Cementless Hip Arthroplasty Using a Long Double-Tapered Rectangular Stem in Patients with Osteoporotic Proximal Femoral Fractures or Reoperation / 대한정형외과학회잡지

Purpose@#This study examined the clinical and radiological results of cementless hip arthroplasty using a long double-tapered rectangular stem in cases with osteoporotic proximal femoral fractures or in reoperation cases. @*Materials and Methods@#This was a retrospective study on patients treated with a Benfix ® stem (Corentec, Cheonan, Korea) by a single surgeon at a single tertiary institution from September 2011 to August 2020, where 92 hips were treated. Thirty-nine patients were followed up for less than one year. Excluding those patients, the mean follow-up duration was 3.0 years (range 1–8 years). The patients’ deaths were confirmed through data from the Ministry of Interior and Safety. Clinical outcomes were assessed using a modified Harris hip score (mHHS), and radiologic outcomes, such as fixation and subsidence, were assessed by surgeons who did not participate in the surgery. @*Results@#mHHS improved from 45 to 79 points at the latest follow-up, and thigh pain was not observed in 53 patients who were followed up for more than one year. Notching of the stem was not noted. The average subsidence was approximately 1 mm in postoperative one year.Three peri-prosthetic fractures (PPF), one deep prosthetic infection, and one superficial wound infection were observed. Stem loosening occurred in one of these PPF cases, and stem revision surgery was done. All complications occurred within one year postoperatively. The one- and five-year mortality were 21.1% and 50.0%, respectively. @*Conclusion@#The short-term and mid-term results of the cementless hip arthroplasty using long double-tapered rectangular stem appeared encouraging and could be a viable option in osteoporotic proximal femoral fractures or reoperation cases. However, most complications occurred within one postoperative year, and the one-year mortality was relatively high. A long-term follow-up would be necessary with a larger cohort to evaluate its longevity.

Perioperative Concerns and Complaints of Patients Undergoing Total Hip Arthroplasty

Background@#Preoperative concerns of patients undergoing total hip arthroplasty (THA) and their complaints during the initial postoperative period are not well investigated. We evaluated preoperative concerns of patients and patient-perceived problems during the operation and initial 5 days after the operation. @*Methods@#One hundred and thirty-two patients, who underwent primary THA at a tertiary referral hospital, were surveyed using a questionnaire and a face-to-face interview 1 day before the operation, operation day, and postoperative days 1, 2, 3, and 4. The severity of pain was assessed daily using a visual analog scale. @*Results@#The most common preoperative concern was the severity of pain after the surgery (65.2%), followed by the need of transfusion (34.8%) and postoperative rehabilitation (32.6%). Among 29 patients who could recall the experience during the operation, 12 (41.4%) suffered from shoulder pain on the contralateral side, and 6 (20.7%) answered that hammering sound had been annoying. After returning to the ward, 29 patients (22.0%) suffered from nausea, 8 (6.1%) complained of back pain, and 7 (5.3%) had ipsilateral knee pain. On postoperative day 1, 7 patients (5.3%) had persistent back pain, 8 (6.1%) had headache, and 5 (3.8%) suffered from nausea. On postoperative day 2, nine patients (6.8%) complained of radiating pain due to aggravation of preexisting spinal stenosis, 7 (5.3%) complained of weakness of the hip flexor due to periarticular injection of ropivacaine during the operation, and 5 (3.8%) had dressing-related skin problem at the wound. On postoperative days 3 and 4, patients had no problem other than hip pain. The mean pain score was the highest (3.1 ± 1.0) on postoperative day 1. @*Conclusions@#The results of this study might provide information needed to solve problems and improve satisfaction of patients undergoing THA.

The Early- to Mid-term Outcome of Novel Cementless Modular Femoral Stem in East Asian Patients

Background@#Early firm fixation of the femoral implant is crucial in total hip arthroplasty (THA) with unstable metaphysis or a large degree of femoral bone loss. This study aimed to evaluate the outcomes of THA using a novel cementless modular, fluted, tapered stem in such cases. @*Methods@#From 2015 to 2020, 105 hips (101 patients) had surgery performed by two surgeons at two tertiary hospitals using a cementless modular, fluted, tapered stem for periprosthetic fractures, massive bone loss, prosthetic joint infection sequelae, or tumorous condition. Clinical outcomes, radiographic results, and survivorship of the implant were evaluated. @*Results@#The average follow-up period was 2.8 years (range, 1–6.2 years). The Koval grade was 2.7 ± 1.7 preoperatively and maintained at 1.2 ± 0.8 at the latest follow-up. The plain radiograph showed bone ingrowth fixation in 89 hips (84.8%). The average stem subsidence at postoperative 1 year was 1.6 ± 3.2 mm (range, 0–11.0 mm). Five reoperations (4.8%) were needed, including 1 for acute periprosthetic fracture, 1 for recurrent dislocation, and 3 for chronic periprosthetic joint infection. Kaplan-Meier survivorship with reoperation for any reason as the endpoint was 94.1%. @*Conclusions@#The early- to mid-term results of THA with the novel cementless modular, fluted, tapered THA stem system were satisfactory clinically and radiologically. The shortcomings inherent to its modularity were not identified. This modular femoral system may provide adequate fixation and be a practical option in the setting of complicated THA.

Incidence and Risk Factors of Short Axial Length of the Proximal Femur: A Caution in the Use of Femoral Neck System in Patients with Garden Type I/II Femoral Neck Fractures

Background@#In 2018, Femoral Neck System (FNS), a dedicated fixator for femoral neck fractures, was introduced. This device has been in increasing use because it provides excellent rotational and angular stability. However, the shortest bolt of FNS is 75 mm long. Thus, it is not usable when the axial length of the proximal femur (ALPF), the distance between the innominate tubercle and the surface of the femoral head, is less than 80 mm. In this study, we investigated the incidence and associated factors of small ALPF (< 80 mm) in femoral neck fracture patients. @*Methods@#We measured the ALPF on preoperative computed tomography (CT) scans of 261 patients (166 women and 55 men), who were operated due to nondisplaced or impacted femoral neck fractures. The ALPF was measured on reconstructed oblique coronal images along the femoral neck. We evaluated the distribution of ALPF, calculated the incidence of small ALPF (< 80 mm), and correlated it with patient’s height, weight, body mass index, age, bone mineral density (T-score), and caput-column-diaphysis angle. @*Results@#The ALPF ranged from 67.4 mm to 107.1 mm (mean, 88.4 mm; standard deviation, 7.2 mm). In 19 patients (8.6%, 19 / 221), the length was < 80 mm. The ALPF was strongly correlated with height (correlation coefficient = 0.707, R2 = 0.500, p < 0.001) and moderately correlated with weight (correlation coefficient = 0.551, R2 = 0.304, p < 0.001). The T-score was moderately correlated with the ALPF (correlation coefficient = 0.433, R2 = 0.187, p < 0.001). The age was moderately correlated with the ALPF (correlation coefficient = –0.353, R2 = 0.123, p < 0.001). @*Conclusions@#A considerable percentage of femoral neck fracture patients (8.6%) had small proximal femurs (ALPF < 80 mm), which cannot be operated with FNS. We recommend measuring the ALPF using reconstructed oblique coronal CT images or scaled hip radiographs: en face view of the femoral neck prior to surgery in patients with short stature and/or low body weight. If the ALPF is < 80 mm, the surgeon should prepare other fixation devices.

Midterm Results of Total Hip Arthroplasty for Osteonecrosis of the Femoral Head in Human Immunodeficiency Virus-Infected Patients in South Korea

Background@#Studies have reported that osteonecrosis of the femoral head (ONFH) is more prevalent in patients with human immunodeficiency virus (HIV). Total hip arthroplasty (THA) is considered reasonable management of ONFH. However, only scarce data exist on the outcomes of THA for HIV-infected patients in South Korea. The purpose of this study was to evaluate the midterm results of HIV-positive patients who underwent THA for ONFH. @*Methods@#We performed a retrospective review of HIV-infected patients with ONFH who underwent THA in our institution from 2005 to 2021. Twenty-two hips in 15 patients underwent THAs with cementless implants. The clinical and radiographic evaluation was performed at each follow-up, and any complication was recorded. @*Results@#The mean follow-up period was 5.2 years (range, 1.0–16.0 years). The mean age of the HIV infected patients with osteonecrosis at the time of surgery was 44.7 ± 11.6 years. ONFH occurred 9.8 ± 3.7 years after the initial diagnosis of HIV infection.The average modified Harris hip score improved from 58.3 ± 14.8 to 95.2 ± 11.3 at the latest follow-up. Surgical complications such as infection, nerve injury, or dislocation were not present. The radiographic evidence of stable fixation by bone ingrowth without migration was seen in all implants. @*Conclusions@#Our data suggest that THA is a safe and valid option of treatment for ONFH in well-controlled HIV-infected patients in Korea. Further large-scale nationwide studies are warranted.

Total Hip Arthroplasty Performed with a Novel Design Type 1 Femoral Stem: A Retrospective Minimum 5-Year Follow-up Study

Background@#The Bencox M stem is a mid-short type 1 stem with additional unique design features. It has a reduced stem length and a lateral shoulder to facilitate minimally invasive surgery, as well as an angular lateral shoulder and a trapezoidal neck to minimize stem-liner impingement. There have been many mid-term reports on type 1 stems, but no results have been reported so far on this novel design type 1 femoral stem. This study presents the clinical and radiological outcomes of total hip arthroplasty performed with the M stem after a minimum 5-year follow-up. @*Methods@#From July 2014 to February 2015, 125 primary total hip arthroplasties using the M cementless femoral stem were performed on 112 patients in our hospital. Among them, 94 patients (106 hips) were eligible for the study and were followed up for more than 5 years. Our primary outcome was clinical results, which were evaluated by the Harris Hip Score (HHS), thigh pain, noise, and other complications. Secondary outcome was radiological outcomes. Seventy-seven hips were evaluated radiologically with attention to implant fixation, migration, loosening of component, degree of stress shielding, radiolucent lines, focal osteolysis, heterotopic ossification, and the evidence of impingement between the stem and liner. @*Results@#The average HHS improved from 54.6 points (range, 24–67 points) to 96.8 points (range, 91–100 points) at the latest follow-up. Three hips (2.8%) had intermittent thigh pain, which was tolerable without medication. Five hips (4.7%) had ceramicrelated noise. There were no other complications such as infection, nerve injury, dislocation, or revision. All implants showed radiographic evidence of stable fixation by bone ingrowth without migration. Fifty-seven hips (74%) showed mild femoral stress shielding. Distal cortical hypertrophy was detected in 7 hips (9%), and heterotopic ossification was observed in 17 hips (22%). No implant demonstrated focal osteolysis and notching of the femoral neck or shoulder on radiographs. @*Conclusions@#The minimum 5-year results of total hip arthroplasty performed with the M cementless femoral stem were encouraging clinically and radiologically. A long-term follow-up will be necessary to evaluate its longevity.

Effectiveness of Online Video Instruction on Time to Start Ambulation and Duration of Hospital Stay, Satisfaction and Functional Recovery in Patients Undergoing Total Hip Arthroplasty

Background@#At the end of 2014, we implemented an online video to inform patients of the entire process from admission to rehabilitation after total hip arthroplasty (THA). In this study, we investigated the effectiveness of online video instruction in THA patients. @*Methods@#Electronic medical records of 184 patients undergoing THA in 2014 (pre-video group) and 182 patients in 2015 (post-video group) were reviewed. We compared 1) the time to start wheelchair ambulation, 2) walker or crutch ambulation, 3) the length of hospital stay, 4) postoperative satisfaction using visual analogue scale (0–10 points), and 5) modified Harris Hip Score (mHHS) at postoperative 6 weeks. @*Results@#In the post-video group, the time to start wheelchair ambulation (1.8 ± 0.6 vs. 2.4 ± 3.2 days, P = 0.021) and walker/crutch ambulation were faster (2.9 ± 1.2 vs. 3.8 ± 1.0 days, P = 0.016), and the hospital stay was shorter (8.2 ± 4.7 vs. 9.9 ± 7.8 days, P = 0.001) compared to the pre-video group. The visual analogue scale for satisfaction (7.84 ± 1.62 vs. 7.68 ± 1.85 points) and mHHS (89.59 ± 9.47 vs. 89.58 ± 8.59) were similar. @*Conclusion@#Online video instruction is an effective tool to expedite ambulation and reduce the hospital stay without compromising the clinical outcome and postoperative complications after THA.

Surgeons’ Awareness and Impaction Technique of a Ceramic Liner into a Metal Shell

Background@#In ceramic-on-ceramic total hip arthroplasty, firm locking is necessary between a ceramic liner and an acetabular metal shell to prevent dissociation of the liner from the metal shell. We evaluated surgeons’ awareness of the technique for inserting the ceramic liner and measured the impaction force applied by surgeons during the insertion of the ceramic liner. @*Methods@#To evaluate the awareness, we conducted a survey using a questionnaire including techniques for ceramic liner insertion. The impaction force was measured using an impaction simulator in 224 surgeons. @*Results@#Most surgeons answered that they cleaned and dried up the inner surface of the metal shell before inserting a ceramic liner (96.4% and 86.2%, respectively), and 74.6% checked the correct seating of the ceramic liner. However, only 23.2% correctly answered that a minimum of 2kN (a light strike) was necessary to obtain a sufficient fit between the metal shell and the ceramic liner. The impaction force was weaker than 2 kN in 9.4% of the surgeons. @*Conclusions@#Education about the adequate impaction force to obtain a firm fit of the ceramic liner is necessary for surgeons who perform total hip arthroplasty using ceramic-on-ceramic bearings

Osteonecrosis of the Femoral Head: an Updated Review of ARCO on Pathogenesis, Staging and Treatment

Non-traumatic osteonecrosis of the femoral head (ONFH) usually affects adults younger than 50 years and frequently leads to femoral head collapse and subsequent arthritis of the hip.It is becoming more prevalent along with increasing use of corticosteroids for the adjuvant therapy of leukemia and other myelogenous diseases as well as management of organ transplantation. This review updated knowledge on the pathogenesis, classification criteria, staging system, and treatment of ONFH.

Osteonecrosis of the Femoral Head: an Updated Review of ARCO on Pathogenesis, Staging and Treatment

Non-traumatic osteonecrosis of the femoral head (ONFH) usually affects adults younger than 50 years and frequently leads to femoral head collapse and subsequent arthritis of the hip.It is becoming more prevalent along with increasing use of corticosteroids for the adjuvant therapy of leukemia and other myelogenous diseases as well as management of organ transplantation. This review updated knowledge on the pathogenesis, classification criteria, staging system, and treatment of ONFH.

Vitamin D Deficiency and Sarcopenia in Hip Fracture Patients

Background@#Vitamin D plays a critical role in the proliferation and differentiation of skeletal muscle and bone metabolism. We compared the prevalence of vitamin D deficiency in elderly patients undergoing hip fracture surgery (HFS) with those undergoing elective primary total hip arthroplasty (THA). We also evaluated the association between vitamin D deficiency and sarcopenia. @*Methods@#This prospective study included 70 patients in the HFS group, and 100 patients in the elective THA group. The HFS group included 42 women, while the elective THA group included 74 women. The mean age in the HFS and elective THA groups was 79.8 and 75.4 years, respectively, and the mean preoperative Koval score was 2.1 and 2.3, respectively. Serum 25-hydroxy-vitamin D3 levels were measured by I125 radioimmunoassay. Bone mineral density and appendicular skeletal muscle mass (ASM) were measured using dual X-ray absorptiometry. Sarcopenia index was calculated by dividing ASM (kg) by the body mass index (kg/m2). Sarcopenia was diagnosed when the sarcopenia index was <0.789 in men and <0.512 in women. @*Results@#Serum vitamin D levels were lower, and the percentages of patients with vitamin D insufficiency and deficiency were higher in the HFS group than in the elective THA group. In the HFS group, the prevalence of sarcopenia was higher in men (57%, 16/28) than in women (29%, 12/42; P=0.025). @*Conclusions@#Vitamin D deficiency was more prevalent in patients undergoing HFS than in patients undergoing elective THA. Among patients undergoing HFS, vitamin D deficiency was more prevalent in sarcopenic than in non-sarcopenic patients.

Current and Future Burden of Periprosthetic Joint Infection from National Claim Database

Background@#Periprosthetic joint infection (PJI) is the most serious complication after total joint arthroplasty. The incidence and burden of PJI in North America have been reported.There might be potential differences according to ethnics and regional practices between western countries and East Asia. Nevertheless, its incidence in East Asia remains unknown.We aimed to evaluate the incidence and economic burden of PJI in Korea and to project the future burden. @*Methods@#We identified numbers of total hip arthroplasties, total knee arthroplasties and PJIs in Korea from 2010 to 2018 using medical claim data of Korean Health Insurance and Review and Assessment. Annual incidence and medical cost of PJI were calculated. We projected future burden of PJI through 2030 using Quasi-poisson regression model. @*Results@#The annual incidence of PJI ranged from 2.3% to 2.8% and the average cost per each PJI patient ranged from $4,361 to $6,016. Total annual cost of PJI increased from $8.0 million in 2010 to $18.0 million in 2018 and was projected to exceed $57.0 million by 2030. @*Conclusion@#The incidence of PJI in Korea is comparable with reported PJI incidence of 2.0%–2.7% in the United States. Our findings would be used for worldwide comparison of PJI epidemiology and establishment of healthcare policies for PJI in East Asia.

Current and Future Burden of Periprosthetic Joint Infection from National Claim Database

Background@#Periprosthetic joint infection (PJI) is the most serious complication after total joint arthroplasty. The incidence and burden of PJI in North America have been reported.There might be potential differences according to ethnics and regional practices between western countries and East Asia. Nevertheless, its incidence in East Asia remains unknown.We aimed to evaluate the incidence and economic burden of PJI in Korea and to project the future burden. @*Methods@#We identified numbers of total hip arthroplasties, total knee arthroplasties and PJIs in Korea from 2010 to 2018 using medical claim data of Korean Health Insurance and Review and Assessment. Annual incidence and medical cost of PJI were calculated. We projected future burden of PJI through 2030 using Quasi-poisson regression model. @*Results@#The annual incidence of PJI ranged from 2.3% to 2.8% and the average cost per each PJI patient ranged from $4,361 to $6,016. Total annual cost of PJI increased from $8.0 million in 2010 to $18.0 million in 2018 and was projected to exceed $57.0 million by 2030. @*Conclusion@#The incidence of PJI in Korea is comparable with reported PJI incidence of 2.0%–2.7% in the United States. Our findings would be used for worldwide comparison of PJI epidemiology and establishment of healthcare policies for PJI in East Asia.

Physicians’ Attitudes on Management of Osteopenia in South Korea

Background@#Osteopenia patients have a risk of fracture and may develop osteoporosis.We investigated physicians’ management of osteopenia patients in South Korea. @*Methods@#A survey was conducted using a questionnaire including 6 items: (1) do you think anti-osteoporosis medications are necessary in osteopenia patients?; (2) what is your preference to manage osteopenia patients, except for anti-osteoporosis medications?; (3) what is your indication for the anti-osteoporosis medication in osteopenia patients?; (4) what kind of anti-osteoporosis medication do you prefer to treat osteopenia patients?; (5) do you use bisphosphonates?; and (6) if not, what is the reason for not using?. @*Results@#Among the 173 participants, 150 (86.7%) replied that anti-osteoporosis medications were necessary in osteopenia patients. Indications for the medication were (1) past medical history of pathologic fracture in 85 (49.1%); (2) T-score <-2.5 on dual energy X-ray absorptiometry in 73 (42.2%); (3) previous history of osteoporosis in 44 (25.4%);(4) risk of fracture according to fracture risk assessment tool in 34 (19.7%); and (5) progressive bone loss in 31 (17.9%). One hundred and sixteen (67.1%) favored bisphosphonates, 93 (53.8%) selective estrogen-receptor modulator, and 24 (13.9%) hormone replacement therapy. Thirty-one (17.9%) replied that they do not use bisphosphonates due to (1) restricted reimbursement by the health insurance in 24 (77.4%); and (2) bisphosphonate-related complications in 19 (61.3%). @*Conclusions@#Most respondents (86.7%) thought anti-osteoporosis medications were necessary in osteopenia patients, but 17.9% of the respondents did not use bisphosphonates. Restricted reimbursement by the national health insurance was the major obstacle against the use of bisphosphonates.

Comparison of Central Corneal Thickness Measured by Swept-source Optical Coherence Tomography and Ultrasound Pachymetry

PURPOSE: To analyze and compare ultrasound pachymetry (USP) with a more recently adopted device, the intra ocular lens (IOL) master 700, which are both used to measure central corneal thickness. METHODS: The central corneal thickness was measured in 24 eyes of 12 glaucoma patients and in 83 eyes of 42 normal patients. First, the IOL master 700 was used to measure the central corneal thickness, followed by measurements taken using USP later. The results were analyzed using a paired t-test. We analyzed the agreement and the correlations between the two test devices by using Bland-Altman plots and the Pearson correlation test. To evaluate the reproducibility, measurements with the IOL master 700 were taken twice for a few normal patients within a small time interval. RESULTS: Via the IOL master 700, the thickness of the central cornea showed a high reproducibility and repeatability, demonstrating 2.7 ± 1.7 µm for the test-retest variability, 6.78% for the coefficient of variation, and 0.997 for the intraclass correlation value. The mean measurements using USP and the IOL master 700 are 554.4 ± 37.4 µm and 551.1 ± 37.1 µm, respectively, showing that the IOL master 700 measured significantly smaller values than USP with a p-value < 0.001. The deviations between the two methods are scattered throughout the 95% confidence interval. According to the Pearson correlation test, the measured values of the two test devices were found to have a highly positive correlation (r = 0.977, p < 0.0001). CONCLUSIONS: This study demonstrated that the central corneal thickness (CCT) measured via the IOL master was significantly thinner than that of USP, and the two test devices had a high correlation and good agreement. The CCT value measured via the IOL master 700 also exhibited high reproducibility.

Comparison of Automatic Pupillometer and Pupil Card for Measuring Pupil Size

PURPOSE: To compare the pupil sizes measured using the automatic pupillometer and pupil card. METHODS: We measured pupil sizes using a pupil card (Rosenbaum Card, J.G. Rosenbaum, Cleveland, OH, USA) and automated pupillometer (VIP(TM)-200, Neuroptics Inc., San Clemente, CA, USA) under different luminous intensities in 60 eyes of 60 patients who visited the ophthalmology clinic during August 2013. RESULTS: Under the photopic condition, pupil sizes measured using automated pupillometer were larger than those measured using the pupil card with statistical significance. The 2 techniques were not different under mesopic and scotopic conditions. Under all light conditions, automated pupillometer showed higher inter-rater reliability. Under the scotopic condition, pupil sizes measured using the pupil card were smaller than pupil sizes measured using the pupillometer according to increased pupil size. CONCLUSIONS: When compared with pupil card, automated pupillometer provided accurate and reliable measurement with small inter-rater variation and was easy and simple to use. However, based on comparable measurements of both techniques under mesopic and scotopic conditions, the pupil card can be used as preoperative evaluation when considering the cost of purchase and maintenance.

Clinical Efficacy of Topical Diquafosol Tetrasodium after Laser Epithelial Keratomileusis

PURPOSE: To evaluate the clinical effectiveness of topical diquafosol tetrasodium (DQS) after laser epithelial keratomileusis (LASEK). METHODS: This randomized prospective study included 97 eyes of 49 patients who were scheduled for LASEK. Patients in the DQS group used both 0.3% sodium hyaluronate and 3% DQS for 3 months after surgery while patients in the control group used only 0.3% sodium hyaluronate. Corneal staining score, tear film break-up time (TF-BUT), Schirmer test and ocular surface disease index (OSDI) were evaluated before surgery and 2, 4, 8, 12 and 16 weeks after surgery. RESULTS: There was no significant difference in visual acuity, spherical equivalent and corneal haziness between the 2 groups after surgery. Corneal staining score was significantly lower in the DQS group than in the control group 2 weeks after LASEK (p < 0.01) and increased in the control group after LASEK compared with the preoperative value (2 weeks after LASEK, p < 0.01), but decreased in the DQS group (12 and 16 weeks after LASEK, p < 0.05). TF-BUT was significantly higher in the DQS group than in the control group 2 to 16 weeks after LASEK (p < 0.01) and increased values were observed in the DQS group after LASEK compared with the preoperative value (4 to 16 weeks after LASEK, p < 0.05). The mean OSDI was significantly higher 4 to 16 weeks after LASEK in the control group than in the DQS group (p < 0.01). CONCLUSIONS: Subjective dry eye symptoms and objective markers were worse for 4 weeks after LASEK. The use of 3% DQS for 12 weeks after surgery improved these symptoms and markers with the effect lasting 16 weeks after LASEK.

Surface Ablation with 0.02% Mitomycin C for Retreatment after LASIK and LASEK

PURPOSE: To evaluate the efficacy and safety of surface ablation with mitomycin C (MMC) for the retreatment of refractive errors following laser-assisted in-situ keratomileusis (LASIK) and laser-assisted sub-epithelial keratectomy (LASEK). METHODS: In this retrospective clinical study conducted at a single center, we evaluated 23 eyes that received surface ablation with MMC (0.02%, 20 seconds) between 2009 and 2013 for the treatment of residual refractive errors following myopic LASIK and LASEK. All eyes were evaluated for corneal thickness, initial refractive error, time interval to retreatment, amount of retreatment, duration of postoperative topical steroids use as well as uncorrected vision, spherical equivalent and corneal haziness preoperatively and 1, 3, 6 and 12 months postoperatively. RESULTS: Initially corrected myopia in the LASIK group was -6.47 +/- 2.17 D and -5.68 +/- 2.51 D in the LASEK group. Mean time between initial and retreatment by surface ablation was 11.88 +/- 5.59 months for LASIK and 14.07 +/- 10.10 for LASEK. Retreat amount was 1.49 +/- 0.36 D after LASIK and -1.65 +/- 0.41 D after LASEK. At postoperative 12 months, uncorrected visions were -0.061 +/- 0.886 (log MAR) in the LASIK group and -0.004 +/- 0.745 (log MAR) in the LASEK group and spherical equivalents were -0.55 +/- 0.56 D in the LASIK group and 0.36 +/- 0.33 D in the LASEK group. Postoperative hazes developed in 1 of 8 LASIK eyes and 3 of 15 LASEK eyes which resolved with application of topical steroid for 2-3 months postoperatively. CONCLUSIONS: Surface ablation with 0.02% MMC is safe and highly effective for treating myopic regression following LASIK or LASEK. Application of 0.02% MMC for 20 seconds was effective in preventing postoperative haze formation and maintaining stable vision and spherical equivalent at 12 months after retreatment.

Surface Ablation with 0.02% Mitomycin C for Retreatment after LASIK and LASEK

PURPOSE: To evaluate the efficacy and safety of surface ablation with mitomycin C (MMC) for the retreatment of refractive errors following laser-assisted in-situ keratomileusis (LASIK) and laser-assisted sub-epithelial keratectomy (LASEK). METHODS: In this retrospective clinical study conducted at a single center, we evaluated 23 eyes that received surface ablation with MMC (0.02%, 20 seconds) between 2009 and 2013 for the treatment of residual refractive errors following myopic LASIK and LASEK. All eyes were evaluated for corneal thickness, initial refractive error, time interval to retreatment, amount of retreatment, duration of postoperative topical steroids use as well as uncorrected vision, spherical equivalent and corneal haziness preoperatively and 1, 3, 6 and 12 months postoperatively. RESULTS: Initially corrected myopia in the LASIK group was -6.47 +/- 2.17 D and -5.68 +/- 2.51 D in the LASEK group. Mean time between initial and retreatment by surface ablation was 11.88 +/- 5.59 months for LASIK and 14.07 +/- 10.10 for LASEK. Retreat amount was 1.49 +/- 0.36 D after LASIK and -1.65 +/- 0.41 D after LASEK. At postoperative 12 months, uncorrected visions were -0.061 +/- 0.886 (log MAR) in the LASIK group and -0.004 +/- 0.745 (log MAR) in the LASEK group and spherical equivalents were -0.55 +/- 0.56 D in the LASIK group and 0.36 +/- 0.33 D in the LASEK group. Postoperative hazes developed in 1 of 8 LASIK eyes and 3 of 15 LASEK eyes which resolved with application of topical steroid for 2-3 months postoperatively. CONCLUSIONS: Surface ablation with 0.02% MMC is safe and highly effective for treating myopic regression following LASIK or LASEK. Application of 0.02% MMC for 20 seconds was effective in preventing postoperative haze formation and maintaining stable vision and spherical equivalent at 12 months after retreatment.

Conjunctival Flap Surgery Using Calcium Plaque Scissors for Calcified Scleromalacia after Cosmetic Conjunctivectomy

PURPOSE: To research the advantage of using calcium plaque scissors in conjunctival flap surgery for calcified scleromalacia after cosmetic conjunctivectomy. METHODS: We analyzed 55 eyes that had undergone conjunctival flap surgery for calcified scleromalacia occurring after cosmetic conjunctivectomy. Surgical blade was used in 30 eyes (Group 1) and calcium plaque scissors in 25 eyes (Group 2). Time after conjunctivectomy, plaque size, operation time and visual acuity before and after the flap surgery were analyzed and compared. Additionally, necessity of additional scleral surgery was evaluated. Optical coherence tomography (OCT) of the sclera was performed both pre- and postoperatively and the results were compared. RESULTS: An average of 3.9 +/- 1.0 years elapsed until conjunctival flap surgery and follow-up time was 5.2 +/- 3.8 months. Post conjunctivectomy time and plaque size were similar in both groups (p = 0.87 and 0.49, respectively). The surgery time in Group 2 was shorter than in Group 1 (17.5 +/- 6.3 minutes and 21.9 +/- 8.5 minutes, respectively, p = 0.20). Uncorrected visual acuity was similar in both groups before and after conjunctival flap surgery (p = 0.53 and p = 0.20, respectively). In Group 1, one sclera transplantation and three Ologen(TM) insertion surgeries were performed as an additional scleral surgery. Based on OCT, calcium plaque scissors were confirmed as a new surgical tool for calcium plaque removal with minimal scleral damage. CONCLUSIONS: Using calcium plaque scissors when performing conjunctival flap surgery for calcium plaque removal that occurred after cosmetic conjunctivectomy reduces the necessity of an additional scleral surgery and surgery time.