ABSTRACT
Introduction: Transient bone marrow edema (TBME) is a condition that typically presents in middle-aged adults with a male to female ratio of 3:1. Cases have also been noted in females during the third trimester of pregnancy. Vitamin D deficiency has been linked to this condition as the pathophysiology demonstrates poorly mineralized osteoid in presenting lesions. It is rare for a healthy child or adolescent to present with TBME introducing the purpose of this case study. This case report aims to provide medical and surgical education on TBME in a young and healthy adolescent. To our best knowledge, this is the first report on the use of subchondroplasty to treat transient bone marrow of the navicular in an adolescent male. Case Report: A 16-year-old adolescent male with foot and ankle pain is treated from September of 2017 to September of 2019. The patient failed initial conservative treatments. His treatment concluded with subchondroplasty of the navicular bone, typically contraindicated due to the risk of avascular necrosis (AVN). The patient received follow-up in March of 2020, which included additional magnetic resonance imaging (MRI) for long-term treatment outcome data. Conclusion: The patient was successfully treated with subchondroplasty after conservative therapy failed. In patients with TBME, subchondroplasty may not be the best option due to risk of AVN. At 1-year follow-up, our patient was asymptomatic and MRI showed reduction in edema.
ABSTRACT
OBJECTIVE: To estimate long term future of pressure and vision of children who underwent DS for CPG. MATERIAL AND METHODS: Children affected by CPG, aged from 1 day to 3 years at the time of the diagnosis were retrospectively included between 1999 and 2014. All benefited from a DS with use of antimetabolites. Preoperative and long-term post-operative intraocular pressures (IOP), per and postoperative complications as well as visual acuity and refractive status were estimated. Complete IOP control was defined by a postoperative IOP ≤16 mmHg without medical treatment. RESULTS: 141 eyes of 71 children were included (sex ratio: 1.02). Mean follow-up was 56.6 ±9.6 months. Final average IOP among the whole sample was 11.3 +/-7 mmHg. The rate of total success was 69.4 %, partial success 27.6 % and 3 % failure at the last check. No complications were seen in 85.1 % of cases (n=120 eyes). Among 37 children analyzed for visual acuity, maintained visual acuity was found in 50 % of cases (n= 37 eyes). CONCLUSION: DS allows obtaining good IOP control with a very low rate of complications, and should be considered as a technique of choice in the surgical management of CPG. This study is of particular relevance because it has been led on a long term period and on an important staff considering the rare prevalence of the condition.
Subject(s)
Glaucoma/surgery , Intraocular Pressure/physiology , Refraction, Ocular/physiology , Trabeculectomy/methods , Visual Acuity , Child, Preschool , Female , Follow-Up Studies , France/epidemiology , Glaucoma/physiopathology , Humans , Incidence , Infant , Infant, Newborn , Male , Postoperative Complications/epidemiology , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: The purpose of this study was to evaluate the visual outcome of photorefractive keratectomy (PRK) in patients with mild to moderate stable keratoconus and to assess the risk of progression of the disease after the excimer laser procedure. METHODS: In this prospective study, carried out at the Clemenceau Medical Center, an affiliate of Johns Hopkins International, in Beirut, Lebanon, 119 eyes from 72 patients with grade 1-2 keratoconus (Amsler-Krumeich classification) underwent PRK. Forty-seven patients had both eyes treated and 25 patients had one eye treated. The procedure was done using the Wavelight Eye Q Excimer laser. Uncorrected and best-corrected visual acuity, corneal topography, and pachymetry were assessed before the procedure and 3, 6, 12, 36, and 60 months after the procedure. RESULTS: Mean uncorrected visual acuity showed a statistically significant improvement (P < 0.05) at one, 3, and 5 years follow-up. One hundred and seventeen eyes (98.3%) showed no progression while two eyes (1.7%) showed progression of the disease at 5 years follow-up, as documented by corneal topography and pachymetry. These two eyes were treated with corneal collagen crosslinking. CONCLUSION: PRK in mild to moderate keratoconus is a safe and effective procedure for improving uncorrected vision in patients with mild refractive errors. However, close follow-up of patients is needed to detect any progression of the disease. Longer follow-up is needed to assess the overall effect of this procedure on progression of the disease.
