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Background: Trabeculectomy using a small scleral flap appears to provide medium to long-term IOP control comparable to large flap techniques and may offer potential advantages: reduced surgical tissue trauma, a larger area of undisturbed sclera and conjunctiva should repeat surgery be required, and reduced astigmatism induction. Aims & Objective: To evaluate the long term intraocular pressure (IOP) control of small flap trabeculectomy (microtrabeculectomy) vs conventional trabeculectomy. Materials and Methods: A prospective case control study of small flap trabeculectomy (group I) as against conventional trabeculectomy (group II) was performed on 50 eyes from 50 patients in each group with a minimum follow up of 2 years. Results: All patients had a minimum follow up of 2 years, The mean (SD) intraocular pressures at presentation and preoperatively were 34.3 (5.6) and 23.7 (3.7) mm Hg in group I and 35.2(4.5) and 24.2(2.9) mm Hg in group II. The mean (SD) IOP at 6 months, 1 & 2 years was 12.5 (4.0), 12.9 (4.1), 13.5 (4.5) respectively in group I and 12.0 (4.4), 12.7 mmHg (3.6), 13.0 (3.9) respectively in group II. There was no significant difference in IOP levels at any of the analysis points by one way ANOVA. Conclusion: Small flap trabeculectomy (microtrabeculectomy) is effective at reducing IOP in uncomplicated glaucoma patients with IOP control similar to filtering surgery utilising larger scleral flaps. Well-constructed scleral flaps of both sizes were able to achieve and maintain IOP levels well within the desired range and the small flaps had advantages of avoiding complications associated with larger flaps.

Background Penetrating inferior vena caval injuries remain a challenging operative entity. This study reviews our local experience with the injury over a nine‐year period and attempts to contextualize it within the published literature that emanates from South Africa on the topic. Methods A single‐centre retrospective review of prospectively collected data was performed of all patients who underwent a laparotomy for a penetrating IVC injury. Descriptive statistics were calculated for demographics, clinical and biochemical parameters, intraoperative data, ICU admission and outcomes. Results During the nine‐year period, thirty‐five patients sustained penetrating injuries to the IVC. Mechanism of injury included 25 low velocity gunshots (71%) and 10 stab wounds (29%). The anatomical location included two (6%) supra‐renal, six (17%) juxta‐renal and 27 (77%) infra‐renal injuries. Venorrhaphy was performed in 22 cases (63%) and ligation in 13 (37%). Average ICU stay was 5.4 days. Thirteen patients died (37%), of which six (46%) died within 24 h of arrival. Conclusion Despite dramatic improvements in surgical trauma care over the last four decades, penetrating injury to the IVC carries a high mortality rate ranging from 31 to 37%. It is unlikely that further improvements can be achieved by refining operative techniques and approaches to resuscitation. Future endeavours must focus on applying the burgeoning understanding of endovascular surgery to these injuries.