographs had good contour compared with 29 of 37 lids (78.4%) in the traditional group. Operating time per lid was significantly less for the small-incision, minimal dissection group, 25.3+/-13.0 minutes (range, 13-68 minutes) compared with 55.4+/-16.6 minutes (range, 35-119) for the traditional group. The small-incision, minimal dissection technique for ptosis correction is equally effective in correcting eyelid height, superior in producing desirable eyelid contour, and much quicker to perform than the traditional aponeurotic approach.

The small incision non-phacoemulsification cataract extraction and IOL implantation

目的 探讨小切口非超声乳化人工晶状体植入术的临床效果和优点.方法76例(82眼)采用反弧形巩膜隧道切口摘出白内障植入后房型人工晶状体,并与65例(68眼)传统大切口手术进行对比.结果术后1周及2月随访观察:小切口组裸眼视力≥0.5者分别占56.1%和79.3%,平均散光为(1.92±1.02)D和(0.92±0.75)D;大切口组裸眼视力≥0.5者分别占34.0%和60.3%,平均散光为(4.56±1.52)D和(2.51±1.48)D,两组相比差异有显著性意义(P＜0.05).结论小切口手术组织损伤轻,术后视力恢复快、散光小,费用低廉。

Small-incision manual extracapsular cataract surgery in Ghana, West Africa

Purpose To evaluate the results of small-incision manual extracapsular cataract extraction surgery (ECCE) in a district hospital in West Africa. Setting Margret Marquart Catholic Hospital, Ghana, West Africa. Methods This prospective study consisted of 200 eyes of 193 patients who had small-incision manual ECCE between January 1999 and May 2000. For comparison, the charts of 32 patients (32 eyes) operated on between July and December 1998 using a limbal incision (control group) were retrospectively analyzed. Outcome measures included intraoperative and postoperative complications, postoperative visual acuity, and refractive astigmatism. Results In the small-incision ECCE group, self-sealing wounds were achieved in 129 eyes (64.5%). Vitreous loss occurred in approximately 3% of eyes in both the small-incision and control groups. The final visual acuities were similar between the 2 groups, with more than 90% of eyes in both groups achieving a final best corrected visual acuity of at least 20/60. Eyes in the small-incision group had faster visual recovery ( P < .001), a lower incidence of fibrinous iritis ( P = .02), and were more likely to have round pupils ( P < .001) than eyes in the control group. The main complication of small-incision surgery was moderate corneal edema, which persisted until at least the 1-week visit in 14 eyes (7%). At the most recent visit, 1 eye in the small-incision group (0.5%) had bullous keratopathy. Conclusion In a district hospital in West Africa, small-incision manual ECCE surgery yielded faster visual rehabilitation and had a lower incidence of fibrinous iritis than standard ECCE surgery.

PII: S0003-4975(99)01307-7

PII: S0003-4975(99)01307-7

Yield and efficacy of biopty gun testis needle biopsy

Objectives. To assess whether a preliminary skin incision enhances diagnostic yield of percutaneous testis biopsy and to further evaluate the clinical efficacy of this procedure. Methods. A total of 45 men (67 testes) underwent testicular biopsy with two passes of a Biopty gun spring-loaded needle. Twenty-seven biopsies were performed without a preliminary skin incision (group 1), and 40 were performed after a small scrotal incision (group 2). In 56 testes, needle biopsy histopathologic diagnosis was compared with that of open biopsy or orchiectomy specimens from the same patient. Needle and surgical specimens were fixed in Bouin’s solution and sent separately for independent, blinded, histologic interpretation. Results. Complications of the procedure were negligible. In all 67 needle biopsies, specimen quality was adequate for histopathologic interpretation. The mean number of seminiferous tubules obtained from needle biopsy was 28% higher among patients having a preliminary skin incision (25.9) compared with those without (18.7, P = 0.023). Correlation between needle and open histopathologic diagnosis was excellent (55 of 56, 98%). Conclusions. A preliminary skin incision made before needle biopsy increases the diagnostic yield of percutaneous testis biopsy. Percutaneous testis biopsy using the Biopty gun needle provides equal diagnostic information when compared with open testis biopsy or orchiectomy specimens. The concomitant reduction in morbidity and cost make this an attractive diagnostic procedure.

Effect of small incision intraocular lens surgery on postoperative inflammation and astigmatism: A study of the AMO SI-18NB small incision lens

A single center, single surgeon, randomized, prospective clinical trial was performed comparing the effectiveness of small (3.5 mm to 4.0 mm) incision intraocular lens surgery and a larger (6.0 mm) incision in improving uncorrected visual acuity and reducing postoperative inflammation and surgically induced astigmatism. One hundred twelve eligible unilateral cases were randomized to receive a 3.5 mm to 4.0 mm incision with implantation of an Allergan Medical Optics three-piece SI-18NB silicone lens (56 cases) or a 6.0 mm incision with implantation of a three-piece biconvex poly(methyl methacrylate) lens (56 cases). At one day after surgery, significantly (P <.01) more patients with 3.5 mm incisions had 20/40 or better uncorrected visual acuity than patients with 6.0 mm incisions (45% vs 20%). Forty percent of patients with 6.0 mm incisions vs 14% of patients with 3.5 mm incisions had visual acuities of 20/100 or worse. At one day after surgery, the larger incision group had significantly higher (P < .01) mean keratometric cylinder (2.28 diopters vs 1.28 diopters in the small incision group). The two groups were comparable by three months. Laser flare/cell meter measurements were taken for each group but showed no significant differences in mean flare or cell measurements between the groups.

Astigmatism after Small Incision Cataract Surgery: A Prospective, Randomized, Multicenter Comparison of 4- and 6.5-mm Incisions

Four surgeons evaluated induced astigmatism and postoperative wound stability in a randomized prospective study of 130 patients undergoing cataract extraction. After phacoemulsification through a scleral pocket, patients received either a 6.5-mm diameter silicone optic posterior chamber intraocular lens (PC IOL) folded for insertion through a 4-mm small incision or a 6.0-mm diameter polymethyl methacrylate (PMMA) optic PC 10L placed through an approximately 6.5-mm conventional incision. Vector analysis calculations of prism diopters (D) of mean postoperative-induced keratometric astigmatism for the small incision versus conventional incision groups were, at day 1,1.54 D versus 3.07 D (P < 0.0001); at weeks 1 to 2,1.00 D versus 2.43 D (P < 0.0001); at 1 month, 0.98 D versus 1.44 D (P = 0.004); and at 3 months, 0.82 D versus 1.03 D (P = 0.089). Subgroup analysis of the suturing technique for the 6.5-mm incision showed that the technique of wound closure, as well as the wound size, influenced the induced astigmatism. For all four surgeons using three methods of suturing the 6.5-mm wound, however, the variability in the amount of induced cylinder was least with the 4.0-mm wound closed with a horizontal mattress suture. Complications in the two groups were comparable.