The scleral pocket technique has dramatically changed wound closure after phacoemulsification with implantation of a posterior chamber lens. The use of single-stitch technique and wound closure by fibrin adhesive is now possible. We conducted a comparative study of 385 consecutive patients; 167 received only fibrin glue for wound closure and 218 had the single-stitch procedure. No complications were observed in either group. Surgically induced astigmatism was smaller in the fibrin group (vector analysis: 0.80 diopters [D]) than in the single-stitch group (vector analysis: 0.99 D). Minimal, statistically insignificant different against-the-rule astigmatism developed: single-stitch group: -0.07 D (Cravy), -0.09 D (Naeser); fibrin adhesive group: -0.13 D (Cravy), -0.17 D (Naeser). These results suggest that postoperative against-the-rule astigmatism can be prevented with fibrin glue.

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Background Conventional fluoroscopy guided catheter ablation (CA) is an established treatment option for ventricular arrhythmias (VAs). However, with the complex nature of most procedures, patients and staff bare an increased radiation exposure. Near-zero or zero-fluoroscopy CA is an alternative method which could substantially reduce or even eliminate the radiation dose. Our aim was to analyse procedural outcomes with fluoroscopy minimising approach for treatment of VAs in patients with structurally normal hearts (SNH) and structural heart disease (SHD). Methods Fifty-two (age 53.4 ± 17.8 years, 38 male, 14 female) consecutive patients who underwent CA of VAs in our institution between May 2018 and December 2019 were included. Procedures were performed primarily with the aid of the three-dimensional electro-anatomical mapping system and intra-cardiac echocardiography. Fluoroscopy was considered only in left ventricular (LV) summit mapping for coronary angiography and when epicardial approach was planned. Acute and long-term procedural outcomes were analysed. Results Sixty CA procedures were performed. Twenty-five patients had SHD-related VAs (Group 1) and 27 patients had SNH (Group 2). While Group 1 had significantly higher total procedural time (256.9 ± 71.7 vs 123.6 ± 42.2 min; p < 0.001) compared to Group 2, overall procedural success rate [77.4% (24/31) vs 89.7% (26/29); p = 0.20)] and recurrence rate after the first procedure [8/25, (32%) vs 8/27, (29.6%); p = 0.85] were similar in both groups. Fluoroscopy was used in 3 procedures in Group 1 where epicardial approach was needed and in 4 procedures in Group 2 where LV summit VAs were ablated. Overall procedure-related major complication rate was 5%. Conclusions Fluoroscopy minimising approach for CA of VAs is feasible and safe in patients with SHD and SNH. Fluoroscopy could not be completely abolished in VAs with epicardial and LV summit substrate location.

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