Measuring quality of recovery (QoR-15) after degenerative spinal surgery: A prospective observational study.

Introduction: The Quality of Recovery (QoR-15) score evaluates patient's recovery after surgery and anesthesia. There is a lack of studies focusing on the patients' quality of recovery in the early post-discharge phase after elective lumbar spine surgery. Research question: We aimed to identify the QoR-15 score in patients who underwent surgery for degenerative low back conditions. Furthermore, we aimed to identify the individual items of the QoR-15 that are crucial for the patients' quality of recovery. Material and methods: The study was conducted at a spine center in Denmark from December 2021 to September 2022. Data were collected, using a mobile health application, preoperatively and at 3 time points after hospital discharge. Descriptive analysis followed by within-subjects longitudinal repeated measures was conducted. The individual items of the QoR-15 score were explored using a heatmap. Results: Data from 46 patients were analysed. The mean QoR-15 sum score at baseline was 105.4 ± 18.3. The mean QoR-15 sum scores were 108.1 ± 19.2 on post-discharge day 1, 118.5 ± 17.4 on day 7, and 120.7 ± 20.9 on day 14. The mean QoR-15 score from day 1 to day 7 improved significantly. Eight of the 15 items influenced the overall QoR-15 score. Discussion and conclusion: This study applied the QoR-15 score in lumbar spine surgery patients. We identified specific items from the QoR-15 scale that are crucial to improving patients' recovery after hospital discharge. Further research is needed to identify specific needs in the post-discharge period in this group of patients.

Clinical observation of vitrectomy combined with internal limiting membrane peeling and scleral shortening for myopic foveoschisis / 中华眼底病杂志

Objective To observe the efficacy ofvitrectomy combined with internal limiting membrane (ILM) peeling and scleral shortening for myopic foveoschisis (MF).Methods Prospective and non-randomized concurrent control study.A total of 35 MF patients (35 eyes) were enrolled in this study.The patients were divided into 2 groups according to surgery,including group A (18 eyes) and group B (17 eyes),all received vitrectomy combined with ILM peeling,but group A also received scleral shortening.The best corrective visual acuity (BCVA) examination using the Snellen vision chart was converted to the minimum resolution logarithm (logMAR).Ocular axis length (AL) was measured by Zeiss IOL-Master or A-scan ultrasound (Quantel Medical,France).The maximal value of retinal foveoschisis (MxFT) was measured by frequency-domain optical coherence tomography (Heidelberg,Germany).Multifocal electroretinogram (mfERG) responses were obtained with the RETIscan system (Roland Consult,Gemany).There was no statistically significant difference between the two groups (P＞0.05) in age (t=0.460),AL (t=1.520),diopter (t=0.020),logMAR BCVA (t=-2.280),MxFT (Z=-4.179) and b-wave ERG amplitude (Z=-0.198).The changes of BCVA,AL,MxFT and b wave amplitude were followed-up for 3-12 months.Results At the last follow-up,the height of MF was decreased in 18 eyes of group A,and MF was completely disappeared in 4 eyes.The logMAR BCVA (t=7.272,5.951),MxFT (Z=-3.724,-3.622) and b-wave ERG amplitude (Z=-3.223,-3.243) in both groups A and B were statistically improved (P=0.000,0.000,0.000,0.000,0.001,0.001) compared to pre-operational results.There was significant difference of logMAR BCVA (t=-2.280) and MxFT (Z=-4.179) between the two groups (P=0.029,0.000).But there was no significant difference in the amplitude of b-wave (Z=-0.198,P=0.843).The AL in group A was shortened after surgery,the difference was statistically significant (t=10.017,P=0.000).During the follow-up,there was no ocular hemorrhage,endophthalmitis and other complications.Conclusion PPV combined with ILM peeling and scleral shortening can shorten AL significantly for MF patients,and gain relative normal anatomical structure of the fovea,thus improve the vision.

The development of surgery for macular hole with retinal detachment in high myopic eyes / 中华眼底病杂志

Treatment of macular hole associated retinal detachment in high myopia has progressively evolved over the years,including the scleral buckling,simple intravitreal gas injection,pars plana vitrectomy (PPV),PPV combined with internal limiting membrane (ILM) peeling or transplantation and so on.Simple vitreous gas injection is less traumatic and good for the patients with small holes and localized retinal detachment.PPV combined with ILM peeling can achieve better treatment effects for small holes with wide retinal detachment.But for large holes with wide retinal detachment,PPV combined with ILM transplantation is necessary to improve the macular holes closure rate.If the ILM has been peeled before,the lens capsule could be a nice substitute for ILM.The scleral surgery can solve the problem of posterior scleral staphyloma and effectively control the elongation of the axial length.However,there is still no one surgery could deal with all the problems of high myopia,we should consider all the circumstances like the size of the macular hole and the range of the retinal detachment to choose the best individualized therapy.

The efficacy of vitrectomy for myopic traction maculopathy / 中华眼底病杂志

Objective To observe the anatomical and functional changes in patients with different degrees of myopic traction maculopathy (MTM) after vitrectomy.Methods It was a retrospective case series study.Forty-seven consecutive patients (47 eyes) diagnosed with MTM were studied between January 2010 and May 2014.There were 38 females (38 eyes) and 9 male (9 eyes),mean age was (65.13±6.98) years,mean axial length was (29.23±1.77) mm.The eyes was divided into 3 groups according to the macular morphologies on optical coherence tomography (OCT),including macular retinoschisis only group (MRS group,18 eyes),foveal retinal detachment group (FD group,13 eyes) and full-thickness macular hole group (MH group,16 eyes).All the eyes underwent minimum resolution angle in logarithmic (logMAR) best corrected visual acuity (BCVA),intraocular pressure,axial length,A or B-ultrasonography,fundus photography,OCT and microperimetry examinations.The average logMAR BCVA of 47 eyes was 1.43±0.52.The center retinal thickness (CRT) of eyes in MRS and FD group was (528.45± 167.61) μm.All the patients underwent pars plana vitrectomy combined with internal limiting membrane peeling.The mean follow-up period was 23.4 months.The changes of logMAR BCVA,microperimetry and macular microstructural were observed.Results At the final follow-up,the logMAR BCVA of 47 eyes was 0.86 ± 0.42,which improved compared with the preoperative vision (t=7.36,P＜ 0.001).The mean CRT of eyes in MRS and FD group was (250.90 ± 91.81) μm,which improved compared with the preoperative CRT (t=8.17,P＜0.001).In MRS group,the retina was attached in 18 eyes.In FD group,the retina was attached in 11 eyes,MH was observed in 2 eyes.In MH group,recurrent retinal detachment was observed in 1 eye.The differences of logMAR BCVA and retinal sensitivity among MRS,FD and MH groups were significant (x2 =6.38,11.08;P=0.030,0.004).Conclusion The macular structural and visual function in MTM eyes with macular retinoschisis only after vitrectomy are better than those in MTM eyes with MH and foveal retinal detachment.

Ninety-day readmissions after degenerative cervical spine surgery: A single-center administrative database study.

BACKGROUND: Unplanned hospital readmissions result in significant clinical and financial burdens to patients and the healthcare system. Readmission rates and causes have been investigated using large administrative databases which have certain limitations in data reporting and coding. The objective of this study was to provide a description of 90 day post-discharge readmissions following surgery for common degenerative cervical spine pathologies at a large-volume tertiary hospital. The study also compared the readmission rates of patients who underwent anterior- and posterior-approach procedures. METHODS: The administrative records from a single-center, high-volume tertiary institution were queried using ICD-9 codes for common cervical pathology over a three year period to determine the rate and causes of readmissions within the 90 days following the index surgery. RESULTS: A total of 768 patients underwent degenerative cervical spine surgery during the three year study period. Within 90 days of discharge, 24 (3.13%) patients were readmitted; 16 (2.06%) readmissions were planned for lumbar surgery; 8 (1.04%) readmissions were unplanned. 640 patients underwent procedures involving an anterior approach and 128 patients underwent procedures involving a posterior approach. There were 14 (2.17%) planned readmissions in the anterior group and 2 (1.5%) in the posterior group. The unplanned readmission rate was 0.63% (4 patients) and 3.13% (4 patients) in the anterior and posterior groups, respectively. (p=0.0343). CONCLUSION: The 90 day post-discharge unplanned readmission rate that followed elective degenerative cervical spine surgery was 1.04%. The unplanned readmission rate associated with posterior-approach procedures (3.13%) was significantly higher than that of anterior-approach procedures (0.63%). LEVEL OF EVIDENCE: IV.

Disputes revolved about surgeries of macular vitreoretinal interface abnormalities in highly myopic eyes / 中华眼底病杂志

Macular vitreoretinal interface abnormalities in highly myopic eyes are among the most vision-threatening diseases associated with macular retinal schisis and macular holes.To relieve the traction of the posterior vitreous cortex and to recover the anatomy of fovea for good central vision are the keys to successful repair.However,there are many controversial issues in the efficacy of the surgerical procedures including gas injection,scleral buckling and vitrectomy.How to evaluate these different surgeries and to establish standard surgical procedure options for macular vitreoretinal interface abnormalities in highly myopic eyes needs to be explored.

High myopia-related macular lesions: diagnosis and treatment / 中华眼底病杂志

High myopia is frequently associated with retinal degenerative changes (such as myopic foveoschisis, macular hole and its related retinal detachment, and choroidal neovascularization) which are the major causes of visual loss in high myopic eyes. Optical coherence tomography may help us to understand the macular lesions in high myopia. Peeling of internal limiting membrane and removal of posterior vitreous cortex at an appropriate time, are believed to facilitate restoring the retinal flexibility and resolution of myopic foveoschisis, and promote the macular hole closure and retinal reattachment. Anti-angiogenesis treatment combined with photodynamic therapy and (or) corticosteroid therapy are the future options to treat myopic choroidal neovascularization. Correctly understanding and mastering the methods and timing of diagnosis and treatment of high myopia-related macular degeneration, and taking targeted interventions to enable patients to be rational and effective treated, are the keys to further reduce the damage of visual function in patients with high myopia.

Classification of macular retinoschisis in pathological myopic eyes by optical coherence tomography and its clinical applications / 中华眼底病杂志

Pathological myopic macular retinoschisis can be classified into 4 types based on optical coherence tomography (OCT) images: outer layer retinoschisis, outer + middle layer retinoschisis, outer + inner layer retinoschisis and muhilayer retinoschisis. Currently vitrectomy is the major option to treat this condition as it can remove the posterior vitreous cortex completely and peel the internal limiting membrane (ILM) around the posterior vessels arch. Vitrectomy benefits the visual function significantly for outer layer retinoschisis with foveal detachment, but has no or very little effects on muhilayer retinoschisis. The appropriate starting site for removal of posterior cortex and ILM should be the site without inner layer retinoschisis. The knowledge and understanding of the OCT classification of pathological myopic macular retinoschisis is important for us to chose correct operation methods and determine the prognosis after treatment.