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Purpose: To evaluate the success rate of autologous retinal graft (ARG) for the closure of full?thickness macular holes (MHs) and compare the outcomes of three different techniques of harvesting the graft. Methods: Clinic files of all patients who had undergone ARG for MH using intraocular scissors, membrane loop, or retinal punch to harvest retinal tissue were retrospectively reviewed. All patients were evaluated for MH closure, retinal reattachment, and visual improvement. Results: Twenty?two eyes of 22 patients were included. ARG was done for 16 eyes (72.7%) with failed, large persistent MH, and six eyes (27.3%) also underwent simultaneous repair of retinal detachment. The basal diameter of MH was 1103.67 ± 310.09 (range 650–1529) ?m. Intraocular scissors were used in 10 eyes (45.5%), a membrane loop in five eyes (22.7%), and a retinal punch in seven eyes (31.8%). Silicone oil tamponade was used in seven (31.8%) eyes and gas in 15 (68.1%) eyes. The follow?up ranged from 6 to 18 months. The hole closure rate was 72.7% (16/22). Visual improvement was noted in 18 eyes (81.8%). Retinal reattachment was seen in all eyes. Good graft integration with the surrounding area was seen in 17 eyes (77.3%). Graft retraction was seen in four eyes (18.18%) and graft loss in one eye (4.55%). No significant differences were noted among the three groups. Conclusion: ARG is successful in closing large, failed MH with and without retinal detachment. A membrane loop and retinal punch are equally useful in harvesting the graft, but scissors are preferable in case the retina is detached. With all three techniques, integration of the graft with the surrounding tissue can be achieved
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Introduction: A lack of bone stock, deficient medial cupsupport and medial & proximal migration of the joint centerare the main challenges in treating cases of protrusio acetabuliwith end stage arthritis. The purpose of this prospective studywas to assess the functional outcome, radilogical parameters& complications related to uncemented total hip arthroplastyin these patients.Material and methods: From November2017 to December2019, 20 patients (33 hips) with secondary acetabularprotrusions (25 grade II & 8 grade I) with end stage arthritisunderwent uncemented total hip arthroplasties with or withoutautologous bone grafting. The Harris hip scoring systemwas used to evaluate hip function during follow-up. X-rayswere taken to assess the prosthesis loosening, bone grafthealing, cup inclination angle & comparing various pre andpostoperative radiological parameters.Results: The operation time ranged from 60 to 120 min (mean=77.12 ± 14 min). The blood loss was 200 to 400 mL (mean= 252 ± 49.5 mL). The average follow-up duration was 1.5years (range 6m-2yrs). Postoperative X-rays revealed bonegraft union at 6 months post-surgery. The Harris hip scoresincreased from 34.07 ± 11.43 to 86.22 ± 6.85 postoperativelythat was statistically significant (P < 0.01). The distance fromthe center of the femoral head to Kohler’s line increasedfrom 18.76 ± 3.7 mm to 20.4 ± 3.3 mm after the operation(P < 0.01). During follow-up, no hip acetabular prosthesisloosening & progression of protrusio was evident.There wasno dislocation but one case of infection and one case of sciaticnerve injury as postoperative complication.Conclusion: The use of impacted or unimpacted morselizedautograft in conjunction with porous-coated cementlessacetabular components was a technically straight forwardsolution through which the hip bio mechanics were restoredand strong fixation was achieved, thereby preventingrecurrence of protrusio in grade II or III. For grade I protrusiowith end stage arthritis only uncement THR without bonegraft was adequate.
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Spinal tuberculosis is the most frequently encountered & destructive form of skeletal tuberculosis. We wanted to evaluate the advantages of transmanubrial transclavicular approach in the surgical management of the pathologies (mainly tuberculosis) at the cervicothoracic junction (C7,T1-2).METHODSFrom June 2013 to August 2019, thirty patients with tuberculosis of CTJ presented to SCBMC & H and were operated with transmanubrial transclavicular approach. Debridement with corpectomy of tuberculosis of C7-T1 and T1 vertebral bodies were followed by fusion of C6-T2 and C7-T2 vertebra respectively with the help of titanium mesh cage and anterior cervical plating. Advantages & limitations of this surgical approach were evaluated retrospectively. Visual analogue scoring & Frankel scoring were used for assessing postoperative clinical outcome.RESULTSAll 30 cases were of tuberculosis of CTJ involving either C7-T1 or T1-T2. They presented with a permutation combination of upper thoracic pain, paraparesis, and collapse of vertebra & cord compression. All patients were followed up for 12.37 ± 5.38 months on average (range 4 -24 m). The mean postoperative visual analogue scale score was 7.86 ± 1.02 (range 6-10) preoperatively, which improved to 3.27 ± 0.88 (range 0-5) postoperatively at final evaluation (p<0.005). There was also postoperative increase in Frankel score in seventeen cases (56%). Three patients developed temporary hoarseness postoperatively, two cases got infected (one superficial & one deep) & one patient died. There was no non-union or persistent pain at manubrium or clavicle end.CONCLUSIONSThe transmanubrial transclavicular approach for tuberculosis of CTJ lesions can achieve favourable clinical outcomes by providing wide exposure, direct decompression of lesions, fusions and less complications as compared to standard approaches.
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This study was done to compare the results of posterior continuous curvilinear capsulorhexis created using forceps with those created using vitrector in eyes suffering from congenital cataract. Vitrectorhexis term was first used by Wilson et al in 1999.[1] Fifty eyes with congenital and developmental cataract were included in this study. The posterior capsulorhexis was created using utrata forceps in 17 eyes or through a vitrector in 33 eyes. Forceps capsulorhexis was performed before IOL implantation, while vitrectorhexis was performed after IOL implantation in the bag. The results of both the surgery were compared using the following criteria: incidence of extension of rhexis, ability to achieve posterior rhexis of appropriate size, ability to implant the IOL in the bag, the surgical time, and learning curve. Vitrectorhexis after IOL implantation was an easy to learn alternative to manual posterior continuous curvilinear capsulorhexis in pediatric cataract surgery. It was more predictable and reproducible, with a short learning curve and lesser surgical time.
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Background: While lens-sacrificing vitrectomy is the standard approach to manage Stage 5 retinopathy of prematurity (ROP), scleral buckling has been used to manage some cases of Stage 4. Lens-sparing vitrectomy was popularized by Maguire and Trese in selected cases of Stage 4 disease. Purpose: To assess the functional and visual outcomes after primary lens-sparing pars plana vitrectomy for Stage 4 ROP. Materials and Methods: In a retrospective, interventional, consecutive case series, the records of 39 eyes of 31 patients presenting with Stage 4 retinal detachment secondary to ROP who underwent primary two or three-port lens-sparing vitrectomy from January 2000 to October 2006 were evaluated. The outcomes studied at the final follow-up visit were the retinal status, lens and medial clarity and visual acuity. Favorable anatomical outcome was defined as the retinal reattachment of the posterior pole at two months after the surgery; and favorable functional outcome was defined as a central, steady and maintained fixation, with the child following light. Results: At mean follow-up of 15 months, 74% of the eyes had a favorable anatomical outcome with single procedure. The visual status was favorable in 63%. The lens remained clear in all the eyes at the last follow-up, and the media clarity was maintained in 87%. Intraoperative complications included vitreous hemorrhage, pre-retinal hemorrhage and retinal break formation. Conclusions: Lens-sparing vitrectomy helps to achieve a favorable anatomical and functional outcome in selected cases of Stage 4 ROP.