Research progress of obstructive sleep apnea hypopnea syndrome and ocular surface diseases / 国际眼科杂志(Guoji Yanke Zazhi)

Obstructive sleep apnea hypopnea syndrome(OSAHS)is a group of diseases which occurred in the upper respiratory tract with transient, recurrent, partial or complete obstruction during night sleep. It can affect the regulation of hemodynamics, endocrine systems and autonomic nerve, and then result in the reduction of body oxygen saturation, chronic hypoxia and hypercapnia. Beside being an independent risk factor for cardiovascular and cerebrovascular diseases, many studies have shown that it is also associated with ocular surface diseases in OSAHS, such as floppy eyelid syndrome, dry eye, keratoconus, etc., but there is still a lack of perfect systematic analysis. This paper reviews the relationship between OSAHS and relevant ocular surface diseases including pathogenesis,clinical manifestations and treatment progress, in order to reduce the ophthalmic complications of OSAHS patients in clinical diagnosis and treatment,and better improve the quality of life of patients.

Laparoscopic floppy Nissen fundoplication: evaluation of outcome in 34 patients operated without prior oesophageal pH and manometry

Background: Aim of the study was to evaluate prospectively the outcomes of laparoscopic floppy Nissen fundoplication in cohort of patients with typical symptoms of gastroesophageal reflux disease (GERD) and hiatus hernia without pre-operative 24 hours oesophageal pH and manometry study. Methods: Thirty-four patients with typical symptoms of GERD, from March 2009 to November 2019, were studied. The study was limited to patients with positive findings on upper GI endoscopy done by operating surgeon with typical symptoms (heartburn, regurgitation, and dysphagia) of GERD and hiatal hernia. Laparoscopic Nissen’s fundoplication was performed when clinical assessment suggested adequate oesophageal motility and length. Only 1 patient, who had negative endoscopic findings, underwent a 24-hour pH-monitoring before surgery. Outcome measures included assessment of the relief of the primary symptom responsible for surgery in the early postoperative period; the patient's evaluation of outcome and quality of life after surgery.Result: Laparoscopic Nissen’s fundoplication is an effective long-term treatment for GERD and may be performed in patients with typical symptoms of GERD and hiatus hernia and endoscopic findings suggestive of reflux esophagitis and patient who wants to get rid of life long proton-pump inhibitors (PPI) and antacids medication.Conclusions: Preoperative oesophageal manometry and 24-hour pH monitoring are not mandatory for laparoscopic fundoplication if the patient selection is appropriate but may be required in selected patients with atypical symptoms.

Intraoperative Floppy Iris Syndrome in patients on alpha 1 blocker tamsulosin: incidence and predictability

Background: Intraoperative Floppy Iris Syndrome (IFIS) was first described by Chang and Campbell in year 2005 in male patients undergoing phacoemulsification surgery who were on Tamsulosin, an alpha 1 blocker drug for their urinary symptoms for enlarged prostate. This condition was characterized by excessive floppiness of iris, prolapse of iris tissue through phaco and sideport incisions and progressive intraoperative miosis, resulting in increased surgical time and various major surgical complications compromising visual outcome.Methods: This study of 78 patients was undertaken to know the incidence and severity of IFIS as well as to predict its occurrence by observing maximum pupil dilation achieved preoperatively.Results: It was observed that majority of patients on tamsulosin dilated poorly and severe IFIS occurred in those with pupil dilation of 5 mm or less after putting mydriatic eye drops preoperatively.Conclusions: It was concluded that if IFIS was predicted and necessary precautions taken, postoperative complications can be reduced significantly with improved visual outcome.

Relation of diabetes mellitus with intraoperative floppy - iris syndrome during phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To explore relation of diabetes mellitus with intraoperative floppy - iris syndrome ( IFIS) during phacoemulsification. METHODS: Thirty patients with IFIS who underwent phacoemulsification were enrolled as IFIS group. The patients in whom IFIS did not appear were as the control group. The baseline data of two groups were collected. The risk factors of IFIS in phacoemulsification were analyzed by Logistic regression analysis. The forecasting indicators of IFIS were analyzed by ROC curve. RESULTS: Logistic regression analysis showed that diabetes (Exp (B)= 1.514, 95% CI: 0.842-5.281], fast plasma glucose (FPG) [Exp (B)= 1.958,95% CI:1.163-11.728],HbA1c [Exp(B)= 2.044,95% CI:1.409-14.620] and the history of application of α-1 receptor antagonists [Exp (B) = 1. 791, 95% CI: 1. 128 - 10. 752] were independent risk factors for IFIS in cataract phacoemulsification. The AUC of FPG predicting IFIS was 0.645. And The AUC of HbA1c predicting IFIS was 0.767. The sensitivity of FPG >7.0mmol/L predicting IFIS was 0 849, the specificity was 0.241. The sensitivity HbA1c>9 0% predicticting IFIS,was 0.733,specificity was 0.600. CONCLUSION: The occurrence of IFIS in phacoemulsification is related to the history of of diabetes, FPG, HbA1c and application of α-1 receptor antagonist. The preoperative measure HbA1c has a good predictive value of IFIS.

A study of risk factors and predictive factors in intraoperative floppy iris syndrome during phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To determine the incidence of intraoperative floppy iris syndrome (IFIS) in patients undergoing phacoemulsification in a Chinese hospital,and to assess new risk factors and predictive factors for IFIS.METHODS:A prospective,observational case series.In the consecutive cataract surgeries performed in one year,the medicine administration,pupil size (PS)before and after mydriasis,and signs of IFIS were recorded.RESULTS:Totally 807 patients (1068 eyes) underwent cataract surgeries.Among the 1068 eyes,signs of IFIS were noted in 34 eyes.Strong positive correlations were showed between finasteride (6.4％,OR =5.885),tamsulosin (25％,OR=21.578),reserpine (16.7％,OR=12.947),clozapine (66.7％,OR=139.467),post-panretinal photocoagulation (14.3％,OR =10.789) and IFIS.Pupil size was inversely related to IFIS incidence (P＜0.001).A dilated pupil smaller than 7.25mm could predict iFiS (P＜0.001).CONCLUSION:The incidence rate of IFIS was 3.18％.Reserpine,clozapine and post-panretinal photocoagulation emerged as new risk factors for IFIS.A small dilated pupil may imply IFIS occurrence.

Clinical efficacy of coaxial microincision phacoemulsification for intraoperative floppy iris syndrome during cataract surgery / 眼科新进展

Objective To evaluate the clinical efficacy of coaxial micro-incision phacoemulsification for intraoperative floppy iris syndrome (IFIS) during cataract surgery.Methods A prospective randomized control study was conducted in 80 patients (80 eyes) taking tamsulosin more than two weeks with age-related cataract from October 2014 to October 2016.All cases were randomly divided into microincision group (MICS group) and standard incision group (SICS group),40 cases in each group.Coaxial 1.8 mm microincision cataract surgery was performed in the MICS group,and coaxial 2.6 mm standard incision cataract surgery was performed in the SICS group.The incidence and the degree of IFIS and complications were recorded during the operation.The uncorrected visual acuity (UCVA) was compared at 1 day,1 week,1 month after surgery.Results At postoperative 1 day,1 week and 1 month,UCVA was 0.83 ± 0.12,0.86 ±0.10,0.89 ±0.11 in the MICS group,and was 0.71-±0.12,0.75 ±0.11,0.83 ±0.12 in the SICS group,there were statistical differences (all P ＜ 0.05),the UCVA of MICS group was better than that of SICS group.The incidence of IFIS was 60.0％ in the MICS group,and 82.5％ in the SICS group,there was statistical difference (P ＜ 0.05).There was statistical difference on degree of IFIS between two groups (P ＜ 0.05),the degree of IFIS in the MICS group was lower than that in the SICS group.Conclusion The coaxial microincision phacoemuisification is a safe and effective surgery for the patients with cataract and high risk of IFIS.

Clinical study on intraoperative floppy iris syndrome / 眼科新进展

In recent years,there are many studies have reported that a small pupil syndrome appeared during routine phacoemulsification in patients with current or previous use of alpha-1 adrenergic receptor antagonists,with these clinical manifestations:an iris that appears floppy as it billows during normal irrigation and aspiration in the anterior chamber,a tendency for the iris to prolapse and progressive intraoperative miosis during surgery,which called intraoperative floppy iris syndrome This article mainly reviews the mobidity,pathogenesis,clinical features,complications,prophylaxis and treatment of the intraoperative floppy iris syndrome.

Frecuencia y factores pronósticos del síndrome de iris laxo intraoperatorio / Frequency and prognostic factors of the intraoperative floppy iris syndrome

Objetivo: evaluar la frecuencia, los factores pronósticos y el impacto del síndrome de iris laxo intraoperatorio en operaciones de catarata. Métodos: se realizó un estudio de cohorte prospectivo y longitudinal, donde se evaluaron 139 operaciones de catarata realizadas por un solo cirujano, de los cuales 49 ojos (35,3 por ciento) presentaron síndrome de iris laxo intraoperatorio. Se realizó un análisis univariado y multivariado con variables demográficas, antecedentes patológicos personales, uso de medicamentos, características anatómicas del iris, parámetros biométricos y complicaciones intra y posoperatorias. Resultados: en el análisis univariado las variables significativas pronósticas para la aparición de síndrome de iris laxo intraoperatorio fueron: el consumo de psicofármacos (p= 0,001), la cámara anterior estrecha (p= 0,001) y la dilatación pupilar preoperatoria regular o mala (p= 0,001). En el análisis multivariado la cámara estrecha fue, de todas las variables independientes, la que mayor influencia tuvo en la aparición de síndrome de iris laxo intraoperatoriocon una alta significación (p= 0,001). El síndrome de iris laxo intraoperatorio aumentó el riesgo de complicaciones intra y posoperatorias. Conclusiones: con una correcta anamnesis y un examen oftalmológico podemos predecir la ocurrencia de síndrome de iris laxo intraoperatorio durante la cirugía de catarata. El consumo de psicofármacos, la cámara anterior estrecha y la dilatación pupilar preoperatoria regular o mala se pueden considerar factores pronósticos de síndrome de iris laxo intraoperatoriodesde el preoperatorio(AU)

Objective: to evaluate the frequency, the prognostic factors and the impact of the intraoperative floppy iris syndrome in cataract surgery. Method: a prospective and longitudinal cohort study of 139 cataract surgeries performed by the same surgeon, of which 49 eyes (35,3 pércent) presented with intraoperative floppy iris syndrome. An univariate/multivariate analysis was made taking on account demographic, personal history of pathologies, use of medications, anatomical characteristics of the iris, biometric parameters and complications during and after the surgery. Results: in the univariate analysis, the significant prognostic variables for the intraoperative floppy iris syndrome were consumption of antipsychotics (p= 0,001), narrow anterior chamber (p= 0,001) and regular or bad dilated pupil (p= 0,001) before surgery. In the multivariate analysis, the narrow anterior chamber was, among all the independent variables, the most influential for the onset of the intraoperative floppy iris syndrome, with a highly significant association (p= 0,001). The intraoperative floppy iris syndrome increased the intra and postoperative risk for complications. Conclusions: correct interrogation and an eye exam can predict the occurrence of intraoperative floppy iris syndrome during the cataract surgery. The use of antipsychotics, the narrow anterior chamber and regular or bad pupil dilation before the surgery can be considered as prognostic factors for the intraoperative floppy iris syndrome(AU)

Congenital Guillain-Barre Syndrome: A Rare Entity

A term male infant presented with generalized hypotonia, paucity of lower limb movements, and diminished muscle stretch reflexes. At 3 weeks of age, motor nerve conduction studies demonstrated evidence of demyelination and axonal involvement. These findings indicated demyelination and patient was diagnosed to have congenital Guillain-Barre syndrome. Improvement was seen after a course of IVIG. We are reporting this case because of rarity of its occurrence and should be considered in differential diagnosis in floppy neonate.

MINIMALLY INVASIVE TREATMENT OF POSTERIOR CRUCIATE LIGAMENT AVULSION FRACTURE IN A FLOPPY LATERAL POSITION / 中国修复重建外科杂志

OBJECTIVE: To conclude the effectiveness of arthroscopy combined with Burks and SchaVer's approach in the treatment of posterior cruciate ligament (PCL) avulsion fractures in a floppy lateral position. METHODS: Between May 2010 and March 2014, 21 patients with PCL avulsion fractures were treated. There were 13 males and 8 females, aged 21 to 62 years (mean, 39.1 years). The causes included traffic accident injury in 10 cases, sports injury in 5 cases, and falling injury from height in 6 cases. The time from injury to hospital was 1-6 days (mean, 2.5 days). The results of posterior drawer test were all positive, and the results of anterior drawer test and lateral stress test were all negative. The Lysholm score was 28.0±5.5 before operation. And the American Orthopaedic Foot and Ankle Society (IKDC) score was 46.2±7.6 before operation. According to Meyer standards for fractures classification, 11 cases were rated as type II and 10 cases as type III. Arthroscopy was used to inspect and treat the intra-articular lesions, then avulsion fracture was fixed by Burks and SchaVer's approach in lateral position. Postoperative functional exercises were performed. RESULTS: Primary healing of incision was obtained, without nerve and vascular injury or joint infection. All patients were followed up 18-36 months (mean, 27.2 months). The X-ray films of the knee joint showed good fractures reduction and healing at 3 months after operation. The results of posterior drawer test and reverse Lachman test were negative. The knee range of motion was recovered to normal level. At last follow-up, the Lysholm score of the knee joint was significantly improved to 90.9±1.4 from preoperative one (t=54.584, P=0.000), and the IKDC score was significantly increased to 90.5±5.3 from preoperative one (t=15.638, P=0.000), including 19 cases of grade A and 2 cases of grade B. CONCLUSIONS: A combination of arthroscopy and Burks and SchaVer's approach for the treatment of PCL avulsion fractures in a floppy lateral position has the advantages of minimal invasion and safe approach, short operative time, and early postoperative rehabilitation exercises, so it can provide satisfactory function recovery of the knee joint.

Research progress of intraoperative floppy iris syndrome during phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

? Intraoperative floppy iris syndrome is a particular symptom in phacoemulsification, and it is often occurred in patients with the history of using alpha-1 adrenergic antagonist before cataract surgery. Although the pupil be fully mydriatic before the operation, the progressive constricting of the pupil, the relaxing of iris even the iridoptosis and the unstable anterior chamber still can be found during the phacoemulsification. If treated inappropriately, severe complications and terrible outcomes may happen, which would influenced the surgery effectives. This paper reviewed the epidemiological characteristics, pathogenesis, risk factors, clinical manifestations, complications, and coping strategies of the intraoperative floppy iris syndrome.

Enfoque clínico del recién nacido y lactante hipotónico / Neonatal hypotonia

El síndrome del niño hipotónico es una entidad bien reconocida por pediatras y neonatólogos. Se refiere a un niño con hipotonía generalizada presente desde el nacimiento o infancia precoz. Es el signo de disfunción neurológica más frecuente en el recién nacido y lactante, resultado de injurias agudas o crónicas a cualquier nivel del sistema nervioso, desde la corteza cerebral al músculo. Por la multiplicidad de causas y condiciones que subyacen a la hipotonía es imprescindible un enfoque ordenado y sistemático en la evaluación del niño hipotónico.

Floppy infant syndrome is a well recognized entity for pediatricians and neonatologists. It refers to a child with decreased muscle tone present at birth or in early infancy. It is the commonest sign of neurological dysfunction in newborns and infants, which can result from acute or chronic injuries at any level of the nervous system from cerebral cortex to muscle. Because of the multiple causes and conditions underlying hypotonia, asystematic assessment is essential in the approach to the floppy infant.

Incidence and Risk Factors of Intraoperative Floppy Iris Syndrome During Cataract Surgery

PURPOSE: To determine the incidence and risk factors of intraoperative floppy iris syndrome (IFIS) in patients undergoing cataract surgery. METHODS: The present study included 981 eyes of 655 patients who underwent cataract surgery and development and grade of IFIS were recorded. Correlation analysis was performed to determine the relationship between the IFIS and risk factors such as alpha1-adrenergic antagonist (tamsulosin, terazosin, alfuzosin), benzodiazepine, 5-alpha-reductase inhibitor, age, gender, hypertension, diabetes and glaucoma. RESULTS: IFIS developed in 178 eyes (18.1%) out of 981 eyes. There was a correlation between the development of the IFIS and alpha1-adrenergic antagonist and benzodiazepine and male gender; however, there was no correlation with 5-alpha-reductase inhibitor, age, gender, hypertension, diabetes and glaucoma. IFIS grade tended to be higher as the cumulative dosage of the alpha1-adrenergic antagonist increased. Odds ratio of the patients using tamsulosin was the highest among the other risk factors, which was 3.8 times higher than the patients using terazosin, 9.0 times higher than the patients using alfuzosin and 11.1 times higher than the patients using benzodiazepine. Among patients who underwent cataract surgery on both eyes and who were confirmed with IFIS in 1 or both eyes, no significant grade differences between the 2 eyes were noted. CONCLUSIONS: Alpha 1-adrenergic antagonist and benzodiazepine were risk factors for the development of the IFIS, and as the cumulative dosage of the alpha1-adrenergic antagonist increased, the probability of developing a higher grade of IFIS increased. Therefore, predicting and preparing for potential IFIS in patients who have the above-mentioned risk factors are necessary before planning cataract surgery. Additionally, the IFIS aspect of the first eye could be utilized as a predictive value for developing IFIS profile of the fellow eye.

Congenital combined eyelid imbrication and floppy eyelid syndrome: Case report and review of literature.

was in sleep, bilateral medial and lateral canthal tendon laxity and tarsal conjunctival hyperemia. We report a third case of congenital combined eyelid imbrication and floppy eyelid syndrome in healthy neonate that was resolved within a week with conservative treatment.

Floppy iris syndrome with oral imipramine: A case series.

Intraoperative floppy iris syndrome (IFIS) has commonly been seen with long-term use of α1-adrenoceptor blocking agents. We observed IFIS in three patients during phacoemulsification due to oral imipramine therapy. The three patients took imipramine for 25 years, 10 months and 1 year, respectively. However, only the first patient was on oral therapy at the time of surgery, while the other two patients had stopped 4 months and 2 months prior to undergoing phacoemulsification. The first and third patients developed complete IFIS features, while the second had only partial IFIS characteristics. Phacoemulsification could be completed in all three patients without any complication. None of these patients had history of taking any of the α1-adrenoceptor blocking agents. This is the first anecdotal report of IFIS with the oral use of imipramine and hence further evidences are required to ascertain the association of oral imipramine therapy and IFIS. However, ophthalmologists undertaking phacoemulsification on patients on imipramine therapy should be alert for the occurrence of IFIS.

The Effect of alpha1-Adrenergic Blocker on Phacoemulsification

PURPOSE: To evaluate the influence of alpha1-adrenergic blocker on phacoemulsification and the preventive effect of adrenergic blocker (AB) cessation before cataract surgery. METHODS: A prospective study was performed involving 92 eyes of 60 patients undergoing cataract surgery. Cases were divided into three groups: the use of alpha1AB with discontinuance before surgery (32 eyes), the use of alpha1AB with no discontinuance before surgery before surgery (31 eyes), and eyes not treated with alpha1AB (29 eyes). Clinical measurements and intraoperative parameters were compared among the three groups. RESULTS: Preoperative maximum pupil diameters of patients treated with alpha1AB were smaller than those of patients not administered alpha1AB (p = 0.027 and p = 0.018, respectively). The incidence of IFIS in the patients using of alpha1AB with discontinuance before surgery was 6.25%, and that in the patients using of alpha1AB with no discontinuance before surgery was 6.45%. There was no IFIS outbreak in the patients not using of alpha1AB. We noted no significant differences in absolute phaco time during phacoemulsification (p = 0.207) or in the three-month postoperative best corrected visual acuities among the three groups (p = 0.189). CONCLUSIONS: Importantly, there appears to be a significant correlation between alpha1AB and the development of IFIS. To prevent complications of IFIS, surgeons should be vigilant in identifying patients taking alpha1AB, checking the degree of preoperative pupil dilatation and anticipating intraoperative difficulties. In addition, appropriate modifications should be made to the surgical strategy. Furthermore there was no benefit to discontinuing alpha1AB treatment before cataract surgery in the prevention of IFIS.

Congenital Myotonic Dystrophy with Asymptomatic Mother.

Myotonic dystrophy is an autosomal dominant neuromuscular disorder characterised by extreme pleiotropism and variability in disease expression. A congenital form is rare and is observed in infants born to symptomatic mothers with multisystem involvement. We report a case of a neonate with congenital myotonic dystrophy born to an asymptomatic mother.

Anterior-posterior approach internal fixation and reduction for complex acetabular fractures / 中华创伤杂志

Objective To evaluate the curative effect of ilio-inguinal and Kocher-Langenbeck (K-L) approach internal fixation and reduction in the treatment of acetabular fractures in a floppy lateral position.Methods A retrospective study was done on 31 patients treated from February 2005 to March 2009,including 15 patients with complex acetabular fractures treated with ilio-inguinal and K-L approach internal fixation and reduction in a floppy lateral position ( Group A) and 16 patients with complex acetabular fractures treated with anterior ilio-inguinal approach and posterior K-L approach internal fixation and successive reduction in a floppy lateral position Group B).Operation time,intra-operative blood loss,number of X-ray fluoroscopy times,degree of postoperative reduction,results of Merled' Aubigne and Postel scores as well as the rate of postoperative complications were recorded.Results All the patients were followed up for 15-27 months.In Groups A and B,the operation time was for ( 176 ± 17 ) minutes and ( 196 ± 23 ) minutes ( P ＜ 0.05 ),the intra-operative blood loss for ( 880 ± 16) ml and (874 ± 19) ml (P＞0.05),the number of X-ray fluoroscopy times for 6 ±2 and 14 ±6 respectively ( P ＜ 0.05 ).According to Mata analysis standard,the postoperative fracture reduction was anatomical in 11 patients (73％),good in three and poor in one in Group A; while the postoperative fracture reduction was anatomic in nine patients 56％ ),good in five and poor in two in Group B.The rate of anatomical reduction between the two groups had statistical difference (t =2.731,P ＜ 0.05 ).The modified Merled' Aubigne and Postel score system showed excellence rate of joint function of 93％ ( 14/15 ) in Group A and 75％ (12/16) in Group B,with statistical difference ( x2 =15.292,P ＜ 0.05).There was no statistical difference in the aspect of postoperative complications between the two groups,such as heterotopic ossification,traumatic arthritis,avascular necrosis of the femoral head,nerve injury and so on.Conclusions In a floppy lateral position,combined ilio-inguinal and K-L approach internal fixation and reduction takes advantages of sufficient exposure,good reduction,strong fixation,short operation time and few complications in the treatment of certain complex acetabular fractures,while its long-term effects are worthy of further clinical researches.

Benign prostatic hyperplasia: clinical treatment can complicate cataract surgery

PURPOSE: To investigate the effects of alpha-1 adrenergic receptor antagonists for the treatment of benign prostatic hyperplasia (BPH) regarding potential risks of complications in the setting of cataract surgery. AIM: To address recommendations, optimal control therapy, voiding symptoms and safety within the setting of cataract surgery. MATERIALS AND METHODS: A comprehensive literature review was performed using MEDLINE with MeSH terms and keywords "benign prostatic hyperplasia", "intraoperative floppy iris syndrome", "adrenergic alpha-antagonist" and "cataract surgery". In addition, reference lists from identified publications were reviewed to identify reports and studies of interest from 2001 to 2009. RESULTS: The first report of intraoperative floppy iris syndrome (IFIS) was observed during cataract surgery in patients taking systemic alpha-1 AR antagonists in 2005. It has been most commonly seen related to use of tamsulosin. Changes of medication and washout periods of up to 2 weeks have been attempted to reduce the risk of complications in the setting of cataract surgery. CONCLUSION: Patients under clinical treatment for BPH should be informed about potential risks of this drug class so that it can be discuss with their healthcare providers, in particular urologist and ophthalmologist, prior to cataract surgery.