A Multicenter Prospective Randomized Controlled Study of a New Corneal Wetting Agent During Ophthalmologic Surgery.

INTRODUCTION: A multicenter prospective randomized controlled study was used to investigate the effect and safety of a new corneal wetting agent called the Corneal Surface Viscoelastic Protector (CsVisc, Success Bio-Tech Co., Ltd, China), on the corneal epithelium during ophthalmic surgery by comparison with the commercially available Cornea Protect (CP, Valeant Med Sp. zo. o. Leobendorf, Austria). METHODS: This multicenter prospective randomized controlled study comprised patients scheduled for cataract surgery and pars plana vitrectomy. The patients were randomly assigned to receive either a new corneal wetting agent (CsVisc) or Cornea Protect (CP, Valeant Med Sp. zo. o. Leobendorf, Austria). Optical clarity during surgery, application frequency, duration of effect, diffusion time of corneal wetting agents, fluorescein staining, intraocular pressure (IOP), tear-film break-up time (TBUT), and Schirmer I test (SIT) were assessed. Adverse events were noted on the designated patient case report forms. RESULTS: A total of 149 eyes (149 patients, mean age 62 years; range 25-80 years) were included in the study. There were 74 eyes in the control group and 75 eyes in the study group. In patients who underwent vitrectomy, the frequency of application was 1.62 ± 1.03 in the study group and 1.39 ± 0.66 in the control group, with no significant difference (P = 0.399), and the duration of effect was 19.16 ± 6.94 min in the study group and 19.06 ± 7.22 min in the control group, with no significant difference (P = 0.835). The optical clarity of the study group was not significantly different from that of the control group (P = 0.485). In patients who underwent cataract surgery, the frequency of application was 1.10 ± 0.38 in the study group and 1.07 ± 0.26 in the control group, and the difference was not significant (P = 0.950). The difference between the duration of effect in the study group (8.32 ± 2.50 min) and the control group (7.63 ± 2.52 min) was not significant (P = 0.310). The difference in optical clarity scores between the two groups was not statistically significant (P = 0.600). Among all patients in this study, the diffusion time of the corneal wetting agent was 14.97 ± 10.07 s in the control group and 11.23 ± 8.41 s in the study group, with a statistically significant difference (p = 0.008). The frequency of adverse events was 20.00% (15/75) in the study group and 14.86% (11/74) in the control group, with no statistically significant difference (P = 0.409). There were no serious adverse events related to the test medical device or causing patients to withdraw from the study. CONCLUSIONS: The CsVisc is safe and effective in preventing intraoperative corneal epithelial damage due to corneal dryness and can be comparable to the CP. In addition, the CsVisc has a shorter diffusion time.

8-0 Polypropylene Suture Looping and Overhand Knot: Transconjunctival Approach to Four-Point Scleral Fixation of an Akreos Adapt Intraocular Lens.

PURPOSE: To evaluate a novel surgical technique for transscleral fixation of the intraocular lens (IOL) with four hollow haptics using 8-0 polypropylene suture looping and overhand knot. METHODS: An 8-0 polypropylene suture was tied to a 10-0 polypropylene suture with an overhand knot. One set of 8-0 polypropylene suture was then passed through the IOL four haptics. The suture knot was buried by rotating into the sclera tunnel. Best-corrected visual acuity, intraocular pressure, and complications were determined. RESULTS: The IOLs were fixed with using an 8-0 polypropylene suture in 13 eyes of 11 patients with aphakia and dislocated crystalline lens. The mean preoperative corrected distance visual acuity was 0.71 ± 0.58 logarithm of the minimum angle of resolution (Snellen 20/103), and it improved to 0.24 ± 0.25 logarithm of the minimum angle of resolution (Snellen 20/35) at the final follow-up ( P < 0.05). No vitreous hemorrhage, hypotony, suture exposed, and pupillary capture of the IOL were observed in any of the patients. CONCLUSION: The authors have developed a new technique for transscleral IOL fixation with one set of an 8-0 polypropylene suture tied to a 10-0 polypropylene suture with an overhand knot. The overhand knot offers the opportunity to use an 8-0 polypropylene suture for the long-term safety and may not require the surgeon to learn any new technique.

Four-Point Scleral Fixation of An Akreos Adapt AO Intraocular Lens Using Double-Strand 9-0 Polypropylene Suture.

PURPOSE: To report the results of a novel surgical four-point transscleral suture fixation of intraocular lens (IOL) with four hollow haptics using the double-suture technique. METHODS: We retrospectively reviewed the medical records of 15 eyes of 15 patients who underwent 4-point transscleral suture fixation of a foldable IOL using the double-suture technique. Preoperative data and follow-up data for at least 4 months were collected for all patients. RESULTS: The IOLs were fixed and centered well. The mean preoperative corrected distance visual acuity was 0.70 ± 0.54 logarithm of the minimum angle of resolution (Snellen 20/102), and it improved to 0.29 ± 0.26 logarithm of the minimum angle of resolution (Snellen 20/39) at the final follow-up ( P = 0.001). No vitreous hemorrhage, hypotony, suture breakage, retinal detachment, IOL dislocation, and iris capture was detected during the follow-up period in any of the patients. CONCLUSION: We have developed a novel technique for 4-point transscleral suture fixation of IOL using the double-suture technique with 9-0 polypropylene suture. This technique seemed to be safe and it may not require the surgeon to learn any new technique.

[The use of superficial cervical artery island skin flaps in the repair of the maxillofacial and cervical scar].

OBJECTIVE: To investigate the method of harvesting of superficial cervical artery island skin flap, and its clinical application in the repair of the maxillofacial and cervical scars. METHODS: The origin, course, branches and distribution of the superficial cervical artery were studied in 10 adult cadavers. The superficial cervical artery could be divided into three segments: i.e. the segment before entering the trapezius muscle, the segment in the trapezius muscle, and the segment emerging from the trapezius muscle. Fourteen patients with maxillofacial and cervical scar contracture were enrolled in the study. The postburn scars were removed, and the wounds were covered by superficial cervical artery island skin flaps. The survival of the flap after the operation and the recovery of the neck movements were observed. RESULTS: The length of superficial cervical artery before entering the trapezius muscle was 5.1 +/- 0.4 cm, while that inside the trapezius muscle was 2.1 +/- 0.5 cm, and that after emerging from the trapezius muscle was 4.7 +/- 0.7 cm, respectively. The internal perforating branch was located 7.3 +/- 0.6 cm beside the seventh cervical vertebrae, and 3.9 +/- 0.7 cm above the spine of scapula. The flap was from 16 cm x 7 cm to 35 cm x 12 cm in size. All the flaps survived, except one with partial necrosis in the distal part (3.0 cm x 1.5 cm) of the flap. Follow-up observation for 4 months to 3 years showed satisfactory results. CONCLUSION: Superficial cervical artery island skin flap is simple in the flap preparation, and there is no necessity to cut the pedicle, thus it is particularly suitable for the reconstruction of severe postburn maxillofacial and cervical contracture.