The flap is placed into the pocket by a simultaneous gentle pull on the three sutures and a combined lateral push. The stitches are then tied and buried after completion of flap inset.The authors performed rigid reconstruction using the sandwich technique for full-thickness chest wall defects by using two layers of acellular dermal matrix and bone cement. We assessed six patients who underwent chest wall reconstruction. Reconstruction was performed by sandwiching bone cement between two layers of acellular dermal matrix. In all patients, there was no defect of the overlying soft tissue, and primary closure was performed for external wounds. The average follow-up period was 4 years (range, 2-8 years). No major complications were noted. The sandwich technique can serve as an efficient and safe option for chest wall reconstruction.

Blepharoplasty has both aesthetic and functional benefits in patients with pseudoptosis; however, previous studies could not demonstrate its beneficial effects quantitatively and objectively. The authors objectively analyzed the visual field before and after surgery and investigated whether measurements of the visual field can be applied as a suitable predictor of surgical outcomes.

In total, 18 eyelids in nine patients with pseudoptosis who had undergone simple skin excision blepharoplasty were evaluated prospectively from February to May 2016. The visual fields were analyzed preoperatively and 3 months postoperatively using the Goldmann kinetic perimetry test. The visual field test area was assessed using Adobe Photoshop.

Blepharoplasty had an average 4.99-fold beneficial effect on the superior visual field. In particular, more improvement was seen in the superior temporal quadrant than in the nasal quadrant. No correlation was found between the preoperative margin-to-reflex distance 1 (MRD1) and the surgical outcome (P=0.119). However, there was a strong correlation between the preoperative superior visual field and the surgical outcome (P=0.001).

Using the Goldmann kinetic perimetry test, we objectively and quantitatively proved the beneficial effect of blepharoplasty on patients with pseudoptosis. Furthermore, we demonstrated that the preoperative visual field is a better preoperative surgical outcome predictive factor than the preoperative MRD1.

Using the Goldmann kinetic perimetry test, we objectively and quantitatively proved the beneficial effect of blepharoplasty on patients with pseudoptosis. Furthermore, we demonstrated that the preoperative visual field is a better preoperative surgical outcome predictive factor than the preoperative MRD1.Botulinum toxin treatment is the most common non-surgical cosmetic treatment. Although there are many available treatments using botulinum toxin, their effects are temporary and repeated injections are required. These frequent injections can trigger an immunological response. In addition, botulinum toxin acts as an antigen in the body; thus, its effect disappears progressively due to this immunological reaction, which may cause treatment failure. Active botulinum toxin consists of a core neurotoxin and complexing proteins, the exact effects of which remain unclear. However, the complexing proteins are closely related to the immune response and the formation of neutralizing antibodies. Since neutralizing antibodies can lead to treatment failure, their formation should be prevented. Furthermore, various methods of detecting neutralizing antibodies have been used to predict treatment failure.Facial feminization surgery (FFS) refers to a set of procedures aimed at altering the features of a masculine face to achieve a more feminine appearance. In the second part of this twopart series, assessment and operations involving the midface, mandible, and chin, as well as soft tissue modification of the nasolabial complex and chondrolaryngoplasty, are discussed. Finally, we provide a review of the literature on patient-reported outcomes in this population following FFS and suggest a path forward to optimize care for FFS patients.[This corrects the article DOI 10.4103/ijo.IJO_1655_18].

There are many landmark clinical trials in ophthalmology, the context of which provide a more relevant understanding of their results. E-64 datasheet The Age-related Eye Diseases (AREDS) studies were conducted in a large population to understand the effect of nutritional supplements on the progress of age-related macular degeneration.

This instructional video is being presented to familiarize the postgraduate residents as well as interested researchers of the details of the landmark AREDS studies.

The video describes the enrollment of participants, their demographics, the protocols of the studies, and the key results.

The AREDS formulations, the specific effects of key components of the formulations, and results of the trials that guide present day treatment guidelines are discussed.

https//youtu.be/SPsikgx8SCI.

https//youtu.be/SPsikgx8SCI.

Scleral buckling is considered an art, which has a long learning curve compared to other surgical retina techniques. Unfortunately, this beautiful surgical technique is getting less attention as new retina surgeons don’t get much exposure to this age-old surgical technique, reason being less interest shown by young retina surgeons and tremendous advancement in micro-incision vitrectomy system.This video is a modification of the present technique of placement of band buckle, which uses science rather than art.The most important aspect in band buckle is getting the optimal buckle height which needs a lot of experience before one can achieve it. Most of the surgeons tend to tighten it more than needed that can lead to complications. This new technique is easy to learn and will give controlled reproducible buckle height and can be done safely by the trainees.

The aim of this video is to simplify the technique of scleral buckling which can produce controlled and reproducible buckle height and will reduce the complications associated with a tight band buckle.

A 360-degree peritomy is made. Four recti muscles are identified and separated and traction sutures are passed under their insertions. A partial thickness scleral tunnel is made in all four quadrants. A silicone band (style#41 used in this video) is passed through the scleral tunnel and under the insertion of all four recti.The two ends of the silicone band are trimmed so that they are opposed to each other. Then a 12-mm strip is cut off from one end, and the two remaining ends are tied with a 5-0 nonabsorbable suture. This technique ensures a 2-mm optimal buckle height.

We present an elegant technique of placing the band buckle in retinal detachment surgery.

https//youtu.be/9_dh6qsd-7A.

https//youtu.be/9_dh6qsd-7A.

„Achoo“ is the sound that is correlated with sneezing. A sneeze, in rare occasions, it can cause Valsalva retinopathy. Usually, small bleeding gets absorbed with time. But if the haemorrhage stays for a longer period of time, it can lead to de-hemoglobinization of blood which can cause damage to the photoreceptors. If such a damage occurs over the macula, it can cause irreversible visual loss. Hence, prompt and meticulous treatment is indicated in such cases. One such case is described here where a lady suffered from a sudden bout of sneezing and presented to us after a month later. A large sub-internal limiting membrane (ILM) bleed was noted over the macula. Hence a vitrectomy with ILM peeling with drainage of blood was advised. She recovered 20/40 visual acuity one month following surgery.

This video emphasizes on diagnosis of sub-ILM hemorrhage and the technique in which the sub-ILM bleed can be drained in the modern era of microincision vitreoretinal surgeries.

A key aspect in such cases is to distinguish sub-ILM from sub-hyaloid bleed. Subtle differentiating points on imaging are described in the video. In cases of sub-ILM hemorrhage, the most important surgical step after performing a core vitrectomy is a good posterior vitreous detachment (PVD) induction. After that, ILM peeling is carried out with the help of finesse loop and ILM peeling forceps. Using proportional vacuum and aspiration alternatively from the cutter, the hemorrhage is displaced and drained. This step can prevent damage to the underlying retinal tissue. After the macula hemorrhage is completely cleared, an air-fluid exchange is done.

Teaching points include 1. Diagnostic markers for sub-ILM hemorrhage; 2.The method of PVD induction in cases of Sub ILM hemorrhage; and 3.Technique of drainage of sub-ILM hemorrhage using proportional vacuum and aspiration function of the cutter.

https//youtu.be/hBhfLDy9o-Y.

https//youtu.be/hBhfLDy9o-Y.

Trabeculectomy, a mainstay in the management of glaucoma is associated with various complications, the most dreaded being hypotony.

We present a challenging case of late-onset refractory hypotony following trabeculectomy.

A 64-year-old male patient diagnosed with primary open angle glaucoma in the right eye underwent combined surgery. Three weeks later, he presented with hypotony which responded well with medical management and then he was lost to follow-up. Two years later, he presented with severe hypotony with shallow choroidal detachment in the right eye, which failed to respond to medical management. Compression sutures were placed over the bleb which also failed to work. Subsequently bleb repair was done with corneal patch graft, which helped resolve the bleb leak, with an improvement in visual acuity and intraocular pressure.

This video highlights the importance of prompt and timely intervention of an overfiltering bleb in preventing irreversible visual loss.

https//youtu.be/8DrxzqQ4qP4.

https//youtu.be/8DrxzqQ4qP4.

Ectopia lentis is a condition that compromises vision in childhood by inducing either double vision or aphakic visual axis. Correction of lens status is of prime importance to prevent amblyopia or sensory strabismus.

Placing an intraocular lens (IOL) in the bag in such cases will maintain aqueous vitreous barrier but it is a difficult task.This video demonstrates the method of placing modified Cionni capsular tension ring (CTR) and placement of IOL in children.

This video shows the management of multiple cases of ectopia lentis with more than 180 degree subluxation. Making intact rhexis is crucial and technically difficult in such cases. The way of making a proper capsulorhexis is shown. After making capsulorhexis, all the cases were managed with single loop Cionni CTR. Cionni CTR has a loop with a anterior offset of 0.4 mm to override the anterior capsule. It has two designs – right and left design, based on the position of islet in the CTR. Since the offset of the hook is tiny, there are high chances to flip the Cionni CTR. If the Cionni CTR is placed in a flipped manner, it would not give effective pull of the bag, when fixated to sclera. And also, it could be traumatic to explant and place in correct manner. Hence it is vital to place the Cionni CTR in correct orientation, so that anterior offset will orient anteriorly. This video gives guidance to the viewers about the correct way of placing different designs of Cionni CTR in different types of subluxation.Timing of passing sutures through sclera may be done either before or after placing the Cionni CTR in the bag. Both the ways are demonstrated in different cases.

Different technique of doing Cionni CTR fixation with IOL placement are demonstrated. Surgeons who wish to try this procedure can choose the option that they feel comfortable with. We conclude that choice of Cionni CTR design and technique of placement depends on surgeon’s choice and not based on the type of subluxation.

https//youtu.be/zbdpP0lhykw.

https//youtu.be/zbdpP0lhykw.