Suction Loss Research Articles

A review of small incision lenticule extraction complications.

As a flapless procedure, SMILE brings benefits to refractive surgery, such as lower corneal biomechanical impact, less dry eye risk and less stromal bed exposure. However, the longer learning curve can be a risk factor for complications. This article aims to discuss SMILE complications and proposes a categorized analysis of occurrences, dividing into two groups: intraoperative and postoperative complications. Among intraoperative, we also suggest a subdivision between those related to the laser (lenticule construction), tissue separation (lenticule dissection) and tissue removal (lenticule extraction). The majority of SMILE complications are related to surgeon inexperience and reversible if precociously diagnosed and correctly managed. Intraoperative complications related to lenticule creation such as suction loss, opaque bubble layer and black spots, are correlated with later difficulties during lenticule dissection and removal, and may lead to unwanted situations, such as cap perforation, lenticule tear and cap-lenticule adhesion. Postoperative complications as dry eye, keratitis and ectasia should not be underestimated. Analyzing what has been reported as major or unique among the complications with SMILE, and dividing them into subgroups, we aim to help refractive surgeons in becoming familiar with the things that can go wrong during SMILE. Early recognition and correct management will be fundamental for optimizing the final visual result.

Learning Curve of Small Incision Lenticule Extraction: Challenges and Complications.

To describe the intraoperative complications observed during the initial learning curve of small incision lenticule extraction (SMILE) and their management. Prospective evaluation of 100 consecutive eyes (50 patients) undergoing SMILE was performed at an apex tertiary care ophthalmic center. Patients older than 18 years with a stable refractive error ranging from -1.0 to -10.0 D myopia and up to 3.0 D astigmatism were included. Any intraoperative complications and their management were noted. Postoperative examination including visual acuity was performed on day 1, 1 week, and 1 month. Intraoperative difficulties observed in the initial 100 eyes included suction loss (2%), black spots (11%), opaque bubble layer (19%), epithelial defect (2%), and difficult lenticule extraction (9%). Difficult lenticule dissection and extraction was the most surgically challenging step and resulted in posterior stromal damage, anterior cap tear (1%), side-cut tears (4%), partially retained lenticule (1%), and completely retained lenticule (2%). Its incidence decreased from 16% (8/50) in the initial 50 cases to 2% (1/50) in the next 50 cases. Two eyes with completely retained lenticule were re-treated with flap-based excimer laser ablation after 3 months. Optimal visual and anatomical outcomes could be achieved, and no sight-threatening complication was observed in any case. The learning curve of SMILE is surgically challenging. Lenticule dissection and extraction is the most difficult step and leads to a multitude of complications. Most complications that result in delayed visual recovery are observed in the initial 50 cases.

Comparison of immediate small-incision lenticule extraction after suction loss with uneventful small-incision lenticule extraction

To evaluate and compare the predictability and safety of immediate small-incision lenticule extraction, also known as SMILE, after suction loss during the procedure with those of uneventful small-incision lenticule extraction. Nunemiso Eye Center, Seoul, South Korea. Retrospective case series. Patients who had immediate small-incision lenticule extraction using reapplied suction (study group) or uneventful small-incision lenticule extraction (control group) for myopia or myopic astigmatism were included. All patients were followed for at least 12months. Demographic as well as visual and refractive outcomes were compared between the 2 groups. Twenty-three eyes were enrolled in the study group and 48 eyes in the control group. The overall cumulative incidence of suction loss was 0.2% (28 of 11 762 eyes). Twenty-two eyes (96%) in the study group had unchanged or improved decimal Snellen corrected distance visual acuity (CDVA). At 12months, the mean uncorrected distance visual acuity, CDVA, and manifest refraction defocus equivalent in the study group and control group were 0.99±0.17 (SD), 1.11±0.14, 0.75±0.50 diopters (D), and 1.25±0.22 D, 1.26±0.21 D, 0.35±0.26 D, respectively (P=.000, P=.007, and P=.000, respectively). The correlation between the achieved and the attempted spherical equivalent refraction was slightly better in the control group (R2=0.972) than in the study group (R2=0.933). Immediate small-incision lenticule extraction using reapplied suction resulted in safe and clinically predictable long-term outcomes. However, predictability was lower for immediate than for uneventful small-incision lenticule extraction.

Enhancement after Small-Incision Lenticule Extraction: Incidence, Risk Factors, and Outcomes

To report the incidence, risk factors, and outcomes of enhancement after small-incision lenticule extraction (SMILE). Retrospective cohort study. Five hundred twenty-four eyes of 307 patients who underwent SMILE at Singapore National Eye Center between February 2012 and March2016. The data collected included patient age at primary SMILE, gender, race, preoperative and postoperative manifest refraction spherical equivalent (MRSE), preoperative and postoperative uncorrected distance visual acuity and corrected distance visual acuity, the occurrence of suction loss during the procedure, and the need for enhancement. All enhancements were carried out by performing an alcohol-assisted photorefractive keratectomy (PRK) procedure with application of mitomycin C (MMC). Incidence, prevalence, preoperative and intraoperative risk factors for enhancement, and outcomes after enhancement. The prevalence of enhancement was 2.7%, and 71.4% eyes had enhancement within 1 year of primary SMILE. The incidence of enhancement was 2.1% and 2.9% at 1 and 2 years, respectively. Age older than 35 years, preoperative MRSE more than-6.00 diopters (D), preoperative myopia more than 6.00 D, preoperative astigmatism more than 3.00 D, and intraoperative suction loss were significant risk factors for enhancement after SMILE after adjusting for all other covariates (odds ratios, 5.58, 4.80, 1.41, 3.06, and 2.14, respectively; P= 0.004, 0.021, 0.022, 0.002, and 0.020, respectively). In the patients who underwent bilateral SMILE, the first-operated eye had a marginal trend toward significance for enhancement (P= 0.054). There was no gender or racial difference. In the 14 eyes requiring enhancement, the uncorrected distance visual acuity before enhancement ranged from 20/80 to 20/25, and the mean attempted enhancement spherical equivalent was-0.50±0.86 D. The uncorrected distance visual acuity improved in most patients (92.9%) after enhancement. The 2-year incidence of enhancement after SMILE was 2.9%. Risk factors associated with enhancement included older age at SMILE procedure, greater preoperative MRSE, greater preoperative myopia, greater preoperative astigmatism, and the occurrence of intraoperative suction loss. Clinical outcomes of using PRK with application of MMC for enhancement were good.

Refraction outcomes after suction loss during small-incision lenticule extraction (SMILE).

PurposeTo evaluate refractive outcomes of two management approaches after suction loss during the small-incision lenticule extraction (SMILE) technique.Patients and methodsThis retrospective and comparative study was conducted at the El-Gowhara Private Eye Center. It included 26 consecutive eyes of patients who experienced suction loss during the SMILE technique. Patients were divided into two groups by the technical difficulties in redocking: in group A (12 eyes) suction loss occurred after the posterior lenticular cut and the creation of side-cuts, then suction was reapplied, and the procedure was completed; in group B (14 eyes) suction loss occurred after the posterior lenticular cut and the creation of side-cuts, then the procedure was postponed for 24 hours and completed with the same parameters. Manifest refraction outcomes were measured and compared 6 months postoperatively.ResultsThis study included 26 eyes with suction loss during the SMILE technique: five patients with suction loss in both eyes, nine patients with suction loss in the right eye and seven patients with suction loss in the left eye. The incidence of suction loss in this study was 2.7%. At the postoperative 6-month follow-up time, there were statistically significant differences in refraction outcomes between the two groups, with a hyperopic shift in group A compared with group B.ConclusionA good refraction outcome can be achieved with appropriate management of suction loss during the SMILE technique, and it is recommended to postpone the treatment if this happens.

Internal Flow Analysis of Seawater Cooling Pump using CFD

This research focuses on simulation and visualization of flow field characteristics inside a centrifugal pump. The 3D numerical analysis was carried out by using a numerical CFD tool, addressing a Reynolds Average Navier-Stock code with a standard k-Ɛ two-equation turbulence model. The simulation accounts for friction head loss due to rough walls at suction, impeller, discharge areas and volumetric head loss at impeller wear ring. A comparison of performance curves between simulation and experimentation is included, and it reveals a same trend of those results with a small difference of maximum 5 %. At best efficiency point, velocity vectors are smooth but it changes significantly under off-design point, a strong recirculation appears at the outlet of impeller passages near tongue area. A relatively uniform preassure distribution was observed around the impeller in despite of the tongue. Within the volute, because of its geometry, spiral vortexes formed, proving that the flow field in this region was relatively turbulent and unsteady.

Seasonal effects on geophysical\u2013geotechnical relationships and their implications for electrical resistivity tomography monitoring of slopes

Current assessments of slope stability rely on point sensors, the results of which are often difficult to interpret, have relatively high costs and do not provide large-area coverage. A new system is under development, based on integrated geophysical–geotechnical sensors to monitor groundwater conditions via electrical resistivity tomography. So that this system can provide end users with reliable information, it is essential that the relationships between resistivity, shear strength, suction and water content are fully resolved, particularly where soils undergo significant cycles of drying and wetting, with associated soil fabric changes. This paper presents a study to establish these relationships for a remoulded clay taken from a test site in Northumberland, UK. A rigorous testing programme has been undertaken, integrating the results of multi-scalar laboratory and field experiments, comparing two-point and four-point resistivity testing methods. Shear strength and water content were investigated using standard methods, whilst a soil water retention curve was derived using a WP4 dewpoint potentiometer. To simulate seasonal effects, drying and wetting cycles were imposed on prepared soil specimens. Results indicated an inverse power relationship between resistivity and water content with limited hysteresis between drying and wetting cycles. Soil resistivity at lower water contents was, however, observed to increase with ongoing seasonal cycling. Linear hysteretic relationships were established between undrained shear strength and water content, principally affected by two mechanisms: soil fabric deterioration and soil suction loss between drying and wetting events. These trends were supported by images obtained from scanning electron microscopy.

Femtosecond laser-assisted cataract in vitreoretinal surgery.

To assess the safety and surgical results of femtosecond laser-assisted phacovitrectomy. Fifteen patients over 50 years of age with coexisting vitreoretinal pathologies and cataract underwent combined femtosecond laser-assisted cataract extraction and sutureless 25-G and 27-G vitreoretinal surgery. The indication for surgery was macular hole in 6 patients, epiretinal membrane in 6, vitreous hemorrhage in 2, and retinal detachment in 1. The mean preoperative best-corrected visual acuity (BCVA) was 0.64 ± 0.23 logMAR and the mean postoperative BCVA was 0.19 ± 0.11 logMAR. In 4 patients with epiretinal membrane with corneal astigmatism of 3.35 ± 0.32 D as mean value, a toric intraocular lens (IOL) was implanted: mean residual refractive cylinder was 0.47 ± 0.23 D. Three months postoperatively, mean IOL rotation was 1.64 ± 0.28°. All patients improved their visual acuity. The intraoperative complications of femtosecond laser were 1 subconjunctival hemorrhage, 1 case of miosis, and 1 suction loss. The surgeon was able to maintain a clear view of the retina at all times. After surgery, a better fundus examination was possible with no capsular opacification. Mean follow-up was 6 months. Femtosecond laser cataract in vitreoretinal surgery appears a safe and effective technique with potential benefits: the precision and centration of the capsulorhexis may potentially reduce the risk of IOL prolapse into the anterior chamber in gas-filled eyes. Implantation of the toric IOL was effective in reducing preexisting corneal astigmatism and provided good rotational stability and refractive outcome.

The Association between Hemoglobin Value and Estimation of Amount of Intraoperative Blood Loss

Introduction: The estimation of blood loss rate during surgery for prediction of transfusion of blood or blood products requirement is important for surgeon and anesthesiologist. In regard to various results and lack of definite index for start of transfusion in operating rooms, the assessment of blood loss reduction is necessary. The aim of study was evaluation of hemoglobin (Hb) value and hemorrhage estimation rate. Methods and materials: 48 cases underwent major orthopedic surgery with high probability of intraoperative blood loss rate was included in study. Hb, hematocrit (Hct) and basic vital signs were measured preoperatively and blood loss rate was estimated by using of blood volume in suction, bloody gases and blood loss in operation field and recorded. The blood sample per 100 mL blood loss was sent to laboratory. For transfusion deciding based on Hb, we did not any intervention. Results: 26 males and 22 females were included in study. Our results showed that Hb value of males was higher significantly of females in preoperative period. After beginning of blood loss, Hb and Hct values declined with fixed slope and there was high negative correlation between them. First, intraoperative systolic and diastolic pressures declined with high slope and then reduced with mild slope. Hb value reduced significantly per 100 mL blood loss. During survey, no alteration in urine output did not be observed. Conclusion: Present study showed that much more intraoperative blood loss could reduce Hb with high correlation coefficient and measurement of it is efficient on transfusion.

Impact of Suction Loss During Small Incision Lenticule Extraction (SMILE).

To evaluate the clinical results of suction loss in eyes during small incision lenticule extraction (SMILE). This prospective paired-eye case study enrolled 8,490 eyes of 4,296 patients, of which 35 eyes experienced suction loss during the SMILE procedure while being treated for myopia or myopic astigmatism. The eyes with suction loss were re-treated with SMILE, femtosecond laser-assisted LASIK (FS-LASIK), or pseudo SMILE, and the fellow eyes were treated with SMILE. Patients were examined before surgery and at 1 day, 1 week, and 1 and 3 months postoperatively. Corrected distance visual acuity (CDVA) and uncorrected distance visual acuity (UDVA), manifest refraction, higher order aberrations (HOAs), and morphologic modifications of corneal architecture were evaluated. At 3 months, patients were asked if they preferred the vision in either eye. High-contrast CDVA was worse in the eyes that suffered loss of suction than in the fellow eyes at 1 week postoperatively (two-tailed paired t tests, P = .04), but not at 1 and 3 months. There was no statistical significance between the two treatments in the safety and efficacy indices or the 3rd and 4th order aberrations at 3 months postoperatively (two-tailed paired t tests, all P > .05). No apparent abnormalities were observed in the corneas by frequency-domain optical coherence tomography. Re-treatment with femtosecond laser for incomplete SMILE was safe, predictable, and effective, and the patients did not perceive a difference in vision. [J Refract Surg. 2016;32(10):686-692.].

Thermodynamic Simulation on the Performance of Twin Screw Expander Applied in Geothermal Power Generation

A three-dimensional (3D) geometry model of twin screw expander has been developed in this paper to measure and analyze geometric parameters such as groove volume, suction port area, and leakage area, which can be described as functions of rotation angle of male rotor. Taking the suction loss, leakage loss, and real gas effect into consideration, a thermodynamic model is developed using continuity and energy conservation equation. The developed model is verified by comparing predicted results of power output and internal efficiency with experimental data. Based on the model, the relationship between mass flow rate through inlet port and leakage path with rotation angle of male rotor as well as effects of the inlet parameter and operating parameter on the performance of the expander are analyzed.

Suction loss during femtosecond laser–assisted small-incision lenticule extraction: Incidence and analysis of risk factors

To determine the incidence of and analyze risk factors for suction loss during femtosecond laser-assisted small incision lenticule extraction in the management of myopia or myopic astigmatism. Roayah Vision Correction Center, Alexandria, Egypt. Retrospective comparative case-control study. All eyes that had femtosecond laser-assisted small-incision lenticule extraction for the correction of myopia and myopic astigmatism performed between August 2010 and April 2014 were included. Eyes that developed suction loss were identified. Their characteristics, including demographic data (age and sex), eye laterality, manifest refraction, flat keratometry (K) reading, steep K reading, K astigmatism, optical zone, central corneal thickness, and corneal cap diameter and thickness, were compared with those in randomly selected control eyes to determine the risk factors for developing suction loss. Of the 3376 eyes that had femtosecond laser-assisted small-incision lenticule extraction during the study, 70 (2.1%) developed loss of suction. The incidence decreased with surgical experience (5.06% in 2010, 3.59% in 2011, 3.41% in 2012, 2.32% in 2013, and 1.84% in 2014), suggesting a learning curve. A multivariate logistic regression model showed that eyes with a larger cap diameter were significantly more likely to develop suction loss (P = .023; odds ratio, 9.60). Surgical experience significantly decreased the risk for suction loss during femtosecond laser-assisted small incision lenticule extraction for the correction of myopia or myopic astigmatism but did not eliminate it. A larger cap diameter significantly increased the risk for developing the suction loss. No author has a financial or proprietary interest in any material or method mentioned.

Clinical analysis of complications of LASIK using the WaveLight FS200 femtosecond laser

To explore the incidence of intraoperative and early postoperative complications associated with the WaveLight FS200 femtosecond laser-assisted flap creation in LASIK surgery. A consecutive series of 400 patients (786 eyes) who underwent LASIK using the WaveLight FS200 femtosecond laser from March 2011 to December 2012 were included in this retrospective study. Intraoperative and early postoperative complications were described and analyzed. The intraoperative complications included suction loss (two eyes, 0.25%), incomplete flap creation (one eye, 0.13%), severe opaque bubble layers (three eyes, 0.38%), anterior chamber gas bubbles (eight eyes, 1.02%), skip lines (12 eyes, 1.53%), and corneal epithelial defects (eight eyes, 1.02%). The early postoperative complications included canal bleeding (eight eyes, 1.02%), diffuse lamellar keratitis (23 eyes, 2.93%), haze (six eyes, 0.76% ), and flap dislocation (one eye, 0.13% ). Intraoperative and early postoperative complications of LASIK using the WaveLight FS200 were relatively mild. All patients could obtain satisfactory clinical results with proper treatment.

Clinical Outcomes in the First Two Years of Femtosecond Laser–Assisted Cataract Surgery

To analyze outcomes of femtosecond laser cataract surgery cases in the first 2 years in an ophthalmic institution. Nonrandomized treatment comparison with matched, historical controls. Outcomes and intraoperative events of all laser cataract surgeries (5.0- to 5.5-mm-diameter laser capsulotomies and nuclear fragmentation) at the Singapore National Eye Centre (May 2012-December 2013) were prospectively audited. The 6-weeks-postoperative unaided visual acuities (UAVA), mean absolute error (MAE), mean square error (MSE), and manifest refraction spherical equivalent (MRSE) results of surgeons with >50 laser cases were compared with controls, a random sample of manual cases with similar age, axial length, and preoperative cylinders. Statistical analysis was performed with SPSS (P < .05). A total of 1105 eyes (803 patients) underwent laser cataract surgery by 18 surgeons. The majority were female (56.9%) and Chinese (90.9%) with mean age 66.1 ± 11.0 years. Intraoperative complications were subconjunctival hemorrhage (290, 26.2%), anterior capsule tear (9 eyes, 0.81%), posterior capsule rupture (3 eyes, 0.27%), suction loss (5 eyes, 0.45%), iris hemorrhage (1 eye, 0.09%), and endothelial incision (1 eye, 0.09%). There was no dropped nucleus. Visual outcomes of 794 laser surgeries were compared to 420 controls. The %UAVA 20/25 or better was higher in laser cases (68.6% vs 56.3%; P < .0001) but MAE (0.30 ± 0.25 diopter [D] vs 0.33 ± 0.25; P = .062) and MSE (0.16 ± 0.27 D vs 0.17 ± 0.28 D; P = .065) were not significant. MRSE comparison was significant (target plano, preoperative cylinder <1.5 D -0.08 ± 0.36 D vs -0.13 ± 0.40 D; P = .034). Femtosecond laser cataract surgery has a low complication rate. Cases compared to controls had statistically better %UAVA ≤20/25 and MRSE, although MAE was not significant.

A Case of Suction Loss During SMILE and a Switch to LASIK

Purpose: To report a case of suction loss during small incision lenticule extraction (SMILE) and a good visual outcome after switching to femtosecond laser-assisted in-situ keratomileusis (LASIK). Case summary: A 20-year-old female was admitted to receive refractive surgery. During SMILE in the left eye, suction loss occurred at 65% of posterior cut completion. We switched to LASIK and SMILE was performed in the right eye as planned. The uncorrected distance visual acuity was 1.2 with a manifest refraction of +0.25 Dsph with 0 Dcyl. The patient had no complications at 3 months postoperatively. Conclusions: Suction loss during SMILE is a rare complication. Good visual outcome was achieved by switching to LASIK. J Korean Ophthalmol Soc 2015;56(8):1274-1277

Incidence and management of suction loss in refractive lenticule extraction

To describe the incidence, management, and outcomes of suction loss in refractive lenticule extraction (ReLEx). Tertiary eye hospital. Retrospective case series. All patients who experienced suction loss during refractive lenticule extraction from March 9, 2010, to August 5, 2013, were evaluated preoperatively, including slitlamp biomicroscopy, fundoscopy, corneal topography, ultrasound pachymetry, manifest and cycloplegic refractions, and measurement of uncorrected (UDVA) and corrected (CDVA) distance visual acuities. Patients were followed at predetermined timepoints. At each follow-up visit, the UDVA and CDVA were measured and slitlamp biomicroscopy was performed. Manifest refraction was measured 1 and 3 months postoperatively. During the study period, 340 refractive lenticule extractions were performed. The overall cumulative incidence of suction loss was 3.2%. The incidence of suction loss was 4.3% (2/46) for femtosecond lenticule extraction, 4.4% (8/183) for small-incision lenticule extraction, and 0.9% (1/109) for pseudo small-incision lenticule extraction. Of the 11 eyes in which suction loss occurred, 8 (72.7%) had a UDVA of 20/30 or better and 9 (81.8%) had a spherical equivalent within ± 0.5 diopter of emmetropia at 3 months. Suction loss occurred in 4 eyes during the posterior lenticule cut, in 5 eyes during the anterior lenticule cut, and in 2 eyes during the lamellar flap cut. In 9 of these (81.8%), suction was reapplied and the procedure was completed without further complications. The incidence of suction loss during refractive lenticule extraction was relatively low. Good visual outcomes were achieved with appropriate management.

Theoretical analysis and mathematical modelling of a high-pressure pump in the common rail injection system for diesel engines

In this paper, a study on the performance of a high-pressure pump of the common rail fuel injection system is presented. The mathematical models established include: (i) the fluid model for the pump chamber and rail which takes the structural deformation and interface leakage into consideration; (ii) the nonisothermal fluid–structure interaction model for the leakage at the piston/cylinder interface; and (iii) the unified model for the physical properties of the fuel such as dynamic viscosity, density and isobaric specific heat capacity versus pressure and temperature relationships. The factors leading to the loss of the pump volumetric efficiency during the four phases of the pump working cycle are theoretically analysed. Both differential and iterative methods are applied in the numerical solution of the model. The leakage model was validated against the measured leakage rates, and showed satisfactory results. A parametric study is carried out to analyze the effects the piston diameter has on the establishment process of the chamber pressure, the piston/cylinder interface leakage and the compression stroke. Results show that the impacts of the leakage, the compression stroke and the suction loss on the volumetric efficiency loss of the pump all increase with the nominal rail pressure.

Mechanical Performance of a Self-Unplugging Surgical Suction Instrument: A Randomized Controlled Trial

Introduction: Obstruction of the surgical suction instrument is a common problem in orthopaedic surgery. Previous attempts have tried to address this problem. The ‘Super Sucker’ has a screen compartment that can be unclogged upon disassembly. The Yankauer sucker has small holes in its tip that strain larger bits of debris. The aim of this study is to clinically evaluate a new gas-actuated suction instrument in which a special screen at its tip is cleared, as needed, by a rapid burst of pressurized carbon dioxide gas.Methods: This IRB-approved, prospective, randomized study compared a gas-actuated suction instrument with the Super Sucker and Yankauer in 70 consecutive primary total joint arthroplasty cases. Outcome measures included: incidence of complete suction loss due to suction instrument obstruction; time lost while unplugging the suction instrument; number of additional suction instruments needed; and a subjective surgeon-assessed performance score (1 to 5, with 5 being most favorable) for type of suction instrument. Results: There were no cases in which the gas-actuated suction instrument could not be rapidly cleared of debris. The Super Sucker completely plugged in 71% of cases, requiring 67 minutes total to unplug (3.9 minutes per case, range 0 to 12 minutes). In four cases, replacement Super Suckers were required to finish the case. The Yankauer completely plugged in 47% of cases, requiring 52 minutes total to unplug (2.8 minutes per case, range 0 to 10 minutes). In three cases, replacement Yankauers were required to finish the case. The average performance score was 2.7 for the Super Sucker, 3.6 for the Yankauer, and 5 for the gas-actuated suction instrument on a scale of 1 to 5, with 5 being most favorable.Discussion: This study evaluated a suction instrument in which a screen tip prevents obstruction, and a burst of pressurized carbon dioxide gas clears debris from the tip. The new suction instrument was successful in 100% of cases, with considerably less time lost compared to the other suction instruments. The gas-actuated suction tool actively and rapidly cleared obstructive debris with minimal disruption to the surgical flow. Recent clinical experience has shown the gas-actuated suction tool to be particularly enabling in the settings of tourniquet-free total knee replacement, small incision total hip replacement, bipolar hemiarthroplasty, and revision total hip replacement.Keywords: suction, total joint arthroplasty, tourniquet-less, carbon dioxide gas

One-year refractive results, contrast sensitivity, high-order aberrations and complications after myopic small-incision lenticule extraction (ReLEx SMILE)

To report one year results of the first cohort of routine refractive lenticule extraction through a small incision (ReLEx SMILE) for correction of myopia and myopic astigmatism. Fifty-four eyes of 27 patients with spherical equivalent of -4.68 ± 1.29D who underwent routine ReLEx SMILE by a single surgeon were prospectively followed-up for 1 year. We used the VisuMax femtosecond laser system (Carl Zeiss Meditec AG, Germany) with a 500 kHz repetition rate. Folow-up intervals were at 1 day, 1 week, 1, 3, 6, and 12 months after surgery. We obtained following parameters: uncorrected (UDVA) and distance-corrected visual acuity (CDVA), contrast sensitivity, and wave front measurements. We also recorded all complications. Because of suction loss in one eye, 12-month results were obtained in 53 eyes as follows. After 1 year, 88% of eyes with plano target had an UDVA of 20/20 or better. Twelve percent of eyes lost 1 line of CDVA, while 31% gained 1 line and 3% gained 2 lines. The mean SE after 1 year was -0.19 ± 0.19. The mean refraction change between month 1 and 12 was 0.08 D. Neither mesopic nor photopic contrast sensitivity showed any significant changes. The high-order aberrations (HOA) increased from 0.17 to 0.27 μm (Malacara notation). No visually threatening complications were observed. In this first cohort, ReLEx SMILE produced satisfactory refractive outcomes with moderate induction of HOA and unaffected contrast sensitivity after 1 year.

Sleeveless-extrusion cannula for levitation of dislocated intraocular lens

Background/aimsTo characterise a sleeveless-extrusion cannula-based suction technique to levitate dislocated intraocular lens (IOLs) and review the surgical outcome.MethodsThis retrospective, non-comparative, single surgeon, interventional, consecutive case series examined 10 patients (10...