Trocar assisted nonappositional repair of iridodialysis

Novel trocar assisted intraocular lens and capsular bag complex fixation

PURPOSE

To describe the innovative technique of trocar-assisted intraocular lens (IOL) and capsular bag complex fixation.

METHODS

In this technique, initial pupil dilatation is achieved either with intracameral adrenaline or with the help of iris hooks. Automated anterior vitrectomy is performed in cases with vitreous prolapse. A 25 G trocar cannula is placed at the limbus through a paracentesis opposite the zonular dialysis area. The cannula lumen act as a guide to pass the double-arm polypropylene suture attached to the needle. This prevents any inadvertent corneal injury and acts as a perpendicular tract to pass the needle through IOL capsular bag complex.

RESULTS

We performed this technique in 9 cases with an excellent outcome with a minimum of 3 months of follow-up. All patients had well-centred IOL. There was no incidence of corneal injury, Descemet membrane detachment, iris trauma, IOL tilt, decentration, dislocation, vitreous prolapse or retinal detachment. All patients achieved excellent visual acuity ranging from 6/12-6/6 postoperatively.

CONCLUSION

The novel trocar-assisted IOL bag complex fixation technique is very effective and allows smooth IOL fixation in technically challenging cases with IOL subluxation. The trocar acts as a guide to prevent injury to the surrounding tissue, and IOL fixation is achieved with minimal manipulations in the anterior chamber. It also prevents the need for IOL explantation in these cases.

More advantages of trocar compared than steel needle in deep venipuncture catheterization

BACKGROUND

Deep venipuncture catheterization is widely used in clinical anesthesia. However, it is worth thinking about how to improve the rate of successful catheter insertion, and relieve patients' discomfort. This paper aimed to compare the clinical advantages between trocar and steel needle.

METHODS

Total 503 adult patients were recruited and randomly assigned. The control group was punctured with steel needle, and the experimental group was punctured with trocar needle. Clinical and followed-up information was recorded. Pearson's chi-squared and spearman test were performed to analyze the correlation between intervention and relative parameters. Univariate logistic regression was performed to verify the odds ratio of trocar needle compared with steel needle.

RESULTS

Pearson's chi-square test and Spearman's correlation test showed a significant correlation between puncture success, puncture comfort, successful catheter insertion, puncture time, thrombosis, catheter fever, bleeding, infection and interventions (P < .05). Univariate logistic regression showed that there existed better puncture comfort (odds ratio [OR] = 6.548, 95% confidence interval [CI]: 4.320-9.925, P < .001), higher successful catheter insertion (OR = 6.060, 95% CI: 3.278-11.204, P < .001), shorter puncture time (OR = 0.147, 95% CI: 0.093-0.233, P < .001), lesser thrombosis (OR = 0.194, 95% CI: 0.121-0.312, P < .001), lesser catheter fever (OR = 0.263, 95% CI: 0.158-0.438, P < .001), lesser bleeding (OR = 0.082, 95% CI: 0.045-0.150, P < .001) and lesser infection (OR = 0.340, 95% CI: 0.202-0.571, P < .001) in trocar group compared with steel needle group.

CONCLUSION

Trocar application in deep venipuncture catheterization can improve successful catheter insertion, relieve pain and discomfort of patients, reduce incidence of complications, and provide better security for patients.

"In-N-Out" Technique - A double flanged suture ab-interno iridodialysis repair

ABSTRACT

The procedure presented here is for iridodialysis repair using an elegant, cost-effective and quick technique using 6-0 polypropylene sutures, low-temperature electrocautery, and a 27-gauge needle. Previously, all methods required performing a conjunctival peritomy to expose bare sclera, then typically intricate movements and knot tying. Described here is a method combining the sewing machine technique and a modified Yamane scleral fixation technique to treat iridodialysis that requires no knots, peritomies or specialized equipment.

Results of a novel surgical technique for iridodialysis repair using an iris retractor segment

PURPOSE

To describe a novel surgical technique for iridodialysis repair using an iris retractor segment and report its clinical results.

METHODS

Fifty-three eyes of 53 patients who underwent iridodialysis repair using an iris retractor segment were enrolled in this retrospective study. Data recorded from patient files consisted of age, sex, degree of iridodialysis, surgical techniques, number of segments used, preoperative and postoperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), complications, and follow-up time.

RESULTS

Mean follow-up time was 34.4 months. The subjects included 29 men (54.7%) and 26 women (45.3%), and the mean age was 56.6 ± 14.0 years. According to the degree of iridodialysis, the patients were divided into Group 1 (60°-89°, n = 19) and Group 2 (90°-270°, n = 34). During the iridodialysis repair for Group 1, a single segment was sufficient; however, in Group 2, one segment was used in 18 eyes (52.9%), two segments in 15 eyes (44.1%), and three segments in one eye (2.9%). The pre- and postoperative last control CDVA value in Group 2 was significantly lower than in Group 1. The pre- and postoperative IOPs for Group 2 were significantly higher than Group 1.

CONCLUSION

Iridodialysis repair using an iris retractor segment is a minimally invasive technique and found to be safe and effective. It will be a good option for patients with large iridodialysis, as it avoids excessive surgical manipulations and prolonged surgical time.