New model for the prediction of visual outcomes in young children with mechanical ocular conditions and comparison with other models

Purpose: Herein, we compared the efficacy among the Ocular Trauma Score (OTS), Toddlers Ocular Trauma Score (TOTS), and Pediatric Ocular Trauma Score (POTS) for prognosis prediction in Indian children who had mechanical ocular conditions causing traumatic cataract. Methods: This prospective, interventional study recruited consecutive children undergoing operation for traumatic cataracts caused by mechanical eye injuries at Drashti Netralaya. The following details were obtained from their medical files: the circumstance and time of injuries, penetrating injury type, initial and final visual acuity (VA), time of operation, and associated eye diseases. Specific variables were employed to determine the OTS, TOTS, and POTS. For all patients, the final and predicted VA determined using all scores were compared using Fischer’s exact test. Accuracy, specificity, and sensitivity were evaluated for all the scores by using the area under receiver operating characteristic curve. Results: We enrolled 124 eyes. Patients’ mean value for age was 4.6 ± 1.29 years; 44 (35.41%) and 74 (64.5%) were female and male patients, respectively. Visual outcomes significantly improved after operation, and the outcomes did not differ between closed? and open?globe injuries (P = 0.162). The actual and predicted VA did not exhibit a statistically significant difference among the three scores. TOTS and POTS were more suitable for evaluating low?risk injuries, whereas the OTS could more efficiently examine high?risk cases. Conclusion: TOTS and POTS were more accurate than the OTS in VA prediction after operation in toddlers with traumatic cataracts caused by mechanical globe injury. TOTS and POTS were more suitable for evaluating low?risk injuries, whereas the OTS could more efficiently examine high?risk cases. All the examined scores can be helpful in estimating VA following treatment

A prospective cohort study on the epidemiology of ocular trauma associated with closed-globe injuries in pediatric age group

Purpose: To study the epidemiology of mechanical ocular trauma and closed globe injury using the Birmingham Eye Trauma Terminology System in patients belonging to the pediatric age group. Methods: This work involved a prospective cohort study of all ocular trauma patients (pediatric age group) registered between 2002 and 2017 at the ocular trauma care center. The data were collected using the international ocular trauma society form through our online MIS data and exported to the Excel sheet. The statistical analyses including the univariate analysis and cross tabulation were carried out using SPSS 22 software. Results: Our cohort consisted of 12687 patients with mechanical ocular trauma. There were 7546 (59.4%) eyes with open globe ocular injuries and 5328 (41.9%) with closed globe injuries. Of all closed globe injury patients, 1010 (19.0%) belonged to the pediatric age group (0-18 years), including 690 males (68.3%) and 320 females (31.7%). The mean age of the patients was 10.2 ± 5.1 years. Of all closed globe injuries, 692 (68.5%) were closed globe contusion and 318 (31.5%) were lamellar laceration. Conclusion: Closed globe injury is an important in cause of vision loss in children (24% <1/60). The condition is more prevalent in males and >51.7% in children under 10 years of age. The treatment has significant impact on the visual outcome in patients belonging to the pediatric age group.

Outcomes and metal ion levels of birmingham hip resurfacing versus total hip Arthroplasty: A systematic review and meta-analysis / 中国组织工程研究

BACKGROUND: Total hip arthroplasty is the gold standard for the end stage of elderly hip disease, but Birmingham hip resurfacing has become an effective alternative to total hip arthroplasty for young people with high levels of exercise. Whether Birmingham hip resurfacing has an advantage over total hip arthroplasty is still inconclusive. OBJECTIVE: To systematically review the efficacy and metal ion level of Birmingham hip resurfacing and total hip arthroplasty. METHODS: The electronic databases of PubMed, EMBASE, Cochrane library, and Web of Science, which last updated on November 30, 2018, were searched for clinical control study of Birmingham hip resurfacing and total hip arthroplasty. Literature data were extracted and literature quality was evaluated. Meta-analyses were performed with RevMan 5.3 software. RESULTS AND CONCLUSION: (1) Twelve studies were identified with a total of 2 317 patients (n=1 279 in Birmingham hip resurfacing group and n=1 038 in total hip arthroplasty group). (2) Meta-analysis results demonstrated that in the primary outcome measures, the Birmingham hip resurfacing group did not differ from the total hip arthroplasty group during short-term follow-up (RR=0.13, 95% CI [0.02, 1.01], P=0.05), but Birmingham hip resurfacing had a lower revision rate during long-term follow-up (RR=0.27, 95% CI [0.15, 0.50], P 0.05). (4) Finally, in the metal ion level, whether it was short-term follow-up or long-term follow-up, there was no significant difference between Birmingham hip resurfacing and total hip arthroplasty (P < 0.05). While at the Cr ion level, there was no significant difference between Birmingham hip resurfacing and total hip arthroplasty in short-term follow-up (P=0.55), but long-term follow-up showed that Birmingham hip resurfacing released more Cr ions than total hip arthroplasty after surgery, and the difference between the groups was statistically significant (P=0.03). (5) In conclusion, compared with total hip arthroplasty, Birmingham hip resurfacing has a smaller revision rate and overall complication, a better hip function score, but its Cr ion level is higher. This conclusion still needs further a great amount of large-sample, multi-center, high-quality randomized controlled trials to verify its correctness.

Epidemiological profile of pediatric ocular trauma in a tertiary hospital of northern India / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Ocular trauma is one of the most common causes of acquired blindness in children. It measures about 8%-14% of total childhood injuries. This study aims to determine the epidemiological profile of ocular trauma in the pediatric age group attending a tertiary hospital in northern India.</p><p><b>METHODS</b>A retrospective study was conducted in our hospital between June 2014 to July 2015 and all the children aged 0-16 years presenting with ocular trauma in eye outpatient department and emergency were enrolled in the study. Various epidemiological parameters like age, sex distribution, duration of presentation, mode of injury, type of injury and final visual outcome were analyzed.</p><p><b>RESULTS</b>Of total 357 patients, 271 (76%) were below the age of 12 years; 41.1% of children with ocular trauma belonged to age group 2-6 years. The male to female ratio was 2.9:1. Out of total patients, 242 (67.8%) presented with closed globe injury. Among the closed globe injury, the history of fall was present in about 35% of children, followed by trauma while playing with bat/ball (15.7%) and finger nail trauma (13.2%). Among open globe injury, trauma with needle, knife, glass and pen were common causes. Home was the most common place of injury (47.8%), followed by streets (17.9%) and playground (14.9%).</p><p><b>CONCLUSION</b>Children are vulnerable to ocular trauma and need more supervision. Sharp objects like needles, knives, household chemicals like acids should be out of reach of children.</p>

Clinical profile of medicolegal cases presenting to the eye casualty in a tertiary care center in India.

Purpose: The purpose of this study was to analyze the clinical profile of medicolegal cases (MLCs) presenting to the eye casualty in a tertiary care hospital. Materials and Methods: Retrospective review of records. The cases were grouped according to the Ocular Trauma Classification Group classification system. Results: Out of 188 MLCs, 164 (87.2%) were male. Mean age (±standard deviation) was 31.6 (±12.7) years. Age ranged from 7 to 75 years. Twenty‑six (13.8%) patients had bilateral involvement. The fist was the most common mode of injury, which was seen in 109 (58%) cases. A total of 27 (14.3%) patients had associated extraocular injury. No evidence of ocular or orbital trauma (malingering) could be found in 13 (7%) patients. Mechanical trauma was present in 169 (90%) patients with injury to globe in 129 (69%) patients and injury to lid or orbit without damage to the globe in 40 (21%) patients. Chemical injury was observed in 6 (3%) patients. Closed globe injury (CGI) was seen in 116 eyes and open globe injury (OGI) was noted in 29 eyes. The most common type of injury, zone, pupil, and grade of injury in CGI were Type A or contusion (79%), Zone I (72%), Pupil B (absence of relative afferent pupillary defect) in 95%, and Grade A [visual acuity (VA) ≥20/40] in 68% of the eyes, respectively. The most common type of injury, zone, pupil, and grade of injury in OGI were Type B or penetrating (48%), Zone II (38%), Pupil B (59%), and Grade D (VA 4/200‑light perception) (42%), respectively. Conclusions: The most common form and mode of ocular injury in MLC were closed globe injury and fist, respectively. The most common type of injury in CGI and OGI was contusion and penetrating injury, respectively.

Birmingham Mid-Head Resection Periprosthetic Fracture

Total hip arthroplasty in the young leads to difficult choices in implant selection. Until recently bone conserving options were not available for younger patients with deficient femoral head bone stock. The novel Birmingham Mid-Head Resection (BMHR) device offers the option of bone conserving arthroplasty in spite of deficient femoral head bone stock. Femoral neck fracture is a known complication of standard resurfacing arthroplasty and is the most common reason for revision. It is unknown whether this remains to be the case for the BMHR neck preserving implants. We report a case of a 57-year-old male, who sustained a periprosthetic fracture following surgery with a BMHR arthroplasty. This paper illustrates the first reported case of a BMHR periprosthetic fracture. The fracture pattern is spiral in nature and reaches to the subtrochanteric area. This fracture pattern is different from published cadaveric studies, and clinicians using this implant should be aware of this as revision is likely to require a distally fitting, rather than a metaphyseal fitting stem. We have illustrated the surgical technique to manage this rare complication.

Visual recovery and predictors of visual prognosis after managing traumatic cataracts in 555 patients.

Aim: The aim was to evaluate the visual recovery after managing traumatic cataracts and determine the predictors of a better visual prognosis. Materials and Methods: This was a prospective study. We enrolled patients with specific inclusion criteria, examined their eyes to review the comorbidities due to trauma, performed surgery for traumatic cataracts, and implanted lenses. The patients were reexamined 6 weeks postoperatively. We divided the cases of traumatic cataract into two groups, the “open globe” (Group 1) and “closed globe” (Group 2) groups, according to the ocular trauma based on the Birmingham Eye Trauma Terminology System (BETTS) and compared the determinants of visual acuity. Results: Our cohort of 555 eyes with traumatic cataracts included 394 eyes in Group 1 and 161 in Group 2. Six weeks postoperatively, the visual acuity in the operated eye was >20/60 in 193 (48%) and 49 (29%) eyes in Groups 1 and 2, respectively (P = 0.002, ANOVA). At follow-up, >20/60 vision was significantly higher in Group 1 than in Group 2 (OR = 1.61; 95% CI, 0.85–3.02). Overall 242 (43.5%) eyes gained a final visual acuity of >20/60. Conclusion: Open globe injury has a favorable prognosis for satisfactory (>20/60) visual recovery after the management of traumatic cataracts.

Birmingham Resurfacing Hip Joint Arthroplasty: Minimum 5 Year follow-up study

PURPOSE: We wanted to evaluate more than 5 years of the clinical follow-up results of Birmingham hip joint resurfacing arthroplasty. MATERIALS AND METHODS: 20 cases of Birmingham resurfacing arthroplasties were performed in 17 patients (8 males and 9 females) between August 2001 and April 2002. Eleven patients had avascular necrosis of the femoral head, nine had osteoarthritis and two had ankylosing spondylitis. All the patients could be followed-up and the mean age at the time of operation was 35.9 (range: 22~65) years. Clinical evaluation was done with using the Harrris hip score; the osteolysis, migration of the femoral component and acetabular cup, the presence of femoral neck fracture and the secondary changes around the components were evaluated according to the radiological follow up findings. RESULTS: The mean preoperative Harris hip score of 38 points was improved to 94 points at the time of the final follow-up. Complications developed in the avascular necrosis patients, in the two cases of femoral neck fracture and in one case of incomplete sciatic nerve palsy. There was no osteolysis or movement of the femoral cap, peg and acetabular cup on the radiological evaluation. Some degree of periacetabular osteoporosis and some change of the trabecular pattern were found in all cases due to the secondary change from mechanical stress. CONCLUSION: Birmingham resurfacing hip arthroplasty provided excellent clinical and radiological results, and especially in the osteoarthritis patients. Special concern might be needed for the patients with avascular necrosis of the femoral head and for protecting the sciatic nerve.