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At least 199 records · Page 11Linked to original sources

PubMed2003

Small-gauge, sutureless pars plana vitrectomy to manage vitreous loss during phacoemulsification.

This technique manages vitreous prolapse associated with posterior capsule rupture during phacoemulsification by performing small-gauge pars plana vitrectomy with a sutureless, self-sealing incision performed in a closed chamber, maintaining normal intraocular pressure. A high-speed cutter exerts minimal traction on the vitreous. Accessibility to the vitreous through the pars plana is better, ensuring more complete removal of the vitreous and restoration of normal anatomy.

Eye Diseases↗

PubMed1995

Sutureless scleral tunnel cataract surgery using topical and low dose perilimbal anesthesia.

Because of risks and complications inherent to retrobulbar anesthesia, alternative techniques such as peribulbar and topical approaches have been devised. These also have associated problems. We have developed a technique that combines a single, minimal volume, perilimbal injection with topical anesthesia. It provides sutureless scleral tunnel cataract surgery without the risks of retrobulbar or peribulbar anesthesia, maximizing patient comfort and allowing immediate return of vision postoperatively.

Administration, Topical↗

PubMed1995

Corneal sensation after small incision, sutureless, one-handed phacoemulsification.

Corneal sensitivity was measured in 60 eyes preoperatively and at one day, one week, and one month after small incision, sutureless, one-handed phacoemulsification performed by the same surgeon using the same technique. Corneal sensation remained normal at the center and the 3, 6, and 9 o'clock positions. Decreased corneal sensation was found over the width of the scleral tunnel incision at the limbus, extending in a wedge-shaped sector not encompassing the central cornea.

Aged↗

PubMed1994

Astigmatic changes after cataract surgery with 5.1 mm and 3.5 mm sutureless incisions.

We evaluated postoperative keratometric astigmatism in 80 eyes that had phacoemulsification and intraocular lens implantation through sutureless corneal incisions. The eyes were separated into two groups based on the use of rigid ovoid or foldable silicone lenses inserted through 5.1 mm corneal lip incisions or 3.5 mm lip incisions, respectively. In the early postoperative period (one to three months), vector analysis showed less induced astigmatism in the 3.5 mm group than in the 5.1 mm group. Uncorrected visual acuity during the postoperative period was also better in the smaller incision group.

Adult↗

PubMed1991

Chevron sutureless closure: a preliminary report.

An inverted V-shaped cataract incision with a scleral tunnel entry into the anterior chamber was used in 700 eyes. Two details distinguish this incision from other sutureless closures: the fulcrum in the crotch of the V provides easier access to the anterior chamber for instrument manipulation, and the termination of the scleral tunnel entry posterior to the cornea lessens the likelihood of corneal folds that may interfere with visualization during surgery. The surgical results in a preliminary survey show minimal iatrogenic change in corneal toricity and the type of complications usually associated with conventional cataract surgery.

Astigmatism↗

PubMed1996

Evaluation of intraocular pressure with Healon and Healon GV in sutureless cataract surgery with foldable lens implantation.

PURPOSE: To evaluate transient increases in intraocular pressure (IOP) after use of high-viscosity viscoelastic agents in cataract surgery. SETTING: Military Hospital, Ulm, Germany. METHODS: In a prospective, randomized study, we evaluated IOP following cataract surgery using two different viscoelastic substances (Healon, Healon GV). The viscosity of Healon GV is 10 times higher than that of Healon because of higher concentration and molecular weight. Patients having identical phacoemulsification procedures (sutureless clear corneal tunnel incision with foldable silicone lens implantation) (N = 60) and identical viscoelastic removal were assigned to groups of 15 based on viscoelastic used and removal time (20 or 40 seconds). Intraocular pressure was measured preoperatively and at 6, 24, 36, and 48 hours and 1 month postoperatively. RESULTS: The highest mean IOP elevations in both viscoelastic groups were obtained at 24 hours postoperatively (2.9 mm Hg +/- 4.3 [SD] with Healon and 3.3 +/- 6.3 mm Hg with Healon GV). There were no statistically significant differences between the two viscoelastics and the two removal times during the entire follow-up period (unpaired t-test), but standard deviations were higher in the Healon GV groups at 6 and 24 hours. Two patients in the Healon groups and three in the Healon GV groups required medical treatment for IOP within the first 24 postoperative hours; however, all five patients had an IOP lower than 22 mm Hg on the second postoperative day. CONCLUSIONS: Based on postoperative IOP, both viscoelastics can be equally well removed from the anterior chamber. Incidence of high IOP using high-viscosity hyaluronic acid is minimized by the described removal technique.

Aged↗

PubMed1996

Batch-by-batch analysis of topographic changes induced by sutured and sutureless clear corneal incisions.

PURPOSE: To evaluate the effect of a suture on surgically induced corneal topographic changes in 5.0 mm clear corneal incisions. SETTING: University Eye Hospital, Vienna, Austria. METHODS: Thirty-seven eyes that had cataract surgery were included in the prospective study. A 5.0 mm long and 0.3 mm deep precut was followed by preparation of a corneal tunnel. After phacoemulsification and intraocular lens implantation, the self-sealing wound was left unsutured in 19 eyes; one radial 11-0 nylon suture was applied in 18 eyes. Using a TMS-1 videokeratoscope, corneal topography was measured preoperatively and at 1 week and 1 and 3 months postoperatively. The topographic data were evaluated by statistical batch-by-batch analysis. Each topographic image was cut into 178 fields in eight concentric rings. The refractive values of these fields were stored in a database. Differences between the four readings of each patient were calculated and the mean differences of the 178 fields in each group were transformed into color-coded maps. The significance of topographical changes and group comparisons of induced changes were computed by Wilcoxon tests. RESULTS: Both groups exhibited significant temporal flattening and vertical steepening. The unsutured eyes also displayed significant nasal flattening. Sutureless 5.0 mm clear corneal incisions induced significantly more vertical steepening and nasal flattening than sutured incisions. CONCLUSION: Application of one radial 11-0 nylon suture in 5.0 mm temporal clear corneal incisions significantly reduced shape changes in the nasal corneal region.

Aged↗

PubMed1997

Computer-assisted videokeratography to measure changes in astigmatism induced by sutureless cataract surgery.

PURPOSE: To compare the visual outcome, change in surgically induced astigmatism, and corneal thickness after sutureless cataract surgery through either a scleral tunnel or clear corneal incision. SETTING: Department of Ophthalmology, Kangnam St. Mary's Hospital, Catholic University Medical College, Seoul, Korea. METHODS: This retrospective study evaluated 79 eyes of 64 patients who had cataract surgery using a 6.0 mm scleral tunnel incision (Group 1, n = 20 eyes), 3.1 mm clear corneal incision at the 10 o'clock position (Group 2, n = 35 eyes), or 3.1 mm clear corneal incision at the 10 o'clock position (Group 3, n = 24 eyes). Changes in surgically induced astigmatism were analyzed using computer-assisted videokeratography (CVK) 1 day, 8 weeks, and 6 months postoperatively. RESULTS: Eleven eyes (55.0%) in Group 1, 15 (42.8%) in Group 2, and 11 (48.5%) in Group 3 had an uncorrected visual acuity of 20/40 or better 1 day postoperatively. The CVK measurements showed significantly more flattening at radial distances of 0.75, 1.50, and 2.50 mm along the 90 degree semimeridian in Group 2 than in Group 1 (P < .05) 1 day after surgery; in Group 3, flattening along the incisional semimeridian fell between the amounts in Groups 1 and 2. At 8 weeks, the amount of flattening decreased in all groups, and the differences between groups were not statistically significantly different (P > .05). In the CVK pattern, corneal flattening along the incisional meridian was narrower and longer in Groups 2 and 3 than in Group 1. CONCLUSION: Localized flattening along the incisional meridian was prominent temporally after clear corneal incision surgery. However, there was no difference in early visual rehabilitation between the clear corneal and scleral tunnel incision groups.

Adult↗

PubMed1998

Corneal flap incision technique for sutureless cataract surgery.

A self-sealing incision technique for cataract surgery has been developed. It is appropriate for implantation of rigid-optic intraocular lenses (IOLs) up to 7.0 mm. The incision is designed to meet the principle criteria of sutureless cataract surgery, such as optimal instrument handling, easy IOL implantation, and minimal postoperative patient care.

Cataract Extraction↗

PubMed1998

Comparison of surgically induced astigmatism after sutureless temporal clear corneal and scleral frown incisions.

PURPOSE: To compare the corneal astigmatic changes induced by clear corneal incisions with those induced by scleral tunnel frown incisions., both from a temporal approach, in sutureless cataract surgery. SETTING: Department of Ophthalmology, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China. METHODS: This prospective study comprised 120 eyes divided into two groups of 60 each based on incision type. All patients had examinations with an autokeratometer preoperatively and 1 week and 1, 3, and 6 months postoperatively. RESULTS: Simple subtraction of the scalar analysis in each group showed minimal astigmatic changes; however, the standard deviation of astigmatic change was greater in the clear corneal incision group. The mean vector analysis of surgically induced astigmatism in the scleral frown incision group was 0.;69, 0.75, 0.72, and 0.61 diopter (D) at 1 week and 1, 3, and 6 months, respectively. In the clear corneal incision group, it was 1.55, 1.12, 0.93, and 0.92 D at the same intervals. In the scleral frown incision group, Naeser's polar value also showed minimal changes in polar astigmatism throughout the study; in the clear corneal incision group, it showed a mean with-the-rule (WTR) astigmatic shift of +0.73, +0.22, +0.13, and +0.08 D at 1 week and 1, 3, and 6 months, respectively. CONCLUSION: Corneal stability was achieved with minimal astigmatic change 1 week after scleral frown incisions, while clear corneal incisions induced greater WTR astigmatism with delayed stabilization 1 to 3 months postoperatively.

Aged↗

PubMed1999

Intraocular pressure trends after supranormal pressurization to aid closure of sutureless cataract wounds.

PURPOSE: To measure intraocular pressure (IOP) immediately and 25 minutes after small sutureless cataract surgery to estimate the duration of any elevation and to evaluate the relationship between supranormal pressurization and an elevated IOP 24 hours postoperatively. SETTING: Routine outpatient cataract surgery at a tertiary referral center. METHODS: Thirty-six consecutive eyes that had uneventful phacoemulsification cataract extraction were studied in a prospective fashion. Supranormal pressurization was attempted in all cases. Surgery was performed through a 3.5 mm scleral wound. RESULTS: Mean IOP dropped from 38.8 mm Hg +/- 11.4 (SD) to 19.8 +/- 5.3 mm Hg 25 minutes after the surgery (P < .0001). A subgroup of patients (n = 6) whose IOP was greater than 24 mm Hg 24 hours postoperatively had a pressure drop from 36.8 +/- 12.3 mm Hg to 23.2 +/- 6.2 mm Hg 25 minutes postoperatively (P = .051). In this subgroup, the mean 24 hour IOP then rose to 30.8 +/- 5.2 mm Hg (P = .043). Another subgroup of patients (n = 7) whose IOP was greater than 24 mm Hg at 25 minutes had a pressure drop from 46.3 +/- 8.5 mm Hg to 27.9 +/- 2.4 mm Hg (P = .0014), falling to 21.7 +/- 6.6 mm Hg at 24 hours (P = .018). CONCLUSION: These findings demonstrate the rapid decline of IOP after supranormal pressurization at the conclusion of cataract surgery. In addition, supranormal pressurization did not seem to contribute to IOP elevation at 24 hours.

Aged↗

PubMed2001

Sutureless vascular anastomosis: the VCS clip.

Non-penetrating, arcuate-legged clips facilitate vascular reconstructions and significantly reduce the incidence of anastomotic neointimal hyperplasia. Though originally developed as a microvascular-approximating instrument, by far the largest application has been for hemodialysis vascular access. Long-term studies comparing suture to clip for access creation have demonstrated the clear technical and biological superiority of the clip for this procedure. This "sutureless" vascular anastomotic technique is more demanding than conventional suturing, requiring precise vessel preparation and supervised training.

Anastomosis, Surgical↗

PubMed2002

Sutureless coronary anastomoses: revival of old concepts.

Surgical environment is becoming increasingly challenging for the cardiac surgeon since off-pump coronary arteries bypass grafts and minimally invasive approach came up. The suture technique for coronary anastomosis construction is becoming inadequate to meet new surgeons' demand. Therefore, there is an increasing need for alternative ways to perform coronary bypasses. This article reviews the most recent devices developed for cardiac surgery (Q-Cab and distal connector from St. Jude Medical, CoreLink from Ethicon, GraftConnector from Jomed Int.), and demonstrates that the new anastomotic technologies are based on concepts expressed by Payr and other authors in the 19th century. We propose to consider three aspects to evaluate a sutureless anastomotic device: the device-vessel wall connection, the graft preparation and the anastomosis' biomechanical properties. Pins, wall eversion on an anvil and squeezing are the three systems used to anchor the connector to the graft and to the native artery. The graft preparation and anastomotic biomechanics are analysed with respect to the possibility of affecting graft patency rate. Finally, we trace the profile of the ideal anastomotic device: minimal graft manipulation, no limitation in anastomotic timing, no material in the vessel lumen and optimal anastomotic angle and compliance. The evidence of long-term graft patency is fundamental for any anastomotic device to become widely acceptable.

Anastomosis, Surgical↗

PubMed2002

New operative method for a giant bulla: sutureless and stapleless thoracoscopic surgery using the Ligasure system.

Thoracoscopic bullectomy performed with staplers is the main treatment for giant bullae in many institutions. However, there are certain problems associated with the increasing use of stapling devices. In response, we have applied a new operative method in which we excised a bulla with an ultrasonic-driven scalpel and successfully sealed the cut ends using the LigaSure Vessel Sealing System, a new bipolar system developed by Valleylab Inc. Herein we describe our experience with this newly designed technique which could render possible 'sutureless and stapleless' thoracoscopic surgery in the future.

Adult↗

PubMed2000

Evaluation of a new device for quick sutureless coronary artery anastomosis in surviving sheep.

OBJECTIVE: A new device for performing quick sutureless vascular anastomosis by means of stent technology has recently been developed by Jomed International, Helsingborg, Sweden. The efficacy of this GraftConnector was studied in a sheep model. METHODS: In adult sheep, a left anterior thoracotomy under the fourth rib extended across the sternum gave good access to the left anterior descending branch (LAD) and the right internal mammary artery (RIMA). On beating hearts, the GraftConnector group had the RIMA connected to the LAD by means of the new device, while the control animals had the same anastomoses sutured with continuous 7-0 polypropylene sutures. The time for completing the anastomosis (ischemic time) was recorded and the blood flow in the RIMA was recorded with the proximal LAD open and closed, respectively. An intra-operative fluoroscopy with contrast injection directly into the graft was done. Finally the proximal LAD was ligated. The surviving animals are to be followed up. RESULTS: Seven (46%) of the 15 animals operated on with the traditional suturing technique and seven (63%) of the 11 GraftConnector sheep survived the procedures and are to be followed up. The 11 anastomoses done with the GraftConnector were completed in 2.41+/-0.2 min, and the 14 anastomoses sutured with continuous suture were completed in 6.93+/-0.419 min (P<0.0001). The RIMA blood-flows in the two groups were comparable and are presented. All the surviving animals had open anastomoses at fluoroscopy. CONCLUSIONS: Quick coronary artery anastomoses without suturing on beating hearts can be completed with the new GraftConnector. The GraftConnector creates reproducible anastomoses in much less time than suturing, the per-operative mortality in the GraftConnector Group was accordingly lower. Long-time follow-up of the patency in surviving animals is pending. The presented device may ultimately permit quick anastomoses endoscopically.

Anastomosis, Surgical↗

PubMed1997

Clear cornea sutureless phacoemulsification and astigmatic decay after two years.

PURPOSE: To determine whether clear cornea temporal sutureless sections lead to astigmatic decay over a 2 year period. METHOD: The difference between (a) pre-operative keratometric cylinder and keratometric cylinder at final follow-up, and (b) spectacle cylinder at 1 month post-operation and final follow-up, was calculated for 43 eyes. RESULTS: The mean difference in keratometric cylinder between pre-operation and final follow-up was 0.12 D with the rule (WTR) or against the wound. The range was from 0.7 D WTR to 0.4 D against the rule (ATR). Eighty-two per cent of eyes did not change by more than 0.3 D. The mean change in spectacle prescription between 1 month post-operation and final follow-up was 0.05 D ATR, range 0.5 D WTR to 1.0 D ATR. At final follow-up 93% of eyes were seeing 20/40 or better unaided. CONCLUSION: A carefully constructed temporal wound can remain astigmatically neutral.

Adult↗

PubMed1987

Microarterial sutureless sleeve anastomosis using a polymeric adhesive: an experimental study.

A new technique for microarterial sutureless anastomosis that involves telescoping one vessel into the other and placing a microdrop of a polymeric adhesive (iso-propyl-cyanoacrylate) is described. Sixty-six anastomoses were performed in rat femoral arteries with a patency rate of 95 percent. Light and electron microscopic studies were conducted at regular intervals, starting immediately to 90 days postoperative. From this experimental study, it appears that the described method of anastomosis is faster and easier to perform and at least as reliable as the conventional end-to-end suture anastomosis. In addition, it was observed that tissue reaction to the glue remained primarily adventitial and did not disturb vessel patency.

Animals↗

PubMed2001

Early clinical experience with a new sutureless anastomotic device for proximal anastomosis of the saphenous vein to the aorta.

BACKGROUND: Avoiding aortic side clamping is useful to avoid local particulate embolization. A device that allows a saphenous vein graft to be anastomosed to the aorta without aortic manipulation is clinically evaluated. METHODS AND RESULTS: From July 1999 to March 2000, 17 patients who underwent myocardial revascularization had an aorta-saphenous vein graft anastomosis performed by means of an aortic anastomotic device. Eight were operated on with cardiopulmonary bypass and 9 without. The proximal anastomoses created by the aortic anastomotic device were performed before the institution of cardiopulmonary bypass or before the related distal anastomosis was performed. In 11 patients transcranial Doppler ultrasound was used. In 1 (6%) patient the saphenous vein graft was not deployed, and in 2 (12%) a single suture was added for minor bleeding. None of the 11 patients evaluated with transcranial Doppler ultrasound had evidence of particulate embolization during the procedure. No patient died or was reoperated on for bleeding. Six (35%) patients had a postoperative angiogram 48 +/- 26 days after the operation that showed widely patent proximal anastomoses. CONCLUSIONS: Use of an aortic anastomotic device allows a sutureless anastomosis to be created between the aorta and saphenous vein graft. The device could be used in totally endoscopic myocardial revascularization. A second-generation device is ready to solve the problems encountered and to increase the ease in handling the device.

Anastomosis, Surgical↗