Association with Systemic and Ophthalmic Disease in Korean Pseudoexfoliation Syndrome Patients

Purpose@#To analyze the association of systemic and ophthalmic disease in patients with pseudoexfoliation syndrome. @*Methods@#We retrospectively reviewed the records of 207 patients with pseudoexfoliation syndrome and 201 age-matched controls without pseudoexfoliation syndrome seen from January 2016 to January 2021. Age, sex, systemic diseases such as diabetes mellitus, hypertension, cardiovascular and cerebrovascular disease, and ocular disease including retinal vascular occlusion, age-related macular degeneration (AMD), glaucoma, cataract surgery rate, complications related to cataract surgery, and ocular characteristics were compared. Factors associated with pseudoexfoliation syndrome were analyzed using logistic regression. @*Results@#The frequencies of diabetes mellitus, hypertension, AMD, glaucoma, a history of cataract surgery, and complications related to cataract surgery were significantly higher in patients with pseudoexfoliation syndrome (all Ps ≤ 0.049). The pseudoexfoliation syndrome group had a significantly thinner global retinal nerve fiber layer, worse mean deviation and pattern standard deviation, and smaller dilated pupil size than the controls (all Ps < 0.001). In univariate and multivariate logistic regressions, the presence of diabetes mellitus (odds ratio [OR] = 1.613, p = 0.041), AMD (OR = 3.071, p = 0.001), and glaucoma (OR = 17.800, p < 0.001) were associated with pseudoexfoliation syndrome. @*Conclusions@#Diabetes mellitus, hypertension, AMD, and glaucoma were more frequent in pseudoexfoliation syndrome patients. Since pseudoexfoliation syndrome is closely related to AMD and glaucoma, this requires clinical consideration.

Stereoacuity in Patients with Non-Amblyopic Anisometropia

Purpose@#To compare the stereoacuity between patients with uncorrected and corrected non-amblyopic anisometropia, and to evaluate the correlation between the degrees of anisometropia and stereoacuity. @*Methods@#We retrospectively reviewed the records of patients with non-amblyopic anisometropia who underwent the stereoacuity test. Patients were divided into uncorrected anisometropia (n = 33) and corrected by spectacles (n = 30) groups. The clinical characteristics and sensory status of patients were evaluated using the Worth 4-dot, Titmus, Lang II, and TNO tests, and compared between the groups. Correlation analysis was performed between the degree of anisometropia and the level of stereopsis. @*Results@#The uncorrected and corrected anisometropia groups did not significantly differ in mean age (12.2 ± 3.7 and 11.8 ± 4.0 years) or degree of anisometropia (2.12 ± 1.21 and 1.81 ± 1.25 diopters). The rate of sensory fusion in the distant Worth 4-dot test was lower in the uncorrected anisometropia than the corrected anisometropia group. The level of stereopsis was also worse in the uncorrected anisometropia than the corrected anisometropia group in all stereoacuity tests. There was a strong positive correlation between the degree of anisometropia and the level of stereoacuity on the Titmus, Lang II, and TNO tests (r = 0.690, r = 0.614, and r = 0.655, respectively; all p < 0.001) in the uncorrected anisometropia group. However, the corrected anisometropia group showed a weak positive correlation between the degree of anisometropia and the level of stereoacuity only on the TNO test (r = 0.366; p = 0.047). @*Conclusions@#Stereoacuity was better in the corrected anisometropia group than in the uncorrected group. It significantly worsened with increasing anisometropia in the uncorrected group, but only a weak correlation was observed in the corrected group. Therefore, prescribing glasses could be recommended to improve stereopsis in adolescents and young adults with anisometropia.

Ocular Pain According to Needle Diameter during Intravitreal Injection

Purpose@#To compare the ocular pain scores and injection times of patients during 30 and 40-gauge intravitreal injection procedures. @*Methods@#This study was performed prospectively in patients who had not previously received intravitreal injection. Patients were randomly divided into two groups and intravitreal injections of bevacizumab, ranibizumab, and aflibercept were performed using a 30-gauge needle (30G Group) or a 40-gauge needle (40G group). The injection time defined as the time between conjunctival touching of the needle and finishing the hemostasis after needle removal was measured in each patient. Immediately after the injection, patients were asked to rate their pain level during the injection using a visual analogue scale (0, no pain; 10, unbearable pain). @*Results@#Sixty eyes of 60 patients were included in this study and 30 patients were assigned to each group. The mean injection times of the 30G and 40G groups were 42.00 ± 37.18 and 32.73 ± 14.58 seconds, respectively, with no significant difference (p = 0.212). The visual analogue scale, pain scores in the 30G and 40G groups were 3.50 ± 1.25 and 2.87 ± 1.01, respectively, with a significant difference (p = 0.035). @*Conclusions@#Intravitreal injection with a 40-gauge needle was less painful than that with a 30-gauge needle.

Outcome of Extraarticular Dorsal Closing Wedge Osteotomy for Freiberg's Disease / 대한족부족관절학회지

PURPOSE: The aim of this study was to evaluate the result of extraarticular dorsal closing wedge osteotomy in Freiberg's disease. MATERIALS AND METHODS: Between February 2012 and July 2014, total 10 patients who underwent dorsal closing wedge osteotomy and followed up more than 1 year were selected for inclusion. Average age was 16.3 years, and average follow-up period was 15.5 months. The diagnosis was made using magnetic resonance imaging of those with a limitation in walking or usual activity due to pain in the metatarsal head. During operation, we removed loose body, and synovectomy was done. Osteotomy at the metatarsal neck and fixation with Kirschner wire were performed. X-ray was taken to check shortening of 2nd metatarsal and bone union. Moreover, we checked the active range of motion of 2nd metatarsophalangeal joint before and after surgery. At the last follow-up, the shortening of metatarsal, American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS), and patient's subjective satisfaction were evaluated. RESULTS: According to the Smillie's stage, there were 3 cases of stage II, 4 cases of stage III, and 3 cases of stage IV. Average bone union time on the osteotomy site was 8 weeks. Average shortening of metatarsal was 2.53 mm. Average AOFAS score improved significantly from 56.9 to 82.8 points at final follow-up (p<0.05), and average VAS score also improved significantly from 6.4 to 1.4 points at final follow-up (p<0.05). Average active range of motion at metatarsophalangeal joint improved from 28.0° preoperatively to 46.5° at the final follow-up. Other complications, such as metatarsalgia and arthritis, were not found; however, there was 1 case of delayed union with no symptom. CONCLUSION: In Freiberg's disease, dorsal closing wedge osteotomy is recommended for the improvement of clinical symptoms and range of motion.

Simultaneous Bilateral Patellar Tendon Ruptures Associated with Osteogenesis Imperfecta / 대한정형외과학회잡지

Bilateral patella tendon rupture is rare, particulary when associated with osteogenesis imperfecta. Brittleness of the bone in osteogenenesis imperfect patients may cause this rupture. We report on this rare case and suggest the direct repair with the additional wire loop as a proper treatment option for patients with the substantial rupture of patella tendon.

Results of Intramedullary Nailing of Femoral Shaft Fracture: Trochanteric Entry Portal (Sirus Nail) versus Piriformis Entry Portal (M/DN Nail)

PURPOSE: To compare treatment results obtained using the trochanteric (Sirus nail) entry portal with those obtained using the Piriformis fossa (M/DN) entry portal during intramedullary (IM) nailing of femur shaft fractures. MATERIALS AND METHODS: Four hundreds and thirty-two patients treated for femur shaft fracture using IM nails from February, 2001 to May, 2010 were divided into two groups. group 1 was composed of 180 patients treated through the trochanteric (Sirus nail; n=180) entry portal, while group 2 contained 170 patients treated through the piriformis fossa (M/DN nail; n=170) entry portal. We compared the clinical and radiographic findings of both groups to evaluate the treatment results. RESULTS: Functional result, range of motion and union time (18, 20 weeks) were similar in both groups. The operation time of patients in the over-weighted group was 90 minutes in group 1 and 120 minutes in group 2 (p0.05). There were 18 iatrogenic fractures in group 1 and 4 in group 2 (p<0.05). CONCLUSION: There was not much difference in complications based on clinical and radiographic findings of both groups. For groups using the trochanteric entry portal, the operation time was shorter and blood loss was lower than in groups using the piriformis entry portal. Iatrogenic fracture occurred more often in the group using the trochanteric entry portal than in the group using the piriformis entry portal.

Response to: Comment on "Comparison of Operative Results of Distal Chevron Osteotomy with and without Akin Osteotomy for Moderate to Severe Hallux Valgus" / 대한족부족관절학회지

No abstract available.

Comparison of Operative Results of Distal Chevron Osteotomy with and without Akin Osteotomy for Moderate to Severe Hallux Valgus / 대한족부족관절학회지

PURPOSE: This study was conducted among patients with moderate to severe hallux valgus who underwent distal chevron osteotomy and groups of patients with or without Akin osteotomy were compared for evaluation of the relationship between their radiological and clinical outcomes. MATERIALS AND METHODS: From January 2009 to January 2012, among patients with moderate to severe hallux valgus who underwent distal chevron osteotomy at our institution, 28 cases with additional Akin osteotomy and 35 cases without Akin osteotomy available to follow up of more than one year were included in this study. For radiologic evaluation, hallux valgus angle, 1, 2 intermetatarsal angle, and hallux interphalangeal angle were measured before and after surgery. For clinical assessment, visual analogue scale score, American Orthopaedic Foot and Ankle Society score, subjective satisfaction of the patients, and passive range of motion of the first metatarsophalangeal joints were evaluated. RESULTS: At the final follow up, correction of valgus hallux angle and 1, 2 intermetatarsal angle was obtained from radiation results of both groups and it was found that patients who underwent Akin osteotomy showed radiographically larger angle correction but less subjective satisfaction. CONCLUSION: Patients with moderate to severe hallux valgus who underwent distal chevron osteotomy showed not only functional but also radiographically satisfactory results, and patients who underwent additional Akin osteotomy showed decreased subjective satisfaction. Therefore, if an incongruent first metatarsophalangeal joint is not observed, distal chevron osteotomy without Akin osteotomy seems preferable.

Cementless Total Hip Arthroplasty Using the Conical Femoral Stem / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the clinical and radiological results of cementless total hip arthroplasty using a conical stem. MATERIALS AND METHODS: From June 2005 to December 2007, total hip arthroplasty using the conical stem was performed in 47 patients and 51 hips. The most common causes for total hip arthroplaty were osteonecrosis of the femoral head in 32 cases. The mean follow-up period was 74.3 months (range: 62-93 months) and the mean age was 51.2 years (range: 36-84 years). The clinical evaluation included the Harris hip score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and pain on the inguinal area or thigh. Radiographic evaluation was performed for determination of the fixation status of the implant, the radiolucent line, subsidence, loosening and heterotopic ossification around the acetabular cup and the femoral stem. RESULTS: At the most recent follow-up, the mean Harris hip score was 94.1 points and the WOMAC score was 11.3 points. Radiologically, bone ongrowth was seen in all cases without migration of acetabular cup, femoral stem, changing of the position, subsidence and loosening. Complications included two cases of posterior dislocation, one case of heterotopic ossification, and one case of deep vein thrombosis. CONCLUSION: Cementless total hip arthroplasty using the conical femoral stem shows good clinical and radiologic results in treatment of osteonecrosis of the femoral head with normal canal flare index and femur neck fracture with stove pipe type.

Minimally Invasive Plate Osteosynthesis with Locking Compression Plate for Distal Femur Fracture

PURPOSE: To analyze the clinical and radiologic results of minimally invasive plate osteosynthesis (MIPO) for distal femur fractures using a locking compression plate (LCP) and to evaluate its usefulness. MATERIALS AND METHODS: From May 2006 to April 2011, 23 patients (24 cases) with distal femur fracture were treated by MIPO with a LCP and followed-up for at least 12 months. Mean age was 61.6 years (35-80 years). Union time and post-operative alignment were measured on radiograph, and clinical function was evaluated by range of motion (ROM), Knee Society Score and complications. RESULTS: In 22 patients (23 cases) except for 1 case, bony union was obtained after an average of 18 weeks (12-26 weeks). The mean ROM was 124 degrees (80-135 degrees). According to the Knee Society Score, there were 12 excellent, 8 good, 1 fair and 2 poor results and the mean score was 87.5 (60-98). Postoperative complications were nonunion in 1 case, ankylosis in 1 case, malunion in 2 cases and superficial wound infection in 2 cases. CONCLUSION: The treatment of distal femoral fracture with MIPO using a LCP was considered a useful method which can result in satisfactory clinical and radiologic outcomes if there is accurate understanding about the surgical techniques and appropriate procedures involved.