Anterior Thigh Pain Following Minimally Invasive Oblique Lateral Interbody Fusion: Multivariate Analysis from a Prospective Case Series

Background@#Oblique lateral interbody fusion (OLIF) involves the antepsoas approach and psoas major muscle (PMM) retraction to insert the interbody cage orthogonally. Therefore, OLIF is often associated with postoperative anterior thigh pain (ATP) on the approach side. However, there is limited evidence on the nature and risk factors of ATP following OLIF. @*Methods@#Consecutive patients who planned to undergo minimally invasive OLIF and percutaneous pedicle screw instrumentation for lumbar degenerative diseases were prospectively enrolled. The visual analog scale (VAS) for ATP was recorded, and a pain map was drawn daily from the operation day to postoperative day 7 in all patients. We also prospectively collected the preoperative and intraoperative data to identify the risk factors associated with ATP. Radiologically, the total cross-sectional area (CSA), retraction length, and retraction CSA of PMM were measured from the preoperative T2-weighted axial magnetic resonance imaging scans at the L4–5 intervertebral disc level. The patients were stratified into two groups based on the experience of ATP with a VAS score of ≥ 7 at any time point. Additionally, a binary logistic regression analysis was performed to identify the associated factors. @*Results@#The current prospective study included 92 patients (31 men, 61 women) with a mean age of 70.4 years (range, 56–86 years), who underwent OLIF at our institution. The left-side approach was used in 73 patients (79.3%), while 19 (20.7%) underwent a right-side approach. Sixty-five of the total patients (70.6%) experienced approach-side ATP to any extent during postoperative 0–7 days following OLIF. The mean pain VAS (4.4 ± 2.1) and the prevalence (57.6%) were highest at postoperative 2 days. On postoperative day 7, there were 19 patients (20.7%) who complained of residual ATP with a mean VAS of 2.6 ± 1.8. In the multivariate analysis, the PMM retraction length was significantly associated with ATP of VAS ≥ 7 (adjusted odds ratio, 2.316; p = 0.044). @*Conclusions@#In this study, we prospectively collected and analyzed the ATP and associated factors following OLIF and identified the PMM retraction length as a potential independent risk factor for severe ATP in the immediate postoperative period following OLIF.

Risk Factor Analysis of Extended Opioid Use after Coronary Artery Bypass Grafting: A Clinical Data Warehouse-Based Study / 대한의료정보학회지

OBJECTIVES: A clinical data warehouse (CDW) is part of our hospital information system, and it provides user-friendly ‘data search and extraction’ interfaces for query composition. We carried out a risk factor analysis for the extended use of opioids after coronary artery bypass grafting (CABG), taking advantage of the CDW system. METHODS: From 2015 to 2017, clinical data from 461 patients who had undergone either isolated or concomitant CABG were extracted using the CDW; the extracted data included baseline patient characteristics, various examination results, and opioid prescription information. Supplementary data that could not be extracted with the CDW were collected via manual review of the electronic medical records. RESULTS: Data from a total of 447 patients were analyzed finally. The mean patient age was 66.8 ± 10.9 years, 332 patients (74%) were male, and 235 patients (53%) had diabetes. Among the 447 patients, 90 patients (20.1%) took some type of opioid at the 15th postoperative day. An oral rapid-acting agent was the most frequently used opioid (83%). In the risk factor analysis for extended opioid use, duration of operation was the only significant risk factor (odds ratio = 1.004; 95% confidence interval, 1.001–1.007; p = 0.008). CONCLUSIONS: Longer operation time was associated with the risk of extended opioid use after CABG. CDW was a helpful tool for extracting mass clinical data rapidly, but to maximize its utility, the data should be checked carefully as they are entered in the system so that post-processing can be minimized. Further refinement of the clinical data input and output interface is warranted.

High Temperatures and Kidney Disease Morbidity: A Systematic Review and Meta-analysis / 예방의학회지

OBJECTIVES@#In recent years, serious concerns have been raised regarding the impacts of rising temperatures on health. The present study was conducted to investigate the relationship between elevated temperatures and kidney disease through a systematic review and meta-analysis.@*METHODS@#In October 2017, 2 researchers independently searched related studies in PubMed and Embase. A meta-analysis was conducted using a random-effects model, including only studies that presented odds ratios, relative risks, or percentage changes, along with 95% confidence intervals (CIs). The characteristics of each study were summarized, and the Egger test and funnel plots were used to evaluate publication bias.@*RESULTS@#Eleven studies that met the criteria were included in the final analysis. The pooled results suggest an increase of 30% (95% CI, 20 to 40) in kidney disease morbidity with high temperatures. In a disease-specific subgroup analysis, statistically significant results were observed for both renal colic or kidney stones and other renal diseases. In a study design–specific subgroup analysis, statistically significant results were observed in both time-series analyses and studies with other designs. In a temperature measure–specific subgroup analysis, significant results were likewise found for both studies using mean temperature measurements and studies measuring heat waves or heat stress.@*CONCLUSIONS@#Our results indicate that morbidity due to kidney disease increases at high temperatures. We also found significant results in subgroup analyses. However, further time-series analyses are needed to obtain more generalizable evidence.

High Temperatures and Kidney Disease Morbidity: A Systematic Review and Meta-analysis / 예방의학회지

OBJECTIVES: In recent years, serious concerns have been raised regarding the impacts of rising temperatures on health. The present study was conducted to investigate the relationship between elevated temperatures and kidney disease through a systematic review and meta-analysis. METHODS: In October 2017, 2 researchers independently searched related studies in PubMed and Embase. A meta-analysis was conducted using a random-effects model, including only studies that presented odds ratios, relative risks, or percentage changes, along with 95% confidence intervals (CIs). The characteristics of each study were summarized, and the Egger test and funnel plots were used to evaluate publication bias. RESULTS: Eleven studies that met the criteria were included in the final analysis. The pooled results suggest an increase of 30% (95% CI, 20 to 40) in kidney disease morbidity with high temperatures. In a disease-specific subgroup analysis, statistically significant results were observed for both renal colic or kidney stones and other renal diseases. In a study design–specific subgroup analysis, statistically significant results were observed in both time-series analyses and studies with other designs. In a temperature measure–specific subgroup analysis, significant results were likewise found for both studies using mean temperature measurements and studies measuring heat waves or heat stress. CONCLUSIONS: Our results indicate that morbidity due to kidney disease increases at high temperatures. We also found significant results in subgroup analyses. However, further time-series analyses are needed to obtain more generalizable evidence.

Tachyarrhythmia Cycle Length in Appropriate versus Inappropriate Defibrillator Shocks in Brugada Syndrome, Early Repolarization Syndrome, or Idiopathic Ventricular Fibrillation

BACKGROUND AND OBJECTIVES: Implantable cardioverter–defibrillators (ICDs) are indicated in patients with Brugada syndrome (BS), early repolarization syndrome (ERS), or idiopathic ventricular fibrillation (IVF) who are at high risk for sudden cardiac death. The optimal ICD programming for reducing inappropriate shocks in these patients remains to be determined. We investigated the difference in the mean cycle length of tachyarrhythmias that activated either appropriate or inappropriate ICD shocks in these three patient groups to determine the optimal ventricular fibrillation (VF) zone for minimizing inappropriate ICD shocks. SUBJECTS AND METHODS: We selected 41 patients (35 men) (mean age±standard deviation=42.6±13.0 year) who received ICD shocks between April 1996 and April 2014 to treat BS (n=24), ERS (n=9), or IVF (n=8). Clinical and ICD interrogation data were retrospectively collected and analyzed for all events with ICD shocks. RESULTS: Of the 244 episodes, 180 (73.8%) shocks were appropriate and 64 (26.2%) were inappropriate. The mean cycle lengths of the tachyarrhythmias that activated appropriate and inappropriate shocks were 178.9±28.7 ms and 284.8±24.4 ms, respectively (p<0.001). The cutoff value with the highest sensitivity and specificity for discriminating between appropriate and inappropriate shocks was 235 ms (sensitivity, 98.4%; specificity, 95.6%). When we programmed a single VF zone of ≤270 ms, inappropriate ICD shocks were reduced by 70.5% and appropriate shocks were missed in 1.7% of these patients. CONCLUSION: Programming of a single VF zone of ≤270 ms in patients with BS, ERS, or IVF could reduce inappropriate ICD shocks, with a low risk of missing appropriate shocks.

Transvenous Lead Extraction via the Inferior Approach Using a Gooseneck Snare versus Simple Manual Traction

BACKGROUND AND OBJECTIVES: The number of patients with cardiac implantable electronic devices needing lead extraction is increasing for various reasons, including infections, vascular obstruction, and lead failure. We report our experience with transvenous extraction of pacemaker and defibrillator leads via the inferior approach of using a gooseneck snare as a first-line therapy and compare extraction using a gooseneck snare with extraction using simple manual traction. SUBJECTS AND METHODS: The study included 23 consecutive patients (43 leads) who underwent transvenous lead extraction using a gooseneck snare (group A) and 10 consecutive patients (17 leads) who underwent lead extraction using simple manual traction (group B). Patient characteristics, indications, and outcomes were analyzed and compared between the groups. RESULTS: The dwelling time of the leads was longer in group A (median, 121) than in group B (median, 56; p=0.000). No differences were noted in the overall procedural success rate (69.6% vs. 70%), clinical procedural success rate (82.6% vs. 90%), and lead clinical success rate (86% vs. 94.1%) between the groups. The procedural success rates according to lead type were 89.2% and 100% for pacing leads and 66.7% and 83.3% for defibrillator leads in groups A and B, respectively. Major complications were noted in 3 (mortality in 1) patients in group A and 2 patients in group B. CONCLUSION: Transvenous extraction of pacemaker leads via an inferior approach using a gooseneck snare was both safe and effective. However, stand-alone transvenous extraction of defibrillator leads using the inferior approach was suboptimal.

Complications of Cardiac Perforation and Lead Dislodgement with an MRI-Conditional Pacing Lead: a Korean Multi-Center Experience

Medtronic CapSureFix MRI 5086 pacing lead (5086; Medtronic, Inc., Minneapolis, MN, USA) has been reported to be associated with increased cardiac perforation and lead dislodgement. This study aimed to compare the incidence of cardiac perforation and lead dislodgement within 30 days after pacemaker implantation between 5086 MRI lead and previous Medtronic CapSureFix Novus 5076 non-MRI pacing lead. This was a nationwide, multicenter retrospective study in which we compared the incidence of adverse events between 277 patients implanted with 5086 lead and 205 patients implanted with 5076 lead between March 2009 and September 2014. Cardiac perforation within 30 days of pacemaker implantation occurred in 4 patients (1.4%) with the 5086 lead and in no patient with the 5076 lead (P = 0.084). Lead dislodgement occurred in 8 patients (2.9%) with the 5086 lead and in 5 patients (2.4%) with the 5076 lead (P = 0.764). On multivariate logistic regression analysis, age was significantly associated with cardiac perforation. Congestive heart failure and implantation of right atrial (RA) lead at RA free wall or septum were significant factors for the incidence of lead dislodgement and lead revision. The incidence of cardiac perforation and lead dislodgement were not statistically different between the patients with 5086 lead and the patients with 5076 lead. However, careful attention for cardiac perforation may be needed when using the 5086 MRI lead, especially in elderly patients.

Role of Coronary Artery Calcium Scoring in Detection of Coronary Artery Disease according to Framingham Risk Score in Populations with Low to Intermediate Risks

Current guidelines recommend that coronary artery calcium (CAC) screening should only be used for intermediate risk groups (Framingham risk score [FRS] of 10%-20%). The CAC distributions and coronary artery disease (CAD) prevalence in various FRS strata were determined. The benefit to lower risk populations of CAC score-based screening was also assessed. In total, 1,854 participants (aged 40-79 years) without history of CAD, stroke, or diabetes were enrolled. CAC scores of > 0, ≥ 100, and ≥ 300 were present in 33.8%, 8.2%, and 2.9% of the participants, respectively. The CAC scores rose significantly as the FRS grew more severe (P 20% strata were 3.4%, 6.7%, 9.0%, and 11.6% (P 20%; P < 0.05). In conclusion, the yield of screening for significant CAC and occult CAD is low in the very low risk population but it rises in low and intermediate risk populations.

Impact of Impaired Renal Function on the Incidence of Atrial Fibrillation following Radiofrequency Ablation of Cavotricuspid Isthmus-Dependent Atrial Flutter

BACKGROUND AND OBJECTIVES: Atrial fibrillation (AF) occurs frequently after successful radiofrequency ablation (RFA) of cavotricuspid isthmus-dependent atrial flutter (CTI-AFL). Renal impairment has been implicated in the development of AF. The purpose of this study is to clarify the impact of impaired renal function on the incidence of AF after RFA of CTI-AFL. SUBJECTS AND METHODS: Between January 2001 and December 2013, 240 non-dialysis patients with no prior history of AF {mean age 55.9+/-15.2 years old; male, 192 (80.0%)} who had undergone successful CTI-AFL ablation were included in the present study. The baseline estimated glomerular filtration rate was calculated, and patients were divided into those with impaired renal function ( or = 60 mL/min/1.73 m2). The incidence of AF was retrospectively analyzed. RESULTS: 69 (28.8%) patients experienced new onset AF during a median follow-up duration of 26 months (inter-quartile, 7-53). The incidence of AF was significantly higher in patients with impaired renal function than in those with preserved renal function {13/25 (52.0%) versus 56/215 (26.0%), log rank p=0.019}. Age, CHADS2 score, impaired renal function, and left atrial diameter were significantly associated with the incidence of AF in univariate Cox regression analysis. Multivariate analysis showed that age was the only significant predictor of AF incidence (hazard ratio, 1.024; 95% confidence interval, 1.004-1.044, p=0.020). CONCLUSION: Patients with impaired renal function may require careful attention for the incidence of new onset AF following successful RFA of CTI-AFL.

Uterine artery embolization for primary postpartum hemorrhage

Postpartum hemorrhage is the leading cause of severe maternal morbidity and death. A prompt management of uterine artery embolization [UAE] is important for a good outcome. UAE is generally accepted to be a safe and reliable procedure. To estimate critical patient characteristics influencing the success of UAE for the treatment of emergent primary postpartum hemorrhage. This was a cross sectional study that reviewed 121 patients who were diagnosed primary postpartum hemorrhage between February 2002 and December 2009 at a tertiary treatment center among 4,022 deliveries. We evaluated patient clinical characteristics associated with a successful surgical outcome of UAE. The success rate for UAE was 96%. For two cases, UAE complication was associated with fever [>38.5°C]. Five patients had problems that required admission to the intensive care unit [ICU]. To increase the surgical success rate and lower the number of ICU admissions, the decision to treat primary postpartum hemorrhage using UAE should be based on individual patient clinical findings under the direction of obstetrics staff and an interventional radiologist

Comparison of Four Systems of IOL Calculation after Keratorefractive Surgery in Eyes Requiring Cataract Surgery

PURPOSE: To report the evaluation and comparison of true corneal power after corneal refractive surgery through ARK, Orbscan II(R), Pentacam and IOL master. METHODS: Target IOL (Intraocular lens) power calculated with the SRK/T formula using SMK (Sungmo Eye Hospital keratometry), which is a new method for measuring corneal refractive power, was compared with the back-calculated ideal IOL power after cataract surgery for 30 eyes that required cataract surgery and had previously undergone refractive surgery. Target IOL powers calculated using 4 systems were compared with IOL power calculated using the clinical history method for 64 eyes that had undergone refractive surgery. RESULTS: Using SMK with the SRK/T formula, the actual refraction was within +/-0.5 diopter (D) of the intended refraction for 63.8% of eyes and within +/-1.0 D for 90.9% of eyes. Compared with target IOL power calculated with the clinical history method, target IOL power calculated by SMK with the SRK/T formula had a difference of 1.95 +/- 0.86 D, which was similar to the results calculated by the Haigis-L formula and by TNP with Haigis. CONCLUSIONS: The method of IOL calculation using SMK with the SRK/T formula showed the best predictability in patients after corneal refractive surgery. Comparatively accurate results were produced in IOL power calculations using the Haigis-L formula, and the TNP with Haigis method.

Comparison of Laser Refractive Cataract Surgery with a Femtosecond Laser Versus Conventional Phacoemulsification

PURPOSE: To evaluate the surgical results and efficacy of laser refractive cataract surgery with a femtosecond laser compared with conventional phacoemulsification. METHODS: Thirty-one eyes from 31 patients underwent laser refractive cataract surgery (femtosecond laser group), and conventional cataract surgery with phacoemulsification was performed in 30 eyes from 30 patients (conventional group). Best corrected visual acuity, spherical equivalent, surgical induced astigmatism, corneal and ocular astigmatism, total high order aberration, Strehl ratio, objective scatter index, diameter of continuous curvilinear capsulorrhexis (CCC), distance from visual axis to the center of CCC, intraocular lens (IOL) tilt, mean absolute error, effective phaco time, average phaco power and operation time were measured to compare the 2 groups. RESULTS: No significant differences were found between best corrected visual acuity, spherical equivalent, surgical induced astigmatism, corneal and ocular astigmatism, total high order aberration, Strehl ratio, objective scatter index, mean absolute error, effective phaco time, average phaco power or operation time. Significant differences were found in the diameter of CCC, distance from visual axis to the center of CCC, and IOL tilt. CONCLUSIONS: Results of laser refractive cataract surgery with a femtosecond laser showed more precise CCC, and more stable IOL position than conventional cataract surgery.

Expression of Vitamin D Receptor by Pulse Consumption in the Uterus of Menopausal Mouse Model / 대한폐경학회지

OBJECTIVES: Phytoestrogen-containing pulse supplements have beneficial effects on postmenopausal symptoms, but how such effects are achieved is unclear. This study investigates the effects of pulse consumption on the menopausal changes in ovariectomized rats. METHODS: Female Sprague-Dawley rats were either sham operated (Sham; n = 3) or surgically ovariectomized (n = 13). The Sham group was fed the regular AIN-93M diet. Ovariectomized group was divided into 3 sub-groups and fed AIN-93M containing soybean (n = 5), mung bean (n = 3), or cowpea (n = 5) for 10 weeks. At the end of the experiment, all rats were sacrificed, and the uterus was harvested, rinsed, and weighed. Expressions of vitamin D receptor (VDR), estrogen receptor (ER) beta, and ezrin in uterus were evaluated by immunohistochemistry. RESULTS: VDR was highly expressed in the uterus of rat, irrespective of ovariectomized state. VDR was more definitely expressed in the uterus of ovariectomized groups than the sham-operated group. There were no significant differences in expression of ER beta. However the expression of ezrin was highly expressed in the cowpea group compared to sham group (P = 0.044). CONCLUSION: This study suggested that legumes diet may concern menopausal changes via VDR and ezrin. The result may partly explain the beneficial effects of VDR on menopausal symptoms. Further study is necessary to study the detailed mechanisms of VDR and ezrin on the menopausal changes in the uterus.

Risk Factors for Retinal Pigment Epithelium Tears after Anti-VEGF Agent Injection in Age-Related Macular Degeneration

PURPOSE: Intravitreal anti-vascular endothelial growth factor (VEGF) treatment has become an important part in the treatment of neovascular age-related macular degeneration (AMD). In the present study we describe the clinical feature of retinal pigment epithelium (RPE) tears after intravitreal injection of anti-VEGF agent and compared the tear group to the control group. METHODS: In this retrospective case series, data of 11 patients with eyes that developed RPE tears after intravitreal anti-VEGF injection (8 ranibizumab and 3 bevacizumab) were collected and analyzed. The tear group included 11 patients with eyes that developed RPE tears and the control group included 22 patients with no RPE tears after treatment. We investigated age, gender, bilaterality, duration from injection to tear, pigment epithelial detachment (PED) height and diameter, along with central retinal thickness (CMT) using optical coherence tomography (OCT), fluorescein angiography (FAG), and visual acuities before and after treatment. RESULTS: The mean age of the tear group was 81.36 +/- 5.55 years which was significantly different from the control group's mean age of 74.82 +/- 5.28 years (p = 0.003). OCT findings showed PED greatest linear dimension (GLD) was 2978.45 +/- 947.69 microm in the tear group and 2250.23 +/- 988.49 microm in the control group (p = 0.027). PED height was 507.09 +/- 153.97 microm in the tear group and 353.23 +/- 199.42 microm in the control group (p = 0.010). CMT was 431.64 +/- 200.33 microm in the tear group and 289.95 +/- 61.27 microm in the control group (p = 0.005). There was no significant difference between groups according to gender, bilaterality, visual acuities, and subretinal fluid based on OCT and FAG findings. In the tear group, visual acuities before and after the tear were not significantly different. CONCLUSIONS: Old age and eyes with high and wide PED appear to be more vulnerable to RPE tear. Further investigation with a larger number of patients is needed to further confirm these results.

Routine Application of the Korean FRAX Model in Women: a Single-center Study

OBJECTIVES: The objective of this study was to assess the efficacy of the Korean fracture-risk assessment tool (FRAX) model for routine application in women who had a general check-up for bone mineral density (BMD). METHODS: This retrospective study was conducted at a university hospital and comprised 343 patients, whose BMD and clinical risk factors were assessed for FRAX calculation. The 10-year probabilities of hip and major osteoporotic fractures were compared with the result of the FRAX(R) tool (http://www.shef.ac.uk/FRAX, web version 3.5) applied to Korean models developed at the World Health Organization Collaborating Center with or without femoral neck bone mineral density. RESULTS: The T-score gradually decreased with increasing age. Additionally, the 10-year probability of a major osteoporotic fracture increased with age. However, the probability of hip fracture showed no correlation with age if BMD was not included in the estimation. CONCLUSION: Previous report on patients whose probability of a proximal femoral fracture were calculated using Korean FRAX models produced a higher score than our data because our data involved a general population. A larger general population is needed to confirm the Korean FRAX model. However, our data provide information for physicians to assess the Korean FRAX model in the general female population.

Routine Application of the Korean FRAX Model in Women: a Single-center Study

OBJECTIVES: The objective of this study was to assess the efficacy of the Korean fracture-risk assessment tool (FRAX) model for routine application in women who had a general check-up for bone mineral density (BMD). METHODS: This retrospective study was conducted at a university hospital and comprised 343 patients, whose BMD and clinical risk factors were assessed for FRAX calculation. The 10-year probabilities of hip and major osteoporotic fractures were compared with the result of the FRAX(R) tool (http://www.shef.ac.uk/FRAX, web version 3.5) applied to Korean models developed at the World Health Organization Collaborating Center with or without femoral neck bone mineral density. RESULTS: The T-score gradually decreased with increasing age. Additionally, the 10-year probability of a major osteoporotic fracture increased with age. However, the probability of hip fracture showed no correlation with age if BMD was not included in the estimation. CONCLUSION: Previous report on patients whose probability of a proximal femoral fracture were calculated using Korean FRAX models produced a higher score than our data because our data involved a general population. A larger general population is needed to confirm the Korean FRAX model. However, our data provide information for physicians to assess the Korean FRAX model in the general female population.

The Clinical Manifestation of the Gynecologic Emergency in Postmenopausal Women / 대한폐경학회지

OBJECTIVES: The objective of this study was to assess the clinical characteristics of postmenopausal women who were admitted to the emergency room. METHODS: This study was conducted at a university hospital. The retrospective study of medical records comprised 26 patients who were admitted to the emergency room, between September 2010 and August 2011. RESULTS: The age of the twenty-six patients was 51-90 years. Abdominal pain and vaginal bleeding were the main complaints. The final diagnoses were 6 cases of postmenopausal atrophic vaginitis, 6 cases of ovarian cyst, 5 cases of pelvic inflammation disease, 3 cases of post-conization bleeding, 1 case of menopausal symptoms, 1 case of atrophic endometrium, 1 case of uterine prolapse, 1 case of pyometra, and acute pyeolonephritis with stone. Among the 6 cases of ovarian cyst, 5 cases performed an operation. Pathologic findings revealed 2 cases of simple cyst, 1 case of paratubal cyst, 1 case of teratoma, and 1 case of granulosa cell tumor. CONCLUSION: The incidence of post-menopausal distress in women is increasing, and the numbers of post-menopausal women being admitted to the emergency room are also increasing, so attention needs to be paid to the case of postmenopausal women in the future.

A Case of Localized Merkel Cell Carcinoma on the Upper Eyelid

PURPOSE: To report a case of Merkel cell carcinoma on the left upper eyelid without metastasis and its immunohistochemical features. The carcinoma was successfully treated with excisional surgery and prophylactic radiation therapy. CASE SUMMARY: A 76-year-old woman presented to the hospital complaining of a 0.6 x 0.9-cm-sized painless and purplish-red colored mass that had grown rapidly on her left upper eyelid margin over the previous two months. An excisional biopsy was performed. On immunohistochemical examination of the lesion, the tumor cells expressed immunoreactivity for synaptophysin and were negative for LAC and cytokeratin, confirming the diagnosis of Merkel cell carcinoma. Additional surgery was performed because the surgical margins were positive. No other primary or metastatic lesions were found. The patient was treated with local prophylactic irradiation and remained disease-free at her 10-month follow-up visit.

Lateral Tarsal Strip Procedure Combined with Quickert Sutures in Correcting Involutional Entropion

PURPOSE: To evaluate long-term effectiveness of lateral tarsal strip procedure combined with Quickert sutures in correcting involutional entropion. METHODS: The retrospective study reviewed 82 eyes of 71 patients with involutional entropion whose follow-up period was more than 6 months among patients who underwent lateral tarsal strip procedure combined with Quickert sutures between February 2003 and February 2010. RESULTS: The postoperative follow-up period was 6 months to 78 months (average 40.2 months) and the average age was 63.5 years. Out of 82 eyes, 3 eyes recurred and the recurrence rate in the lateral tarsal strip procedure combined with Quickert sutures was 3.6%; postoperative overcorrection was not observed. Out of the 3 recurrence cases, 2 eyes both recurred 6 months after the operation and were treated by Quickert sutures alone with no recurrence. The other case recurred 1 year and 4 months after lateral tarsal strip procedure combined with Quickert sutures and was corrected by this operation again. There was no recurrence for a follow-up period of 2 years. CONCLUSIONS: An effective approach was obtained during long-term follow-up when lateral tarsal strip procedure combined with Quickert sutures was conducted as repairing operations in involutional entropion. The approach showed lower recurrence rate than the existing reports of operations such as lateral tarsal strip procedure or Quickert sutures when conducted alone and provided long-lasting effectiveness in the correction of involutional entropion.

Visual and Surgical Outcomes of Lamellar Macular Hole

PURPOSE: To investigate the visual and anatomical results of surgical treatment for symptomatic lamellar macular hole. METHODS: Ten eyes of ten patients with decreased visual acuity and lamellar macular hole were diagnosed using optical coherence tomography (OCT). Pars plana vitrectomy, epiretinal membrane removal, internal limiting membrane peeling, and gas tamponade (5 eyes) were performed for the treatment of lamellar hole. The resolution of the lamellar hole was assessed in relation to each OCT image at baseline. RESULTS: The mean postoperative follow-up duration was 7.5 months, and best corrected visual acuity improved from log MAR 0.67 +/- 0.38 to log MAR 0.30 +/- 0.28. Central foveal thickness decreased from 441 +/- 184 microm to 291 +/- 64 microm. The OCT of all eyes demonstrated improvement in macular contour. However, retinal detachment in one eye occurred at two months after the operation and was reattached with gas tamponade and photocoagulation. CONCLUSIONS: Vitrectomy, epiretinal membrane removal and internal limiting membrane peeling showed benefit in the treatment of symptomatic lamellar macular hole. However, large and prospective studies are necessary regarding the surgical indication, time and procedure for lamella macular hole.