Objective To observe the relationship between the suturing patterns to close the scleral incision and postoperative intraocular pressure (IOP) in 23G minimally invasive vitrectomy. Methods Eighty eyes of 80 patients with vitreoretinal diseases, who were treated with primary 23G minimally invasive vitrectomy, were enrolled in this prospective clinical study. Patients with poor closed scleral incision which need suturing were excluded from this study. The corrected visual acuity ranged from hand movement to 0.2. The IOP ranged from 7.9 to 19.8 mm Hg (1 mm Hg=0.133 kPa), with the mean of (13.9plusmn;1.8) mm Hg. The eyes were randomly divided into three groups: group A (20 eyes), suturing all three scleral puncture after vitrectomy; group B (20 eyes), suturing only two upper scleral puncture, but not the lower infusion puncture after vitrectomy; group C (40 eyes), no suturing for all 3 scleral puncture after vitrectomy. All patients underwent 23G vitrectomy only. The corrected visual acuity and IOP were observed after surgery. Results The corrected visual acuity were 0.1 -0.3, 0.2- 0.5, 0.3 -0.8 in one, seven and 14 days after surgery, respectively. No one in group A, B experienced hypotony in one, three, seven and 14 days after surgery. Thirteen (32.5%), five (12.5 %), two eyes (5.0%) in group C experienced hypotony in one, three and seven days after surgery. Seven eyes (17.5%) experienced severe hypotony (＜5 mm Hg) in 14 day after surgery in group C. The difference was statistically significant compared the incidence of hypotony in group C with group A, B respectively at different time points after surgery (chi;2= 16.82,P=0.007). The difference was statistically significant compared the incidence of hypotony in group C at different time points after surgery (chi;2=11.64,P=0.003). The difference was no significant compared the IOP between group A and B at different time points after surgery (F=1.618,P=0.205). Compared the IOP of group C to group A and B, the difference was statistically significant in one and three days after vitrectomy (F=9.351,P=0.000); but not statistically significant in seven and 14 days after vitrectomy(F=0.460,P=0.633). Conclusions Whether or not suturing the scleral punctures is closely related to postoperative hypotony in 23G vitrectomy. Suturing only the two upper scleral punctures can reduce the occurrence of postoperative hypotony.
Objective To evaluate the safety and ascendancy of small caliber stapler application for anterior resection in ultra-low rectal cancer with anal sphincter preservation. Methods A retrospective analysis of the data of 60 cases of ultra-low rectal cancer treated by anterior resection with anal sphincter preservation by double stapling technique according to TME principle between June 2006 and June 2009 were undertaken. The 60 patients were divided into two groups, each group included 30 cases. One group adopted 33 mm stapler and another group adopted 29 mm stapler, and then the profiles of medi-operation, post-operation, and prognosis were assessed. Results Time of simple anastomose in operation was (9.0±3.3) min in 33 mm stapler group and (6.0±2.6) min in 29 mm stapler group, and there was significant difference between them (P=0.022 5). There were 6 cases needed to be restored because of lesion during operation or dys-anastomosis in 33 mm stapler group, while 2 cases in 29 mm stapler group, there was significant difference between them (P=0.030 1). No significant differences were observed between the two groups in terms of the time for operation, leakage, bleeding, stenosis, anastomotic recurrence, and fecal incontinence after operation or length of stay. Conclusion The application of 29 mm stapler not only can shorten time for anastomose and step down the degree of difficulty, but also dosen’t increase stenostomia and other complications.
ObjectiveTo evaluate the clinical outcomes of idiopathic macular epiretinal membrane (IMEM) by 23G vitrectomy with or without internal limiting membrane peeling. MethodsA total of 40 eyes in 40 patients diagnosed as IMEM underwent 23G pars plana three-port vitrectomy (23G PPV). The macular ERM alone was removed in 20 eyes (non-ILM peeling group). Both ERM and ILM peeling were performed in another 20 eyes (ILM peeling group). All patients underwent removal of ERM with assistance of triamcinolone acetonide. For patients who underwent ILM peeling, indocyanine green dye was used to stain the ILM. ILM was peeled off up to the marginal of macular vessels arch. The patients in ILM peeling group and non-ILM peeling group had postsurgical follow-up for (15.85±3.79) months and (16.45±3.72) months respectively. There were no significant differences in gender, age, OD/OS, preoperative best-corrected visual acuity (BCVA), preoperative central macular thickness (CMT), preoperative total macular volume (TMV) and follow-up time between the two groups (P > 0.05). Intraoperative or postoperative complication was recorded during the follow-up period. At the final visit, the differences in BCVA, CMT and TMV between the two groups were analyzed, so did the correlations between BCVA and CMT or TMV in each group at the same time. ResultsThere was no recurrence of an ERM or severe complications, such as retinal detachment and endophthalmitis in either group. The mean BCVA of ILM peeling group and non-ILM peeling group was 0.53±0.27 and 0.54±0.26 respectively at the final visit. Postoperative BCVA improved significantly in both groups with significant difference (t=5.035, 4.964; P < 0.05). The was no difference of postoperative BCVA between two groups (t=0.176, P > 0.05). The mean CMT was (343.55±48.74) μm and (311.70±42.48) μm, and the mean TMV was (7.78±0.40) mm3 and (7.88±0.43) mm3. CMT (t=9.508, 8.549) and TMV (t=11.098、15.372) revealed a significant decrease in both groups with significant difference (P < 0.05).The postoperative CMT in the ILM peeling group was significantly higher than that in the non-ILM peeling group (t=-2.203, P < 0.05). No difference was found between the two groups in terms of TMV (t=0.755, P > 0.05). Furthermore, no correlation was observed between postoperative BCVA and CMT (r=0.244, 0.266; P > 0.05) or TMV (r=-0.096, 0.157; P > 0.05). Conclusions23G PPV combined with or without ILM peeling is an efficient and safe treatment for IMEM. ILM peeling appears to have similar effect on the long-term visual outcomes comparing with non-ILM peeling, combined with much thicker postoperative CMT.
Objective To evaluate the clinical characteristics of end oscopically guided thorough vitrectomy in managing exogenous endophthalmitis with cloudy cornea. Methods The clinical data of 20 patients (20 eyes) suffered from exogenous endophthalmitis with cloudy cornea and underwent endoscopically guided total vitrectomy were retrospectively analyzed. The patients (18 males and 2 females) aged from 5 to 79 years with the average age of 35.9 years. There were 16 post-trauma and 4 post-cataract endophthalmitis. The cornea was cloudy with the visual acuity of not better than counting fingers in all eyes. During the operation, posterior vitreous detachment was induced, vitreous at the base and bands over the ciliary body was removed, and membrane at the anterior or posterior surface of the iris was also removed after lensectomy. The median of the duration of hospita lization to operation was 1.5 days, and the follow-up period was 6～42 months (mean=23 months). Results Positive cultures were obtained in 9 (45%) cases. Seven intraocular foreign bodies were extracted from 6 eyes. Ora serrata was separated at one place in 2 cases, iatrogenic retinal tear at one, two place in 1 case respectively. Vitrectomy and intravitreal injection were underway again in 2 cases respectively after surgery. Ten eyes (50%) retained useful vision (ge;0.05). The visual acuity was decreased, maintained and improved in 1, 3 and 16 eyes, respectively, and 4 cases over than 0.08. Cornea was clear in 11 (55%) eyes after operation; 9 cases with silicon oil in; ocular pressure was slanting low in 2 cases , but more than 5 mm Hg（1 mm Hg=0.133 kPa）; intraocular hypertension in 1 case , controlled by medicine; local and questionable retinal detachment in 1 case respectively, without surgery again. The visual acuity of none of the 9 eyes with silicon oil in was lower than counting fingers, only one eye in 11 eyes without silicon oil in was lower than 0.05 and no eye lost at the end of follow-up. Conclusion Endoscopically guided total vitrectomy is useful, safe and reliable for the management of exogenous endophthalmitis with cloudy cornea in time. （Chin J Ocul Fundus Dis，2008，24：202-205）
ObjectiveTo explore the surgical procedures for primary spontaneous pneumothorax without bullae. MethodsWe retrospectively analyzed the clinical data of 52 patients with primary spontaneous pneumothorax without bullae, who underwent surgical treatment in Second Affiliated Hospital of Kunming Medical University between January 2008 and January 2013. There were 46 males and 6 females, with mean average age of 23.2±4.3 years (ranged from 16 to 34 years). According to the different methods of intraoperative surgery, all patients were divided into three groups. The patients in a group Ⅰ (n=20) underwent video-assisted thoracoscope (VATS) selective apex of low energy electric coagulation treatment. The patients in a group Ⅱ (n=21) underwent VATS lung tip part of lung resection. The patients in a group Ⅲ (n=11) received VATS resection of the pleura. The clinical effectiveness among the three groups was compared. ResultsCompared with other two kinds of operation schemes,the leak duration(2.61±1.89 d vs. 4.90±3.20 d vs. 5.36±2.57 d, P=0.012), postoperative chest tube drainage time (3.67±2.13 d vs. 6.00±3.73 d vs. 7.03±2.58 d, P=0.003), postoperative length of hospital stay (4.95±2.16 d vs. 7.35±3.03 d vs. 8.61±2.67 d, P=0.002) and the recurrence rate (0.0% vs. 23.1% vs. 12.5%, P=0.021) of the patients with lung tip part resection of lung tissue by VATS were significantly lower. There were no statistically significant differences in the indicators of the patients with selective apex of low energy electric coagulation by VATS and those with pleural resection by VATS (P>0.05). ConclusionLung tip part of the lung tissue resection by VATS for primary spontaneous pneumothorax without bullae is better than VATS selective apical low energy coagulation treatment and VATS resection of the pleura both in the short and long-term efficacy.
Silicone oil is widely used in intraocular filling of fundus disease after vitrectomy, which improves retinal reattachment rate andpostoperative visual function of patients. With the era of minimally invasive vitreous surgery coming, the utilization rate of silicone oil filling is decreasing, however, it still plays an indispensable role in the surgical treatment of complex fundus diseases. In the process of using silicone oil, the indications should be strictly selected, and the potential risks should be fully considered and possibly avoided. The study of vitreous substitutes with certain physiological functions is currently a research hotspot in the field of fundus diseases.
ObjectivesTo assess the methodological and reporting quality of surgical meta-analyses published in English in 2014.MethodsAll meta-analyses investigating surgical procedures published in 2014 were selected from PubMed and EMbase. The characteristics of these meta-analyses were collected, and their reporting and methodological quality were assessed by the PRISMA and AMSTAR, respectively. Independent predictive factors associated with these two qualities were evaluated by univariate and multivariate analyses.ResultsA total of 197 meta-analyses covering 10 surgical subspecialties were included. The mean PRISMA and AMSTAR score (by items) were 22.2±2.4 and 7.8±1.2, respectively, and a positive linear correlation was found between them with a R2 of 0.754. Those meta-analyses conducted by the first authors who had previously published meta-analysis was significantly higher in reporting and methodological quality than those who had not (P<0.001). Meanwhile, there were also significant differences in these reporting (P<0.001) and methodological (P<0.001) quality between studies published in Q1 ranked journals and (Q2+Q3) ranked jounals. On multivariate analyses, region of origin (non-Asiavs. Asia), publishing experience of first authors (ever vs. never), rank of publishing journals (Q1 vs. Q2+Q3), and preregistration (presence vs. absence) were associated with better reporting and methodologic quality, independently.ConclusionThe reporting and methodological quality of current surgical meta-analyses remained suboptimal, and first authors' experience and ranking of publishing journals were independently associated with both qualities. Preregistration may be an effective measure to improve the quality of meta-analysis, which deserves more attention from future meta-analysis reviewers.
Objective To evaluate the effect of 27G pars plana vitrectomy (PPV) and 25G PPV on idiopathic epiretinal membrane (IMEM). Methods Thirty-eight eyes of 38 patients with IMEM were enrolled into this retrospective and comparative study. Eighteen eyes were treated with 27G PPV (group A), 20 eyes underwent 25G PPV (group B) voluntarily. The best corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp microscope, indirect ophthalmoscopy, fundus color photograph, ocular coherence tomography (OCT) and counting of corneal endothelial cells (CEC) were examined before the surgery. BCVA results were converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity. There was no statistically significant difference between two groups in terms of BCVA, IOP, foveal macular thickness (FMT), the counting of CEC and CEC hexagon rate before the surgery (t=1.627, 0.860, 0.293, 1.238, 0.697;P＞0.05). All operations were performed by the same doctor. Operation time for vitrectomy and peeling membrane was recorded. BCVA, IOP, OCT, FMT, counting of CEC and the improvement of metamorphopsia were observed on 1, 7 days and 1, 3 months after PPV. Results The mean operation time for vitrectomy in group A and B were (6.7±2.8), (10.5±3.3) min, respectively. The mean operation time for vitrectomy in group A was significantly longer than that in group B (t=3.084,P＜0.05). The mean operation time for peeling membrane in group A and B were (10.2±5.2), (11.0±5.9) min, respectively. There was no statistically significant difference between two groups in terms of the time for peeling membrane (t=1.970,P=0.187). On 1, 7 days and 1, 3 months after PPV, the difference of BCVA (t=1.463, 0.683, 0.961, 1.226;P=0.833, 0.509, 0.699, 0.744) and IOP (t=1.314, 1.262, 0.699, 1.116;P=0.763, 0.721, 0.534, 0.712) between two groups were not statistically significant. On 1 day after PPV, there were 2 eyes and 5 eyes with ＜9 mmHg (1 mmHg=0.133 kPa) IOP in group A and B. On 7 days and 1, 3 months after PPV, the difference of FMT between two groups were not statistically significant (t=1.257, 1.368, 1.437;P=0.735, 0.745, 0.869). On 3 months after PPV, the difference of CEC between two groups were statistically significant (t=2.276,P＜0.05); the difference of hexagon rate between two groups were not statistically significant (t=1.473,P=0.889). Conclusion The efficacy of 27G PPV for IMEM appears similar to 25G PPV. But 27G PPV has a shorter operating time for vitrectomy, a more stable IOP and a minimal damage to CEC.
Objective To analyze the strategy and skill of resection for lung cancer invading the superior vena cava (SVC) and improve the surgical treatment results. Methods An analysis of 35 patients who underwent surgery for lung cancer invading the SVC was performed. The pressure of SVC before and during operation, and the time of clamping the SVC were recorded. The conjunctival oedema was observed. 14 mm or 16 mm diameter terylene or expanded polytetrafluoroethylene graft artificial vessel were used to replace SVC.The continuous everted suture was applied with 4-0 Prolene. The embolism of artificial vessel and stomal hemorrhage were observed after operation. Results The SVC replacement with prothesis were performed in 20 patients in which the SVC hadn’t clamped in 5 patients. The clamping time was 8-35 mins for another 15 patients with SVC clamped.The clamping time were 1735 mins and 8-20mins respectively for patients with or without conjunctival oedema.The pressure of SVC was 20-45cmH2O before operation and the maximal pressure was 37-56cmH2O during operation for patients with clamping SVC. The maximal pressure during operation was 48-56cmH2O and 37-47cmH2O for patients with or without conjunctival edema, the difference was significant (P=0.000).No mortality or embolism of artificial vessel,but the stomal hemorrhage was found for one patients cured by reoperation. Thirtytwo patients was followed up for 4-130 months,the median survival time was 35 months. Conclusion No clamping of SVC or short time clamping with some operative skill can avoid the occurrence of cerebral edema. Selecting suitable length and roughness of the expanded polytetrafluoroethylene artificial vessel and continuous everted suture with suitable slide suture is important for avoiding the occurrence of embolism and the stomal hemorrhage.
Objective To observe the related complications of 23G pars plana vitrectomy (PPV). Methods One hundred and fifteen patients who underwent 23G PPV were enrolled in this study. There were 98 patients (65.3%) with macular diseases, 46 patients (30.7%) with proliferative diabetic retinopathy, four patients (2.7%) with vitreous hemorrhage, one patient (0.7%) with rhegmatogenous retinal detachment, and lens nucleus falling off in cataract surgery in one patient (0.7%). Among 98 patients with macular diseases, 21 patients (21.4%) underwent topical anesthesia, 77 patients (78.6%) underwent retrobulbar anesthesia. DORC "twostep method" was performed in three patients, and Alcon 23G PPV "onestep method" was performed in 147 patients. The operation times ranged from 20 to 100 minutes, with a mean of (51.1±18.9) minutes. The follow-up ranged from three to 12 months. The intraoperative and postoperative complications were observed. Results Intraoperative complications was found in seven patients (4.7%), which included iatrogenic retinal breaks in one patient (0.7%), macular damage in one patient (0.7%), suprachoroidal perfusion in one patient (0.7%), puncture leakage and closure incision in two patients (1.3%), vitreous hemorrhage in one patient (0.7%) and stopper broken off in cannula in one patient (0.7%). Postoperative complications was found in 34 patients (22.7%), which including retinal detachment in one patient (0.7%), vitreous hemorrhage in three patients (2.0%), cataract in three patient (2.0%), intraocular pressure ＜10 mm Hg（1 mm Hg=0.133 kPa） in 20 patient (13.3%), and transient ocular hypertension in seven patients (4.7%). After treatment there was no complication associated with surgery. Conclusion Intraoperative complications related to incision and transient hypotony are mainly complications of 23G PPV.