Measures for preventing recurrence after pterygium surgery

PURPOSE: To introduce an improved technique of pterygium surgery and to compare postoperative results between this technique and previous techniques. METHODS: In a retrospective survey, the records of 216 consecutive eyes with primary pterygium that underwent surgery by three different techniques were reviewed. The new technique (mini-flap technique) involves making a small excision of the pterygium body, removing the pterygium head by scraping with forceps, applying mitomycin C (MMC), and performing a small conjunctival transposition flap. The previous technique (large-flap technique II) involved making a large excision in the pterygium body, removing the pterygium head with a knife, applying MMC, and performing a large transposition flap. Large-flap technique I is the same as large-flap technique II except for the use of intraoperative MMC. The recurrence rate of each technique was estimated by the Kaplan-Meier life table analysis. RESULTS: The recurrence rates estimated at 1 year after surgery were 15.5% in large-flap technique I, 4.2% in large-flap technique II, and 0% in the mini-flap technique. Large-flap technique II or the mini-flap technique had significantly lower recurrence rates compared with large-flap technique I ( p = 0.02 and p < 0.01, respectively). The mini-flap technique had a significantly lower incidence of conjunctival scarring or granuloma compared with large-flap technique I and large-flap technique II ( p = 0.05 and p = 0.03, respectively.) CONCLUSIONS: The mini-flap technique was useful for preventing recurrence and was technically easier and induced fewer postoperative complications than large-flap techniques I and II.     

无缝线巩膜脉络膜切开法引流视网膜下液

目的 探讨引流视网膜下液新方法的效果。方法 设计一种无缝线巩膜脉络膜切开放液法,并将本方法与传统的巩膜切开加脉络膜穿刺放液法进行前瞻性研究比较。４０例４０眼巩膜喧术病例纳入本研究。结果 ４０例视网膜下液均引流成功。２０例应用本方法者无任何并发症发生,２０例传统方法者２例发生视网膜下出血。结论 无缝线巩膜脉络膜切开放液法与传统方法一样有效,但更为简单、安全。     

A sutureless technique for securing leaking sclerotomies with viscoelastic substances in 23-gauge microincision vitrectomy surgery

AIM: To introduce and evaluate the clinical efficacy of a new technique, the use of viscoelastic substances (VS) to close leaking sclerotomy in 23G microincision vitrectomy, and to observe its effect on the visual acuity and intraocular pressure (IOP) of patients. METHODS: Patients who underwent 23G vitrectomy in Ningbo Eye Hospital before the use of VS technique (June 2019 to September 2020) and after the use of VS technique (October 2020 to December 2021) were selected as the subjects of this study. The above cases underwent operation by the same surgeon and were retrospectively analyzed. VS technique was used as the alternative to suturing, in which a small amount of VS was injected at the leaking sclerotomy and then gently massaged to confirm leaking sclerotomy closure. RESULTS: A total of 174 eyes were covered in the study, including 84 eyes in the control group (before the use of VS technique) and 90 eyes in the VS technique group. The number of eyes that needed to be sutured decreased considerably from 42.9% in the control group to 3.3% in the VS technique group, and the proportion of subconjunctival hemorrhage at 1-2d after surgery decreased remarkably from 35.7% in the control group to 2.2% in the VS technique group. No substantial differences in the incidence of mean IOP and low IOP were found between 1-2 and 3-20d after surgery in the VS technique group. No major complications associated with VS technique were identified during the study. CONCLUSION: In 23G microincision vitrectomy, VS technique is a safe, simple, and effective method to close leaking sclerotomy.     

AAA—ICM技术单次提取图形视觉诱发电位的可行性分析

目的比较基于自参考、自相关、自适应干扰对消技术（AAA—ICM）的单次提取与传统叠加平均两种方法在图形视觉诱发电位（P—VEP）信号提取中的效果,并评估该技术临床应用的可行性。方法对40例青光眼患者与33例正常对照者进行P-VEP检测,分别应用单次提取及叠加平均两种方法提取出VEP波形,并计算出Pm波潜伏期（LPm）的正常值范围,参照正常值分析疾病组的检测结果,并与经叠加平均法计算所得结果进行比较。结果参照本研究得出的正常值范围,对患者组的检测结果进行分析,得出这种基于AAA—ICM技术的单次提取对青光眼检测的灵敏度为98．4％,特异度为88．9％,准确度为96．3％。两种信号提取方式得出的Pm潜伏期结果比较,差异无统计学意义（P〉0．05）。结论应用单次提取方式提取VEP,在对青光眼疾病的诊断结果上与传统叠加平均方法相一致,且用时短、患者耐受性好、背景干扰少,有较高的临床应用价值。     

Minimally invasive pterygium surgery: a new approach for prevention of recurrence

PURPOSE: To introduce a novel approach for pterygium excision, to report recurrence rates, and to compare with conjunctival autografting. DESIGN: A comparative, prospective clinical case series design was used. METHODS: The study population consisted of 155 patients with unilateral primary or recurrent pterygia. All patients underwent pterygium excision, either by conventional conjunctival autografting (Group A) or by the minimally invasive pterygium excision (MIPE) technique (Group B). The new technique involves making a limbal incision of the conjunctiva through the body of pterygium, removing the head of the pterygium by blunt dissection, keeping the adjacent Tenon capsule intact, and performing a small conjunctival autograft to cover the epithelial defect. The recurrence rate of each technique was compared statistically. RESULTS: There were 84 patients in Group A and 71 patients in Group B. The recurrence rates were 18% at 1 year after surgery in the conjunctival autografting technique and 4.2% in the MIPE technique. The MIPE technique had significantly lower recurrence rates compared with conjunctival autografting technique (p<0.0001). CONCLUSIONS: The MIPE technique had lower recurrence rate and fewer postoperative complications than the conjunctival autografting technique. Preserving the Tenon capsule and minimizing conjunctival excision in pterygium surgery does not appear to increase the recurrence rate in the 1- year period. However, the effectiveness of this technique in preventing recurrences needs to be proven with more than 1-year results, which we plan to report in the future.     

内界膜剥除方式进展

内界膜剥除术因能够有效地解除玻璃体视网膜界面的牵拉而在多种玻璃体视网膜疾病中得到应用,但其对巨大、难治性黄斑裂孔及高度近视性黄斑裂孔等棘手疾病的效果欠佳.同时,内界膜剥除本身及染色剂的使用均可导致黄斑发生结构和功能的改变.为了更好地保持黄斑结构的完整性,多种改良的内界膜剥除术,如翻转内界膜瓣、自体内界膜移植、保留中心凹的内界膜剥除术应运而生.研究显示这些新术式在治疗巨大黄斑裂孔、高度近视性黄斑裂孔以及难治性黄斑裂孔上表现出较好的解剖和功能疗效,且无明显的并发症,但仍需要更多大样本的长期随访研究来证实.本文就内界膜剥除术的改良方式及其在玻璃体视网膜中的应用情况进行综述.     

Quantitative layer-by-layer perimetry adapted to the Humphrey Field Analyzer. I. Design of methodology and instrumentation.

Quantitative layer-by-layer perimetry is a psychophysical technique believed to assess response characteristics of individual retinal layers. This paper presents a new design of this technique, implemented into the existing hardware environment of the computerized perimeter Humphrey Field Analyzer. The technique was optimized for a more simple, fast and reproducible testing of larger visual field point patterns. The paper deals with the design of instrumentation and with methodological aspects of this adaptation of the technique.     

超声乳化蚀刻翘起翻转法和拦截劈裂法的对照研究

目的：探讨超声乳化碎核方式－蚀刻翘起翻转法和拦截劈裂法的临床优越性。方法：超声乳化手术365眼，其中85眼采用蚀刻翘起翻转法，280眼采用拦截劈裂法碎核，并分析2种方法的结果。结果（1）碎核时间；同对3级核，翻转法平均为81．26s，拦截法平均为40．71s；（2）术后1wk视力；翻转法的85眼中，视力≥0．5者76眼（89．4％），0．2－0．5者7眼（8．2％），视力≤0．2者2眼（2．4％（；拦截法的280眼中，视力≥0．5者253眼（90．4％），0．2－0．5者21眼（7．5％），视力≤0．2者6眼（2．1％）；（3）术后角膜内皮反应；1wk后仍有中心内皮皱褶者翻转法4眼（4．7％），拦截法7眼（2．5％）。结论：前相对手术难度小、碎核时间相对较长；后者的手术时间短，适于硬核，且技术更趋于成熟。二者术后视力及小角膜损伤无显著性差异。     

Tilt and decentration of bag-fixated intraocular lenses: A comparative study between capsulorhexis and envelope techniques

Malposition of an intraocular lens (IOL) may cause symptoms such as glare, halos, and other visual aberrations. The purpose of this study is to determine the effect of two different anterior capsulotomy techniques on IOL tilt and decentration. Bag-fixated IOL implantation after uncomplicated extracapsular cataract extraction was performed using both envelope (65 eyes) and continuous circular capsulorhexis (CCC) technique (42 eyes). Eyes were followed-up at least 6 months postoperatively. While the mean IOL decentration after envelope technique was found to be 0.65 mm, this was 0.15 mm after CCC technique. On the other hand, the mean actual tilting angle of IOL after envelope technique was 5.66 degrees, whereas this was 1.13 degrees after CCC technique. The aforementioned differences were statistically significant (p<0.01, and p<0.01). Furthermore, in 17 eyes (26.1%) where envelope technique and in 29 (69.0%) eyes where CCC technique was used demonstrated no IOL tilt and decentration. This study shows that the CCC technique may result in less optical problems due to IOL malposition compared to the envelope technique.Abbreviations IOL intraocular lens - IOLs intraocular lenses - CCC continuous circular capsulorhexis - ECCE extracapsular cataract extraction Read in part before the IXth Congress of Societas Ophthalmologica Europea, Brussels, May 23–28, 1992.The authors do not have any commercial or proprietary interest in any of the companies or products mentioned in this communication     

短眼轴浅前房眼超声乳化术中的控制性连续环形撕囊(英文)

目的:探讨短眼轴浅前房眼控制性连续环形撕囊技术的有效性。方法:在68例行白内障超声乳化术患者中,32例采用常规连续环形撕囊技术,36例采用控制性连续环形撕囊技术,比较两组患者撕囊的成功率和并发症情况。结果:常规方法组撕囊成功率为53.13%,囊口撕裂达后囊膜者为9.38%。控制性撕囊组成功率为86.11%,无囊口撕裂达后囊膜者。结论:控制性连续环形撕囊技术可显著提高短眼轴浅前房眼撕囊成功率,减少撕囊并发症。     

压核进钩劈核技术与乳化劈核技术在白内障超声乳化手术的应用比较

目的：分析压核进钩劈核技术与乳化劈核技术在白内障超声乳化手术的应用比较,探讨压核进钩劈核技术的优点。

方法：将年龄相关性白内障70例70眼随机分为压核进钩劈核组35例35眼和乳化劈核组35例35眼。分别使用压核进钩劈核技术、乳化劈核技术进行白内障超声乳化摘除术。两组病例均完成透明角膜切口、撕囊、水分离后,压核进钩劈核组先用超乳针头吸除表层皮质和软核,轻压晶状体核,然后用劈核钩勾住晶状体5：00位赤道部,超乳针头退回主切口,吃进晶状体核与劈核钩对向用力,将核一分为二。乳化劈核组用超乳针头吃入晶状体核心至晶状体1/2～2/3厚度并吸住晶状体核,劈核钩划入超乳针头对侧晶状体赤道部与超乳针头对向用力劈开晶状体核。记录两组术中实际超声乳化时间(U/S time)、术前及术后1mo角膜内皮细胞计数、角膜内皮细胞丢失率、术后1、7d角膜水肿、术前术后最佳矫正视力等情况并进行比较。

结果：压核进钩劈核组的U/S time低于乳化劈核组[12.76(8.76,16.76)s vs 22.87(18.36, 27.38)s, P<0.01]; 压核进钩劈核组术后1mo平均角膜内皮细胞计数高于乳化劈核组(2133.44±348.58/mm² vs 1957.94±280.54/mm²,P<0.05),压核进钩劈核组术后1mo平均角膜内皮细胞丢失率低于乳化劈核组[0.15(0.08,0.22)vs 0.22(0.16, 0.28), P<0.01]。术后1d压核进钩劈核组角膜水肿轻于乳化劈核组(Z=13.195,P=0.004),术后7d两组角膜水肿均消退。术后1d两组视力较术前均有提高,而两组间无差异(Z=-0.48,P=0.63)。

结论：与乳化劈核技术相比,压核进钩劈核技术劈核操作简单,手术安全且并发症少。     

穿透性小梁切除调节技术及疗效

小梁切除术是治疗青光眼的主要手段,但手术失败率较高,失败原因主要是手术区滤过口处成纤维细胞增殖,瘢痕形成而使伤口愈合所致。因此,建立现代改良的标准小梁切除术并结合调节技术减少手术失败是青光眼滤过性手术的发展趋势,小梁切除联合调节技术是21世纪青光眼小梁切除新发展,本文对小梁切除联合药物调节技术、非药物调节技术及复合式小梁切除术有关文献进行综述。     

Castroviejo''s square corneal grafts

The evolutionary history of the modern day keratoplasty technique is filled with numerous attempts to implant all manner of material using very creative surgical techniques. Many different shapes of incisions were tried. Castroviejo introduced a square shaped keratoplasty technique which had considerable success. He also introduced new surgical instruments which made the procedure easier to perform. This technique remained popular until the 1950s when improved instrumentation along with the demand for the most cosmetically pleasing result displaced the square keratoplasty technique as the keratoplasty procedure of choice.     

Total en bloc excision: a modified vitrectomy technique for proliferative diabetic retinopathy

PURPOSE: To report a modified vitrectomy technique for proliferative diabetic retinopathy. DESIGN: Interventional case series. METHODS: In the modified vitrectomy technique for proliferative diabetic retinopathy, core vitrectomy is performed, followed by separation of the glial ring from the optic disk using a hook or forceps. The posterior hyaloid membrane, including proliferative tissues, is lifted and peeled from the posterior to the peripheral retina without creating a window in the posterior hyaloid membrane. At any strong vitreoretinal adhesion site, the posterior hyaloid is partially removed, followed by membrane delamination. RESULTS: In the 18 eyes that underwent the modified technique, iatrogenic retinal breaks occurred less often compared with the 48 eyes that underwent the conventional technique. The difference was not statistically significant (P =.14), but the surgical time was significantly reduced (P =.0003). The glial ring and proliferative tissue arising from the optic disk can be readily separated, and other adhesion sites can be satisfactorily peeled after separating the posterior hyaloid membrane around the optic disk. CONCLUSIONS: This modified vitrectomy technique for proliferative diabetic retinopathy may be an alternative surgical technique to the conventional technique.     

Two-incision push-pull capsulorhexis for pediatric cataract surgery

Pediatric capsulorhexis is a challenging surgical technique because of the elasticity of the pediatric anterior capsule. This technique of manual capsulorhexis allows reliable and reproducible results for the size and centration of anterior and posterior capsulorhexes in pediatric cases. The technique is a modification of a previously reported method.     

Two cases of AlphaCor surgery performed using a small incision technique

The authors have evaluated the AlphaCor artificial cornea (previously Chirila KPro) in human patients since 1998, utilizing an intrastromal technique requiring extensive corneal lamellar dissection and recommending conjunctival flaps in all cases. Recent availability of low-profile instruments has facilitated a simpler technique, which was first evaluated in two subjects followed for over 1 year prior to recommending the technique for wider adoption. The new technique is presented and illustrated herein, and its benefits and limitations compared with the traditional AlphaCor implantation are discussed.     

Treatment of benign eyelid conditions with Argon laser

Eyelid surgery is not always uneventful. Complications (punctal ectropion, retractile scars) can sometimes occur. Argon laser treatment is an interesting alternative technique, particularly in cases with cosmetic indications. The advantages of the procedure, compared to surgery are numerous: magnified view of tissue removal, enhancing complete excision; good hemostasis, avoiding wound sutures and bandage; fast and painless technique; outpatient office procedure with little post-operative care; good acceptance of the technique by most of the patients. The technique and the main indications are described in this paper.     

Sources of variability in the clinical photostress test

The photostress test is a simple clinical technique that can differentiate between retinal and postretinal disease. Unfortunately a wide range of normal results have been reported in the literature and it is perhaps for this reason that the test has been little used by clinicians. The purpose of this investigation was to evaluate the effect of photostress technique, age, ametropia, pupil size and acuity on photostress recovery time (PSRT) in normal subjects. Photostress recovery time was measured in 50 healthy subjects whose ages ranged from 21 to 69 using three clinically applicable techniques and a reference technique designed to bleach a consistent amount of photopigment. The agreement between each clinical technique and the reference technique was determined. Mean photostress recovery time differed for each of the techniques studied. Analysis of the data obtained with the reference and the best clinical technique showed that age was the only factor that had a significant effect on PSRT. The best clinical technique involves exposing the eye to the light from the direct ophthalmoscope for 30 s and measuring the time taken for acuity to return to within one line of pre-bleach acuity. Photostress recovery time increases with age but is independent of pupil size, ametropia and visual acuity.     

The efficiency of limbal conjunctival autografting in pterygium surgery

PURPOSE: To investigate the efficiency of limbal conjunctival autografting technique in pterygium surgery. METHODS: Eighty-four eyes of 68 patients with pterygium were treated by simple excision technique and 29 eyes of 24 patients with pterygium were treated by limbal conjunctival autografting technique. The definition of recurrence was fibrovascular tissue over the limbus onto the cornea in the area of previous pterygium excision. RESULTS: The ages of the patients were between 25 and 88. The follow-up periods ranged from 6 to 25 months. The patients treated by simple excision technique were followed up for 6 to 25 (average 15+/-6) months and the patients treated by limbal conjunctival auto-grafting technique were followed up for 7 to 24 (average 17+/-5) months. The recurrence rates were 27% (23 eyes) and 7% (2 eyes), respectively. There was a statistically significant difference in the recurrence rate between the patients who underwent simple excision and those who underwent limbal conjunctival autografting (p=0.016). CONCLUSIONS: Limbal conjunctival autografting is an effective surgical technique for the treatment of pterygium. It has a low recurrence rate when compared with the simple excision technique.