scholarly journals A CHANGE OF THE LENGTH OF THE ANTERO-POSTERIOR AXIS OF THE EYE IN THE CHILDREN PRESENTING WITH HYPEROPIA FOLLOWING FEMTOSECOND LASER-ASSISTED IN SITU KERATOMILEUSIS: 3 YEAR FOLLOW-UP

2018 ◽  
Vol 13 (1) ◽  
pp. 31-37
Author(s):  
I. L Kulikova ◽  
N. P Pashtaev ◽  
Anastasiya Vladimirovna Gagloeva ◽  
O. V Shlenskaya ◽  
N. V Chapurin

Aim. The objective of the present study was the analysis of the changes in the length of the antero-posterior axis of the eye (AL) in the children and adolescents presenting with hyperopia and anisometropia in 3 years after femtolaser-assisted in situ keratomileusis (FS-LASIK). Material and methods. The study included 33 patients at the age from 5 to 16 years divided into two groups. Group 1 was comprised of the patients having initially the mean spherical refractive equivalent (SE) +3.69 D. Those of group 2 had initial SE +5.88 D. In all the patients, FS-LASIK was carried out at the amblyopic eye in the absence of the positive results of the conventional conservative treatment. Results. During three years after FS-LASIK, AL of the treated patients in the first group increased by 0.41 mm and reached the mean value of 22.41 mm while the spherical refractive equivalent became equal to 0.25 D. During the same period, AL in the contralateral eye increased by 0.92 mm and became equal to 23.47 mm on the average with SE equaling +0.81 D. AL of the patients in the second group increased by 0.29 mm and reached the mean value of 21.59 mm while the spherical refractive equivalent became equal to 0.25 D. During the same period, AL in the contralateral eye increased by 0.97 mm and became equal to 23.32 mm on the average with SE equaling +0.62 D. Conclusion. During three years after hyperopic S-LASIK, the minimal growth of the antero-posterior axis of the eye was documented in the children presenting with hyperopia (+5 D) whereas its length increased by more than 0.29 mm. In the children with hyperopia of less than +5 D, it increased by 0.41 mm. It is concluded that prognosis of the results of femtosecond laser-assisted in situ keratomileusis leading to the alteration of the refraction in the amblyopic eye with the initially moderate or high-degree hyperopia should be made taking into consideration that AL continues to change in the cource of further growth of the child.

2016 ◽  
Vol 11 (4) ◽  
Author(s):  
Mohammad Shahzad ◽  
Rana Muhammad Mubeen ◽  
Khursheed Anwar

Objective: To assess in situ Piezoelectric ESWL for ureteric calculi, avoiding false positive results arising from the spontaneous passage of small stones and also to evaluate the efficiency of the EDAP LT02 Lithotriptor for insitu ESWL treatment of ureteric calculi. Study Design: A prospective evaluation of patients with ureteric calculi treated with Piezoelectric ESWL using EDAP LT 02 Lithotriptor. Place & Duration of Study: patients with ureteric calculi treated with Piezoelectric ESWL using EDAP LT 02 Lithotriptor for a period of twelve months, coming to Urology department of Pakistan Institute of Medical Sciences (PIMS), Islamabad, as out door patients. Patients and methods: A prospective evaluation of patients with ureteric calculi treated with Piezoelectric ESWL using EDAP LT 02 Lithotriptor for a period of twelve months, Seventy two patients, 60 males and 12 females, with mean age of 39.6 years, presenting with solitary ureteric calculus were treated using EDAP LT 02 Piezoelectric Lithotriptor, lo calization with fluoroscopy. No regional or general anesthesia given. Results: After 3 months follow-up, of the 72 ureteric calculi cases, 60(83.3%) were successfully fragmented and ureter was stone free in 54 patients (75.1%) after insitu ESWL alone. The mean duration of stone clearance was 50 days (SD +11.58). Sixteen patients required one session only, 28 patients required 2 sessions and twelve patients required three and more than three sessions. Stone location was 28 upper ureteric, 18 middle and 26 in lower ureter. Stone size varied from 7mm.to 17mm. in longest diameter. The average number of session, 1.5 for upper ureteric stone, 1.8 for mid and lower ureteric stones. Stone clearance for upper ureteric calculus was 85.7%, for mid ureteric 66.7% & for lower ureteric 69%, the overall stone clearance was 75%. Conclusion: In situ piezoelectric ESWL is safe, simple and effective technique for treating ureteric calculi. The site and size of the stone affects the success rate.


2019 ◽  
Vol 75 (2) ◽  
pp. 65-71
Author(s):  
Tereza Řeháková ◽  
Věra Veliká ◽  
Naďa Jirásková

Aim: We analysed one-year refractive results and the incidence of complications in patients with correction of low-to-high myopia or myopic astigmatism by femtosecond laser in situ keratomileusis (FS-LASIK) using femtosecond laser LenSx® (Alcon, Fort Worth, Texas, USA) a excimer laser Excimer Amaris 500 (Schwind eye-tech-solutions GmbH and Co KG, Kleinostheim, Germany). Methods: To the retrospective study were included 171 eyes of 87 patients (38 men, 49 women) who underwent correction of myopia and myopic astigmatism by FS-LASIK in the outpatient Department of Ophthalmology, University Hospital in Hradec Králové between 2013-2017. We assessed uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA), subjective refraction, central corneal thickness (CCT) in the thinnest point, patient’s satisfaction and the incidence of complications in the one-year follow-up period. Results: At the time of laser procedure the mean patient‘s age was 29,26 ± 6,47 years (range 18 to 46 years). In 21 eyes was corrected myopia (range -6,5 to -2,5 D sph) and in 150 eyes myopic astigmatism (range -8,75 to -0,25 D sph and -3,0 to -0,25 D cyl). The mean preoperative UCVA 0,06 ± 0,08 (range 0,02 to 0,8) got better to 1,12 ± 0,17 (range 0,8 to 1,5) at the end of follow-up period. There wasn’t statistically significant change in BCVA between preoperative and postoperative values. Preoperative mean value of subjective refraction was -4,14 ± 1,43 D sph (range -8,5 to -1 D sph) and -0,57 ± 0,58 D cyl (range -3 to 0 D cyl) and after 12 months -0,02 ± 0,16 D sph (range -0,1 to 0,75 D sph) and -0,01 ± 0,1 D cyl (range -0,5 to 0,5 D cyl). The initial mean CCT was 554,76 ± 30,07 μm (range 485 to 660 μm), after 6 months 494,06 ± 34,99 μm (range 421 to 594 μm) and after 12 months 492,92 ± 34,55 μm (range 411 to 592 μm). We observed peroperative complications in 3 eyes. The suction loss of femtosecond laser occurred during flap creation due to sudden eye movement. Postoperatively in one case we enrolled flap pucker first postoperative day. In other case flap dislocation occurred after abdonimal surgery under general anesthesia which was performed 3 months after refractive procedure and we had to indicate flap reposition. The mean grade of patient’s satisfaction was at the end of follow-up period 1,04. The most often complaints were the sensation of dry eye (10 patients) and blurry vision during computer working, inadequate lighting and fatique (6 pacients). Conclusions: According to our experience correction of low-to-high myopia or myopic astigmatism by using FS-LASIK is an effective, relatively safe and predictable method. The basic assumption of good postoperative results and patient’s satisfaction is thorough and comprehensive preoperative examination with respect to indication criteria.


BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e021702
Author(s):  
Qing Zhang ◽  
Jing Wang ◽  
Mohan Li ◽  
Xiaohu Ding ◽  
Liming Tao

ObjectivesPoor follow-up after femtosecond laser-assisted in situ keratomileusis (FS-LASIK) is common in general clinical practice. We aimed to assess the surgical outcomes of patients with poor compliance to FS-LASIK follow-up but who returned to the clinic with additional prompting at a 1-year visit. We also compared their surgical outcomes with those of patients who returned unprompted.DesignRetrospective and observational study.SettingAn urban tertiary hospital in China.ParticipantsWe reviewed the medical records of myopic patients who underwent binocular FS-LASIK. These patients were all recommended, but not compulsively required, to return for termly postoperative examinations including measurement of uncorrected distance visual acuity (UDVA), refraction and assessment of complications. According to records of follow-up visits, 1009 eligible patients were categorised as follows: (1) 124 who returned unprompted at the 1-year visit (group 1) and (2) 885 lost to follow-up at the 1-year visit. We randomly selected and called back 105 (group 2) out of the 885 patients for an extra postoperative examination.ResultsAt the 1-year visit, the visual outcomes of the two groups of patients were comparable. No differences in postoperative UDVA were found between the two groups (−0.02±0.06 logarithm of the minimum angle of resolution (logMAR) and −0.02±0.05 logMAR for groups 1 and 2, respectively, p=0.175). Patients in group 2 showed greater hyperopic dioptres than patients in group 1 (0.37±0.59 D vs −0.29±0.69, p<0.0001). No vision-threatening complications were observed in either group of patients.ConclusionsThe visual and refractive outcomes of patients who were lost to follow-up after FS-LASIK surgery were good and comparable to those who returned unprompted. The results indicated that rigorous postoperative follow-up may be unnecessary in general clinical practice, except for patients who are at a high risk for postoperative complications.


2021 ◽  
Vol 10 (6) ◽  
pp. 1309
Author(s):  
Hye Young Han ◽  
Ki Cheol Park ◽  
Eun-Ae Yang ◽  
Kyung-Yil Lee

We have found that early corticosteroid therapy was effective for reducing morbidity during five Korea-wide epidemics. We evaluated the clinical and laboratory parameters of 56 children who received early corticosteroid treatment for pneumonia that was caused by macrolide-resistant Mycoplasma pneumoniae (M. pneumoniae) or macrolide-sensitive M. pneumoniae between July 2019 and February 2020. All subjects had dual positive results from a PCR assay and serological test, and received corticosteroids within 24–36 h after admission. Point mutation of residues 2063, 2064, and 2067 was identified in domain V of 23S rRNA. The mean age was 6.8 years and the male:female ratio was 1.2:1 (31:25 patients). Most of the subjects had macrolide-resistant M. pneumoniae (73%), and all mutated strains had the A2063G transition. No significant differences in clinical and laboratory parameters were observed between macrolide-resistant and macrolide-sensitive M. pneumoniae groups that were treated with early dose-adjusted corticosteroids. Higher-dose steroid treatment may be needed for patients who have fever that persists for >48 h or increased biomarkers such as lactate dehydrogenase concentration at follow-up despite a usual dose of steroid therapy.


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Proff ◽  
B Merkely ◽  
R Papp ◽  
C Lenz ◽  
P.J Nordbeck ◽  
...  

Abstract Background The prevalence of chronotropic incompetence (CI) in heart failure (HF) population is high and negatively impacts prognosis. In HF patients with an implanted cardiac resynchronisation therapy (CRT) device and severe CI, the effect of rate adaptive pacing on patient outcomes is unclear. Closed loop stimulation (CLS) based on cardiac impedance measurement may be an optimal method of heart rate adaptation according to metabolic need in HF patients with severe CI. Purpose This is the first study evaluating the effect of CLS on the established prognostic parameters assessed by the cardio-pulmonary exercise (CPX) testing and on quality of life (QoL) of the patients. Methods A randomised, controlled, double-blind and crossover pilot study has been performed in CRT patients with severe CI defined as the inability to achieve 70% of the age-predicted maximum heart rate (APMHR). After baseline assessment, patients were randomised to either DDD-CLS pacing (group 1) or DDD pacing at 40 bpm (group 2) for a 1-month period, followed by crossover for another month. At baseline and at 1- and 2-month follow-ups, a CPX was performed and QoL was assessed using the EQ-5D-5L questionnaire. The main endpoints were the effect of CLS on ventilatory efficiency (VE) slope (evaluated by an independent CPX expert), the responder rate defined as an improvement (decrease) of the VE slope by at least 5%, percentage of maximal predicted heart rate reserve (HRR) achieved, and QoL. Results Of the 36 patients enrolled in the study, 20 fulfilled the criterion for severe CI and entered the study follow-up (mean age 68.9±7.4 years, 70% men, LVEF=41.8±9.3%, 40%/60% NYHA class II/III). Full baseline and follow-up datasets were obtained in 17 patients. The mean VE slope and HRR at baseline were 34.4±4.4 and 49.6±23.8%, respectively, in group 1 (n=7) and 34.5±12.2 and 54.2±16.1% in group 2 (n=10). After completing the 2-month CPX, the mean difference between DDD-CLS and DDD-40 modes was −2.4±8.3 (group 1) and −1.2±3.5 (group 2) for VE slope, and 17.1±15.5% (group 1) and 8.7±18.8% (group 2) for HRR. Altogether, VE slope improved by −1.8±2.95 (p=0.31) in DDD-CLS versus DDD-40, and HRR improved by 12.9±8.8% (p=0.01). The VE slope decreased by ≥5% in 47% of patients (“responders to CLS”). The mean difference in the QoL between DDD-CLS and DDD-40 was 0.16±0.25 in group 1 and −0.01±0.05 in group 2, resulting in an overall increase by 0.08±0.08 in the DDD-CLS mode (p=0.13). Conclusion First results of the evaluation of the effectiveness of CLS in CRT patients with severe CI revealed that CLS generated an overall positive effect on well-established surrogate parameters for prognosis. About one half of the patients showed CLS response in terms of improved VE slope. In addition, CLS improved quality of life. Further clinical research is needed to identify predictors that can increase the responder rate and to confirm improvement in clinical outcomes. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Biotronik SE & Co. KG


2009 ◽  
Vol 1 (1) ◽  
pp. 4 ◽  
Author(s):  
Marcus Jaeger ◽  
Michael Schmidt ◽  
Alexander Wild ◽  
Bernd Bittersohl ◽  
Susanne Courtois ◽  
...  

Correction osteotomies of the first metatarsal are common surgical approaches in treating hallux valgus deformities whereas the Scarf osteotomy has gained popularity. The purpose of this study was to analyze short- and mid-term results in hallux valgus patients who underwent a Scarf osteotomy. The subjective and radiological outcome of 131 Scarf osteotomies (106 hallux valgus patients, mean age: 57.5 years, range: 22-90 years) were retrospectively analyzed. Mean follow-up was 22.4 months (range: 6 months-5 years). Surgical indications were: intermetatarsal angle (IMA) of 12-23&deg;; increased proximal articular angle (PAA&gt;8&deg;), and range of motion of the metatarsophalangeal joint in flexion and extension &gt;40&deg;. Exclusion criteria were severe osteoporosis and/or osteoarthritis. The mean subjective range of motion (ROM) of the great toe post-surgery was 0.8&plusmn;1.73 points (0: full ROM, 10: total stiffness). The mean subjective cosmetic result was 2.7&plusmn;2.7 points (0: excellent, 10: poor). The overall post-operative patient satisfaction with the result was high (2.1&plusmn;2.5 points (0: excellent, 10: poor). The mean hallux valgus angle improvement was 16.6&deg; (pre-operative mean value: 37.5&deg;) which was statistically significant (p&lt;0.01). The IMA improved by an average of 5.96&deg; from a pre-operative mean value of 15.4&deg; (p&lt;0.01). Neither osteonecrosis of the distal fragment nor peri-operative fractures were noted during the follow-up. In keeping with our follow-up results, the Scarf osteotomy approach shows potential in the therapy of hallux valgus. 筻


2017 ◽  
Vol 11 (1) ◽  
pp. 1041-1048 ◽  
Author(s):  
Mehmet Bekir Unal ◽  
Kemal Gokkus ◽  
Evrim Sirin ◽  
Eren Cansü

Objective: The main objective of this study is to evaluate the availability of lateral antebrachial cutaneous nerve (LACN) autograft for acute or delayed repair of segmented digital nerve injuries. Patients and Methods: 13 digital nerve defects of 11 patients; treated with interposition of LACN graft that harvested from ipsilateral extremity were included in the study. Mean follow up period was 35, 7 months. The mean time from injury to grafting is 53, 3 days. The results of the mean 2PDT and SWMT values of injured /uninjured finger at the end of follow up period were evaluated with Paired T test. The correlation between the defect length and the difference of 2PDT, SWMT values between the uninjured and injured finger at the end of follow up period; were evaluated with Pearson - correlation analysis. Results: The mean value of our 2PDT and SWMT results are ~5,923, ~3, 52, respectively in which can be interpreted between the normal and diminished light touch. The defect length and difference percentage of SWMT values is positively and significantly correlated statistically. Mean length of interposed nerve grafts was 18.5 mm. The age of the patient and the mean values of 2PDT and SWMT with the difference % of 2PDT and % of SWMT are not statistically correlated. Conclusion: Based on results regarding sensory regaining at recipient side and negligible sensory deficit at harvesting side, we suggest that lateral antebrachial cutaneous nerve might be a valuable graft option for digital nerve defects.


2021 ◽  
Vol 25 (1) ◽  
pp. 473-479
Author(s):  
Jagar Doski ◽  
Berivan Jamal

Background and objective: The accelerated protocol of Ponseti method was suggested to shorten the period of treatment of the conventional one for the cases of talipes equinovarus deformity. This study aimed to compare the accelerated protocol of Ponseti method in the treatment of clubfoot deformity with the conventional one. Methods: A prospective comparative study was conducted for infants less than six months with congenital talipes equinovarus deformity. The patients were randomized to either Group 1 (casts changed every week, conventional protocol of Ponseti method) or Group 2 (twice weekly, accelerated one). Pirani score was used to assess the severity of the deformity at presentation, at time of last cast removal, and at the last follow up visit (6th months). Results: The patients included were 48 cases with 79 feet. Group 1 (39 clubfeet) had a mean Pirani score of 5.6 (± 1.15) at presentation, which dropped to 0.47 (± 0.41) when the last cast was removed. In Group 2 (40 clubfeet), it dropped from 5.57 (± 0.83) to 0.77 (± 0.01). The result of each treatment protocol was significant, but the difference between them was not significant. Five cases (three patients aged more than three months) of Group 2 needed eight casts to reach an acceptable position of correction. The difference between the mean number of casts applied in Group 1 (5.09) and Group 2 (5.82) was statistically not significant. However, the difference between the mean number of days spent in the cast was significant. The complications occurred in 12 out of 79 feet, with no statistically significant difference between both groups. Conclusion: The accelerated protocol of Ponseti method for treating clubfoot deformity is as effective and as safe as the conventional one. It shortens the time required to complete the treatment program. Those who present lately (beyond the age of three months) may require an additional number of casts. Keywords: Clubfoot; Congenital talipes equinovarus; Ponseti; Accelerated; Cast.


2021 ◽  
Author(s):  
Aylin Karalezli ◽  
Sema Kaderli ◽  
Ahmet Kaderli ◽  
Cansu Kaya ◽  
Sabahattin Sul

Abstract Purpose: To compare the effect of intravitreal ranibizumab (IVR) or intravitreal dexamethasone implants (IVD) on regression of hyperreflective dots (HRDs) on optical coherence tomography (OCT) B-scan in patients with branch retinal vein occlusion (BRVO). Methods: 37 eyes of 37 patients with cystoid macular edema who received IVR or IVD and followed up for at least 12 months were included in this study. The patients were divided into three groups according to intravitreal treatment. Group 1 consisted of 12 eyes who received only IVD, group 2 consisted of 10 eyes who received only IVR on a pro re nata and group 3 consisted of 15 eyes who received both IVD and IVR. OCT parameters (CMT, number of HRDs, status of external limiting membrane (ELM) and ellipsoid zone (EZ)) and best-corrected visual acuity (BCVA) were compared between the groups over the follow-up time. HRDs were categorized as HRD in inner retinal layers (from the internal limiting membrane to the inner nuclear layer) or HRD in outer retinal layers (from the outer plexiform layer to the outer border of the photoreceptor layer).Results: There was no significant difference between groups in terms of BCVA, CMT, HRDs in the inner and the outer retinal layers at baseline visit. (p˃0.05 for all) Comparing the baseline values in all groups, a significant decrease was observed in CMT in the first year. (For group 1; p=0.013, group 2; p=0.010; group 3, p<0.001) The BCVA was significantly increased after 1 year in all groups. (p=0.001, p=0.006, p<0.001) The mean number of HRDs in inner and outer retinal layers were significantly decreased in group 1 and group 3. (For group 1; p<0.001, p=0.001, for group 3; p<0.001, p<0.001) However, there was no significant difference in terms of the mean number of HRDs in inner and outer retinal layers for group 2. (p=0.134, p=0.477) At the first year, the number of HRDs in inner and outer retinal layers was significantly lower in group 1 and group 3 than group 2. (For inner HRDs; group 1 vs. group 2 p=0.007, group 2 vs. group 3 p<0.001. For outer HRDs group 1 vs. group 2 p<0.001, group 2 vs. group 3 p<0.001.) The BCVA was higher in group 3 than group 2 at 1year. (p=0.048). There was no significant difference in terms of post-treatment CMT and the number of HRDs between group 1 and group3 in posthoc tests (p=0.621, p=0.876, and p=0.632).Conclusion: The reduction in HRDs at 12 months and better BCVA after IVD intimates that the HRDs should be considered as inflammatory markers in the follow-up of CME in BRVO. Thus, IVD injection could be more appropriate for patients with higher HRDs after BRVO.


Author(s):  
Wazir Fahad Jan ◽  
Sanjay Sarup ◽  
Mohd Yahya Dar ◽  
Alamgir Jahan ◽  
Ovais Nazir Khan

Background: Several osteotomies have been described for the correction of acetabular dysplasia associated with variable outcomes. The purpose of our study was to evaluate the effect of Dega transiliac osteotomy in radiological correction of acetabular dysplasia by assessing the change in various radiological parameters from preoperative period to postoperative period and at a follow up of two years.Methods: This was a prospective observational study conducted on 35 patients of either sex, in the age range of 18 months to 8 years, presenting to the paediatric orthopaedic OPD, of Artemis Health Institute, Gurgaon, Haryana, India between January 2012 and September 2014 in whom a diagnosis of acetabular dysplasia was made. All the patients underwent Dega transiliac osteotomy and the effectiveness of this osteotomy in the correction of acetabular dysplasia was assessed by measuring various radiological parameters preoperatively, postoperatively, and at a follow up of two years. The various radiological parameters included acetabular index (AI), centre edge angle of wiberg (CEAW), reimer’s extrusion index (REI) and the shenton’s line (SL).Results: In present study sample of 35 cases, 29 had DDH, 4 were secondary to cerebral palsy and 2 had developed dysplasia following septic arthritis of the hip. The sex distribution showed 19 females and 16 male patients. All the patients underwent Dega transiliac osteotomy at a mean age of 42.94±21.68 months. The mean value of AI improved from 42.43±4.77 degrees in preoperative period to 19.86±2.45 degrees at follow up. The mean value of CEAW improved from - 32.49±21.60 degrees in preoperative period to 32.06±5.48 degrees at follow up. The mean value of REI, improved from 91.06±21.43 % in preoperative period to 0.29±1.18 % at follow up. The SL was broken in all the 35 patients preoperatively, while at follow up it was continuous in all the patients. These changes in all the four parameters were statistically highly significant (p value<0.001).Conclusions: Thus results of present study demonstrate that Dega osteotomy is a safe, effective and versatile surgical procedure for the treatment of acetabular dysplasia secondary to DDH and other disorders. Since the majority of the patients included in this study had the diagnosis of DDH, the results of this study are more representative of dysplasia associated with DDH.


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