Value of CT in the postoperative evaluation of patellar dislocation triple surgery / 实用放射学杂志

Objective To study the role of CT in the evaluation after patellar dislocation triple surgeries.Methods Retrospectively analysed the CT measurements of 60 recurrent patellar dislocation patients (61 knees),who had undergone patellar dislocation triple surgeries,within one month before and after procedures.The measurements included patellar tilt angle,lateral patellar displacement,trochlear con-gruence angle,Tibial Tuberosity-Trochlear Groove distance,Insall-Salvati Ratio and Caton-Deschamps Index.Moreover,the troch-lear dysplasia classifications of all patients were evaluated.In addtion,an analysis has also been completed for 40 (41 knees)of 60 patients who had second postoperative CT examinations as follow-up assessment 3 to 6 months after surgeries.Results All one-month postoperative measurements decreased obviously with statistical significance(P <0.05 ).Furthermore,one case of subluxa-tion,1 1 cases of abnormal Tibial Tuberosity-Trochlear Groove distance,13 cases of abnormal Insall-Salvati Ratio and 14 cases of Ca-ton-Deschamps Index abnormities were also observed.Besides that,it was also found that all patients had trochlear dysplasia and 5 cases were diagnosed with patellar subluxation or dislocation at the second postoperative follow-up assessment.Conclusion The patients with redislocation or risks for patellar instability can be detectecd by CT which provides objective evidence for postoperative evaluation and further treatments.

The Effect of Intraocular Lens Insertion Sequence during the Triple Procedure on Corneal Endothelial Cell Survival

PURPOSE: To evaluate the differences in corneal endothelial cell density in patients undergoing intraocular lens insertion at 2 different sequences during the triple procedure. METHODS: The present retrospective study divided 37 eyes of 37 patients and into 2 groups: trephination, phacoemulsification and intraocular insertion, followed by graft suturing (20 eyes, Group I), and trephination, phacoemulsification, graft suturing leaving 3 mm gap, followed by intraocular lens insertion and suturing of the gap (17 eyes, Group II). Intraocular pressure, corneal thickness, and endothelial cell density were measured for 3 months postoperatively. RESULTS: No significant difference in intraocular pressure between the 2 groups (p = 0.14) was observed. However in Group II, the mean corneal thickness showed a greater decrease (p = 0.02) during the 3 months following surgery, and the mean corneal endothelial cell density in this group was higher at 1, 2, and 3 months postoperatively than that of Group I (p = 0.01, 0.02 and 0.04 respectively). There were no significant difference in the rate of endothelial cell loss during the postoperative period between the 2 groups. CONCLUSIONS: The anterior chamber formation before intraocular lens insertion in the triple procedure is hypothesized to decrease corneal endothelial cell loss by minimizing mechanical contact with intraocular structures or intraocular lenses during surgery.

Additional Subconjunctival Low Dose 5-fluoro u racil Injection after Mitomycin C Applied Filtering Surgery in Glaucoma Patients

To evaluate the additive efficacy of postoperative low dose 5-FU subconjunctival injection, we analyzed 43 patients[43 eyes]who had undergone trabeculectomy or triple surgery with intraoperative MMC for 2.5~3min.18eyes[case group =MMC 5-FU group]of 43 eyes had postoperative low dose 5-FU injection additionally and 25 eyes[control group =MMC group]of which had only undergone intraoperative MMC. The mean[+/-SD]follow-up periods were 13.6 +/-5.3 months in MMC 5-FU group and 12.1 +/-3.6 months in MMC group.There was no statistically significant difference in preoperative IOP between the two groups[p>0.05].Mean postoperative intraocular pressures were 12.9 +/-4.2 mms of mercury in MMC 5-FU group and 13.3 +/-4.4 mms of mercury in MMC group at 12 months postoperatively[p>0.05]. Kaplan-Meier survival analysis showed that the cumulative success rates at 1.5 year were 82.6%and 87.2%in the case and control groups, respectively[p>0.05].Of the postoperative complications, corneal epithelial defect was more frequent in MMC 5-FU group[p<0.05]. In conclusion, postoperative injection of low dose 5-FU additionally did not have an additive effect on the IOP control in patients undergone MMC applied filtering surgery. We may need additional postoperative injection of higher dose of 5-FU.Or, we may need to individualize the duration of application or the concentration of intraoperative MMC to begin with.

2 Cases of Combined Cataract and Scleral Buckling Surgery

I have recently experienced 2 cases of triple surgery composed of phacoemulsification, scleral buckling and IOL insertion. This kind of surgery has not been reported yet. One patient had operations of phacoemulsification, scleral buckling and IOL insertion and the other patient had phacoemulsification, encircling buckling and IOL insertion surgeries simultaneously. Corneoscleral wound was created in valve shape so as to tolerate the increment of the IOP. After removing the cataract, the chamber was filled with viscoelastic material. Retinal tear was localized with the help of indirect ophthalmoscope and then buckling surgery was performed. IOL was inserted in the bag at the last procedure. Both patients were satisfied with the attachment of retina and improvement of visual acuity. The triple surgery of phacoemulsification, scleral buckling and IOL insertion is an appropriate choice when properly indicated.