'En bloc' dissection of epimacular membranes using aspiration delamination

'En bloc' dissection is a technique in which epiretinal membranes (ERM) are separated from the retina as a single lamina with a 20-gauge blunt flute needle. We used this technique to remove epimacular membranes of various aetiologies in a consecutive series of 25 eyes, with a minimum follow-up of 5 months (mean 10.4 months). Small residual epicentres of ERM away from the fovea remained in 7 (29.1%) eyes only; 3 were inside and 4 outside the temporal vascular arcades. Postoperatively 64% (16/25) of patients achieved a final visual acuity of 6/12 or better and 76% (19/25) achieved a final visual acuity of 6/18 or better. Progressive lens opacities were the most important postoperative complication in phakic eyes that significantly affected the visual results. This technique successfully removed epimacular membranes over a wide area, without the need to find a starting edge or the use of sharp instruments near the retina. Diaphanous ERMs with ill-defined borders and tenaciously adherent membranes could be removed with minimal trauma to the underlying retina. Histopathological and immunohistochemical examination of 10 ERMs demonstrated the absence of internal limiting lamina in 6 (60%).link_to_subscribed_fulltex

Innovative Process in E-Commerce Fashion Supply Chains

Fashion is price sensitive and runs on tight margins. Consumers expect high quality fashion at competitive prices, and in a recession falling prices and demand are particularly acute. This presents challenges for the supply chain. The sector is driven by cost and the need to manage the supply chain more effectively to reduce excess stock and risk in product forecasting. Increasing competition from low labour cost countries puts pressure on manufacturers to push down prices and, at the same time, to offer exceptional levels of service. Manufacturers may not wish to compete on the basis of price, and thus must find some other means of differentiation to remain competitive. E-commerce allows companies to improve communications within the supply chain and enhance service offering, thus providing opportunities for competitive differentiation. However, companies may not have the skills to develop e-commerce operations immediately, nor be able to realise revenue stream from investment in this technology and so may be unable to assess fully the risk of investment. Through the presentation of primary research, this chapter addresses the adoption process and the use of e-commerce in the textiles and clothing supply chain