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We aimed to evaluate ten-year outcomes of penile prosthesis (PP) implantation for the treatment of erectile dysfunction and to assess predictors of early prosthetic infection (EPI). We identified 549 men who underwent 576 PP placements between 2008 and 2018. Univariate and multivariate analyses were used to identify potential predictors of EPI. An EPI predictive nomogram was developed. Thirty-five (6.1%) cases of EPI were recorded with an explant rate of 3.1%. In terms of satisfaction, 82.0% of the patients defined themselves as \"satisfied,\" while partner's satisfaction was 88.3%. Diabetes (P = 0.012), longer operative time (P = 0.032), and reinterventions (P = 0.048) were associated with EPI risk, while postoperative ciprofloxacin was inversely associated with EPI (P = 0.014). Rifampin/gentamicin-coated 3-piece inflatable PP (r/g-c 3IPP) showed a higher EPI risk (P = 0.019). Multivariate analyses showed a two-fold higher risk of EPI in diabetic patients, redo surgeries, or when a r/g-c 3IPP was used (all P < 0.03). We showed that diabetes, longer operative time, and secondary surgeries were the risk factors for EPI. Postoperative ciprofloxacin was associated with a reduced risk of EPI, while r/g-c 3IPP had higher EPI rates without an increased risk of PP explant. After further validation, the proposed nomogram could be a useful tool for the preoperative counseling of PP implantation.

PurposeComparing two different sutureless scleral fixation techniques.MethodsA retrospective study of patients who underwent sutureless scleral fixation IOL from October 2013 to May 2018 at “Luigi Sacco Hospital”, University of Milan. Comparison between two groups: Group 1 implanted with a 3-piece ALCON-MA60AC and group 2 implanted with a newly developed single-piece foldable IOL SOLEKO FIL-SSF. Patients underwent a complete preoperative ophthalmic assessment and post-operative evaluation at 1, 3, and 6 months. Vitrectomy was performed in all cases. The two groups were compared for age, axial length, and lens status at baseline. Visual acuity, refractive results, surgical time, and post-operative complications were recorded.ResultsThirty-one eyes were included: group 1, 15 eyes of 15 patients, and group 2, 16 eyes of 14 patients. No difference was found in visual acuity. Mean refractive error was 1D in both groups (group 1 1.01D, group 2 1.09D), but spherical equivalent was more often moved toward negative values and induced astigmatism was greater in the 3-piece group (group 1 1.91D [SD ± 2.07], group 2 0.67D [SD ± 0.88] P = 0.04). Surgical procedure was faster in group 2 (mean time difference 21′, P = 0.01*). New displacement occurred in 5 cases (33%) of group 1 and in no cases of group 2 (P = 0.01*). Post-operative bleeding was registered only in group 1 (20%), but the difference was not statistically significant.ConclusionsThe group 2 IOL gives in our sample better results due to less post-operative astigmatism and reducing dislocation and bleeding during follow-up. Surgical technique appeared easier and faster: the specifically designed IOL seems to be a feasible solution for sutureless scleral fixation.

Objective Surgery for aphakic eyes without capsular bag support is challenging and remains a key area of research for ophthalmologists. This retrospective study introduces a novel surgical method for suture fixation of intraocular lenses in such eyes. Methods The modified surgery was performed on eight eyes without a natural lens. The two haptic tabs of the three-piece intraocular lens were secured with two crystal sutures using a wireless junction—defined as a connection point where the loop or haptic is anchored to the eye wall without knots through techniques such as intrascleral pocket embedding, flanged end creation, or sutureless tuck—without creating a scleral flap. Results All eight patients demonstrated improved postoperative visual acuity. The intraocular lenses were reliably fixed, properly centered, and well positioned. No serious complications occurred after the surgery. Conclusions This modified technique appears to offer procedural simplification and a favorable trend in postoperative visual acuity improvement. However, its long-term safety and efficacy require confirmation through larger, controlled studies.

We retrospectively compared the stability of intraocular lenses (IOLs) routinely used at our institution by measuring IOL position after phacovitrectomy for rhegmatogenous retinal detachment (RRD). Patients with RRD who underwent phacovitrectomy with gas tamponade received one of three IOLs: 6-mm, single-piece NS-60YG (NIDEK, 15 eyes); 6-mm, single-piece XY1 (HOYA, 11 eyes); or 7-mm, three-piece X-70 (Santen, 11 eyes). Various parameters associated with the anterior chamber, lens, and IOL were measured by swept-source anterior segment optical coherence tomography (CASIA2; Tomey Corp) before and 1 week and 1 month after surgery. IOL position was determined as follows: IOL position = (postoperative aqueous depth [AQD] − preoperative AQD)/lens thickness. We found no significant difference in axial length between the IOLs (p = 0.97). At 1 week, IOL position was as follows: NS-60YG, 0.32; XY1, 0.24; and X-70, 0.26 (p < 0.05). The respective IOL positions at 1 month were 0.35, 0.27, and 0.28 (p < 0.01). These results indicated the smallest anterior shift with NS-60YG. To replicate the anterior shift of IOL position ex vivo, biomechanical measurement was performed. NS-60YG resisted more displacement force than the other IOLs. Thus, in eyes undergoing phacovitrectomy for RRD, NS-60YG was the most stable of the three IOLs studied.

Background To compare flange creation using high- vs. low-temperature cautery for three piece intraocular lenses (IOLs) with PMMA and PVDF haptics. Methods The ends of the haptics from ten three-piece IOLs with PMMA haptics (AR40, Johnson & Johnson, USA) and ten three-piece IOLs with PVDF haptics (PU6AS, KOWA, Japan) were each heated for 1 mm to form a flange—using low-temperature cautery (593 °C) on the ipsilateral haptic and high-temperature cautery (1205 °C) on the contralateral haptic. Flange size, shape, and formation time were analysed. Results There were no differences in flange shape and flange size between high- and low-temperature cautery for each haptic type ( p  > 0.05). Average flange size of the AR40 IOL and the PU6AS IOL were 422 ± 22 μm and 363 ± 14 μm, respectively. Haptic diameter were 172 ± 5 μm and 126 ± 3 μm, respectively. The shape of the AR40 IOL flange was conic and the shape of the PU6AS IOL flange was mushroom-like, independent of cautery temperature. Flange formation time was 1.7 ± 0.6 s with the high-temperature cautery and 3.7 ± 0.6 s with the low-temperature cautery, regardless of the haptic material. Conclusions Flange size and shape in PMMA and PVDF haptics are independent of low- and high-temperature cautery. However, the extended flange formation time associated with low-temperature cautery may allow for greater control during flange creation.

Purpose: To study the use of sulcus placement of a 3-piece intraocular lens (IOL) with optic capture in patients with exfoliation with zonular weakness. Methods: Data on all exfoliation patients who had direct or indirect evidence of zonular weakness and had a 3-piece IOL implanted in the sulcus with optic capture over a 5-year period between January 2017 and January 2022 were included in this retrospective case series. Results: The study comprised of 35 eyes of 35 patients. The mean age at surgery of the 20 male and 13 female patients was 75.21 years ± 5.74 (standard deviation (SD)). The mean pupillary diameter was 5.77 ± 2.23 mm (range: 10 to 3 mm). A capsular tension ring (CTR) was used in 17 cases and iris hooks as a pupil-expanding device were used in 15 cases. No patients had an increase in inflammation after surgery and there were no late subluxation or dislocation of \"in the bag\" posterior chamber IOL or major complications. There was a significant improvement in visual acuity. Conclusion: The sulcus placement of 3-piece IOL with optic capture is the ideal technique in patients with clinical or intraoperative evidence of mild to moderate zonular weakness. It may also be more appropriate in relatively younger patients (in the fifties or sixties) with exfoliation with no overt zonulopathy to prevent late subluxation or dislocation of \"in the bag\" IOL.

Purpose: To compare the refractive results between sutureless scleral fixation intraocular lens (IOLs) (Carlevale, Soleko) and suture-free scleral fixation three-piece IOLs (Sensar AR40, Johnson & Johnson) for secondary implantation in patients with IOL dislocation or aphakia. Methods: This is a monocentric retrospective study on 28 patients (28 eyes) with sutureless scleral fixation Carlevale IOL and 25 patients (25 eyes) with suture-free scleral fixation three-piece IOL. Best-corrected visual acuity (BCVA) evaluation, refractive measures and IOL tilt evaluation with anterior segment optical coherence tomography were conducted at one, three, six and twelve months after surgery. Point Spread Function (PSF) was measured using a total ocular aberrometer. Results: BCVA in both groups improved since the postoperative visit at 1 month and reached a stable value at 3 months At month 12, mean BCVA was 0.23 logMAR in group one and 0.32 logMAR in group two. Mean IOL tilt angle at 12 months was 2.76° ± 1.87 in group one and 2.51° ± 1.80 in group two. PSF at 12 months was 0.18 ± 0.09 in group one and 0.15 ± 0.05 in group two. There were no statistically significant differences (p > 0.05) for all comparisons. The post-operative complications were similar within the two groups. Conclusions: Our results show that secondary IOL implantation has similar visual and surgical outcomes when a sutureless Carlevale lens scleral fixation and a suture-free scleral fixation three-piece IOL are used.

Three-piece alloy wheels are widely used across the automotive industry, favoured due to their lightweight construction and ease of customisation. Vehicle wheels must withstand forces generated during acceleration, braking, cornering, and impacts, ensuring safety and durability under real-world conditions. Finite element analysis (FEA) plays a crucial role in simulating these loading conditions, thoroughly assessing structural performance prior to manufacturing. This study develops and validates a digital FEA testing framework tailored to low-volume wheel manufacturers, demonstrating that FEA can replace traditional physical wheel fatigue tests where such facilities are unavailable. This research was conducted in collaboration with a UK company specialising in the design and manufacture of bespoke, limited-production three-piece alloy wheels. However, the absence of dedicated structural testing procedures caused many of their existing designs to be overengineered, resulting in excessive material usage, increased weight, and high production costs. In some cases, lack of testing also contributed to wheel failures. This work selected three of the company’s existing wheel designs and subjected them to comprehensive analysis. Using FEA, each wheel was evaluated under industry-standard radial, cornering, biaxial, and impact tests. To verify the simulations, a known case of wheel failure was analysed and compared to real-world values. Once verified, any design issues were addressed. The redesigned wheels achieved substantial weight reduction (up to 25%), while still meeting or exceeding the relevant safety standards and allowing for manufacturability. Ultimately, this work demonstrated that applying digital simulation techniques can significantly improve the performance and safety of custom three-piece alloy wheels.

Purpose: To report results of a novel technique for sutureless, glueless intrascleral fixation of three-piece posterior chamber intraocular lens (IOL) using 26-G needle for management of aphakia. Methods: In this prospective series, 30 eyes of 20 patients with aphakia, subluxated IOL, or crystalline lens were included. 26-G-needle-guided intrascleral fixation of three-piece posterior chamber IOL was performed according to the described technique. The patients were evaluated on day 2, 1 week, 6 weeks, and 3 months postoperatively for change in best-corrected visual acuity (BCVA), intraocular pressure (IOP), IOL centration, and any other complications. The postoperative tilt of the IOL was indirectly measured by determining the lenticular astigmatism which in turn was calculated by the difference between net corneal astigmatism and refractive astigmatism. Paired t-test was used to determine the significance of any association between the preoperative and postoperative BCVA and IOP. P < 0.05 was considered significant. Results: Of 30 eyes (n = 30 patients), 18 were surgical aphakia, 6 traumatic aphakia, 5 subluxated IOL, and 1 ectopia lentis (Marfan syndrome). The mean preoperative BCVA was 1.37 ± 0.37 (logMAR) and postoperative BCVA at 3 months was 0.37 ± 0.29 (logMAR). A significant improvement in the mean BCVA (P < 0.05) was observed after the procedure. The mean IOP preoperatively was 13.33 ± 4.18 and postoperatively at 3 months was 12.82 ± 3.97 (P > 0.05), which was not significant. None of the eyes developed any intraoperative and postoperative complications. The IOLs had appropriate centration and stability. Conclusion: We have developed this new technique for intrascleral IOL fixation which is quite simple, cost-effective, minimally invasive, neither requires glue nor suture and gives consistent outcome.

To present the outcomes of a new technique for intrascleral fixation of a flanged three-piece foldable intraocular lens (IOL) without a conjunctival incision. We retrospectively reviewed a consecutive series of 12 eyes of 12 patients who underwent scleral IOL fixation using this technique. The follow-up period ranged 3-12 months. There was a significant improvement in best-corrected visual acuity, from 0.8 (1.6) logarithm of the minimum angle of resolution (logMAR) preoperatively to 0.45 (0.8) logMAR at the final postoperative follow-up ( = 0.012). Notable complications included one case of pupillary IOL capture and increased intraocular pressure. Our novel technique is a viable solution for managing secondary IOL fixation, enabling the use of a wider variety of IOLs and simplifying the reposition process for dislocated three-piece IOLs. This approach has the potential to lower complication rates and enhance patients' recovery.