Postoperative changes of anterior chamber depth and lens suspensory ligament in patients with ultra-high myopia and cataract and related influencing factors / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the changes of anterior chamber depth(ACD)and lens suspensory ligament after phacoemulsification and intraocular lens(IOL)implantation in patients with ultra-high myopia cataract and related influencing factors.METHODS: A total of 45 patients(60 eyes)with ultra-high myopia and cataract in our hospital from October 2016 to December 2022 were selected. All patients received phacoemulsification and IOL implantation. The patients were randomly divided into implantation group and non-implantation group. Implantation group was combined with capsular tension ring(CTR)implantation, and non-implantation group did not implant CTR during operation. The changes of ACD and lens suspensory ligament length before and after operation were compared and the correlation was analyzed. To observe the differences of ACD and the length of lens suspensory ligament between the two groups before and after operation.RESULTS: The ACD of patients with ultra-high myopia complicated with cataract at 1 and 3mo after operation was higher than that before operation(all P<0.05). The positions of 3:00, 6:00, 9:00, 12:00 and the average length of lens suspensory ligament at 1 and 3mo post-operation were shorter than those pre-operation(all P<0.05). There was no significant difference in the positions of 3:00, 6:00, 9:00, 12:00 and average length of suspensory ligament between 1mo and 3mo after operation(all P>0.05). The preoperative average length of lens suspensory ligament in patients with ultra-high myopia cataract was positively correlated with the ocular axis and the preoperative ACD(all P<0.05). There was no significant difference in ACD between the implantation group and the non-implantation before and at 1 and 3mo after operation(P>0.05). There was no significant difference in the length of lens suspensory ligament between implantation group and non-implantation group at the position of 6:00 before operation and 1mo after operation(P>0.05), but there was difference in lens suspensory ligament between groups at 3mo after operation and the position of 6:00(P<0.05). Furthermore, there was no significant difference at the positions of 3:00, 9:00, 12:00 and the average length of lens suspensory ligament between the implantation group and non-implantation group before and at 1 and 3mo after operation(P>0.05).CONCLUSION: The ACD deepen and lens suspensory ligament shortened in patients with ultra-high myopia and cataract after phacoemulsification; the length of lens suspensory ligament was affected by the combined use of CTR.

Ultrasonographic, macroscopic and histological characterization of the proximal insertion of the suspensory ligament in Crioulo horses / Caracterização ultrassonográfica, macroscópica e histológica da inserção proximal do ligamento suspensório em cavalos Crioulos

Although ultrasound (US) is a routine diagnostic modality, it still presents limitations for the diagnosis of lesions such as those in the proximal insertion of the suspensory ligament (PISL) because of its composition, which includes muscle fibers and adipose tissue interspersed with the ligament fibers. The objective of the present study was to describe the ultrasonographic, macroscopic and histological aspects of the PISL of thoracic limbs (TL) and pelvic limbs (PL) in Crioulo horses (CH). We selected 34 specimens of TL (right and left) and 10 specimens of PL of horses with a mean age of 5.7 years, from a private clinic or sent to the Department of Veterinary Pathology of UFSM, which died from different causes. The animals had no previous history of lameness in selected limbs associated with PISL injuries. The 34 specimens of PISL of TL were divided into CH (n=25) and Thoroughbred horses (TBH) (n=9), which composed the control group, and 11 specimens of PISL of PL were divided into CH (n=8) and TBH (n=3), which also served as control. The US examination was performed in the PISL using a Sonosite Edge device, 5-10 MHz linear transducer, with cross-sectional and longitudinal palmaromedial and palmarolateral images of the proximal surface of metacarpus III, II and IV (MCIII/MCII/MCIV). In PL, the evaluation was performed four centimeters below the chestnut in the plantaromedial aspect of metatarsus III and II (MTIII/MTII). PISL lobulated shape and size were compared with those of the contralateral limb, as well as the regularity of the palmar bone surface of MC III, II and IV. Subsequently, dissection of the PISL lobes was performed, as well as its macroscopic evaluation, which preceded the histological processing of the samples. In specimens of the CH breed, PISL showed echogenicity varying from peripheral dorsal hyperechogenic zones that merge into echogenic and hypoechogenic zones, where lobulation occurs. In the samples from the TBH group, PISL was also lobulated, but with differences in the echogenicity pattern such as diffuse hypoechogenicity and echogenicity. Macroscopically, CH samples presented a large amount of adipose tissue that corresponds to the dorsal peripheral zone of PISL, which ends in the connective tissue that delimits the ligamentous lobes. On a macroscopic cross-section of PISL, muscle fibers in red are mixed with white ligament fibers in the center of the ligament. This macroscopic finding was not observed in TBH samples, in which muscle fibers overlap ligament fibers throughout the ligament extension and a small amount of fat is present in the dorsal periphery of the ligament. PISL of PL had a triangular shape with echogenicity characteristics very similar to those observed in TL. In ultrasonographic, macroscopic and histological evaluation, PISL samples of TL and PL in CH showed a larger amount of peripheral dorsal adipose tissue, as well as a larger number of merged ligament and muscle fibers compared with those in TBH.(AU)

Embora uma modalidade diagnóstica rotineira, a ultrassonografia ainda possui algumas limitações para o diagnóstico de lesões como as que afetam a inserção proximal do ligamento suspensório (IPLS). Uma dessas limitações é relacionada à composição desse ligamento que inclui fibras musculares e tecido adiposo intercalados entre as fibras ligamentares. O objetivo do presente trabalho foi descrever os aspectos ultrassonográficos (US), macroscópicos e histológicos da IPLS de membros torácicos (MT) e membros pélvicos (MP) de equinos da raça crioulo (CC). Foram selecionados 34 espécimes de MT (direito e esquerdo) e 10 espécimes de MP de equinos com idade média de 5,7 anos, que vieram a óbito por diferentes causas, oriundos de uma clínica privada ou destinados ao Laboratório de Patologia Veterinária da UFSM. Não havia histórico prévio de claudicações nos membros selecionados que pudessem estar relacionadas a lesões da IPLS. Os 34 espécimes da IPLS MT foram divididos pela raça CC (n=25) e Puro Sangue Inglês (PSI) (n=9), o qual serviu como grupo controle e, 11 espécimes da IPLS do MP divididos em raça CC (n=8) e PSI (n=3) também como grupo controle. O exame US foi realizado na IPLS com um aparelho Sonosite Edge, transdutor linear de 5-10 MHz, com imagens transversais e longitudinais palmaromedial e palmarolateral da face proximal do metacarpiano (MC) III, II e IV. No MP a avaliação foi realizada quatro centímetros abaixo da castanha no aspecto plantaromedial do metatarsiano III e II (MTIII / MTII). Foram também observadas à forma lobulada da IPLS e o tamanho em comparação ao membro contralateral, bem como a regularidade da superfície óssea palmar do MC III, II, IV. Posteriormente foi realizada a dissecação dos lobos IPLS, bem como a avaliação macroscópica dos mesmos que antecedeu o processamento das amostras para histologia. Em espécimes CC, a IPLS possui uma ecogenicidade que varia de zonas periféricas dorsais hiperecogênicas que se mesclam a zonas ecogênicas e hipoecogênicas onde ocorre a sua lobulação. Nas amostras do grupo PSI, a IPLS também é lobulada, mas com diferenças no padrão de ecogenicidade como, hipoecogenicidade e ecogenicidade difusas. Macroscopicamente, as amostras CC apresentaram uma grande quantidade de tecido adiposo que corresponde à zona periférica dorsal da IPLS, a qual termina no tecido conjuntivo que delimita os lobos ligamentares. Em uma secção transversal macroscópica da IPLS as fibras musculares em vermelho se mesclam as fibras ligamentares brancas no centro do ligamento. Este achado macroscópico não foi observado na raça PSI, onde as fibras musculares intercalam as fibras ligamentares em toda a extensão do ligamento e pequenas quantidades de gordura estão presentes na periferia dorsal do mesmo. A IPLS no MP possui um formato triangular com características de ecogenicidade muito similares as citadas no MT. Na avaliação US, macroscópica e histológica as amostras da IPLS em MT e MP de equinos na raça CC demonstraram uma maior quantidade de tecido adiposo dorsal periférico bem como, uma maior quantidade de fibras musculares e ligamentares mescladas em comparação às amostras PSI.(AU)

Comparative study of lens subluxation in patients with angle-closure glaucoma and shallow anterior chamber with different axial lengths / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To investigate whether there is a difference in the probability of partial zonular dehiscence and subluxation in patients with angle-closure glaucoma and shallow anterior chamber combined with cataract. <p>METHODS: A retrospective analysis was performed,for patients with angle-closure glaucoma and patients of shallow anterior chamber with cataract admitted to our hospital from February 2017 to March 2019. The patients underwent cataract surgeries and were divided into two groups: Group A(visual axis <22mm)and Group B(visual axis ≥22mm). Central anterior chamber depth(ACD)was measured with ultrasound biomicroscopy(UBM); Axial length(AL, length of optic axis)was measured with IOL-Master; Calculation of the ratio of AC depth to axial length(ACD/AL)was performed. The consistency of the anterior chamber depth in all directions in UBM images was analyzed. In cataract surgeries, partial zonulysis with or without lens subluxation was recorded.<p>RESULTS: The result indicated that the rate of partial zonular dehiscence in group B was higher than that in group A(8.46%±1.44% <i>vs</i> 7.56%±1.51%, <i>P</i><0.05). <p>CONCLUSION: When performing cataract surgery in patients of angle-closure glaucoma and shallow anterior chamber in group B, attention should be paid to the probability of zonular abnormality.

Clinical features of secondary glaucoma caused by lens suspensory ligament laxity or occult subluxation / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To investigate the clinical characteristics of secondary glaucoma caused by lens suspensory ligament laxity or occult subluxation, and to analyze the influence of operation on visual acuity and intraocular pressure (IOP). ·METHODS:Totally 38 cases (38 eyes) of the secondary glaucoma caused by lens suspensory ligament laxity or occult subluxation in ophthalmology department of our hospital from December 2014 to December 2016 were enrolled and their medical records were analyzed retrospectively to observe the clinical characteristics of glaucoma. Preoperative mydriasis was carried out and surgical methods were chosen according to the lenses location and extent of suspensory ligament. Preoperative and postoperative anterior chamber depth, corneal endothelial cell density, IOP, visual field, visual acuity and complications were analyzed. ·RESULTS:The average intraocular pressure was 18.17± 1.43mmHg at postoperatively 10d,which was significantly lower than 38. 77 ± 2. 45mmHg before operation, the difference had statistical significance (P<0.05). The IOP of 25 eyes returned to normal (≤21mmHg) at 3d after surgery. The IOP of 34 eyes with the usage of IOP lowering medication returned to normal at postoperative 10d. The IOP of 4 eyes came to normal after undergoing glaucoma drainage valve implantation again. There were 5 eyes with visual acuity ranged 0.1 to <0.2,17 eyes 0.2 to <0.5,16 eyes≥0.5 preoperatively,and 2 eyes,17 eyes and 19 eyes postoperatively, the difference was not significant (P>0.05). The postoperative anterior chamber depth was 2.45 ± 0.44mm, which was significantly higher than 1.23 ± 0.35mm before operation, the difference had statistical significance (P < 0. 05). The postoperative corneal endothelial cell density was 878.34 ± 322.12/mm2 and decreased significantly, compared with 1735.32 ± 340. 32/mm2before operation, the difference had statistical significance (P<0.05). There were 8 eyes with corneal edema,4 eyes with iris adhesion or varying degrees of atrophy,3 eyes with anterior chamber hemorrhage,and 2 eyes with pupil exudate at 3d after surgery. · CONCLUSION: Clinical symptoms and signs of secondary glaucoma in patients with lens suspensory ligament laxity or occult subluxation are more complex, which needs to be distinguished with other types of glaucoma in clinical treatment, and its surgical methods shall be chosen according to different suspensory ligament site and lens subluxation scope.

Observation of artificial lens implantation suture fixation into capsular bag when cataract suspensory ligament rupture without capsular tension ring / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To explore the cataract suspensory ligament rupture and artificial lens implantation suture fixation into capsular bag without capsular tension ring(CTR).METHODS:We reviewed 20 cases of 20 cataract suspensory ligament rupture without CTR intraocular lens (IOL) implantation fixation in our department from Jan.2012 to Dec.2016.The needle crossed into ocular ciliary sulcus, in the equator of the eye ball which suspensory ligament rupture from, then the needle crossed out 1.5mm away from the angle of sclera.Sutures fixed on the IOL, then the artificial lens implantation in the pouch, carried out in accordance with the Z type suture, or to the beforehand prepared triangle scleral flap.The visual acuity, intraocular pressure, the anterior chamber and the IOL position were measured after operations.RESULTS:All of the postoperative visual acuity improved different level.The postoperative best corrected visual acuity(BCVA) was ≥0.8 in 4 eyes(20%), 0.5-0.6 in 7 eyes(35%), 0.3-0.4 in 8 eyes(40%), 0.1 in 1 eye(5%) because of the glaucoma optic atrophy.There were 12 cases with mild corneal endothelium edema, 4 cases exudation membrane in the pupil area, 2 cases hyphema, all of which recovered after treatment.There were 2 eyes with vitreous prolapse in the pupil, 1 case appeared mild IOL center deviation and no special treatment for the vision did not be involved.Followed up for 6mo, displaced stitches or artificial lens shift did not occur.CONCLUSION:Without CTR, the IOL implantation and suture fixation in capsular bag during cataract surgery is a surgical method for basic-level hospitals.

Modelo de indução de lesão no ligamento suspensório equino com utilização de punch para biópsia cutânea / Suspensory ligament lesion model in horses using a skin biopsy punch

O objetivo deste estudo foi avaliar um novo modelo de lesão no ligamento suspensório (LS). Sob anestesia geral, um punch para biópsia cutânea de 0,6cm de diâmetro foi utilizado para criar uma lesão no centro do LS de ambos os membros torácicos e pélvicos, em seis equinos. Todos os animais se recuperam da cirurgia sem nenhuma complicação importante. Realizaram-se avaliações clínicas e ultrassonográficas no período pós-operatório. Durante as primeiras duas semanas, no local da lesão, houve redução no edema de leve para discreto e da dor de discreta para ausente. As lesões foram facilmente observadas ao exame ultrassonográfico 72 horas após a cirurgia como áreas anecoicas homogêneas, representando uma média (± erro padrão) de 33,5±5 por cento da área do LS. Não houve alteração significativa na área de lesão durante as primeiras duas semanas (P=0,77). Concluiu-se que o modelo proposto foi eficiente para promover lesões controladas e homogêneas simultaneamente nos quatro LS, sem causar desconforto importante aos equinos. Esses achados, associados à possibilidade de se avaliar previamente o LS por meio de biópsia, demonstram que esse modelo de indução de lesões ligamentosas se apresenta com um método útil, principalmente se aplicado ao estudo de terapias destinadas a melhorar o processo de reparo do LS.

The aim was to study a novel model of suspensory ligament (SL) lesion. Under general anesthesia, a punch for skin biopsy (0.6cm of diameter) was used to create a circular lesion in the middle of SL simultaneously in the four members of six horses. All horses recovered without any important complication. Clinical and ultrasonographic evaluations were made during the post operative period. During the first two weeks, edema changed from mild to discreet, and pain changed from discreet to none around the surgical site. The lesions were easily observed by ultrasonography 48h after surgery as a homogenous anechoic area representing a mean (± SEM) 33.5±5 percent of the SL area, and did not change size during the first two weeks (P=0.77). In conclusion, the proposed model was efficient to promote controlled and homogeneous lesions in the four SL simultaneously without causing important discomfort to the horses. Taking in account these findings together with the possibility of evaluation of the ligament biopsy previously to any treatment, this method may be useful especially in studies testing therapies for tissue repair.

Ligamento suspensório da articulação metacarpo/metatarso falangianas nos eqüinos: aspectos evolutivos, anatômicos, histofisiológicos e das afecções / Suspensory ligament of equine metacarpus/metatarsus falangeal joint: evolutive anatomical, histophysiological aspects and pathologies

Esta revisão reúne e discute aspectos anatômicos, histofisiológicos e afecções do ligamento suspensório (LS) da articulação metacarpo/metatarso falangiana dos eqüinos. Considerou-se a importância desses aspectos para subsidiar o diagnóstico e o tratamento de afecções no LS, visto que freqüentemente animais portadores dessas doenças permanecem em atividades sob efeito de tratamentos paliativos que, apesar de proporcionarem alívio álgico, quase sempre não garantem a cura definitiva e, por conseguinte, não garantem o bem-estar absoluto do animal.

This review discusses anatomical, histophysiological and pathological aspects of the suspensory ligament (SL) of metacarpal/metatarsal joint in the horse. This knowledge is important to aid in diagnosing and treating the SL diseases in the athlete horses, considering that affected animals remain on training activities under palliative treatments that insure pain relieve, but do not guarantee fully and definitively welfare of the horses.