SLAP Trial: Shock Wave Lithotripsy and Mechanical Percussion Therapy Post ESWL for Renal Calculi.

Methods: We conducted a prospective randomised control trial. Included patients were males and females greater than 18 years of age with single or multiple ipsilateral renal calculi of total ≤10 mm on plain X-ray and noncontrast CT KUB. ESWL was performed at a single centre, at supine position under general anaesthesia with maximum 3000 shocks at a rate of 100 shocks per minute. Patients were discharged and randomised to either the control arm or MPI therapy. MPI therapy was self-directed in a home setting for 10 minutes a day, three times per week. Both arms had standard follow-up at 12 weeks with a plain X-ray KUB. Patients in the control group were offered cross over to the MPI arm after 12 weeks if residual stone fragments were detected. Statistical analysis was performed using SPSS software via Chi squared and Fisher's exact tests. Ethical approval was obtained via the Prince Charles Hospital HREC Committee, HREC/2022/QPCH/84961. Results: 70 patients met inclusion criteria and underwent ESWL, and 5 were withdrawn. 33 patients were randomised to the MPI group and 32 to the control group. MPI significantly increased the stone clearance rate anywhere in the kidney (87.9% in the MPI group versus 59.4% in the control group, p=0.089), as well as the clearance rate in the lower pole (91.7% in the MPI group versus 63.2% in the control group, p=0.022). Delayed percussion did not improve the clearance rate over primary percussion (p=0.835). Conclusion: This study has shown that MPI can be effectively performed in a home setting without the need for medical supervision and results in improved stone clearance rates post ESWL. The main limitations to the study were the use of X-ray over CT during the follow-up and variability in MPI compliance and administration. Further research is warranted into standardising home MPI protocols. This trial is registered with ANZCTR387061.

Extracorporeal shock wave lithotripsy: Prematurely falling out of favour? A 7 year retrospective study from an Australian high-volume centre.

Objectives: The aim of this study is to audit 7 years of data with a 3 year follow up from a high-volume stone centre performing extracorporeal shock wave lithotripsy (ESWL) to evaluate efficacy in stone clearance compared to existing knowledge and understand reasons for this performance. Methods: Patients who received ESWL treatment for renal or proximal ureteric stones at a single centre between January 2012 and January 2019 (to allow minimum 3 year follow up) were retrieved. A retrospective analysis was performed cross referencing for stone size, location, treatment and need for further procedures. Ethical approval was granted through Metro North HHS HREC, Queensland, Australia. Results: A total of 1930 patients met inclusion criteria. Fifty-seven percent (n = 1100) underwent left-sided ESWL, compared to 43% (n = 830) on the right. Stone size and location were both statistically significant to treatment outcome. Small stones (<1 cm) had an overall clearance rate of 81.9%, medium stones (1-2 cm) had a clearance rate of 60.6% and stones (>2 cm) had a clearance rate of 31.3%. Small stones in an upper calyx had the highest clearance rate (87.5%, n = 120). Allowing for two procedures, 89% of stones were treated successfully. Conclusion: ESWL remains a legitimate option for the treatment of small and medium sized renal calculi. ESWL stone clearance rates at our centre are higher than published elsewhere and serve as proof to its efficacy. X-ray imaging on the day of the procedure, heavy consultant input and frequent intra-operative imaging are cited as key reasons for success. Further research is warranted to elucidate factors affecting stone clearance rate and to enable more standardised outcomes. Further investment may be required into ESWL provisions in most Australian states and especially in Queensland to enable its continued use in contrast to developing endourological techniques.

Comparison of cognitive workload and surgical outcomes between a three-dimensional and conventional microscope macular hole surgery.

BACKGROUND: Performing a surgical task subjects the surgeon to multitudinal stressors, especially with the newer 3D technology. The quantum of cognitive workload using this modern surgical system in comparison to the Conventional microscope system remains unexplored. We evaluate the surgeon's cognitive workload and the surgical outcomes of macular hole(MH) surgery performed on a 3D versus a Conventional microscope operating system. METHODS: 50 eyes of 50 patients with MH undergoing surgery using the 3D or Conventional microscope visualization system. Cognitive workload assessment was done by real-time tools(Surgeons' heart rate [HR] and oxygen saturation[SPO2]) and self-report tool(Surgery Task Load Index[SURG-TLX] questionnaire) of three Vitreoretinal surgeons. Based on the SURG-TLX questionnaire, an assessment of the workload was performed. RESULTS: Of the 50 eyes, 30 eyes and 20 eyes underwent surgery with the Conventional microscope and the 3D system, respectively. No difference was noted in the MH basal-diameter(p = 0.128), total surgical-duration(p = 0.299), internal-limiting membrane(ILM) peel time(p = 0.682), and the final visual acuity (VA; p = 0.515) between the two groups. Both groups showed significant improvement in VA(p < 0.001) with a 90% closure rate at one-month post-surgery. Cognitive workload comparison, the intraoperative HR(p = 0.024), total workload score(P = 0.005), and temporal-demand dimension(p = 0.004) were significantly more in Conventional microscope group as compared to 3D group. In both the groups, the HR increased significantly from the baseline while performing ILM peeling and at the end. CONCLUSION: The surgeon's cognitive workload is markedly reduced while performing macular hole surgery with a 3D viewing system. Moreover, duration of surgery including ILM peel time, MH closure rates, and visual outcomes remains unaffected irrespective of the operating microscope system.

Comparative Evaluation of the Effectiveness of Different Pain-alleviating Methods before Local Anesthetic Administration in Children of 6 to 12 Years of Age: A Clinical Study.

BACKGROUND AND AIM OF THE STUDY: Pediatric patients are apprehensive regarding having dental treatment mainly because of painful local anesthetic (LA) injections. Various techniques like transcutaneous electrical nerve stimulation (TENS), topical anesthetic agents, and vibrator device are introduced to reduce discomfort before LA administration. Therefore, the present study aimed to compare and evaluate the effectiveness of TENS, 2% lignocaine gel, eutectic mixture of lignocaine and prilocaine (EMLA), and vibrating device before LA injections in alleviating pain in pediatric patients. MATERIALS AND METHODS: Sixty healthy children aged 6 to 12 years who required LA injections for dental procedures were selected and divided into four groups with 15 patients in each group. Wong-Baker's facial pain rating scale (WBFPRS) and face, legs, activity, cry, and consolability scale (FLACC) are used for pain perception which are tabulated, and statistically analyzed. RESULTS: The test results demonstrated that the TENS group has shown the least mean WBFPRS and FLACC score, followed by vibrator devices, EMLA gel, and lignocaine gel. CONCLUSION: The newly introduced TENS apparatus showed encouraging results, hence can be used as a safe and reliable technique to be used in pediatric dentistry. HOW TO CITE THIS ARTICLE: Patil SB, Popali DD, Bondarde PA, et al. Comparative Evaluation of the Effectiveness of Different Pain-alleviating Methods before Local Anesthetic Administration in Children of 6 to 12 Years of Age: A Clinical Study. Int J Clin Pediatr Dent 2021;14(4):447-453.

Outcomes of preoperative bevacizumab in diabetics with nonclearing vitreous hemorrhage without tractional detachment - A quasi-randomized retrospective study.

PURPOSE: To assess whether preoperative bevacizumab (BVZ) in treatment-naïve eyes with proliferative diabetic retinopathy (PDR) and vitreous hemorrhage (VH) without tractional retinal detachment (TRD) leads to lesser macular edema and better visual outcome compared to eyes that do not receive BVZ. METHODS: This quasi-randomized retrospective study included 217 treatment-naïve eyes with nonclearing VH without TRD that had vitrectomy with or without BVZ and had a minimum 6-months follow-up. Postoperative variables, including visual acuity (BCVA), central macular thickness (CMT) at 1 month, and need for additional anti-VEGF injections till 6 months follow-up, were recorded for analysis. RESULTS: Of the 217 eyes, 107 eyes (49%) received preoperative BVZ and 110 (51%) did not. Groups were comparable in terms of preoperative characteristics. At 1 month, mean CMT was significantly higher in eyes without BVZ (310 ± 33 m vs. 246 ± 34m; P < 0.001). The likelihood of developing center-involving DME at 1 month after vitrectomy was 67% lower if the eye received preoperative BVZ (OR = 0.33, 95%CI = 0.18-2.54, P = 0.56). Though BCVA improved significantly in both groups at 1 month, it was 1/3rd of a line better in the BVZ group (b coefficient = -0.035 logMAR, 95%CI = -0.04 to -0.008 logMAR, P = 0.01). CONCLUSION: Preoperative BVZ in treatment-naïve eyes with PDR and VH but without TRD lead to better macular status and marginally improved vision at 1 month, which was maintained at 6 months. In view of these results, patients may be offered BVZ only when it is readily affordable to them.

Comparison of flanged intrascleral intraocular lens fixation versus iris claw intraocular lens fixation: A retrospective study.

Purpose: To compare the visual outcome and complications of retropupillary fixated iris claw intraocular lens (IOL) and sutureless intrascleral IOL fixation using the flanged fixation technique at 1 year. Methods: In this retrospective study, eyes that underwent either iris claw or flanged SFIOL from January 2016 to July 2017 with a minimum of 1-year follow-up were enrolled. Improvement in visual acuity, intraocular pressure measurements, endothelial cell count, central macular thickness, and complications were compared between and within groups at 6 weeks, 3 months, and 1 year postoperatively. Results: Data from 150 eyes were analyzed (n = 90 in the iris claw group and n = 60 in the flanged SFIOL group). Posterior capsular rent was the most common indication for IOL implantation (n = 51, 34%). The iris claw and SFIOL groups were comparable in terms of demographics and baseline characteristics. There was significant improvement in uncorrected distance visual acuity (UCDVA) at 6 weeks in both groups (P = 0.77), and at 1 year, the UCDVA was comparable between groups (0.36 ± 0.32 in the iris claw group and 0.30 ± 0.28 in the SFIOL, P= 0.75). Transient elevation of intraocular pressure was seen slightly more in eyes with SFIOL (17%), while ovalization of the pupil was the main sequelae seen in the iris claw group (20%). Conclusion: Both iris claw IOL fixation and SFIOL using flange are viable options for surgical correction of aphakia. Visual outcomes are excellent at 6 weeks and are maintained till 1-year follow-up, and complication rates are acceptably low, although ovalization of pupil is common with iris claw IOLs.

Comparison of Two Modified Sutureless Techniques of Scleral Fixation of Intraocular Lens.

BACKGROUND AND OBJECTIVE: To compare the visual outcome and complications of two different sutureless scleral-fixated intraocular lens (IOL) implantation techniques, that is, intrascleral IOL fixation technique and modified Yamane's technique of scleral fixation of IOL. PATIENTS AND METHODS: Patients who underwent scleral fixation of IOL (SFIOL) from June 2015 to February 2017 with more than 6 months of follow-up were examined retrospectively. Improvement in visual acuity (VA), intraocular pressure (IOP) measurements, endothelial cell count, central macular thickness (CMT), and intraoperative/postoperative complications were compared at 6 months follow-up. RESULTS: Seventy eyes were analyzed. The mean follow-up was 10.5 months ± 1.5 months. The final visual outcomes in both groups, modified intrascleral IOL fixation technique (Group A, n = 30) and modified Yamane's technique (Group B, n = 40), were comparable. The indications for surgery were aphakia (n = 15), subluxated/dislocated cataract (n = 31), and dislocated/subluxated IOL (n = 24). The majority of the eyes (92%) improved to VA 0.3 logMAR units or better. The uncorrected distance visual acuity (UDVA), endothelial cell density, and CMT at the 6-month follow-up were comparable in both groups. Postoperatively, transient IOP rise occurred in 18 eyes, retinal detachment in one eye, vitreous hemorrhage in one eye, cystoid macular edema in two eyes, and mild IOL decentration in two eyes. CONCLUSION: Both techniques have favorable visual outcomes; however, modified 27-gauge needle-assisted Yamane's technique is technically superior because of its transconjunctival approach and less surgical time, and its needle-assisted approach for haptic externalization prevents haptic damage during externalization. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e129-e134.].

Precision pulse capsulotomy in phacoemulsification: Clinical experience in Indian eyes.

Purpose: To evaluate the surgical outcome of precision pulse capsulotomy (PPC) in phacoemulsification surgery. Methods: One hundred twenty-three eyes of 99 consecutive patients who underwent phacoemulsification with PPC through a 2.8 mm clear corneal incision were prospectively studied at a tertiary care centre. The size, shape of capsulotomy and intraoperative capsulotomy, and surgery-related complications were noted. Visual outcome, IOL stability, and signs of capsular opacification/contraction were evaluated at 3 and 6 months. Results: The mean age of patients was 49.5 ± 7.77 years. Complete, circular capsulotomy averaging 5.5 mm diameter was achieved in 117 of 123 eyes. In seven eyes, we experienced complications like capsulorhexis tear (n = 6) and inadvertent iris capture (n = 1). Probe malfunction occurred in six cases. Stable intracapsular intraocular lens (IOLs) fixation and centration was achieved in all eyes. None of the eyes had any significant posterior capsular opacification or capsular contraction at 3 and 6 months. In one eye anterior capsular opacification at the capsulotomy edge was noted at 6 months. Conclusion: PPC is a useful device for achieving a perfectly round capsulorrhexis. However, it has a learning curve and chances of skip areas in capsulorhexis, capsular tag, and its extension should be kept in mind. Special care should be taken in initial cases and while operating on eyes with poorly dilating pupil and mature cataracts.

Sutureless 27-gauge needle-assisted transconjunctival intrascleral intraocular lens fixation: Initial experience.

PURPOSE: The purpose of the study was to report our initial experience with the transconjunctival Intrascleral Intraocular Lens (SFIOL) fixation with modified Yamane's double-needle technique and flanged haptics. METHODS: This was a prospective interventional study that enrolled 31 consecutive patients undergoing SFIOL with the modified Yamane's technique. All patients underwent comprehensive evaluation including uncorrected and best-corrected vision, intraocular pressure, ultrasound biomicroscopy, endothelial cell density, and macular thickness using optical coherence tomography (OCT). We excluded patients with visually significant coexistent pathology such as corneal scars, macular pathology, and glaucoma. RESULTS: The mean age of subjects was 57 ± 16.9 years and 23 were men (74%). Surgery was performed for aphakia following complicated cataract surgery in 10 eyes (32%), with lensectomy for subluxated/dislocated cataract in 6 eyes (19%), and with IOL explantation for subluxated/dislocated IOL in 15 eyes (48%). There were no intraoperative complications. Uncorrected visual acuity improved from median of 1.48 logarithm of minimum angle of resolution (logMAR) units (interquartile range [IQR] = 1.3-2 logMAR) at baseline to 0.3 logMAR (IQR = 0.2-0.4 logMAR) at 6 weeks (P < 0.001) which was maintained at 6 months. There were no significant changes in endothelial cell density (P = 0.34) and OCT-based macular thickness (P = 0.31) at 6 months. Two eyes had slight IOL decentration. CONCLUSION: Our initial experience suggests that the Yamane's technique for SFIOL is a simple procedure with a short-learning curve and is independent of scleral flaps, tunnels, sutures, and fibrin glue. Using widely available 27-gauge needle instead of 30-gauge thin wall needle as originally described by Yamane makes it possible for the use of various three-piece IOLs available globally. Further studies are required for widespread acceptance of this technique.