SK Forceps: New Monopolar Electrosurgical Forceps Designed Specifically for Blepharoptosis Surgery.

The electrode tips of conventional monopolar forceps are relatively blunt, complicating the delicate detachment manipulations required for blepharoptosis repair. This study describes the SK forceps, which is a new monopolar electrosurgical forceps we specifically designed for blepharoptosis surgery. The electrode tips in our design were engineered to be as fine as possible. The SK forceps can cut tissues with the electrode tips in contact in the closed position and coagulate bleeding while clasping the blood vessels. When inactivated, the SK forceps can perform similar manipulations to regular surgical forceps. Surgeons holding the nonactivated SK forceps in one hand and regular forceps in the other benefit from greatly improved maneuverability at every step of the procedure. Incision and dissection procedures performed with the SK forceps result in a surgical field with minimal bleeding because the forceps can simultaneously perform hemostasis and incision, which is a characteristic of a high-frequency electrosurgical unit. However, when unexpected bleeding is encountered in the operative field, the SK forceps can clamp the injured vessels and coagulate the bleeding more rapidly and confidently compared with the needle-type monopolar electrodes without switching instruments. Our design allows surgeons to perform successive procedural steps without switching instruments. This characteristic makes the SK forceps a beneficial instrument for blepharoptosis surgery.

Comparison of the Postoperative Outcomes of Posterior Layer Advancement and Modified Iliff Suturing to Correct Involutional Lower Lid Entropion.

ABSTRACT: Involutional lower lid entropion is treated surgically with either incision or rotational suturing. The authors have obtained good results with the modified Iliff suture (MIS) procedure. Here, the authors compare the efficacy and postoperative outcomes of MIS and posterior layer advancement. This study included Japanese patients with a normal snap-back test, who underwent primary surgery for correcting involutional lower lid entropion, performed by the same surgeon, from April 2009 to March 2017, and who were followed up for at least 24 months postoperatively. Posterior layer advancement was performed on 50 eyelids of 48 patients (19 men, 29 women; mean age 74.1 ±â€Š8.7 years) and MIS was performed on 50 eyelids of 40 patients (16 men, 24 women; mean age 77.3 ±â€Š7.5 years). The authors compared the postoperative follow-up duration, recurrence rate, and operating time between groups. Postoperative follow-up duration was 34.5 ±â€Š7.4 months in the posterior layer advancement and 32.3 ±â€Š8.1 months in the MIS group (P = 0.180). Recurrence rate was 6% (3 cases) in the posterior layer advancement group and 4% (2 cases) in the MIS group (P > 0.999). Operating time was significantly shorter in the MIS group (5.8 ±â€Š1.1 minutes) than in the posterior layer advancement group (31.6 ±â€Š4.1 minutes, P < 0.001). Modified Iliff suture is less invasive than posterior layer advancement and has similar postoperative outcomes; thus, it is useful for treating involutional lower lid entropion.

Urethral caruncle in a 9-year-old girl: a case report and review of the literature.

INTRODUCTION: Urethral caruncles are the most frequent benign tumors of the female urethra. Most of them are found in post-menopausal women, and they are rare in childhood. Only a few pediatric cases have been published in the literature. In this report, we present an unusual case of a pediatric patient with a urethral caruncle, along with a review of the literature. CASE PRESENTATION: A 9-year-old Mongolian girl was referred to our hospital with a 2-week history of frequent adherence of a small amount of blood to her underwear. We found a sessile smooth margin, a clear boundary and an elastic, soft red tumor over the entire circumference of the urethral meatus. At the beginning, because of the child's age, urethral prolapse was suspected. There was no response after 3 weeks of conservative treatment with steroid ointment. With the patient under general anesthesia, a partial tumor resection was performed for the purpose of histological examination. The tumor excision was limited to about 1/2 laps of the urethral meatus to prevent the development of urethral stricture. On the basis of clinical and histopathological examinations, a diagnosis of a urethral caruncle was made. Post-operatively, steroid ointment application to residual masses was continued, and these disappeared about 6 months later. Our patient was free of recurrence and had had no complications after 3 years of follow-up. CONCLUSIONS: Urethral caruncles are rare in children, and the possibility of malignancy is slight during this period. Biopsy of the mass is not required for diagnosis. It should be indicated only if the mass has other characteristics that raise suspicion of malignancy. In previously reported cases, all of the tumor was removed. However, the trigger of the caruncle in childhood is chronic inflammation. Conservative therapy with steroid ointment should be the core treatment. However, it may be necessary to proceed to treatment because caruncles take a long time to heal. The case that we describe in this report will serve as an example for similar cases in the future.

27-Gauge vitrectomy.

Ten years or more have passed since the current concept of 25-gauge transconjunctival sutureless vitrectomy with a trocar-cannula system emerged. There is no doubt that current microincision vitrectomy surgery with 25- or 23-gauge instrumentation has simplified the vitrectomy procedure and has provided numerous potential advantages over traditional 20-gauge surgery. The established theory regarding surgical wounds is that 'much smaller is better'. Along with the development of new-generation vitrectomy machines with ergonomic instruments, surgeons have been shifting dramatically from 20-gauge systems to 23- and 25-gauge systems over the last years. Thanks to recent innovations and improvements in high-end multifunctional vitrectomy machines and ultrahigh-speed cutters, the development of powerful light sources, and wide-angle viewing systems, several new techniques have also encouraged us to launch the development of a 27-gauge vitrectomy system over the past several years. Similar to the recent evolution in 23- and 25-gauge systems, further development and refinement of the functionality of instruments with a gauge of 27 or more are under way and will continue over the coming years, which in the future will allow us to establish this system for ultra-minimally invasive surgery for the full spectrum of vitreoretinal pathologies.

Simultaneous development of acute disseminated encephalomyelitis and Guillain-Barré syndrome associated with H1N1 09 influenza vaccination.

A 36-year-old man was admitted to our hospital because of urinary retention and muscle weakness affecting all 4 limbs after receiving a H1N1 09 influenza vaccination. Magnetic resonance imaging demonstrated multiple lesions in his brain and spinal cord. Furthermore, nerve conduction study showed acute sensorimotor neuropathy, and anti-GM2 antibodies were detected in his serum. Based on the temporal association and exclusion of alternative etiologies, we made a diagnosis of acute disseminated encephalomyelitis (ADEM) and Guillain-Barré syndrome (GBS). To our knowledge, this is the first case of co-morbid ADEM and GBS after influenza vaccination with positive anti-ganglioside antibodies.

Effects of scleral buckling without encircling procedures on retrobulbar hemodynamics as measured by color Doppler imaging.

OBJECTIVE: To study the effects of segmental scleral buckling without encircling procedures on retrobulbar hemodynamic conditions using color Doppler imaging. METHODS: In 65 consecutive eyes of 65 patients with unilateral rhegmatogenous retinal detachment repaired by scleral buckling, we prospectively measured the blood flow velocities in the ophthalmic artery, central retinal artery, and short posterior ciliary artery using color Doppler imaging before and 2, 12, and 24 weeks after surgery. Peak systolic velocity (PSV) and end diastolic velocity (EDV) (calculated in centimeters per second) were measured using color Doppler imaging. RESULTS: The PSV and EDV in the ophthalmic artery were not changed significantly during follow-up. The PSV and EDV in the central retinal artery were reduced temporarily at 2 weeks after surgery, but at 12 weeks after surgery had returned to presurgery levels. The PSV and EDV in the short posterior ciliary artery on both sides continued to decrease postoperatively, and the reductions became statistically significant by 24 weeks after surgery (buckled side: P=.001 for PSV and P=.002 for EDV; unbuckled side: P<.001 for PSV and P=.004 for EDV). The decreases of PSV and EDV in the short posterior ciliary artery on the buckled side were positively correlated with the subject's age (R = 0.40, P = .001 for PSV; and R = 0.32, P = .008 for EDV). CONCLUSIONS: Scleral buckling procedures can cause subclinical disturbance of the choroidal circulation, even if encircling procedures are avoided. Aging is one of the risk factors for the disturbance.