Sutureless Surgery Research Articles

6/0 prolene double-flanged IOL sutureless scleral fixation with a 27-gauge needle for intraocular lens surgery.

To report our initial experience of a modified intraocular lens (IOL) scleral fixation technique using 6/0 prolene in a double-flanged sutureless technique with a 27-gauge needle. 29 consecutive patients with IOL surgery were retrospectively reviewed between December 2021 and October 2023. Early Treatment Diabetic Retinopathy Study (ETDRS) letters, spherical equivalent (SE), astigmatism axial degree and intraocular pressure (IOP) were evaluated at baseline, and 1, 2, 3, and 6 months postoperatively. Surgery-related complications were evaluated during follow-up. ETDRS letters or SE at 1, 2, 3, and 6 months postoperation was significantly improved compared to baseline levels. Patients with younger (estimate [SE] = 8.011 [2.485], p = 0.006), preoperative lens drop (estimate [SE] = 8.621 [2.906], p = 0.009), idiopathic cataract (estimate [SE] = 6.021 [2.099], p = 0.048), high baseline ETDRS letters (estimate [SE] = 15.449 [2.352], p < 0.001), or low baseline SE (estimate [SE] = 6.357 [2.406], p = 0.018) had the greatest improvement in ETDRS letters during follow-up. Patients with preoperative lens or IOL dislocation had a greater postoperative SE improvement than those with preoperative lens or IOL subluxation (dislocation vs. subluxation: estimate [SE] = -189.235 [70.692], p = 0.016). There were no cases of vitreous hemorrhage, cystoid macular edema, endophthalmitis, subluxation or dislocation were observed during the 6-month follow-up. Our modified IOL scleral fixation technique is a simple, safe, efficient method that avoids haptic manipulation and slippage, reduces postoperative complications, achieves completely sutureless surgery, and results in an achievement of surgical refractive goals.

The future path to sutureless surgery: Self–adhesive tough hydrogel

The future path to sutureless surgery: Self–adhesive tough hydrogel

Reposition of dislocated piggyback intraocular lens in a patient with induced keratectasia after radial keratotomy

Aim – to substantiate low-traumatic sutureless surgery for piggyback intraocular lens (IOL) reposition as a method of choice in a patient after previous keratorefractive surgery and cataract phacoemulsification.&#x0D; The article provides the examination and surgical treatment data of one patient with piggyback intraocular lens dislocation after previous radial keratotomy and keratectasia.&#x0D; The presented clinical case shows that proper consideration of eye anatomical features allows for effective low-traumatic sutureless piggyback IOL reposition in patients who have previously undergone radial keratotomy, and may lead to sustainable high visual and functional results.

Sub-tenon Versus Sub-conjunctiva Anaesthesia for Intraocular Surgery.

To compare the pain relief achieved using sub-Tenon anesthesia with that of sub-conjunctival anesthesia technique in intraocular surgery at the Guinness Eye Centre Onitsha Nigeria. Consecutive adult patients who had intraocular surgery under local anesthesia were randomized into having sub-Tenon (3 mL) or sub-conjunctival (0.5 mL) injections using xylocaine ± adrenaline. The manual suture-less surgery technique was used for cataract surgery alone and cataract surgery with pterygium excision; the extra-capsular cataract extraction technique was adopted for combined trabeculectomy and cataract surgery. Surgery duration was recorded. Patient's pain perception graded as none, mild, moderate or severe. 100 patients made up 51 (51.0%) males and 49 (49.0%) females, age range was 31-88 years, median - 68 years, participated. Sub-Tenon anesthetic technique was used in 52 (52.0%) and sub-conjunctival in 48 (48.0%) participants. Seventy-eight (78.0%) patients had cataract surgery; 10 (10.0%) had trabeculectomy; 7 (7.0%) had combined trabeculectomy and cataract surgery and 5 (5.0%) had pterygium excision with cataract surgery. The mean surgery duration in the sub-Tenon anesthesia group was 31.8 ± 8.5 minutes and 30.2 ± 9.8 minutes in the sub-conjunctival group (P > 0.05). Fifty (96.2%) patients in the sub-Tenon group and 38 (79.2%) in the sub-conjunctival group experienced mild or no pains; 2 (4.2%) patients in the sub-Tenon group and 10 (20.8%) in the sub-conjunctival group experienced moderate to severe pains (P < 0.05). Both sub-conjunctival and sub-Tenon anesthetic achieved effective analgesia in intraocular surgery. But sub-Tenon anesthesia is significantly associated with lower incidence of severe pains.

Application of sutureless technique in total anomalous pulmonary venous connection repair.

The sutureless technique was initially used for the treatment of postoperative pulmonary vein obstruction (PVO) in patients with total anomalous pulmonary venous connection (TAPVC). However, as the effectiveness of the sutureless technique has been confirmed and widely developed, the sutureless technique has been used for the primary treatment of high-risk children with TAPVC who are at high risk of PVO. Compared with traditional surgery, the sutureless technique significantly reduces the incidence of postoperative PVO, re-intervention rate due to PVO, and postoperative mortality, but there are potential complications such as pericardial and confluent venous anastomosis, phrenic nerve damage, air embolism. In addition, the sutureless technique is not effective in dealing with the progressive stenosis of the pulmonary veins after sutureless surgery and diffuse stenosis of extrapulmonary proximal veins and intrapulmonary veins. These make the efficacy and safety of this procedure controversial. This paper reviews the research status of the sutureless technique in TAPVC repair at home and abroad over the years.

Sutureless Closure Versus Conventional Technique in the Primary Surgery of Total Anomalous Pulmonary Venous Connection: A Systematic Review and Meta-analysis.

Sutureless closure has been used for primary repair of total anomalous pulmonary venous connection (TAPVC) for over 20years but its superiority over conventional technique is still uncertain. This systematic review was conducted to compare the effectiveness of sutureless closure and conventional surgery as the primary repair for TAPVC. Systematic search was performed in June 2021 on 12 databases. All studies comparing sutureless and conventional surgery for TAPVC were included. The primary endpoints were early mortality, overall mortality, postoperative pulmonary venous stenosis (PVS), and reoperation. Meta-analysis of two-arm studies was performed with several sensitivity and subgroup analyses. Six retrospective studies with 767 patients were included in meta-analyses. Sutureless closure significantly reduced the risk of early mortality, overall mortality, postoperative PVS, and reoperation by 53%, 45%, 77%, and 67% compared to conventional technique, respectively. No heterogeneity was found and presence of publication bias was non-significant. The results were consistent in all sensitivity analyses. Subgroup analyses revealed that sutureless closure was superior to conventional technique in patients with and without preoperative pulmonary venous obstruction, and neonates and non-neonates. Sutureless closure is better than conventional closure as the primary surgery for TAPVC patients. We advocate using sutureless closure for patients with TAPVC. Future large-scale observational studies or clinical trials are required to confirm our findings.

A 27 - Gauge Microincision Vitrectomy Surgery for Posterior Segment Diseases in a Tertiary Centre, Nepal

Introduction: Transconjunctival micro incision vitrectomy surgery (MIVS) with 23 or 25 gauge instrumentation is more advantageous than traditional 20 gauge surgery. We intended to evaluate the visual outcome, complications and indication of various vitreoretinal diseases using 27 Gauge vitrectomy systems. &#x0D; Methods: This study was a prospective, interventional, non-comparative study conducted in Nepal Eye Hospital from June 2017 to July 2018. Fifty-two patients with various vitreoretinal diseases were recruited. The main outcome measures included corrected distance visual acuity (CDVA) preoperative and postoperative, intraocular pressure (IOP) preoperative and postoperative, indication for vitreoretinal surgery, intraoperative complications, and postoperative complications.&#x0D; Results: Fifty two eyes of 52 patients (26 men and 26 women; mean age, 59 years) underwent 27-gauge pars planavitrectomy. Surgical indications included epiretinal membrane (n = 11), full-thickness macular hole (n = 11), rhegmatogenous retinal detachment [n = 14 (12 vitrectomy only and two vitrectomy with scleral buckle)], vitreous haemorrhage (n = 3), vitreous opacities (n = 3), silicon oil removal (n = 3), proliferative diabetic retinopathy [n = 6 (5 vitreous haemorrhage and one tractional retinal detachment)], posterior IOL dislocation (n = 1). Postoperative complications included transient ocular hypertension in eight eyes (15.39%), transient hypotony in five eyes (9.62%) and vitreous haemorrhage in five eyes (9.62%). No cases of postoperative endophthalmitis, sclerotomy - related tears, or choroidal detachments were encountered in the follow-up period. Mean corrected distance visual acuity improved from 20 / 796 (logarithm of the minimum angle of resolution, 1.60 ± 0.64) preoperatively to 20 / 49 (logarithm of the minimum angle of resolution, 0.42 ± 0.26) postoperatively (p = 0.000,) at final follow up.&#x0D; Conclusions: 27-gauge micro-incision vitrectomy surgery was found to be a safe and effective suture-less surgery with favourable outcomes, in terms of vision.

IJU this issue

This issue deals with a wide range of clinical topics of urology, and contains 14 Original Articles. Percutaneous nephrolithotomy (PCNL) is a minimally invasive endourological procedure recommended as first-line therapy for kidney stones >2 cm in diameter. In general, however, nephrectomy is carried out in patients with large stones within non-functioning atrophic kidneys. Su et al. (Beijing, China) evaluated outcomes in patients who underwent total ultrasound-guided PCNL for the management of large stones (>2 cm) within non-functioning atrophic kidneys. Their results showed that ultrasound-guided PCNL is safe and feasible, even for stones >2 cm in diameter within non-functioning atrophic kidneys. However, PCNL is not recommended for patients with diabetes. Several energy sources have been used for stone fragmentation during ureteroscopy. Nowadays, the holmium:YAG laser is a standard method that provides effective and safe disintegration of all stone types. However, it has some disadvantages, such as relatively high retropulsion (which might lead to relocation of the stone into the renal pelvis). Enikeev et al. (Moscow, Russia) estimated the efficacy and safety of SuperPulsed thulium-fiber laser ureteral lithotripsy, and identified optimal laser settings. Their results showed that the SuperPulsed thulium-fiber laser provides effective and safe lithotripsy during ureteroscopy regardless of stone density. Fiber diameter and laser frequency do not influence visibility or safety. Optimal laser settings are 0.5 J × 30 Hz for fragmentation and 0.15 J × 100 Hz for dusting. Subclinical Cushing syndrome is defined as a condition of hypercorticolism in patients with adrenal tumors in the absence of clinical features of Cushing syndrome. Although surgical removal of adrenal tumors for subclinical Cushing syndrome patients has been reported to be beneficial with the improvement of comorbidities, such as hypertension, diabetes mellitus and obesity, the surgical benefit is still controversial. Sato et al. (Chiba, Japan) retrospectively investigated whether the result of the 1-mg dexamethasone suppression test could predict the improvement of comorbidities after adrenalectomy in patients with subclinical Cushing syndrome. Their results showed that the greatest reduction of prescribed drugs is observed in patients whose serum cortisol levels are between 1.8 and 3.0 μg/dL after the 1-mg dexamethasone suppression test, implicating that the 1-mg dexamethasone suppression test can be a useful factor predicting the improvement of comorbidities after adrenalectomy. Today, it is well known that approximately half of cases of infertility are attributable to male factors. Recently, the European Association of Urology guideline for male infertility emphasized that oral anti-oxidants were associated with a significant increase in markers of sperm quality. Among the anti-oxidants, one of the elements perhaps most familiar and well known to the general public is zinc. Tsujimura et al. (Chiba, Japan) tried to clarify the factors associated with semen quality, and confirm whether there was an association between semen quality and serum zinc concentration. Although there was no significant correlation between serum zinc concentration and semen quality, the independent predictors for having values below the World Health Organization criteria for assessing sperm quality in binomial logistic regression analysis were follicle-stimulating hormone and serum zinc concentration. They suggested that semen analysis might be considered in men with a low level of serum zinc and high level of follicle-stimulating hormone when developing a reproductive life plan for fertilization. Yasuda et al. (Tokyo, Japan) developed the gasless approach as another type of minimally invasive endoscopic surgery, and applied it to many kinds of urological surgeries, including partial nephrectomy. In gasless partial nephrectomy, they prioritized clampless and sutureless surgery, if feasible, as an attempt to obtain maximal functional preservation. They investigated the outcomes and feasibilities of gasless laparoendoscopic single-port clampless sutureless partial nephrectomy. Their results showed that clampless and sutureless partial nephrectomy can be safely accomplished in most patients undergoing gasless laparoendoscopic single-port surgery, yielding favorable oncological and functional outcomes. Transurethral resection of the prostate represents the standard surgical technique for the management of benign prostatic hyperplasia with a prostate size <80 mL. However, considerable morbidities are associated with larger sizes. Higazy et al. (Cairo, Egypt) evaluated the safety, efficacy and cost-effectiveness of holmium enucleation of the prostate and bipolar transurethral enucleation of the prostate. Their results showed that both holmium enucleation of the prostate and bipolar enucleation of the prostate are safe and effective in the surgical management of large prostatic adenomas. However, holmium enucleation of the prostate has a shorter operative time and hospital stay, with an earlier catheter removal time, and is more cost-effective than bipolar enucleation of the prostate. None declared.

Наш опыт хирургического лечения врожденной катаракты

Aim. To present our experience and evaluate the results of surgical treatment of congenital cataracts. Methods. A clinical analysis of the results of congenital cataract aspiration in 16 children (22 eyes) aged 2 months to 5 years is performed. Bilateral cataract was determined in 6 children, unilateral – in 10. Preoperative examination of children aged 3–5 years was carried out in a standard way. Children younger than 3 years of age at the initial appointment underwent non-contact examination methods, the remaining studies were performed under general anesthesia in the operating room immediately before surgery. Congenital cataract phacoaspiration was performed under general anesthesia using the Stellaris microsurgical system (Bausch and Lomb, USA) through a 1.2-mm paracentesis in the lens irrigation-aspiration regime. Hydrophobic IOL models were implanted. The posterior lens capsule was preserved in all cases. Mandatory was the appointment of cycloplegics in drops in the early postoperative period. Results. An increase in visual acuity (from 0.03 to 0.7) occurred in all cases. However, presence of obscuration amblyopia of varying degrees required regular courses of pleoptic treatment. Conclusions. The effectiveness of congenital cataracts phacoaspiration is ensured by the fulfillment of federal clinical recommendations, however, sutureless surgery allows achieving high functional results in the treatment of this pathology. Key words: congenital cataract; phacoaspiration; intraocular lens.

Comparative Evaluation of Suture Versus Sutureless Surgery in Mandibular Third Molar Impactions.

The purpose of this study is to compare the suture versus sutureless surgery in impacted mandibular third molar and to evaluate the morbidity and complications associated with each technique. A total of 50 patients with asymptomatic impacted mandibular third molars were randomly divided into two groups of 25 patients each. Radiographs were taken to assess the angulation and degree of eruption in the third molar. A small modified Szmyd, V-shaped flap was raised in all cases, and teeth were extracted. In Group I-Suture group (suture was used to close the flap), and in Group II-Sutureless group (no suture used to close the flap). The post-operative pain, swelling, trismus, haemorrhage, periodontal pocket, and alveolar osteitis were evaluated at 24h, 48h, 5th days, 7th days, and 2weeks after surgery. The statistical analysis was done using the Chi-square "t" test and Independent Samples "t" test. Pain, swelling, and trismus were found to be significantly reduced especially in the immediate post-operative period in the sutureless group as compared to the suture group (p < 0.001). There were no incidences of intra-operative and post-operative haemorrhage in any case. Follow-up of all the patients showed that there was no difference in periodontal sequelae and alveolar osteitis. Sutureless surgery with small flap was found to be less invasive, time-saving, and also a cost-effective method. This technique significantly reduced the early crucial phase of patient discomfort and demonstrates good results.

Comparative Study to Evaluate the Outcome of Sutures Versus Sutureless in Attachment of Conjunctival Autograft for Pterygium Excision

Background: Suturing of conjunctival graft is a traditional technique for pterygium excision surgery. Owing to its many disadvantages &amp; complications many newer techniques like autologous fibrin glue have been introduced &amp; accepted as an alternative method of graft adhesion. Methodology: The present study was conducted at the Department of Ophthalmology, MMIMSR, Mullana (Maharishi Markandeshwar Deemed to be University) in the time period extending between December 2017 and January 2019. 100 eyes of patients of either sex with primary pterygium were selected and divided into 2 groups of 50 each in Group 1- patient underwent conjunctival auto graft with 10-0 ethilon sutures while in Group 2 suture less conjunctival auto graft was done with patient’s own blood fibrin. Results: Parameters such as mean operating time, presenting complaints like pain, watering, burning and foreign body sensation, complications &amp; recurrence were compared between the two groups on postoperative Day 1, Day 7, 2 weeks, 1 month, 2 month, 3 month &amp; 6th month. Statistical significant difference (p&lt;0.01) was found between the suture and sutureless surgery for pterygium in relation to post-operative discomfort grading. There was a significant difference (t = 22.149, p = 0.001) in the duration of surgery for GROUP I surgery. Conclusion: Conjunctival auto graft with autologous serum is a safe and fast method. It is equally effective as conventional sutured autograft technique. Post operative discomfort is significantly less in this method. It also prevents suture related complications.

Evaluation of fenestration technique of the medial recuts muscle with resection of ipsilateral lateral rectus muscle in patients with sensory esotropia

Background There is an ongoing need to move toward sutureless surgery with less surgical manipulations, while maintaining the same results achieved by conventional surgery. Aim The aim was to evaluate the safety and the effectiveness of fenestration technique of the medial recuts muscle with resection of ipsilateral lateral rectus muscle in patients with sensory esotropia. Design A prospective, noncomparative, single-institution interventional study was conducted. Patients and methods This is a prospective study conducted on 16 children with sensory esotropia. Fenestration of the medial rectus muscle is a novel technique of weakening of the medial rectus by excising a rectangular wide central part extending from the insertion to a point back 5–8 mm depending on the angle of the esotropia leaving superior and inferior longitudinal muscle sleeves with no muscle sutures needed. Postoperative angle was reported at 3 months and at final follow-up. Results The procedure reduced the angle of esotropia from mean preoperative angle of 36.6±9 (20–50) to 5.3±5.9 (0–20) PD. Satisfactory horizontal alignment, defined as postoperative alignment within 8 PD of orthotropia at distance, was achieved in 81.25% of the cases at 3 months of follow-up. There were no overcorrections. The procedure was well tolerated by patients. Conclusion Fenestration technique is a safe and effective weakening procedure for medial rectus in cases of sensory esotropia.

Total thyroidectomy: conventional suture ligation technique versus sutureless techniques

Background: Since the introduction of successful thyroidectomy no change occurred in the technique but with the innovation of sutureless surgery, sutureless thyroidectomy becomes a competitor for the conventional technique. In this study we tried to analyze the outcomes of each.Methods: This was a prospective cross armed uncontrolled randomized study included 65 patients suffering from non-malignant goiter who underwent total thyroidectomy, admitted to Sohag University Hospital from September 2017 to October 2018. Patients were randomly allocated into two groups; Group (S) managed with sutureless thyroidectomy, and Group (C) managed with conventional knot tying technique. The data of the patients were gathered and analyzed considering the operative and post-operative outcomes. All patients were followed-up for 6 -12 months.Results: We found a significantly shorter operative time (p=0.001), also the amount of intra-operative blood loss was highly significant less in Group S (p=0.001). There was higher incidence of post-operative pain in Group C (p&lt;0.001), post-operative drainage volume was highly significantly less in Group S (p=0.001). Regarding post-operative complications; the incidence of recurrent laryngeal nerve paralysis (RLNP) was insignificant between both groups (p=0.38), in the same time the incidence post-operative transient hypocalcaemia was significantly more in Group C (P=0.025). The overall post-operative complication rate was significantly more in Group C (p=0.002). The duration of hospital stay was highly significant shorter in Group S (p=0.0001).Conclusions: The use of Harmonic FOCUS® is beneficial for both patient and surgeon; it is efficient and a trustable safe substitute to the conventional knot tying technique.

Comparison of conventional and primary sutureless surgery for repairing supracardiac total anomalous pulmonary venous drainage

ObjectiveThe efficacy of using a sutureless approach in order to surgically manage postoperative pulmonary vein stenosis following total anomalous pulmonary venous drainage (TAPVD) has been reported, though outcomes of primary treatment of supracardiac TAPVD remain unclear. We retrospectively reviewed our cardiac center experience, and compared the differences in mid-term outcomes for those patients that received conventional surgery and those that underwent sutureless technique for the primary repair of supracardiac TAPVD.MethodsA total of 43 patients (median age, 199 days; range, 35 days to 1572 days) with supracardiac TAPVD underwent surgical treatment at our cardiac center from 2014 to 2018 were studied retrospectively. Primary sutureless repair was conducted in 20 cases (46.5%). The pulmonary vein scores, left ventricular ejection fraction (LVEF), baseline of the included patients, postoperative, and outcomes data were analyzed between the two groups.ResultsThe pulmonary vein scores, indicating the stenosis degree, of two groups were 0.1 ± 0.3 and 0.1 ± 0.3, left ventricular ejection fraction (LVEF) (%) were separately 66.2 ± 12.1 and 67.1 ± 13.6. The average cardiopulmonary bypass time of sutureless techniques group was much longer than conventional group (96.2 ± 32.6 min vs 75.6 ± 28.2 min, P < 0.05), but there was no difference in aortic cross-clamp time between the two groups. Followed up from 0.1 to 4 years, 3 cases died overall, with 1 (5.0%) individual dying from postoperative pulmonary venous obstruction (PVO) in sutureless group, and 2 (8.6%) dying in the conventional group respectively for postoperative infection and post-PVO. There were no differences in the length of stay in the ICU, grades of PVS after surgery, LVEF and reoperation rate between the two groups.ConclusionsThe mortality, post-PVO, follow up results of supracadiac TAPVD showed no differences between sutureless and conventional techniques. Post-PVO supposed to be the main reason for postoperative mortality.

PHACOEMULSIFICATION OF BROWN CATARACTS ON AVITREAL EYES

Analysis of the features of surgical treatment of brown cataracts in the eyes with previously performed posterior vitrectomy. The study included 25 patients (25 eyes) with nuclear cataracts 6+ density according to LOCS III classification. All patients underwent microinvasive posterior vitrectomy more than 6 months ago. Microcoaxial (2.2 mm) phacoemulsification of cataract with implantation of flexible intraocular lens was planned for all patients. In 15 patients (60 %), a system of capsule hooks was used in order to support the capsule bag 4 in 16 % of cases and 6 in 44 % of cases. Results and discussion. Sutureless surgery were performed in 24 patients (96 %). In one case with nigra cataract despite the use of capsule hooks, due to the high risk of dislocation of the lens into the vitreous cavity, the surgery was converted into a large incision. Microcoaxial phacoemulsification is the surgery of choice in the case of a combination of dense lens and lack of vitreous support. The use of capsular hooks greatly simplifies surgery and increases the chances of sutureless surgery.

Review of Small Gauge Vitrectomy: Progress and Innovations.

Purpose. To summarise the surgical advances and evolution of small gauge vitrectomy and discuss its principles and application in modern vitreoretinal surgery. The advent of microincisional vitrectomy systems (MIVS) has created a paradigm shift away from twenty-gauge vitrectomy systems, which have been the gold standard in the surgical management of vitreoretinal diseases for over thirty years. Advances in biomedical engineering and surgical techniques have overcome the technical hurdles of shifting to smaller gauge instrumentation and sutureless surgery, improving surgical capabilities and expanding the indications for MIVS.

Outcomes of transconjunctival sutureless 27-gauge micro-incision vitrectomy surgery in diabetic vitreous haemorrhage.

Objective:To evaluate the visual outcomes of 27-gauge transconjunctival sutureless vitrectomy surgery and its complications in patients with diabetic vitreous hemorrhage.Methods:A quasi-experimental study was conducted where eighty seven eyes of 87 uncontrolled type II diabetes mellitus patients presenting with diabetic vitreous hemorrhage were selected to undergo 27-gauge transconjunctival sutureless micro-incision vitrectomy surgery. Main outcome measured was best corrected visual acuity (BCVA). Post-operative complications were also screened for at each visit. The follow ups were at post-operative day one, one month, three months and six months respectively.Results:Out of 87 patients, 52 (59.8%) were males and 35 (40.2%) were females. The mean age of the patients was 52.32 ± 6.78 years (95% CI: 53.13 - 55.57). For most of the patients, the BCVA improved progressively with each subsequent follow up visit. Pre-operative BCVA was 1.01 ± 0.206 logMar, compared to BCVA at final follow up of 0.44 ± 0.231 (p-value < 0.001). Six (6.9%) patients developed recurrent vitreous hemorrhage during the study period, four (4.6%) developed cataract, one (1.1%) had increased intraocular pressure and sub conjunctival hemorrhage was present in two (2.3%).Conclusion:27-gauge micro-incision vitrectomy surgery is an effective sutureless surgery with favorable outcomes, in terms of vision, in patients with diabetic vitreous hemorrhage. The associated complications are few which can be easily managed.

The Effect of Sutureless Surgery on Postoperative Pain and Swelling Following Mandibular Third Molar Surgery

Introduction: surgeons have always sought to use techniques to decrease pain and swelling. One of the solutions that can minimize these complications is closing the wound with the minimum number of sutures or sutureless technique. The goal of this study was to evaluate the role of sutureless technique in decreasing pain and swelling after impacted mandibular third molar surgery. Methods: nineteen patients with bilaterally mandibular impacted third molars (one side as control and the other as the case) entered the study. A single surgeon performed the surgery using a single protocol. After removing each tooth, the flap on the control side was sutured, while on the study side, it was handled sutureless. Post-operative pain evaluated with visual analogue scale (VAS) at first, third and seventh days after surgery. Inflammation evaluated with measuring the distance between tragus and oral commissure in the same distance. Result: In our study, in all patients, the average mean pain score increased from the first to the third day and decreased from third to seventh day and the difference in the average of pain scores in the aforementioned three days was significantly different(p<0.001). In all patients, the mean score for swelling increased from the first to third day and decreased from the third to seventh day and its difference in the aforementioned three days was significant(p<0.001). The pain score was similar in two groups in the first day. However, this score was significantly less in the study group than the control group in the third and seventh day (p<0.001). Conclusion: Results of this study showed that secondary wound closure (sutureless technique) was effective in decreasing pain and swelling after mandibular third molar surgery

Endophthalmitis After Pars Plana Vitrectomy: Clinical Features, Risk Factors, and Management Outcomes.

To report the clinical presentations, risk factors, and outcomes of endophthalmitis after pars plana vitrectomy at 4 tertiary eye care centers of an institute in South India. A retrospective case series. The records of 38,591 patients undergoing vitrectomy were reviewed using the coding assigned by the medical records department. Consecutive cases diagnosed as endophthalmitis after pars plana vitrectomy (PPV) between 1990 and 2014 for various indications were analyzed. The clinical incidence of postvitrectomy endophthalmitis was 0.052%, and culture-positive incidence of postvitrectomy endophthalmitis was 0.031%. Twelve cases (60%) were culture positive. Mean presenting vision was 2.16 ± 1.51 logMAR (Snellen equivalent 20/2890). Seventeen eyes had received sutureless vitreous surgery (15 cases 23G, 2 cases 25G) and 3 eyes had received 20G suture-assisted vitreous surgery (P < 0.0001). The odds of developing endophthalmitis in sutureless versus sutured vitrectomy were 25.14 [95% confidence interval (CI), 7.37-85.84] (P < 0.0001) and those of developing endophthalmitis in sutureless surgery versus sutured with final tamponade of Ringer lactate (RL) were 19.53 (95% CI, 5.37-71.03) (P < 0.0001). In sutureless surgeries, the odds of developing endophthalmitis in RL tamponaded eyes versus non-RL ones was 4.39 (95% CI, 1.67-11.56) (P = 0.002). Mean interval between vitreous surgery and endophthalmitis was 4 ± 6.89 days; median, 1.5 days. Mean postoperative vision was 1.7 ± 1.36 logMAR (Snellen equivalent 20/1002) (P = 0.31). Endophthalmitis after vitrectomy is an acute presentation. Sutureless surgery, especially with aqueous tamponade, has a higher risk. The visual outcome is relatively poor.

Poly(Sodium Acrylate)‐Based Nanocomposite Bioadhesives for Sutureless Surgery

SummaryPolymer‐based bioadhesives for surgery provide a promising alternative to conventional suturing. A poly(sodium acrylate)‐based nanocomposite with antibacterial properties was prepared via in situ polymerization using nanosilver. To modify the nanocomposite degradation rate, a second, more degradable polymer was incorporated into the nanocomposite as an interpenetrating polymer network (IPN). The adhesion strength of the resulting bioadhesives was within an appropriate application range. The nanocomposites were shown to be biocompatible and exerted excellent antibacterial properties which makes them suitable to serve as an alternative for traditional suturing for out‐clinic surgeries such as may be necessary in the aftermath of a natural disaster.