Suture Procedure Research Articles

Stabilization of Acute High-Grade Acromioclavicular Joint Separation: A Prospective Assessment of the Clavicular Hook Plate Versus the Double Double-Button Suture Procedure

Background: The stabilization strategy for acute high-grade acromioclavicular (AC) joint separations with AC-stabilizing clavicular hook plate (cHP) or coracoclavicular (CC)–stabilizing double double-button suture (dDBS) is still under consideration. Hypothesis: The CC-stabilizing dDBS is superior to the cHP according to an AC-specific radiologic assessment and score system. Study Design: Cohort study; Level of evidence, 2. Methods: Seventy-three consecutive patients with acute high-grade AC joint separation were prospectively followed in 2 treatment groups (64.4% randomized, 35.6% patient-selected treatment): open reduction and cHP (cHP group) or arthroscopically assisted dDBS (dDBS group) performed within 14 days of injury. Patients were prospectively analyzed by clinical scores (Taft, Constant score [CS], numeric analog scale for pain) and AC-specific radiographs (AC distance, CC distance [CCD], relative CCD [rCCD; 100 / AC distance × CCD]) at points of examination (preoperative and 6, 12, and 24 months). The minimal clinically important differences (MCIDs) were assessed by the anchor-based method. Results: Twenty-seven of 35 patients (mean age ± SD: 37.7 ± 9.7 years) after cHP implantation and 29 of 38 patients (34.2 ± 9.7 years) after dDBS implantation were continuously followed until the 24-month follow-up. All patients showed significantly increased scores after surgery as compared with preoperative status (all P < .05). As compared with GI, GII had significantly better outcomes at 24 months (Taft: cHP = 9.4 ± 1.7 vs dDBS = 10.9 ± 1.1, P < .05, MCID = 2.9; CS: cHP = 90.2 ± 7.8 vs dDBS = 95.3 ± 4.4, P < .02, MCID = 16.6) and at 24 months for Rockwood IV/V (Taft: cHP = 9.4 ± 1.7 vs dDBS = 11.1 ± 0.8, P < .0005; CS: cHP = 90.1 ± 7.7 vs dDBS = 95.5 ± 3.1, P < .04). Clinically assessed horizontal instability persisted in 18.52% (GI) and 6.89% (GII; P = .24). The rCCD showed equal loss of reduction at 24 months (GII = 130.7% [control = 111%] vs GI = 141.8% [control = 115%], MCID = 11.1%). Conclusion: This prospective study showed significantly superior outcomes in all clinical scores between GII and GI. The subanalysis of the high-grade injury type (Rockwood IV/V) revealed that these patients showed significant benefits from the dDBS procedure in the clinical assessments. The cHP procedure resulted in good to excellent clinical outcome data and displayed an alternative procedure for patients needing less restrictive rehabilitation protocols.

Tu1168 MUCOSAL ABLATION AND SUTURING AT THE ESOPHAGOGASTRIC JUNCTION (MASE): A NOVEL PROCEDURE FOR THE MANAGEMENT OF PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE

Many patients with gastroesophageal reflux disease (GERD) either have symptoms refractory to proton-pump inhibitor (PPI) therapy or are worried about long-term risks of PPI. Not all patients are candidates for fundoplication. There is a need for novel endoscopic treatments for reflux, especially for those with altered anatomy who may not be candidates for fundoplication. To evaluate the safety and efficacy of a novel mucosal ablation and endoscopic suturing procedure for the management of patients with GERD. We performed a single-center prospective observational study on all patients who underwent this novel procedure. The standardized procedure involved APC ablation below the GE junction to improve tissue apposition prior to suturing. Next, in the forward viewing position, three sutures were placed along the lesser curvature of the cardia immediately below the esophagogastric junction to create a tightening and tissue bulge to prevent stomach contents from refluxing into the esophagus. Patients were discharged home after the procedure and followed up in clinic or by phone to assess treatment response. The primary outcome evaluated was reduction or cessation of medications used for treatment of GERD. The secondary outcomes evaluated were procedure tolerance and safety. 27 patients with a mean age of 67 years (range, 44-84) underwent the MASE procedure with typical procedural length of 25 minutes. Mean follow-up time was 124 days (range, 34-338). The indications for the procedure included either poorly controlled symptoms (48%) or a desire to discontinue their medication (52%). 7 patients (26%) had altered anatomy from prior surgery: Fundoplication (N=4), Billroth II (N=1), Roux-en-Y (N=1), and Sleeve gastrectomy (N=1). Pre-procedure, 22 patients (82%) were on once or twice daily PPI therapy and 5 patients were on H2-receptor antagonists/topical antacids. Of the 22 patients on daily PPI, 13 patients (59%) were able to discontinue their medication, and 3 patients (14%) were able to reduce their dose (see Figure). Of the 7 patients with altered anatomy, 4 patients (57%) were able to discontinue or reduce their PPI after the procedure. With regards to tolerance, the most common side effect was self-limited epigastric pain post-procedure (22%). One patient required an overnight stay in hospital for intravenous pain control. There were no other early or late complications. The MASE procedure represents a novel endoscopic treatment for GERD. This procedure may serve especially useful in managing complex patients with GERD, including those with altered anatomy who may not be candidates for surgical or endoscopic fundoplication.

Evaluation of the Effectiveness of an Alar Transfixion Suture for the Correction of a Vestibular Web and Alar-Facial Groove: A Photogrammetric Analysis.

Alar transfixion sutures are commonly used for vestibular web correction. The purpose of this study was to evaluate the long-term results of the use of alar transfixion sutures in patients with a unilateral cleft lip nasal deformity using photogrammetric analysis. The study included 42 patients who were divided into child and adult groups. A total of 4 measurement items were evaluated from a basal view by photogrammetry using standardized clinical photographic techniques preoperatively, immediately postoperatively, 3 months postoperatively, and 6 months postoperatively. When the preoperative and last postoperative values were compared, no significant changes in any measurement items were noted in the adult group. In the child group, the proportional index (the ratio of the cleft side to the noncleft side) of the alar slope line inclination was significantly increased, but other measurement items showed no significant change. When the measurement items were compared between time points, no significant changes in any measurement items were noted in the adult group. In the child group, the proportional indexes of the alar length, the width between the subnasale and the alare, and the webbing degree were significantly decreased immediately postoperatively compared with the preoperative values. However, these significant changes were diminished at 3 months postoperatively. The proportional index of the alar slope line inclination was significantly increased at 3 months postoperatively compared with the preoperative value, but the significant change was diminished at 6 months postoperatively. The alar transfixion suture procedure is not effective for correcting a vestibular web and alar-facial groove.

Modified everting sutures: an alternative treatment for mild to moderate epiblepharon

PurposeTo describe a modified everting suture procedure which can be used in patients with mild to moderate epiblepharon who are undergoing general anaesthesia for surgical correction of coexisting ophthalmic conditions.MethodsA...

Non-incisional eyelid everting suture technique for treating lower lid epiblepharon

BackgroundThis study investigated surgical outcomes of full-thickness eyelid everting sutures for lower lid epiblepharon and influential factors leading to surgical failure.MethodsA retrospective review was conducted of patients with lower lid...

Benefits of laparoscopic posterior wall suture repair in treating adolescent indirect inguinal hernias.

Adolescent inguinal hernias are treated using high ligation or posterior wall suture repair with laparoscopic mesh implantation. This study aimed to evaluate the efficacy of laparoscopic intracorporeal posterior wall suture repair without mesh implantation for treating adolescent indirect inguinal hernias. Laparoscopic herniorrhaphy was performed between September 2012 and April 2015 in 244 patients aged 11-18years who were diagnosed with indirect inguinal hernias at Damsoyu Hospital, Seoul, Korea. The patients were stratified by surgical procedure into the high-ligation (115 patients) and wall suture (129 patients) groups. Four (3.5%) of the 115 patients in the high-ligation group experienced recurrence, but those in the wall suture group did not. The difference in recurrence rates between these groups was significant (p<0.001). The wall suture procedures were longer (mean 28.2min) than the high-ligation procedures (mean 17.4min) (p<0.001). The lengths of postoperative hospital stays were similar in both groups. Few complications were observed: one patient developed hematoma and one developed seroma in the high-ligation group; two patients developed inguinal hematomas and one developed seroma in the wall suture group. Visual analog scale scores at 1week after surgery and the mean times to return to normal activities were similar in both groups. No chronic inguinodynia after the operation in either group was observed. Laparoscopic intracorporeal posterior wall suture repair without mesh implantation was effective for treating adolescent indirect inguinal hernias and resulted in fewer recurrences than those with high ligation.

The Brow Fat Pad Suspension Suture: Safety Profile and Clinical Observations.

To evaluate the safety, subjectively assess outcome, and emphasize surgical pearls and critical clinical observations of upper blepharoplasty performed in conjunction with the brow fat pad suspension suture procedure, previously referred to as a "browpexy variant" or "brassiere suture procedure." A retrospective 4-year analysis of patients who underwent the brow fat pad suspension suture with upper blepharoplasty was performed. Adjunctive procedures (brow lift and ptosis repair) were categorized. The surgical technique is detailed with emphasis placed on nuances to aid in optimal outcome. Two hundred and sixteen patients (149 women and 47 men) underwent upper blepharoplasty with the brow fat pad suspension suture. The average patient age is 54 years and follow up is 11 months. One hundred patients had adjudicative brow lift or ptosis repair, and in 20 patients the blepharoplasty was a revision procedure. Subjective assessment of outcome showed excellent aesthetic results with improved brow projection, and enhanced lateral tarsal platform show and eyebrow/eyelid contour. Surgical complications were infrequent and patient satisfaction was high. This initial large series description of the brow fat pad suspension suture demonstrates that it is a safe adjunct to upper blepharoplasty, which the authors believe subjectively improves overall outcome. Evidence-based quantitative assessments of objective measures of surgical results are currently underway.

Endoscopic Suturing of the Gastric Pylorus to Delay Gastric Emptying and Treat Obesity: A Pilot Study in Obese Patients: 2017 Presidential Poster Award

Introduction: Obesity is increasingly in prevalence in the United States and is commonly associated with many serious medical conditions including cardiovascular disease, diabetes, hypertension, osteoarthritis and sleep apnea. The primary treatment objective for obese patients is weight reduction. Even moderate weight loss produces significant health benefits and has been associated with marked reductions in the health risk. Methods: We enrolled consecutive patients who were referred for endoscopic therapeutic procedures for the treatment of obesity. A total of 7 patients were enrolled. Patient's weight and BMI were measured preprocedure and repeated every 4 weeks post-procedure for a total duration of 24 weeks. A gastric emptying scan was also performed prior to and 4 weeks after the suturing procedure. Steps of suturing procedure: An endoscope with a mounted suturing device (Apollo OverStitch) was advanced through an over-tube to the pylorus. One to two sutures were placed at the 2 O'clock and 4 O'clock position to narrow the pylorus by approximately 50%. The sutures are secured using suture anchors. EndoFLIP® was used just before and immediately after the procedure to measure the change in pyloric cross sectional surface area (CSA). Results: There was a significant decrease in weight (223.71lbs±13.69, 216.57lbs±13.88 p=0.01) and BMI (36.80±1.91, 35.50 ± 2.05, p=0.003) at 4 weeks. There was a significant decrease in CSA of the pylorus immediately after the pyloric suturing procedure (258mm2 ±16, 80.93 mm2 ±4.43, p < 0.001). There was a significant decrease in gastric emptying at 2 hours pre and post pyloric suturing (30.97±2.87, 47.47±7.38, p < 0.049). However, upon repeat endoscopy at 12 weeks the sutures were no longer in place and the CSA of the pylorus had returned to the preprocedure values. After 4 weeks, subjects started to regain weight; both weight and BMI returned towards preprocedure values. The study was terminated prior to full enrollment because of the lack of observed durability. Conclusion: The concept of pyloric suturing to narrow the pylorus to treat obesity is a novel and effective therapy. However, due to technical limitations (suture anchors can hold only up to 4 pounds and appear to let go over time) the sutures pulled out of the pyloric muscle after 4 weeks. We anticipate that changing the suture anchor, may allow for long term durability.

Combined tibial plateau levelling osteotomy and lateral fabellotibial suture for cranial cruciate ligament rupture with severe rotational instability in dogs

To report the use of tibial plateau levelling osteotomy and lateral fabellotibial suture in combination for treatment of severe internal tibial rotational stifle instability in cranial cruciate-deficient stifles. Twenty-three stifles in 19 dogs were diagnosed with cranial cruciate ligament rupture with severe stifle instability, characterised by marked cranial tibial translation and internal tibial rotation that was evident during orthopaedic examination. A combined tibial plateau levelling osteotomy and lateral fabellotibial suture procedure were performed to stabilise the stifle joint. The surgical complications, short-term lameness scores and owner satisfaction were evaluated. The postoperative complication rate was 21 · 7% with one minor (4 · 3%) and four major (17 · 4%) complications. At short-term follow-up one dog had an intermittent low-grade lameness and two dogs had mild tibial internal rotational instability present on palpation without lameness. Owner's overall satisfaction with the operation and recovery was good (21 · 4%) to excellent (78 · 6%). The use of lateral fabellotibial suture in combination with tibial plateau levelling osteotomy was an effective technique for managing cranial cruciate ligament rupture with severe internal tibial rotational stifle instability.

Collaborative Human–Robot System for HALS Suture Procedures

Over the last years, minimally invasive surgery (MIS) has continuously improved due to new techniques and technologies. One of these novel techniques is hand-assisted laparoscopic surgery (HALS), where the surgeon inserts one hand through a small incision inside the abdominal cavity of the patient. As this kind of intervention only allows the use of one laparoscopic tool, the surgeon requires a deep collaboration with the assistant in order to coordinate their movements for performing a surgical maneuver. In this way, the replacement of a human assistant with a robot system specifically designed for HALS must include a natural human–machine interface and the capability for taking autonomous decisions. These features need the implementation of a model of the surgical protocol, a system capable of recognizing the corresponding surgical gestures made by the surgeon, and an autonomous task system that assists the surgeon without his direct intervention. This paper is focused on the design of a collaborative surgical robot that implements all the features previously described. This robot assistant has been validated by means of in vitro laparoscopic sutures on a HALS scenario with CISOBOT, a two-arm robotic platform designed and developed at the University of Malaga.

A novel postoperative immobilization model for murine Achilles tendon sutures.

The body's motion and function are all in part effected by a vital tissue, the tendon. Tendon injury often results in limited functioning after postoperative procedures and even for a long time after rehabilitation. Although numerous studies have reported surgical procedures using animal models which have contributed to both basic and clinical research, modeling of tendon sutures or postoperative immobilizations has not been performed on small experimental animals, such as mice. In this study we have developed an easy Achilles tendon suture and postoperative ankle fixation model in a mouse. Right Achilles tendons were incised and 10-0 nylons were passed through the proximal and distal ends using a modified Kessler method. Subsequently, the right ankle was immobilized in a plantarflexed position with novel splints, which were made from readily available extension tubes. Restriction of the tendon using handmade splints reduced swelling, as opposed to fixating with the usual plaster of Paris. Using this method, the usage of the right Achilles tendons began on postoperative days 13.5 ± 4.6, which indicated healing within two weeks. Therefore our simple short-term murine Achilles tendon suture procedure is useful for studying immediate tendon repair mechanisms in various models, including genetically-modified mice.

Epiblepharon in Chinese children: relationships with body mass index and surgical treatment

To evaluate the relationship between the incidence of lower eyelid epiblepharon and body mass index in Chinese children and report the outcomes of a rotating suture technique or the L-plasty procedure aimed at correcting the structural anomalies. The medical records of patients treated surgically, with either rotating suture procedure or L-plasty, for lower eyelid epiblepharon were reviewed retrospectively and compared with an age-matched control group of children without epiblepharon. Body mass index (BMI) was calculated as weight in kilograms divided by the square of height in meters. A total of 67 patients (mean age, 5.7±2.6years) and 178 controls were included. All patients had coexistent epicanthus. In 62 patients, rotating suture procedures were used; in 5, L-plasty. The BMI in 4- to 6-year-old boys with epiblepharon was significantly higher than that in children without epiblepharon (P=0 .042). All patients showed successful surgical outcomes according to improvement of symptoms and lack of cilia-cornea contact. There were no cases of recurrence or other complications. Obesity may be an aggravating factor in cases of lower eyelid epiblepharon, which may be corrected effectively with the rotating suture procedure and the L-plasty procedure. TheL-plasty procedure is recommended for patients with coexistent severe epicanthus.

The role of computed tomography in the immediate workup of open globe injury.

Immediate primary closure is indicated in cases of traumatic open globe injury. Orbital computed tomography (CT) is performed prior to primary closure in order to rule out possible intraocular foreign bodies (IOFB) and/or damage to adjacent extraocular as well as intraocular structures. The aim of the present study is to evaluate the yield of orbital CT scan in immediate clinical decision-making in cases of open globe injury. All cases of open globe injury treated in our institute during a 10-year period were reviewed. All underwent a CT scan before any surgical intervention, regardless of trauma severity. The influence of the CT scan results on decisions regarding the immediate treatment of the open globe injury was analyzed. A total of 125 cases of open globe injury were included in the present study. In none of these cases did the CT scan results have any influence on immediate treatment. The CT scan results did influence decisions that were made after the immediate operative stage. Computed tomography scan has limited value in immediate clinical decision-making in cases of open globe injury scheduled for primary closure. While not crucial prior to the initial procedure, it is of value in managing the case during the following few days as well as later on. This study suggests that a CT scan performed after the initial globe exploration and suturing procedure is a valid alternative to stalling the definite globe suturing process until a CT scan is obtained and interpreted.

Internal inguinal ring closure by laparoscopy using homologous pericardium grafts in horses

ABSTRACT: The occlusion of inguinal ring is the treatment to avoid the inguinal hernia in horses. The aim of this study is evaluate the efficacy of homologous pericardium grafts for internal inguinal ring closure in horses, comparing mechanical or manual laparoscopic suture. Cross over study, using six healthy intact male Mangalarga breed horses aged between 3 and 12 years. Horses were operated under general anesthesia in 25º Trendelenburg position. Five laparoscopic portals were employed. Pericardium grafts measuring 4x5cm were anchored covering the left and right internal inguinal rings using either manual intracorporeal suture or laparoscopic stapler. Horses were followed-up during 11 weeks when were submitted to a laparoscopic control. Surgical time, trans and postoperative complications and effectiveness of internal inguinal closure were evaluated and statistically analyzed. The level of significance was set at 5% P&lt;0.05. The procedures were realized without complications and the mean time required for manual and mechanical suture procedures differed significantly (67.8±15.3 and 14.1±2.1 min respectively; P&lt;0.05). All manually sutured grafts remained in place and partial suture dehiscence with incomplete occlusion of the internal inguinal ring was observed in two stapled grafts. Non-severe complications were observed trans or postoperatively. One synechiae and three omental adhesions were observed by laparoscopic control on day 77, but without clinical relevance in the evaluated period. The use of homologous pericardium grafts was effectiveness to internal inguinal ring closure by laparoscopy. Mechanical suture was faster to perform than manual, but provided less satisfactory results concerning safety of graft fixation.

An investigation of the surgery for the treatment of congenital entropion combined with lower lid retraction

Objective To investigate the effect of surgical treatment on congenital entropion combined with lower lid retraction. Methods Seventy eyes of 35 cases of congenital entropion combined with lower lid retraction underwent the surgical treatment of retractor myectomy combined with rotational suture.During the surgery, the lowerlid retraction muscle was cut off along with inferior border of lower tarsus, and the conjunctiva was sutured with 6-0 polyglycolic sutures, for the rotational suture procedure, after marking the normal position of the eyelid crease, one needle of a double-armed 2-0 nylon sutures was inserted through skin 2 mm away from the inferior border of the tarsus and withdrawed from the conjunctiva and then reversed to skin in the previously marked eyelid crease to make three pair of mattress-suture. The follow-up was 5 to 7 months. The position of lower lid margin was measured and the effect after surgery was observed. The cure criterion was that the lower lid margin was located 0.5 mm above inferior corneal limbus and no trichiasis occurred. Results After the operation, among 70 eyes the position of lower lid was normal in 66 eyes. Another 4 eyes received reoperation. Conclusion Myectomy of lower lid retractor combined with rotational suture is effective for congenital lowerlid entropion with lower lid retraction. Key words: Entropion, congential; Retraction, lower lid; Suture; Surgery, ophthalmic

A new design of a Nitinol ring-like wire for suturing in deep surgical field.

The present work proposes a new suturing procedure based on self-accommodating suture points. Each suture point is made of a commercial NiTi wire hot-shaped in a single loop ring; a standard suture needle is then fixed at one end of the NiTi suture. According to this simple geometry, several NiTi suture stitches have been prepared and tested by tensile test to verify the closing force in comparison to that of commercial sutures. Further experimental tests have also been performed on anatomic samples from animals to verify the handiness of the NiTi suture. Moreover, surface quality of sutures has been carefully investigated via microscopy. Results show that the NiTi suture expresses high stiffness and a good surface quality. In addition, the absence of manual knotting allows for a simple, fast and safe procedure.

A Simple and Reliable Method for Intracorporeal Circular-Stapled Esophagojejunostomy Using a Hand-Sewn Over-and-Over Suture Technique in Laparoscopic Total Gastrectomy.

The controversy regarding laparoscopic total gastrectomy (LTG) is mainly due to the difficulty associated with esophagojejunostomy during this procedure. Although several techniques have so far been reported to overcome this issue,1 (-) 4 a reliable technique has not yet been established. We developed intracorporeal esophagojejunostomy using a circular stapler in LTG with a hand-sewn over-and-over suture technique, and have shown its favorable outcomes compared with those of conventional open surgery.5 This technique is presented in the video. After transection of the esophagus, an over-and-over suture with a 2-0 monofilament is placed counterclockwise from the right to the left side of the cut end in an outside-to-inside direction, and then from the left to the right side in an inside-to-outside direction. After insertion of the anvil head into the esophagus, it was fixed by ligation of the thread. Finally, intracorporeal esophagojejunal anastomosis was performed using a circular stapler. In LTG, reconstruction using this method was performed for 23 consecutive patients with gastric cancer. There were no serious intraoperative complications or need for conversion to open surgery. Anastomotic leakage and stenosis occurred in one case each, respectively. The mean time for fixation of the anvil to the esophagus was 15 min for the last 12 consecutive patients. This method is simple and feasible, and the advantage of this technique is the elimination of the backhand stroke throughout the suturing procedure.

Orbicularis–levator–tarsus composite suture technique in double-eyelid operation

Fold loss and suture extrusion are fairly common in double-eyelid surgeries. We hereby explore a new composite suture technique that aims to reduce such complications and to improve the long-term aesthetic outcome. Based on the conventional external incision procedure, the suture procedure in our technique involves three stitches that fixate the orbicularis oculi, the levator aponeurosis, and the tarsal plate. This modified upper-eyelid blepharoplasty was performed in 98 patients (91 female and seven male, 196 eyes) with either congenital absence of the upper-eyelid folds (n = 84) or loss of fold from previous procedures (n = 14). The patients were followed up for 6-30 months. The complications were documented, and the overall outcomes of upper-eyelid folds were evaluated by both surgeons and patients as excellent, good, fair, or poor. Among 98 patients, 89 (91%) had excellent results and nine (9%) had good results; no patient had fair or poor results. Four patients had scar formation at postoperative week 2, all resolved without particular treatments at 6 months. The buried sutures could not be seen or felt through the skin. In addition, no suture extrusion was noted. There was no case of faded or disappeared folds during the follow-up. All patients were satisfied with the outcome. The composite suture technique ensures a firmer fixation and improves the aesthetic outcomes. It is a highly applicable and reliable approach for upper-eyelid blepharoplasty.

Arthroscopic Meniscal Repair: "Modified Outside-In Technique".

Despite the introduction of different techniques for meniscal repair, no single procedure is superior in all situations. The new method for meniscal repair named "modified outside-in technique" aims to achieve higher primary fixation strength by an alternative suture technique as well as avoid disadvantages of outside-in, inside-out, and all-inside suture procedures. Additionally, the mid-term results of surgically treated patients with meniscal injuries by our new technique were evaluated. The current prospective study included 66 patients who underwent meniscal repair by the modified outside-in technique. The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form was completed pre- and post-operatively. At final follow-up, Lysholm score was completed and patients were questioned about their return to previous sport activities. Clinical success was defined as lack of swelling and joint line tenderness, absence of locking, negative McMurray test and no need for meniscectomy. Patients' satisfaction was evaluated using the visual analogue scale (VAS). Patients were followed for 26±1.7 months. Clinical success was achieved in 61 patients (92.4%) and 5 candidates required meniscectomy (7.6%). IKDC Subjective Knee Evaluation Form score increased significantly from 54.2±12.7 preoperatively to 90.8±15.6 postoperatively (P<0.001). Lysholm score was excellent and good in 49 (80.3%) patients and fair in 12 (19.7%). Patients' satisfaction averaged at 8.35±1 (6-10). Neurovascular injury, synovitis and other knot-related complications were not reported. The modified outside-in technique has satisfactory functional and clinical outcomes. We believe that this procedure is associated with better clinical and biomechanical results; however, complementary studies should be performed to draw a firm conclusion in this regard.

Simple Suturing Procedure to Manage a Flat Anterior Chamber Secondary to a Malfunctioned Ahmed Glaucoma Valve

Introduction: Presenting a case with repeated episodes of flat Anterior Chamber (AC) after Ahmed valve implantation, and suggesting a simple suturing procedure to manage these recurrences. Case:A 65-year-old woman presented to our clinic with uncontrolled Neovascular Glaucoma (NVG) in her left eye due to advanced Proliferative Diabetic Retinopathy (PDR) despite full medication to reduce Intraocular Pressure (IOP). After Ahmed valve implantation, anterior chamber became flattened spontaneously on postoperative day one. Therefore, we filled the AC with air at the first attempt but this procedure failed a day later. Then, we filled the AC with an ocular viscoelastic device. Because of these procedures failed to keep the AC formed, we hypothesized that it may be a malfunctioned valve. Therefore, we inserted 5-0 Nylon in Ahmed tube through AC and fixed it to the subconjunctiva two days after the second procedure. Anterior chamber remained deep and its shallowing did not occur despite removing the suture two weeks after the insertion. The IOP was controlled well with a functional filtering device at the last follow–up visit four months after the surgery. Conclusion: Spontaneous episodes of flat AC after Ahmed valve implantation in an eye can be well managed by inserting a removable suture into the Ahmed valve tube.