Cataract versus combined surgery in pseudoexfoliation glaucoma

Purpose: Pseudoexfoliation glaucoma (XFG) is often associated with a higher rate of intraoperative complications and failure. This study aims to compare the long?term clinical and surgical outcomes of cataract surgery alone versus combined surgery in XFG. This was a retrospective comparative case series. Methods: All patients with XFG who underwent either cataract surgery alone [group 1: either phacoemulsification, PHACO/small?incision cataract surgery (SICS), n = 35] or combined surgery (group 2: phacotrabeculectomy, PHACOT or SICS + trabeculectomy, n = 46) from 2013 to 2018 by a single trained surgeon were screened and recalled for a detailed clinical examination, including Humphrey visual field analysis at 3?monthly intervals for a minimum of 3 years. Surgical success (intraocular pressure, IOP, <21 mm Hg and >6 mm Hg with (qualified success) or without medicines, complete success, survival rates, visual field changes, and need for additional procedures/medicines for IOP control were compared between groups. Results: A total of 81 eyes of 68 patients with XFG were included in this study (groups 1–35 eyes and groups 2–46 eyes each). Both groups achieved 27–40% IOP reduction from preoperative IOP levels, P < 0.001. Surgical success rates were similar in both groups (complete success 66% vs 55%, P = 0.4), qualified success 17% vs 24%, P = 0.8, in groups 1 and 2). Kaplan–Meier analysis showed a marginally better survival rate for group 1, 75% (55–87%), than group 2, 66% (50–78%), at 3 and 5 years which was not significantly different. The number of eyes that progressed at 5 years after surgery (5–6%) was similar in both groups. Conclusion: Cataract surgery can be as effective as combined surgery in XFG eyes with regards to final visual acuity, long?term IOP profile, and visual field progression, and complications/survival rates are comparable between the two procedures.

Reproducibilidad de parámetros radiográficos para determinar el éxito quirúrgico de fracturas de radio distal / Reliability of radiographic parameters to determine the surgical success in distal radius fractures

Resumen: Introducción: las fracturas del radio distal son las más comunes en extremidades superiores. Estandarizar las mediciones radiográficas para su abordaje quirúrgico es importante. Este estudio midió la reproducibilidad intra/interobservador de parámetros radiográficos asociados al éxito quirúrgico en estas fracturas. Material y métodos: diseño transversal retrospectivo con datos secundarios de expedientes clínicos. Se evaluaron radiografías de 112 fracturas en planos posteroanterior y lateral por dos traumatólogos estandarizados en toma de mediciones para calcular cinco parámetros indicativos de éxito postquirúrgico: altura radial, inclinación radial, inclinación volar, varianza cubital y escalón articular. La reproducibilidad de distancias y ángulos se evaluó con el método de Bland-Altman calculando: diferencia media entre mediciones, rango a ± 2 DE y proporción de mediciones fuera de ± 2 DE. El éxito postquirúrgico se comparó en pacientes con/sin obesidad según la media de las dos mediciones de cada evaluador. Resultados: el evaluador 1 tuvo la mayor diferencia intraobservador en altura radial (0.16 mm) y la mayor proporción fuera de ± 2 DE en varianza cubital (8.1%); el evaluador 2 tuvo la mayor diferencia en inclinación volar (1.92o) y la mayor proporción en inclinación radial (10.7%). La mayor diferencia interobservador fue en varianza cubital (1.02 mm) y la mayor proporción fuera de ± 2 DE en altura radial (5.4%). La inclinación radial tuvo la mayor diferencia (1.41o) con 4.5% de mediciones fuera de ± 2 DE. La varianza cubital y la inclinación volar tuvieron la mayor diferencia de éxito postquirúrgico entre evaluadores, sobre todo en pacientes con obesidad. Conclusión: mejorar la calidad radiográfica y estandarizar las mediciones resulta en indicadores más reproducibles.

Abstract: Introduction: distal radius fractures are the most common in upper extremities. Therefore, it is important to standardize radiographic measures for their surgical approach. This study assessed the intra/interobserver reproducibility of radiographic parameters associated with surgical success of distal radius fractures. Material and methods: retrospective cross-sectional design of secondary data extracted from clinical records. Posteroanterior and lateral X-rays of 112 distal radius fractures were assessed by two trauma specialists standardized in the measurements required to compute five parameters indicative of postoperative success: radial height, radial inclination, volar tilt, ulnar variance, and articular stepoff. The reproducibility of distances and angles was evaluated using the Bland-Altman method, calculating the mean of the difference between measurements, the range at ± 2 SD, and the proportion of measurements outside ± 2 SD. Postoperative success was also compared between patients with and without obesity according to the mean of the two measures made by each evaluator. Results: evaluator 1 had the largest intra-observer difference in radial height (0.16 mm) and the largest proportion outside ± 2 SD in ulnar variance (8.1%); evaluator 2 had the largest difference in volar tilt (1.92o) and the highest proportion in radial inclination (10.7%). The largest inter-observer difference was for ulnar variance (1.02 mm) and the largest proportion outside ± 2 SD. for radial height (5.4%). Radial tilt had the largest difference (1.41o) with 4.5% of measurements outside ± 2 SD. Ulnar variance and volar tilt had the largest difference in postoperative success between evaluators, especially in patients with obesity. Conclusion: improving the radiographic quality and standardizing the measurements results in more reproducible indicators.

Clinical observation of combined glaucoma-cataract surgery on pseudoexfoliation glaucoma and primary open angle glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare effects of combined glaucoma-cataract surgery on pseudoexfoliation glaucoma(PXG)and primary open angle glaucoma(POAG).<p>METHODS: This was a retrospective case-control study conducted the hospitalized patients at department of glaucoma from January 2015 to January 2018. The PXG group included 40 eyes of 38 cases, with 46 eyes of 36 cases on POAG group, which were matched for baseline data. Visual acuity, intraocular pressure(IOP), number of anti-glaucoma medications used and occurrence of complications were observed in both groups after trabeculectomy + phacoemulsification + IOL implantation. Surgical success was defined according to the following 2 criteria: criterion A: IOP≤21mmHg, criterion B: IOP≤18mmHg. Complete success, and qualified success is defined as patients met these criteria with medical treatment(≤3 medications). <p>RESULTS: The visual acuity was improved, with IOP and the number of anti-glaucoma medications used both reduced in both group after surgery. There was no statistically significant difference in complete and qualified success rates between the two groups at 1 and 3mo after surgery(<i>P</i>>0.05). Postoperative 6mo, 1 and 2a, for criterion A: the qualified success rates in PXG group(90%, 80%, 74%)were slightly lower than that of POAG group(91%, 86%, 82%, <i>P</i>>0.05). The complete success rates in PXG group(50%, 40%, 29%)were significantly lower than that of POAG group(85%, 64%, 61%, <i>P</i><0.05). For criterion B: the qualified success rates in PXG group(70%, 70%, 59%)were slightly lower than that of POAG group(80%, 80%, 75%, <i>P</i>>0.05). The complete success rates in PXG group(45%, 30%, 18%)were significantly lower than that of POAG group(78%, 61%, 54%, <i>P</i><0.05).<p>CONCLUSION: The combined glaucoma-cataract surgery in PXG and POAG patients can significantly improve visual acuity and reduce intraocular pressure. The short-term success rates of both types of glaucoma were similar, however the long-term success rates of PXG patients was significantly lower, and it was difficult to achieve a low level IOP.

Comparison of seven surgical interventions for lumbar disc Herniation: A network meta-analysis / 中国组织工程研究

BACKGROUND: With the rapid development of intervertebral disc interventional technology, surgical treatment of lumbar disc herniation has made great progress, but at the same time, surgeons and patients have more choices. Therefore, it is particularly important to compare the efficacy and safety of new surgical methods and traditional widely accepted treatment methods. Traditional meta-analysis cannot classify the advantages and disadvantages of various surgical methods. OBJECTIVE: To evaluate the efficacy and safety of seven surgical interventions for the treatment of lumbar disc herniation using network meta-analysis. METHODS: We performed a Bayesian-framework network meta-analysis of randomized controlled trials to compare seven surgical interventions for people with lumbar disc herniation, including percutaneous endoscopic lumbar discectomy, standard open discectomy, standard open microsurgical discectomy, chemonucleolysis, microendoscopic discectomy, percutaneous laser disc decompression, and automated percutaneous lumbar discectomy. The eligible randomized controlled trials were identified by searching the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase and Google scholar. Data from three outcomes (success rate, complication rate, and reoperation rate) were independently extracted by two assessors. RESULTS AND CONCLUSION: (1) A total of 29 randomized controlled trials (31 literatures) including 3 146 participants were finally included into this article. (2) Our Meta-analysis provides hierarchies of these seven interventions. For the success rate, the rank probability is as follows (from best to worst): Percutaneous endoscopic lumbar discectomy > standard open discectomy > standard open microsurgical discectomy > chemonucleolysis > microendoscopic discectomy > percutaneous laser disc decompression > automated percutaneous lumbar discectomy. (3) For the complication rate, the rank probability is as follows (from best to worst): Percutaneous endoscopic lumbar discectomy > standard open microsurgical discectomy > standard open discectomy > microendoscopic discectomy > percutaneous laser disc decompression > chemonucleolysis > automated percutaneous lumbar discectomy. (4) For the reoperation rate, the rank probability is as follows (from best to worst): Standard open microsurgical discectomy > standard open discectomy > microendoscopic discectomy > percutaneous laser disc decompression > percutaneous endoscopic lumbar discectomy > chemonucleolysis > automated percutaneous lumber discectomy. (5) This meta-analysis provides evidence that percutaneous endoscopic lumbar discectomy might be the best choice to increase the success rate and decrease the complication rate. Moreover, standard open microsurgical discectomy might be the best option to drop the reoperation rate. Automated percutaneous lumbar discectomy might lead to the lowest success rate and the highest complication rate. It is hoped that one-to-one randomized controlled trials of high quality will further validate the results of this study.

Cut-off Value for Body Mass Index in Predicting Surgical Success in Patients with Lumbar Spinal Canal Stenosis

STUDY DESIGN: Case-control. PURPOSE: To determine optimal cut-off value for body mass index (BMI) in predicting surgical success in patients with lumbar spinal canal stenosis (LSCS). OVERVIEW OF LITERATURE: BMI is an essential variable in the assessment of patients with LSCS. METHODS: We conducted a prospective study with obese and non-obese LSCS surgical patients and analyzed data on age, sex, duration of symptoms, walking distance, morphologic grade of stenosis, BMI, postoperative complications, and functional disability. Obesity was defined as BMI of ≥30 kg/m². Patients completed the Oswestry Disability Index (ODI) questionnaire before surgery and 2 years after surgery. Surgical success was defined as ≥30% improvement from the baseline ODI score. Receiver operating characteristic (ROC) analysis was used to estimate the optimal cut-off values of BMI to predict surgical success. In addition, correlation was assessed between BMI and stenosis grade based on morphology as defined by Schizas and colleague in total, 189 patients were eligible to enter the study. RESULTS: Mean age of patients was 61.5±9.6 years. Mean follow-up was 36±12 months. Most patients (88.4%) were classified with grades C (severe stenosis) and D (extreme stenosis). Post-surgical success was 85.7% at the 2-year follow-up. A weak correlation was observed between morphologic grade of stenosis and BMI. Rates of postoperative complications were similar between patients who were obese and those who were non-obese. Both cohorts had similar degree of improvement in the ODI at the 2-year follow-up. However, patients who were non-obese presented significantly higher surgical success than those who were obese. In ROC curve analysis, a cut-off value of ≤29.1 kg/m² for BMI in patients with LSCS was suggestive of surgical success, with 81.1% sensitivity and 82.2% specificity (area under the curve, 0.857; 95% confidence interval, 0.788–0.927). CONCLUSION: This study showed that the BMI can be considered a parameter for predicting surgical success in patients with LSCS and can be useful in clinical practice.

The Impact of Body Mass Index on the Surgical Outcomes in Open Rectal Cancer Surgery.

Technical difficulties which affect the outcomes of abdominal operations are common in obese patients, especially in rectal and gastric cancer cases. In several studies, it has been shown that increased body mass index (BMI) is associated with increased morbidity, reduced lymph node retrieval and prolonged hospital stay after colorectal surgery. The aim of this study was to assess the influence of obesity on the surgical outcomes (surgical margin, number of lymph nodes excised) of rectal cancer patients who were operated by open surgery. One hundred rectal cancer patients who underwent open surgery in a single center between January 2011 and August 2014 were included in this study. Patients were divided into two groups according to their BMI values. According to their preoperative BMI values, patients with a BMI of ≥30 kg/m2 (n=29) were defined as ‘obese’. Patients with a BMI of <30 kg/m2 (n=71) were placed in the normal (non-obese) group. Demographic data, surgical margins, the number of lymph nodes retrieved and surveillance of both groups were compared. Obese and normal groups were statistically indifferent in terms of age, sex and stage of the disease. Comparison of the obese and normal groups showed no statistically significant difference in terms of surgical margins and the number of lymph nodes retrieved. This study showed that obesity does not affect the surgical outcomes in rectal cancer. However, prospective studies with larger patient series are needed.

Clinical Results of Nasopore(R) Nasal Packing on Endonasal Dacryocystorhinostomy

PURPOSE: To investigate the effects of Nasopore(R) as a nasal packing material on the surgical success rate and prevalence of postoperative complications after endonasal dacryocystorhinostomy (DCR). METHODS: The present study included a total of 558 patients (699 eyes) with primary acquired nasolacrimal duct obstruction who underwent endonasal DCR; 227 eyes were packed with Nasopore(R) and 472 eyes were packed with Merocel(R). The surgical success rate and postoperative complications such as synechiae, granulation, wound healing (osteal mucosal epithelium epithelialization), postoperative bleeding, infection, and revision rate were compared between the packing materials. RESULTS: The surgical success rate of the Nasopore(R) group (99.1%, 98.6%) showed significantly better results than the Merocel(R) group (97.2%, 95.1%) at postoperative 1 and 3 months (p = 0.04, 0.03 Pearson chi-square test), whereas there was no statistically significant difference between the 2 groups in postoperative surgical success rate at 1 week and 6 months. In comparison of postoperative complications, the Nasopore(R) group (0%) showed a lower incidence of delayed wound healing (delayed epithelialization of osteal mucosal epithelium) than the Merocel(R) group (2.3%; p = 0.013), whereas there was no difference in granulation, synechiae, postoperative bleeding, infection and revision rate (p > 0.05). CONCLUSIONS: The Nasopore(R) group showed a lower proportion of delayed wound healing and improvement of the surgical success rate at an early postoperative period after endonasal DCR compared to non-absorbable nasal packing material.

Clinical Characteristics and Related Factors of Surgical Outcome in Patient who Underwent LR Recession After the age of 10 years

PURPOSE: To identify clinical characteristics and preoperative factors that influence the surgical results of an intermittent exotropia patient who underwent lateral rectus recession after the age of 10 years. METHODS: A retrospective study was performed based on the medical records of 45 patients who underwent unilateral lateral rectus recession or bilateral lateral rectus recession for intermittent exotropia after the age of 10 years and who had undergone at least three months of postoperative follow-up. The authors investigated the clinical characteristics and factors associated with surgical success according to gender, age at surgery, fusion ability, preoperative angle of deviation, preoperative difference between near and far angles of deviation, vertical deviation, spherical equivalent of refractive error, Randot stereo test and postoperative angle of deviation at one week, one month, and three months. The postoperative deviation change according to the time between groups who underwent surgery before and after 10 years of age for intermittent exotropia was also compared. RESULTS: Surgical success was defined as a final deviation of less than 10 prism diopters. Patients without vertical deviation had a better surgical outcome than did patients with vertical deviation (p=0.022). There was no significant difference in the postoperative deviation changes between groups who underwent surgery for intermittent exotropia before 10 years and after 10 years of age. CONCLUSIONS: Among the many preoperative influencing factors, vertical deviation showed a significant difference in postoperative improvement after intermittent exotropia surgery undergone after the age of 10 years. There was no difference in the aspects of surgical success between surgeries for intermittent exotropia before and after the age of 10 years.

Factors of Surgical Success with Unilateral Recession and Resection in Intermittent Exotropia

PURPOSE: To investigate the factors associated with surgical success in cases of unilateral medial rectus resection and lateral rectus recession in the intermittent exotropia. METHODS: Ninety-eight patients with basic-type intermittent exotropia were included in this study. They underwent unilateral recession of the lateral rectus and resection of the medial rectus muscle and were followed postoperatively for at least one year. Surgical results were analyzed to assess the association with preoperative factors, including the angle of deviation, difference of deviation between near and far, stereoacuity at far using B-VAT(R), and Worth 4 dot test (W4DT) at near, and postoperative factors, including the position at near and far at one week, stereoacuity at far using B-VAT(R) at one year, and W4DT at near and far. Surgical success was defined as esotropia within 5 prism diopters (PD) at near and far or within 10PD at near and far at one year postoperatively. RESULTS: Patients with a preoperative difference of deviation between near and far within 5PD had a better surgical outcome than patients with 6~10PD (p=0.03). There was a statistically significant relationship between position at one week postoperatively (especially esotropia or orthotropia at near and far) and success ratio (p0.05). CONCLUSIONS: The difference of preoperative deviation between near and far within 5PD and within 5PD esotropia and orthotropia at near and far at one week postoperatively were significantly associated with a good surgical outcome and could be good prognostic indicators.

A Clinical Study: Change of the Eye Position under General Anesthesia

This study was undertaken to evaluate the relationship between eye positions in the awake state and in the surgical plane of anesthesia induced with anesthetics and muscle relaxants in 167 non-paralytic horizontal strabismus patients. All 27 patients with esotropia demonstrated divergence under general anesthesia when compared with their pre-anesthetized state. In 140 patients with exotropia, 107 patients(76.4%) demonstrated convergence under general anesthesia, 6 patients(4.3%) demonstrated divergence, 27 patients demonstrated no change of the eye position. A statistically significant relationship was found between the preanesthetized position of the eyes(P) and the eye position under general anesthesia(A). The relationship is linear and can be written as the approximate regression fomula: A=0.44P+6.34, R=0.73(p<0.01). When surgical success was defined as an eso- or exodeviation within 10 delta of orthotropia at postoperative 12 weeks, final success rate revealed statistically significant difference between the following two groups of exotropic patients(p<0.05). The patients whose amount of vergence were under 15 delta had a success rate of 96.6%, while those over 16 delta had a success rate of 86.3%. In esotropia, surgical success was not satisfactory in patients whose amount of deviation were over 41 delta. These results suggest the significant relationship between eye positions in the awake state and those under general anesthesia, which could be clinically applied in deciding the surgical amount and predkting the success of strabismus surgery.