ABSTRACT
PURPOSE OF THE STUDY: We reviewed 30 cases of osteochondral lesions of the astragalar vault treated surgically. MATERIAL AND METHODS: Among the 30 patients, 17 participated in sports activities and 24 had a history of trauma. Mean delay to surgery was 10 months. Treatment included osteochondritis curettage and Pridie perforations. Direct access was used in 11 cases, malleolar osteotomy in 13 and arthroscopy in 6. Cancellous bone grafts were used in 6 cases. RESULTS: Mean follow-up was 3 years 7 months (minimum 2 years). All patients had an arthroscan at last follow-up. Evaluation of post-operative outcome was based on clinical assessment and arthroscan findings. Surgical treatment provided very good results in 75 p. 100 of cases with pain relief and improved walking distance. DISCUSSION: Our cases pointed out the important contribution of the FOG (Fracture Osteonecrosis Geode) classification to pathogenic and prognostic analysis. The Berndt and Harty classifications were not found to be useful. CONCLUSION: In case of localized necrosis, we propose arthroscopic perforation curettage. In case of bone loss, a direct cancellous graft may be used.
Subject(s)
Ankle Joint/surgery , Osteochondritis/surgery , Talus/surgery , Adolescent , Adult , Ankle Injuries/surgery , Ankle Joint/physiopathology , Arthroscopy , Bone Transplantation , Curettage , Female , Follow-Up Studies , Humans , Male , Middle Aged , Osteochondritis/physiopathology , Osteonecrosis/physiopathology , Osteonecrosis/surgery , Osteotomy , Pain/physiopathology , Prognosis , Range of Motion, Articular/physiology , Retrospective Studies , Tomography, X-Ray Computed , Treatment Outcome , Walking/physiologyABSTRACT
PURPOSE: To determine the problems, safety, and results of phacoemulsification cataract surgery in previously vitrectomized eyes. SETTING: Department of Ophthalmology of Galdácano Hospital, Galdacano, Spain. METHODS: In this prospective study, phacoemulsification was performed in 23 eyes that had had vitrectomy between February 1992 and May 1994. Surgical and postsurgical difficulties and complications and visual acuity results were analyzed. Follow-up ranged from 12 to 24 months. RESULTS: The incidence of surgical problems and complications was higher than usual: 7 eyes presented small pupil size (< 3.0 mm); sudden changes in anterior chamber depth and pupil size during surgery occurred in 6 eyes; unusual mobility and flaccidity of the posterior capsule was observed in 6 cases, which was associated with posterior subcapsular cataract and young age (< 50 years); posterior capsule tear occurred in 2 eyes, 1 of which required anterior vitrectomy. Postoperatively, best visual acuity improved two Snellen lines or more in 17 eyes (73.91%), did not change in 3 (13.04%), and worsened in 3. CONCLUSION: Phacoemulsification in vitrectomized eyes presented more problems and complications than usual. However, it seems to be safer than manual extracapsular surgery because it minimized the risk of intraoperative eye hypotony or collapse.
