Adjustable temporal suture in trabeculectomy with scleral flap

BACKGROUND AND OBJECTIVE: The long-term success of trabeculectomy depends primarily on the degree of scarring that occurs to the artificial filtration route that is created by the procedure. The most serious postoperative complication of trabeculectomy is a persistent shallow anterior chamber or a flat chamber. The objective of this study was to evaluate the effect of a suturing technique on the long-term success of trabeculectomy. PATIENTS AND METHODS: In this study, the authors analyzed a trabeculectomy technique that is based on the application of a suture of variable tightness on the scleral flap. The technique was performed on 11 patients subjected to trabeculectomy. RESULTS: The postoperative complication of shallow anterior chamber was successfully treated with further tightening of the suture for one patient. For each patient, the authors loosened the suture on the fourth postoperative day and removed it completely on the seventh or eighth postoperative day. The patients were observed postoperatively for a minimum of 1 year. During this period the intraocular pressure for each patient was within the normal limits. CONCLUSION: The authors contend that this trabeculectomy technique, in which a suture on the scleral flap can be adjusted for tightness and is later removed, contributes significantly to the treatment of a postoperative shallow anterior chamber or a flat chamber and to the long-term function of an effective filtration fistula.     

Minimum specimen volume requirements for routine coagulation testing: dependence on citrate concentration

An audit of post-operative nausea and vomiting (PONV) was undertaken in 935 female patients who used morphine patient-controlled analgesia (PCA) for pain relief after major gynaecological operations in a district general hospital. We investigated retrospectively five different antiemetic policies and a reference group without policy from January 1993 to July 1995. The department's computerized audit system was used to analyse the observations. At the beginning of the audit, the incidence of nausea and vomiting was as high as 71.5%. But as a consequence of this audit, a departmental policy was adopted 3 years later, which had an incidence of PONV of only 51.7%. During this time the compliance with antiemetic protocols increased from 41% to 76%. There was significantly less PONV if an antiemetic protocol was followed (P = 0.002). This emphasizes the importance of corporate involvement in the development, formulation and evaluation of departmental protocols if compliance is to be high. We conclude that audit as a corporate effort improves the acceptance of departmental protocols. This reduces PONV significantly irrespective of the type of antiemetic drug used.