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      Minimally Invasive Strabismus Surgery for Rectus Muscle Posterior Fixation

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          Abstract

          Aims: To present a novel, minimally invasive strabismus surgery (MISS) technique for rectus muscle posterior fixation. Methods: This study reports the results of 32 consecutive MISS rectus muscle posterior fixation surgeries performed on 19 patients by applying only two small L-shaped openings where the two retroequatorial scleromuscular sutures were placed. Results: On the first postoperative day, in primary position, redness was hardly visible in 16 eyes (50%) and only moderate redness was visible in 6 eyes (19%). No serious complication occurred. Preoperative visual acuity and refraction remained unchanged at 6 months (p > 0.1). The preoperative convergence excess (n = 13) decreased from 10.3 ± 4.1 to 5.2 ± 4.0° at 6 months (p < 0.005). In all patients operated on for gaze incomitance (n = 6) improvement was achieved at 6 months. Conclusions: This study shows that keyhole minimal-dissection rectus muscle posterior fixation surgery is feasible and effective to improve ocular alignment. The MISS technique seems to be superior in the direct postoperative period since only minimal conjunctival swelling and no corneal complications were observed.

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          Most cited references9

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          Outcomes of 140 consecutive cases of 25-gauge transconjunctival surgery for posterior segment disease.

          To evaluate the safety and efficacy of 25-gauge instrumentation for a variety of vitreoretinal conditions on previously nonvitrectomized eyes. Single-center, retrospective, interventional case series. One-hundred forty eyes of 140 patients were evaluated at the Doheny Retina Institute from July 2002 to July 2003. All patients underwent surgical procedures using the Millennium 25-gauge Transconjunctival Standard Vitrectomy system. Twenty eyes (14.3%) underwent procedures without vitrectomy. Postoperative visual acuity (VA), intraocular pressure, surgical time, postoperative inflammation, complications, and number of sutured sites. No intraoperative complications were noted. No cases required conversion to 20-gauge machines. Ten cases (7.1%) involved single-site sclerotomy suture placement due to bleb formation at the conclusion of the procedure, but 5 of these entry sites were enlarged to facilitate larger instrumentation for tissue manipulation. Median VA improved from 20/250 (logarithm of the minimum angle of resolution, 1.08+/-0.47) preoperatively to 20/60 (0.47+/-0.30) (P<0.0001) at final visit. Mean follow-up was 33.8+/-9.7 weeks, and all eyes were observed for a minimum of 12 weeks. Mean total surgical time was 17.4+/-6.9 minutes. Intraocular pressures remained stable throughout the postoperative course. Five eyes (3.8%) presented on day 1 with shallow choroidal detachments, but all resolved by day 7, and none required volume infusion during the postoperative period. All but one of these cases was within the first 50 procedures performed. No detectable inflammation was noted in any eyes by 4 weeks postoperatively. No case of retinal detachment or endophthalmitis was recorded. Transconjunctival surgery using 25-gauge instrumentation may hasten postoperative recovery by decreasing overall surgical time and postoperative inflammation. Procedures requiring minimal intraocular manipulation did not require sutures and, thus, may be better suited for this surgical modality.
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            Minimally invasive abdominal surgery: lux et veritas past, present, and future.

            Laparoscopic surgery has developed out of multiple technology innovations and the desire to see beyond the confines of the human body. As the instrumentation became more advanced, the application of this technique followed. By revisiting the historical developments that now define laparoscopic surgery, we can possibly foresee its future. A Medline search was performed of all the English-language literature. Further references were obtained through cross-referencing the bibliography cited in each work and using books from the authors' collection. Minimally invasive surgery is becoming important in almost every facet of abdominal surgery. Optical improvements, miniaturization, and robotic technology continue to define the frontier of minimally invasive surgery. Endoluminal resection surgery, image-guided surgical navigation, and remotely controlled robotics are not far from becoming reality. These and advances yet to be described will change laparoscopic surgery just as the electric light bulb did over 100 years ago.
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              Deep Sclerectomy versus Trabeculectomy with Low-Dosage Mitomycin C: Four-Year Follow-Up

              Aims: To compare the long-term effects of low-dosage mitomycin C (MMC) in both deep sclerectomy (DSMMC) and trabeculectomy (TPMMC) on intraocular pressure (IOP). Methods: Analysis of extended follow-up of data from a prospective clinical trial. Forty patients were originally randomised to undergo either DSMMC (19 eyes) or TPMMC (21 eyes). Follow-up was performed at postoperative day 1, weeks 1, 2 and 3, as well as months 1, 3, 6, 9, 12, 18, 24, 36 and 48. Two- to three-week data were not included in the statistical analysis. Postoperative complications, number of antiglaucoma medications and IOP were recorded at each visit. Complete (no medications) and qualified (with or without medications) successes were assessed at 2 target IOPs (≤21 and ≤17 mm Hg) and evaluated by Kaplan-Meier curves. Results: At 48 months, the mean IOP (± SD) was 17.6 ± 3.4 and 17.8 ± 3.6 mm Hg in the DSMMC and TPMMC eyes, respectively, a significant reduction from preoperative IOP in each group (p < 0.0005). Complete success was achieved at the ≤21 mm Hg target IOP in 10 (52.6%) and 14 (66.6%) eyes and qualified success in 15 (78.9%) and 18 (85.7%) eyes in the DSMMC and TPMMC groups, respectively. There were no differences in the Kaplan-Meier curves. Hypotony and shallow anterior chamber were significantly more frequent in the TPMMC group. Conclusions: Either procedure controlled IOP efficaciously at our endpoint. Low-dosage MMC can be considered a mild enhancement of deep sclerectomy IOP-lowering effect.
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                Author and article information

                Journal
                OPH
                Ophthalmologica
                10.1159/issn.0030-3755
                Ophthalmologica
                S. Karger AG
                0030-3755
                1423-0267
                2009
                February 2009
                10 December 2008
                : 223
                : 2
                : 111-115
                Affiliations
                Department of Strabismology and Neuro-Ophthalmology, Kantonsspital, St. Gallen, and University of Bern, Bern, Switzerland
                Article
                180279 PMC2790776 Ophthalmologica 2009;223:111–115
                10.1159/000180279
                PMC2790776
                19066435
                4bf85838-85e2-47a2-a469-7759ac0ed142
                © 2008 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 06 August 2008
                : 21 August 2008
                Page count
                Figures: 2, References: 20, Pages: 5
                Categories
                New Technologies in Ophthalmology

                Vision sciences,Ophthalmology & Optometry,Pathology
                Minimally invasive surgery,Strabismus surgery,Minimally invasive strabismus surgery,Conjunctival opening,Rectus muscle posterior fixation

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