AIM： This study aimed to expound the individual idea of micro-invasive surgery from pre-operative preparation, intra-operative processing and post-operative management. METHODS： Pre-operative preparation was improve...AIM： This study aimed to expound the individual idea of micro-invasive surgery from pre-operative preparation, intra-operative processing and post-operative management. METHODS： Pre-operative preparation was improved by analyzing pathological factors and hematoma property, and considering patients＇ age, basic disease, blood pressure control, with persistent haemorrhagia/rehaemorrhagia or not, operative occasion choice, positioning and other procedures. In the surgery, positioner was used. Initial aspiration volume was cautiously controlled. After operation, vital signs of patients were kept stable by cautiously using hematoma liquefacient and combining with free radical scavenger. RESULTS： The core content of individual micro-invasive surgery was mainly to relieve intracranial pressure. Under the condition of sufficient pre-operative preparation known by patients＇ family members, precise positioning was determined and individual therapeutic regimen was made. Meanwhile, caution should be taken in hematoma aspiration. Liquefaction and drainage should be paid more attention, and complications were processed actively. CONCLUSION： During the process of micro-invasive evacuation of intracranial hematoma for treating cerebral hemorrhage, attention should be paid to analyzing cerebral hematoma etiology and pathophysiological mechanism, and individual idea should be considered in surgical treatment aiming at patients＇ concrete disease condition.展开更多
Objective The cardiac synchronization therapy (CRT) was proven to have good treatment for the cardiacconduction disorders patients with serious heart failure. But many disadvantages were gradually be noticed,such as d...Objective The cardiac synchronization therapy (CRT) was proven to have good treatment for the cardiacconduction disorders patients with serious heart failure. But many disadvantages were gradually be noticed,such as difficulty of sinus electrode implantation,coronary sinus injury and bleeding,still one third展开更多
The glaucoma surgical landscape has changed dramatically over the last decade with the introduction and integration of micro-invasive glaucoma surgery(MIGS)techniques.These modalities target physiologic outflow pathwa...The glaucoma surgical landscape has changed dramatically over the last decade with the introduction and integration of micro-invasive glaucoma surgery(MIGS)techniques.These modalities target physiologic outflow pathways or optimize previously utilized glaucoma surgical methods in order to deliver safety,efficacy,and individualized care to the patient.MIGS techniques can be classified based on anatomical location as well as method of intraocular pressure(IOP)reduction.This review will focus on MIGS optimizing the conventional outflow pathway via intervention at Schlemm’s canal,MIGS optimizing the uveoscleral outflow pathway via suprachoroidal shunting,and MIGS optimizing the transscleral or subconjunctival outflow pathway which has long been utilized by glaucoma surgeons performing traditional filtration procedures.The wide array of currently available MIGS modalities can be staggering to the glaucoma care provider,but an understanding of the landscape and the large classes of interventional strategies can allow for clinical decision making based on the specifics of the patient’s needs and the pathophysiology of their disease.展开更多
Objective:To evaluate the clinical therapeutic effects of oral administration and external application of Chinese drugs combined with micro-invasive surgery for the treatment of varicose ulcers in the lower extremitie...Objective:To evaluate the clinical therapeutic effects of oral administration and external application of Chinese drugs combined with micro-invasive surgery for the treatment of varicose ulcers in the lower extremities(ecthyma).Methods:A total of 152 patients(163 limbs) suffering from varicose ulcers on the lower limbs were assigned to two groups according to the patients willingness.The 102 cases(109 limbs) in the treatment group underwent the method of endovenous microwave closure of communicating veins ...展开更多
Background Although traditional surgical procedures for glaucoma(such as trabeculectomy and tube-shunt implantation)can significantly reduce intraocular pressure(IOP),they are associated with numerous complications,so...Background Although traditional surgical procedures for glaucoma(such as trabeculectomy and tube-shunt implantation)can significantly reduce intraocular pressure(IOP),they are associated with numerous complications,some of which are vision-threatening,or involve prolonged recovery or a highly intensive postoperative course.Micro-invasive glaucoma surgery(MIGS)procedures have shown better safety but reduced efficacy in achieving target IOP.Combinations of these methods have led to the development of subconjunctival micro-invasive procedures with safety comparable to traditional surgery and greater efficacy than minimally invasive methods.This review describes the use of one of these devices,the poly(styrene-block-isobutylene-block-styrene)(SIBS)-based PreserFlo MicroShunt(Santen,Emeryville,CA),in the surgical treatment of patients with glaucoma.Main text The MicroShunt is an 8.5-mm tube made of an inert polymer with no endplate,an internal diameter of 70μm,and fins intended to prevent peritubular flow and anchor the device within the sclera to prevent proximal migration into the eye.Following ab externo implantation,the tube provides a conduit for flow of aqueous humor from the anterior chamber into the subconjunctival/sub-Tenon space.Clinical trials to date have shown that,when paired with mitomycin C(MMC)treatment,MicroShunt implantation significantly reduced both IOP and the number of glaucoma medications.These IOP-lowering results were found both when surgery was performed alone and with phacoemulsification.The MicroShunt also showed a safety profile comparable to that of traditional filtering surgery.Conclusions The MicroShunt and other novel subconjunctival procedures have shown substantial IOP reductions while mitigating hypotony-related complications.MMC,which modulates fibrosis and scarring postoperatively,is essential to surgical success.Randomized,long-term clinical trials will further clarify the role of controlled micro-incisional device-assisted ab externo glaucoma filtering surgery in long-term glaucoma management.展开更多
Trabeculectomy remains the‘gold standard’intraocular pressure(IOP)-lowering procedure for moderate-to-severe glaucoma;however,this approach is associated with the need for substantial post-operative management.Micro...Trabeculectomy remains the‘gold standard’intraocular pressure(IOP)-lowering procedure for moderate-to-severe glaucoma;however,this approach is associated with the need for substantial post-operative management.Microinvasive glaucoma surgery(MIGS)procedures aim to reduce the need for intra-and post-operative management and provide a less invasive means of lowering IOP.Generally,MIGS procedures are associated with only modest reductions in IOP and are targeted at patients with mild-to-moderate glaucoma,highlighting an unmet need for a less invasive treatment of advanced and refractory glaucoma.The PRESERFLO®MicroShunt(formerly known as InnFocus MicroShunt)is an 8.5 mm-long(outer diameter 350μm;internal lumen diameter 70μm)glaucoma drainage device made from a highly biocompatible,bioinert material called poly(styrene-block-isobutylene-blockstyrene),or SIBS.The lumen size is sufficiently small that at normal aqueous flow hypotony is avoided,but large enough to avoid being blocked by sloughed cells or pigment.The MicroShunt achieves the desired pressure range in the eye by draining aqueous humor from the anterior chamber to a bleb formed under the conjunctiva and Tenon’s capsule.The device is implanted ab externo with intraoperative Mitomycin C via a minimally invasive(relative to incisional surgery)surgical procedure,enabling precise control of placement without the need for gonioscopy,suture tension control,or suture lysis.The implantation procedure can be performed in combination with cataract surgery or as a standalone procedure.The MicroShunt received ConformitéEuropéenne(CE)marking in 2012 and is intended for the reduction of IOP in eyes of patients with primary open-angle glaucoma in which IOP remains uncontrolled while on maximum tolerated medical therapy and/or in which glaucoma progression warrants surgery.Three clinical studies assessing the long-term safety and efficacy of the MicroShunt have been completed;a Phase 3 multicenter,randomized clinical study comparing the MicroShunt to primary trabeculectomy is underway.In preliminary studies,the MicroShunt effectively reduced IOP and use of glaucoma medications up to 3 years after implantation,with an acceptable safety profile.This article summarizes current literature on the unique properties of the MicroShunt,the preliminary efficacy and safety findings,and discusses its potential use as an alternative to trabeculectomy for glaucoma surgery.展开更多
Background:Retrospective,consecutive case series to evaluate the implantation of two second-generation trabecular microbypass stents in combination with cataract surgery in a real-world,clinical setting.Methods:The se...Background:Retrospective,consecutive case series to evaluate the implantation of two second-generation trabecular microbypass stents in combination with cataract surgery in a real-world,clinical setting.Methods:The series included 56 eyes implanted with the iStent inject device with phacoemulsification.The series consisted of eyes with primary open-angle glaucoma(n=52)and pseudoexfoliative glaucoma(n=4).Primary outcome measures included intraocular pressure(IOP)and number of glaucoma medications.Safety outcomes included the need for secondary surgical intervention and the incidence of IOP spikes≥10 mmHg and≥15 mmHg.Results:IOP was reduced by 21%to 14.7±2.9 mmHg(p<0.01)at 6 months postoperative from 18.7±5.8 mmHg at baseline.Preoperatively,the mean number of glaucoma medications was 1.5±0.9 and reduced by 39%to 0.9±1.2(p<0.01)at 6 months.At 6 months,68%of eyes had an IOP≤15 mmHg,increased from 30%at baseline.55%of eyes were medication-free at 6 months,up from 18%at baseline.There were no severe postoperative complications.No eyes underwent an additional glaucoma procedure.Conclusions:Implantation of the iStent inject device with concomitant cataract surgery effectively provides a sustained reduction in IOP with a markedly improved medication burden out to 6 months postoperative.The safety profile is excellent.展开更多
Background:Retrospective,consecutive case series to evaluate the implantation of two sec on d-generation trabecular microbypass stents in combination with cataract surgery in a real-world,clinical setting.Methods:The ...Background:Retrospective,consecutive case series to evaluate the implantation of two sec on d-generation trabecular microbypass stents in combination with cataract surgery in a real-world,clinical setting.Methods:The series in eluded 56 eyes implanted with the iSte nt inject device with phacoemulsification.The series consisted of eyes with primary open-angle glaucoma(n=52)and pseudoexfoliative glaucoma(n=4).Primary outcome measures included intraocular pressure(IOP)and number of glaucoma medications.Safety outcomes included the need for secondary surgical intervention and the incidence of IOP spikes>10 mmHg and>15 mmHg.Results:IOP was reduced by 21%to 14.7±2.9 mmHg(P<0.01)at 6 months postoperative from 18.7±5.8 mmHg at baseline.Preoperatively,the mean number of glaucoma medications was 1.5±0.9 and reduced by 39% to 0.9±1.2(P<0.01)at 6 months.At 6 months,68%of eyes had an IOP<15 mmHg,increased from 30%at baseline.55%of eyes were medicati on-free at 6 months,up from 18%at baseline.There were no severe postoperative complications.No eyes underwent an additional glaucoma procedure.Conclusions:Implantation of the iStent inject device with concomitant cataract surgery effectively provides a sustained reduction in IOP with a markedly improved medication burden out to 6 months postoperative.The safety profile is excellent.展开更多
基金the National Natural Science Foundation of China, No. 3057062830770751
文摘AIM： This study aimed to expound the individual idea of micro-invasive surgery from pre-operative preparation, intra-operative processing and post-operative management. METHODS： Pre-operative preparation was improved by analyzing pathological factors and hematoma property, and considering patients＇ age, basic disease, blood pressure control, with persistent haemorrhagia/rehaemorrhagia or not, operative occasion choice, positioning and other procedures. In the surgery, positioner was used. Initial aspiration volume was cautiously controlled. After operation, vital signs of patients were kept stable by cautiously using hematoma liquefacient and combining with free radical scavenger. RESULTS： The core content of individual micro-invasive surgery was mainly to relieve intracranial pressure. Under the condition of sufficient pre-operative preparation known by patients＇ family members, precise positioning was determined and individual therapeutic regimen was made. Meanwhile, caution should be taken in hematoma aspiration. Liquefaction and drainage should be paid more attention, and complications were processed actively. CONCLUSION： During the process of micro-invasive evacuation of intracranial hematoma for treating cerebral hemorrhage, attention should be paid to analyzing cerebral hematoma etiology and pathophysiological mechanism, and individual idea should be considered in surgical treatment aiming at patients＇ concrete disease condition.
文摘Objective The cardiac synchronization therapy (CRT) was proven to have good treatment for the cardiacconduction disorders patients with serious heart failure. But many disadvantages were gradually be noticed,such as difficulty of sinus electrode implantation,coronary sinus injury and bleeding,still one third
文摘The glaucoma surgical landscape has changed dramatically over the last decade with the introduction and integration of micro-invasive glaucoma surgery(MIGS)techniques.These modalities target physiologic outflow pathways or optimize previously utilized glaucoma surgical methods in order to deliver safety,efficacy,and individualized care to the patient.MIGS techniques can be classified based on anatomical location as well as method of intraocular pressure(IOP)reduction.This review will focus on MIGS optimizing the conventional outflow pathway via intervention at Schlemm’s canal,MIGS optimizing the uveoscleral outflow pathway via suprachoroidal shunting,and MIGS optimizing the transscleral or subconjunctival outflow pathway which has long been utilized by glaucoma surgeons performing traditional filtration procedures.The wide array of currently available MIGS modalities can be staggering to the glaucoma care provider,but an understanding of the landscape and the large classes of interventional strategies can allow for clinical decision making based on the specifics of the patient’s needs and the pathophysiology of their disease.
基金Supported by the Funds of Shanghai Health Bureau(No. 2007156)
文摘Objective:To evaluate the clinical therapeutic effects of oral administration and external application of Chinese drugs combined with micro-invasive surgery for the treatment of varicose ulcers in the lower extremities(ecthyma).Methods:A total of 152 patients(163 limbs) suffering from varicose ulcers on the lower limbs were assigned to two groups according to the patients willingness.The 102 cases(109 limbs) in the treatment group underwent the method of endovenous microwave closure of communicating veins ...
文摘Background Although traditional surgical procedures for glaucoma(such as trabeculectomy and tube-shunt implantation)can significantly reduce intraocular pressure(IOP),they are associated with numerous complications,some of which are vision-threatening,or involve prolonged recovery or a highly intensive postoperative course.Micro-invasive glaucoma surgery(MIGS)procedures have shown better safety but reduced efficacy in achieving target IOP.Combinations of these methods have led to the development of subconjunctival micro-invasive procedures with safety comparable to traditional surgery and greater efficacy than minimally invasive methods.This review describes the use of one of these devices,the poly(styrene-block-isobutylene-block-styrene)(SIBS)-based PreserFlo MicroShunt(Santen,Emeryville,CA),in the surgical treatment of patients with glaucoma.Main text The MicroShunt is an 8.5-mm tube made of an inert polymer with no endplate,an internal diameter of 70μm,and fins intended to prevent peritubular flow and anchor the device within the sclera to prevent proximal migration into the eye.Following ab externo implantation,the tube provides a conduit for flow of aqueous humor from the anterior chamber into the subconjunctival/sub-Tenon space.Clinical trials to date have shown that,when paired with mitomycin C(MMC)treatment,MicroShunt implantation significantly reduced both IOP and the number of glaucoma medications.These IOP-lowering results were found both when surgery was performed alone and with phacoemulsification.The MicroShunt also showed a safety profile comparable to that of traditional filtering surgery.Conclusions The MicroShunt and other novel subconjunctival procedures have shown substantial IOP reductions while mitigating hypotony-related complications.MMC,which modulates fibrosis and scarring postoperatively,is essential to surgical success.Randomized,long-term clinical trials will further clarify the role of controlled micro-incisional device-assisted ab externo glaucoma filtering surgery in long-term glaucoma management.
基金support was provided by Lucy Cartwright,MChem,Helios Medical Communications,Cheshire,UKfunded by Santen.MicroShunt studies were sponsored by InnFocus,a Santen company.
文摘Trabeculectomy remains the‘gold standard’intraocular pressure(IOP)-lowering procedure for moderate-to-severe glaucoma;however,this approach is associated with the need for substantial post-operative management.Microinvasive glaucoma surgery(MIGS)procedures aim to reduce the need for intra-and post-operative management and provide a less invasive means of lowering IOP.Generally,MIGS procedures are associated with only modest reductions in IOP and are targeted at patients with mild-to-moderate glaucoma,highlighting an unmet need for a less invasive treatment of advanced and refractory glaucoma.The PRESERFLO®MicroShunt(formerly known as InnFocus MicroShunt)is an 8.5 mm-long(outer diameter 350μm;internal lumen diameter 70μm)glaucoma drainage device made from a highly biocompatible,bioinert material called poly(styrene-block-isobutylene-blockstyrene),or SIBS.The lumen size is sufficiently small that at normal aqueous flow hypotony is avoided,but large enough to avoid being blocked by sloughed cells or pigment.The MicroShunt achieves the desired pressure range in the eye by draining aqueous humor from the anterior chamber to a bleb formed under the conjunctiva and Tenon’s capsule.The device is implanted ab externo with intraoperative Mitomycin C via a minimally invasive(relative to incisional surgery)surgical procedure,enabling precise control of placement without the need for gonioscopy,suture tension control,or suture lysis.The implantation procedure can be performed in combination with cataract surgery or as a standalone procedure.The MicroShunt received ConformitéEuropéenne(CE)marking in 2012 and is intended for the reduction of IOP in eyes of patients with primary open-angle glaucoma in which IOP remains uncontrolled while on maximum tolerated medical therapy and/or in which glaucoma progression warrants surgery.Three clinical studies assessing the long-term safety and efficacy of the MicroShunt have been completed;a Phase 3 multicenter,randomized clinical study comparing the MicroShunt to primary trabeculectomy is underway.In preliminary studies,the MicroShunt effectively reduced IOP and use of glaucoma medications up to 3 years after implantation,with an acceptable safety profile.This article summarizes current literature on the unique properties of the MicroShunt,the preliminary efficacy and safety findings,and discusses its potential use as an alternative to trabeculectomy for glaucoma surgery.
基金This study was funded by an investigator-initial trial grant from Glaukos Corp.(San Clemente,CA,USA).
文摘Background:Retrospective,consecutive case series to evaluate the implantation of two second-generation trabecular microbypass stents in combination with cataract surgery in a real-world,clinical setting.Methods:The series included 56 eyes implanted with the iStent inject device with phacoemulsification.The series consisted of eyes with primary open-angle glaucoma(n=52)and pseudoexfoliative glaucoma(n=4).Primary outcome measures included intraocular pressure(IOP)and number of glaucoma medications.Safety outcomes included the need for secondary surgical intervention and the incidence of IOP spikes≥10 mmHg and≥15 mmHg.Results:IOP was reduced by 21%to 14.7±2.9 mmHg(p<0.01)at 6 months postoperative from 18.7±5.8 mmHg at baseline.Preoperatively,the mean number of glaucoma medications was 1.5±0.9 and reduced by 39%to 0.9±1.2(p<0.01)at 6 months.At 6 months,68%of eyes had an IOP≤15 mmHg,increased from 30%at baseline.55%of eyes were medication-free at 6 months,up from 18%at baseline.There were no severe postoperative complications.No eyes underwent an additional glaucoma procedure.Conclusions:Implantation of the iStent inject device with concomitant cataract surgery effectively provides a sustained reduction in IOP with a markedly improved medication burden out to 6 months postoperative.The safety profile is excellent.
基金funded by an investigator-initial trial grant from Glaukos Corp.(San Clemente,6,USA).
文摘Background:Retrospective,consecutive case series to evaluate the implantation of two sec on d-generation trabecular microbypass stents in combination with cataract surgery in a real-world,clinical setting.Methods:The series in eluded 56 eyes implanted with the iSte nt inject device with phacoemulsification.The series consisted of eyes with primary open-angle glaucoma(n=52)and pseudoexfoliative glaucoma(n=4).Primary outcome measures included intraocular pressure(IOP)and number of glaucoma medications.Safety outcomes included the need for secondary surgical intervention and the incidence of IOP spikes>10 mmHg and>15 mmHg.Results:IOP was reduced by 21%to 14.7±2.9 mmHg(P<0.01)at 6 months postoperative from 18.7±5.8 mmHg at baseline.Preoperatively,the mean number of glaucoma medications was 1.5±0.9 and reduced by 39% to 0.9±1.2(P<0.01)at 6 months.At 6 months,68%of eyes had an IOP<15 mmHg,increased from 30%at baseline.55%of eyes were medicati on-free at 6 months,up from 18%at baseline.There were no severe postoperative complications.No eyes underwent an additional glaucoma procedure.Conclusions:Implantation of the iStent inject device with concomitant cataract surgery effectively provides a sustained reduction in IOP with a markedly improved medication burden out to 6 months postoperative.The safety profile is excellent.
