bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic and Delayed Mustard Gas Keratopathy: A Histopathologic and Immunohistochemical Study
Authors: Kanavi Mozhgan Rezaei , Javadi Atefeh , Javadi Mohammad Ali
Published: January 2018

Purpose

To specify histopathologic and immunohistochemical features of chronic and delayed mustard gas keratopathy.

Methods

Corneal buttons from patients with chronic and delayed mustard gas keratopathy were examined for routine histopathology special histologic stainings, and immunohistochemistry for CD31 and CD68.

Results

Twenty-five corneal buttons from 25 patients with chronic and delayed mustard gas keratopathy were evaluated. Irregular epithelial thickness (100%), degenerative changes (24) (96%), thickened epithelial basement membrane (23) (92%), keratocytes loss (18) (72%), and destroyed Bowman layer (18) (72%) were predominant histopathologic features. Amyloid degeneration was the most commonly observed degenerative change in the specimens (83%). Immunoreactivity for CD68 and CD31 was detected in 88% and 56%, respectively.

Conclusions

In this observational case series, although all corneal layers from epithelium to the endothelium were involved from mild to severe degrees, the anterior corneal layers were more affected on histopathology than the posterior parts in chronic and delayed mustard gas keratopathy.
Systemic Cyclosporin a in Severe Atopic Keratoconjunctivitis
Authors: Cornish Kurt Spiteri , Gregory Maria Elena , Ramaesh Katheravelu
Published: January 2018

Purpose

Severe atopic keratoconjunctivitis (AKC) is associated with atopic dermatitis and is often refractory to topical treatment and potentially blinding. Because T lymphocytes are central in the pathogenesis of these diseases, systemic cyclosporin A (CSA) should treat both dermatologic and ocular manifestations. We describe the successful treatment of 8 patients with severe AKC, resistant to conventional management, with systemic CSA.

Methods

This was a retrospective observational case series. The notes of patients with severe AKC were reviewed, where the disease did not respond to topical or other systemic treatment, and was treated with systemic CSA. Response to such treatment was observed and reported in 8 patients.

Results

Cyclosporin A was effective as a steroid-sparing agent. Systemic corticosteroids were stopped in half of the patients. Dosage varied between 50 mg and 300 mg daily (in divided doses), and duration of treatment varied between 5 months and 7 years. Papillary blepharoconjunctivitis and punctuate keratopathy completely resolved a few weeks after CSA therapy. Corneal ulcers resolved after 5 to 10 weeks of treatment. Coexistent eczema or dermatitis was brought under control with systemic immunosuppression, and flare-ups were not present during the duration of treatment. There was remission of AKC in all 8 patients with increase in visual acuity and low incidence of side effects.

Conclusions

Cyclosporin A is effective in the treatment of atopic dermatitis and keratoconjunctivitis. Our case series potentiates previous smaller case series that systemic CSA can be used effectively and safely in cases that are resistant to conventional treatment to preserve vision.
Comparison of Central Corneal Thickness Measurements Using Pentacam and Ultrasonic Pachymetry in Post-LASIK Eyes for Myopia
Authors: Al-Mezaine Hani S. , Al-Amro Saleh A. , Kangave Dustan , Al-Obeidan Saleh , Al-Jubair Khaled M.
Published: January 2018

Purpose

To compare central corneal thickness (CCT) measurements obtained using the Pentacam Scheimpflug system with those obtained using DGH ultrasound pachymetry (UP) in post-laser in situ keratomileusis (LASIK) eyes for myopia.

Methods

In a prospective study, measurement agreement was assessed in 143 eyes of 72 post-LASIK patients using both the Pentacam and UP at the Eye Consultants Center in Riyadh, Saudi Arabia.

Results

The mean CCT was 522±42.2 μm with the Oculus Pentacam and 516.2±40.6 μm with UP. The Bland-Altman plot showed that the mean ± SD for the differences between the 2 devices was 5.8±13.6 μm, with 95% confidence interval limits ranging from −20.9 μm to 32.6 μm. A test of statistical significance indicated that the mean differences of 5.8±13.6 μm differed significantly from zero (p<0.001; Wilcoxon signed-rank test), thus indicating that the Pentacam measurements tended to overestimate CCT compared with UP. Analysis of regression showed a high correlation between the values obtained with both devices (r=0.947, p<0.001).

Conclusions

In post-LASIK myopic eyes, although a high correlation has been shown between Pentacam and UP measurements, Pentacam tends to overestimate CCT compared to UP. Pentacam probably cannot be used interchangeably with UP in post-LASIK eyes for myopia.
Treatment of Keratoconus with Ferrara ICRS and Consideration of the Efficacy of the Ferrara Nomogram in a 5-Year Follow-Up
Authors: Pesando Paolo Maria , Ghiringhello Maria Pia , Di Meglio Giuseppe , Romeo Salvatore
Published: January 2018

Purpose

To investigate Ferrara intrastromal ring segments (FIRS) as a therapeutic opportunity to treat keratoconus (KC), to reduce the necessity for cornea transplant, and to improve quality of vision of patients with this disease. We demonstrate that the procedure is safe, reversible, and reliable, and can delay/stop the KC progression.

Methods

A total of 130 eyes of 83 patients with KC, intolerant to contact lenses, implanted with FIRS were considered. Average follow-up was 37 months with a minimum of 2 years and a maximum of 5 years. For all patients, manifest refraction, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA) corneal map, Orbscan, and intraoperative pachymetry were performed and were compared to postoperative measurements.

Results

A total of 93.84% (122 patients) of the eyes gained lines of UCVA and only 1.53% (2 eyes) lost them. A total of 97.69% (127 patients) of the treated eyes gained lines of BCVA and no eyes lost them. The value of K1 and K2 were considerably reduced over 5 years. The preoperative value of K average of 49.27 D became 4.68 D postoperatively. Both the UCVA and the BCVA showed an increase. The UCVA changed from 0.14 lines preoperatively to 0.32 postoperatively while the BCVA changed from 0.40 to 0.59. The spherical equivalent changed from −8.34 D before the operation to −2.83 D after the operation.

Conclusions

FIRS make KC cornea more regular and the patients have increased corrected and uncorrected visual acuity postoperatively. The progression of KC was stopped and the cornea thickness minimally, but regularly, improved.
Cataract and Pseudophakia in Elderly European Drivers
Authors: Nischler Christian , Michael Ralph , Wintersteller Christine , Marvan Patrick , Emesz Martin , Van Rijn Laurentius J. , Van Den Berg Thomas J.T.P. , Wilhelm Helmut , Coeckelbergh Tanja , Barraquer Rafael I. , Grabner Günther , Hitzl Wolfgang
Published: January 2018

Purpose

To evaluate the prevalence and association of different types and seventies of cataract or pseudophakia with visual impairments in older European drivers.

Methods

In this prospective European multicenter study, 2211 active drivers, 45 years of age and older, participated in an ophthalmologic examination, the measurement of visual functions, and were asked to fill in the NEI-VFQ-25 and another questionnaire about driving habits, driving difficulties, and self-reported accidents.

Results

Prevalence of moderate and severe forms of cataract in an active driving population is lower than that in the general population, but could be found in both eyes in 20% (95% confidence interval [CI] 16%–25%) and 17% (95% CI: 13%–21%) of subjects 75 years of age and older. In addition, there is a strong relationship between severity of cataract and parameters such as age, visual acuity, intraocular straylight, and contrast sensitivity.

Conclusions

Cataract is not as highly prevalent in the elderly active driving population as in the general population, but is frequently present in drivers over 65 years of age. Lower prevalence of severe bilateral cataracts in countries with mandatory tests of visual functions of drivers suggest that this could be a suitable measure to detect and to reduce the number of active drivers with severe bilateral cataracts.
Comparison of Optic Disc Topography before and after Antiglaucoma Treatment in Juvenile Glaucoma
Authors: Elgin Ufuk , Ozturk Faruk , Sen Emine , Serdar Kurtulus
Published: January 2018

Purpose

To compare the optic disc topography parameters of cases of juvenile glaucoma before and after antiglaucoma treatment by using Heidelberg Retinal Tomograph (HRT II).

Methods

The medical records of 21 eyes of 21 consecutive patients (mean age 13±2 years) with juvenile glaucoma, who had been examined between 2006 and 2008, were reviewed retrospectively. The topographic optic disc parameters (cup volume, cup area, rim volume, rim area, mean cup to disc ratio and mean cup depth) and mean retinal nerve fiber layer thickness of 21 eyes of 21 children with juvenile glaucoma at baseline and at the sixth month of antiglaucoma treatment were compared with paired t test.

Results

NO statistically significant differences were found among cup volume (p=0.137), rim area (p=0.07), rim volume (p=0.102), and mean cup depth (p=0.892) before and after treatment. Mean cup area and cup to disc ratio at the sixth month of treatment were statistically significantly smaller than the values at baseline (p=0.041, p=0.002). The mean retinal nerve fiber layer at baseline was statistically significantly smaller than the value after treatment (p= 0.016).

Conclusions

The result suggests that glaucomatous changes of optic disc topography may be reversible after antiglaucoma treatment in juvenile glaucoma.
Focal Posterior Pole Viral Retinitis
Authors: Hazirolan Diele , Sungur Gulten , Demir Necati , Kasim Remzi , Duman Sunay
Published: January 2018

Purpose

To describe the clinical features of an atypical form of viral retinitis in immunocompetent patients.

Methods

This was a retrospective noncomparative case series. The charts of 8 patients diagnosed with and treated for focal posterior viral retinitis were reviewed. Clinical and demographic features were evaluated. All the patients had extensive laboratory tests, fundus fluorescein angiography, optical coherence tomography of macula, and polymerase chain reaction of vitreous.

Results

All the patients were referred to our Uveitis Service from other hospitals, as their uveitis symptoms deteriorated in spite of treatment. The mean age of 4 male and 4 female patients was 32.1 years (range, 22–42 years). The mean follow-up period was 10 months (range, 6–18 months). All of the patients had unilateral disease. Polymerase chain reaction analysis of vitreous specimen was positive for herpes simplex virus-1 in 5 patients and varicella zoster virus in 3 patients. Retinitis resolved after systemic acyclovir treatment in all patients.

Conclusions

Viral etiology must be borne in mind in the differential diagnosis of atypical retinitis. It can be a milder form of viral retinitis like focal viral retinitis, as mentioned in this study. The prognosis of this disease is better than the other forms of necrotizing retinopathies involving a larger area of retina.
Screening Criteria for Retinopathy of Prematurity in Developing Countries
Authors: Akman Ipek , Demirel Utku , Yenice Özlem , Ilehsoy Hacer , KazokoğLu Haluk , Özek Eren
Published: January 2018

Purpose

Retinopathy of prematurity (ROP) is a serious problem which potentially can lead to blindness. The objective of this study is to detect the incidence of ROP and the number of preterm babies requiring treatment for ROP in our center and to establish the screening criteria for our country.

Methods

A total of 801 babies with a gestational age less than 37 weeks were screened for ROP. Babies with a gestational age (GA) less than 32 weeks (n=348) were assigned as group 1. Babies with a GA between 32 and 34 weeks (n=335) were assigned as group 2 and between 35 and 37 weeks (n=98) were assigned as group 3. Clinical features and ROP screening results of the cases were documented.

Results

In group 1, ROP was detected in 176 (50.9%) babies, 41 (11.8%) of whom were treated with laser I cryotherapy. In group 2, 83 (25%) cases of ROP were detected, and 11 of them (3.1%) required therapy. In group 3, 9 (9.1%) infants were diagnosed with ROP, and none of them required treatment. Clinical factors associated with ROP in group 1 were gestational age, birthweight, duration of ventilation, duration of oxygen supplementation, sepsis, and bronchopulmonary dysplasia.

Conclusions

In developing countries, the criteria for ROP screening programs should be designed according to local conditions. In our country, screening all premature babies with a gestational age less than 34 weeks or a birthweight less than 1850 g appears to be appropriate.
Choroidal Metastasis with Adenocarcinoma of the Lung Treated with Gefitinib
Authors: Inoue Maiko , Watanabe Yoichiro , Yamane Shin , Kobayashi Satoshi , Arakawa Akira , Tsukahara Toshinori , Kaneko Takeshi , Kadonosono Kazuaki
Published: January 2018

Purpose

To report a case of bilateral regression of choroidal metastasis with adenocarcinoma of the lung treated with gefitinib.

Methods

Retrospective case review of a 68-year-old woman with pulmonary adenocarcinoma with choroidal metastasis who presented with visual loss in the left eye as the initial manifestation. Her visual acuity was 6/6 in the right eye and 6/60 in the left eye before the start of gefitinib administration. Best-corrected visual acuity and spectral-domain optical coherence tomography were compared between baseline and 3 months after treatment.

Results

Best-corrected visual acuity in the left eye had improved to 6/30 3 months after oral gefitinib. The elevated lesions of the right eye disappeared, with decrease of subretinal fluid and retinal pigment epithelial atrophy. Spectral-domain optical coherence tomography showed that subretinal fluid of the left eye was also reduced.

Conclusions

Oral gefitinib could be effective for regression of choroidal metastasis in patients with adenocarcinoma of the lung and provides a potential treatment option.
Ocular Neovascularization following Central Retinal Artery Occlusion: Prevalence and Timing of Onset
Authors: Rudkin Adam K. , Lee Andrew W. , Chen Celia S.
Published: January 2018

Purpose

Debate exists in the literature on the prevalence and etiology of neovascularization following central retinal artery occlusion (CRAO). The reported prevalence varies from 2.5% to 31.6%. We conducted a retrospective study to determine the prevalence of ocular neovascularization following acute CRAO in our institution.

Methods

A retrospective audit of consecutive patients with nonarteritic/thromboembolic CRAO presenting between 1997 and 2009 in a single tertiary teaching hospital.

Results

Thirty-three patients were identified as having nonarteritic CRAO, and of this cohort 6 patients (18.2%) developed ocular neovascularization. Neovascular glaucoma was present in 5 cases (15.2%); 2 of these presented through an emergency department with painful eyes, both at 16 weeks post CRAO. The other cases of neovascularization were detected on scheduled follow-ups. Mean time from retinal occlusive event to observed neovascularization was 8.5 weeks (range 2–16 weeks). One case of neovascularization was associated with hemodynamically significant ipsilateral carotid stenosis; no patient had proliferative diabetic retinopathy or other causes of neovascularization.

Conclusions

The prevalence of neovascularization following acute CRAO in our population was 18.2% at an average of 8.5 weeks post CRAO. There was a temporal relationship between the 2 events and no other causes of neovascularization demonstrable in our cohort of patients. There is no consensus on the follow-up regimen post CRAO to detect ocular neovascularization complications. Our study suggests that neovascularization can occur early and regular follow-up especially in the first 4 months is important post CRAO.
Periorbital and Orbital Cellulitis: A 10-Year Review of Hospitalized Children
Authors: Georgakopoulos Constantine D. , Eliopoulou Maria I. , Stasinos Stavros , Exarchou Artemis , Pharmakakis Nikolaos , Varvarigou Anastasia
Published: January 2018

Purpose

Periorbital cellulitis is often difficult to distinguish from orbital cellulitis, which is a potentially lethal infection involving the contents of the orbit. A delay in diagnosis and appropriate treatment may result in serious complications. We studied the predisposing factors, microbiologic data, clinical features, complications, and treatment of periorbital and orbital cellulitis in childhood.

Methods

Eighty-three medical records of patients (mean age 3.7±3.1 years) admitted to the Department of Pediatrics with a diagnosis of periorbital or orbital cellulitis during the 10-year period January 1997 to December 2007 were retrospectively studied.

Results

In this series, periorbital cellulitis occurred more frequently (83%) than orbital cellulitis (17%). Of the children with periorbital cellulitis, 85% were younger than 5 years of age, while 62% of the children with orbital cellulitis were older than 5 years of age. The most common predisposing factors in periorbital cellulitis were upper respiratory infection (68%) and trauma to the eyelids (20%), while sinusitis was more frequently associated with orbital cellulitis (79%). Blood and skin cultures were usually negative. The most common isolated pathogens were Staphylococcus aureus, Streptococcus pneumoniae, and Staphylococcus epidermidis. Forty-five of the 83 children were treated with intravenous ceftriaxone + clindamycin (mean duration 8.6±5.5 days). Intravenous antibiotics alone was an effective management in most of the patients, but a small proportion (6%) required surgical intervention.

Conclusions

Upper respiratory infection and sinusitis are the most important predisposing factors for periocular infection. Streptococcus species are the predominant causative agents. Both diseases can usually be successfully treated with intravenous antibiotics, but some patients may require surgery to control extensive infection.
Unusual Presentation of Giant Cell Angiofibroma of the Eyelids
Authors: Surace Dario , Blandamura Stella , Bernardini Francesco P. , Galan Alessandro , Giudice Giuseppe Lo
Published: January 2018

Purpose

To describe a case of bilateral eyelid-confined giant cell angiofibroma (GCAF) in a patient with a slowly progressive bilateral eyelid swelling.

Methods

A 40-year-old man with a 5-year history of slowly progressive bilateral eyelid swelling, severe functional impairment, and bilateral cosmetic deformity was studied. An extensive ophthalmologic evaluation, laboratory examinations, and orbital magnetic resonance imaging were carried out.

Results

Clinical examination showed nonpitting lymphedema affecting both upper and lower eyelids, with orange peel skin. Orbital magnetic resonance imaging revealed diffuse thickening of the preseptal structures in the eyelids without extension to the orbit. Histologic specimen revealed the presence of spindle and multinucleated giant cells surrounding pseudovascular spaces strongly positive to CD34 and vimentin. A diagnosis of GCAF was made and radiation therapy was performed 3 weeks after surgical debulking with partial recovery of visual and anatomic function.

Conclusions

Giant cell angiofibroma involving the eyelid is rare and can represent a diagnostic and therapeutic challenge to the ophthalmologist.
Sequential Anterior Ischemic Optic Neuropathy and Central Retinal Artery and Vein Occlusion after Ranibizumab for Diabetic Macular Edema
Authors: Parodi Maurízio Battaglia , Lacono Pierluigi , Cascavilla Maria Lucia , Zucchiatti Ilana , Kontadakis Dimitris Stelios , Vergallo Stefano , Bandello Francesco
Published: January 2018

Purpose

To describe a rare adverse event characterized by anterior ischemic optic neuropathy (AION) associated with central retinal artery occlusion (CRAO) followed by central retinal vein occlusion (CRVO) secondary to treatment with intravitreal injection of ranibizumab for diabetic macular edema (DME).

Methods

A patient with DME refractory to focal grid laser photocoagulation in the left eye was prospectively followed and treated with intravitreal injection of ranibizumab. Over a 12-month period and after 4 injections, best-corrected visual acuity (BCVA) improved from 20/63 to 20/50 (Snellen equivalent) and central retinal thickness (CRT) reduced from 551 to 279 μm. In July 2009, BCVA dropped to 20/100 with CRT of 421 μm due to the recurrence of DME and a further injection was administered.

Results

One month later, the left eye showed a sudden visual acuity loss. Best-corrected visual acuity was 20/400 and the fundus examination revealed a hyperemic and swollen optic disc, with several retinal hemorrhages. Retina at the posterior pole was pale, with attenuation and sheathing of arterial vessels. Fluorescein angiography showed a delayed optic disc and arterial filling with retinal ischemia involving both posterior pole and periphery and confirmed the diagnosis of AION associated with CRAO. One month later, the BCVA decreased to 20/800, and fundus examination evidenced a CRVO with diffuse retinal hemorrhages in the 4 quadrants, congestion, and tortuosity of the retinal veins.

Conclusions

Although severe ocular adverse events are generally rare, patients receiving intraocular anti-vascular endothelial growth factor injection should be monitored carefully for the development of vascular complications.
Acquired Senile Retinoschisis of the Peripheral Retina Imaged by Spectral Domain Optical Coherence Tomography: A Case Report
Authors: Landa Gennady , Shirkey Belinda L. , Garcia Patricia M.T. , Milman Tatyana , Garcia Julian P.S. , Rosen Richard B.
Published: January 2018

Purpose

We report spectral domain optical coherence tomography findings of the peripheral retina in a patient with senile (acquired) retinoschisis.

Methods

This is an observational case report. Spectral domain optical coherence tomography was performed to image the peripheral retina at the area of retinoschisis in a 70-year-old man with bilateral inferonasal elevated peripheral retinal lesions. Since the lesions were not entirely transparent and smooth, and demonstrated a certain degree of mobility, the diagnosis of retinal detachment could not be excluded.

Results

Spectral domain optical coherence tomography scans obtained at the margin of the lesions demonstrated attached retina with a characteristic splitting of the neurosensory retina at the outer plexiform layer and cystic changes in the inner retina.

Conclusions

Spectral domain optical coherence tomography can assist in the diagnosis of senile (acquired) retinoschisis, particularly in cases where retinal detachment cannot be excluded on clinical examination alone.
Vitrectomy for Treatment of a Lamellar Hole in a Patient with Exudative Macular Degeneration: The Role of Vitreous Traction Elimination
Authors: Theodossiadis Panagiotis , Charonis Alexandros , Panagiotidis Dimithos , Papathanassiou Miltiadis , Petrou Petros
Published: January 2018

Purpose

Lamellar macular hole (LMH) represents a well-defined clinical entity with variable pathophysiologic mechanisms and a controversial therapeutic approach. The purpose of the present work is to present a patient with an epiretinal membrane (ERM)–associated LMH on the background of exudative age-related macular degeneration (AMD) that was successfully managed with pars plana vitrectomy.

Methods

Interventional case report.

Results

A 67-year-old man presented with progressive visual loss OS of 5 months’ duration. He was diagnosed with an ERM-associated LMH with coexisting subretinal fluid arising by a neovascular membrane on the background of exudative AMD confirmed with fundus fluorescein angiography. He underwent a 3-port pars plana vitrectomy with ERM–internal limiting membrane peeling and gas tamponade (14% C3F8) for treatment of the LMH and ERM with a view to undergo anti-vascular endothelial growth factor treatment for the exudative AMD. Postoperative optical coherence tomography demonstrated complete closure of the LMH with simultaneous total subretinal fluid absorption that was maintained at the 2-month follow-up period.

Conclusions

To our knowledge, this is the first report whereby pars plana vitrectomy in a patient with an ERM-associated LMH on the background of exudative AMD resulted in improvement of both clinical entities. The latter strengthens the role of vitreous traction elimination in exudative AMD and highlights the need for further research.
Comparative Study of Mydriasis in Cataract Surgery: Topical versus Mydriasert versus Intracameral Mydriasis in Cataract Surgery
Authors: Morgado Gabriel , Barros Pedro , Martins Joana , Lima André , Martins Neves
Published: January 2018

Purpose

To compare the mydriatic efficacy and cardiovascular safety of the mydriatic options.

Methods

This was a prospective randomized analysis of 90 eyes submitted to senile cataract surgery. Group A (30 eyes) included topical mydriasis, group B (30 eyes) included mydriasis with the ophthalmic insert (Mydriasert), and group C (30 eyes) included intracameral mydriasis. Measures were mydriasis value before ophthalmic viscoelastic device (OVD) injection and at the end of surgery, blood pressure and heart rate, need for antihypertensive medication, and subjective iris stability.

Results

Before OVD injection and at the end of surgery, pupillary dilation was 8.1 and 7.0 mm in group A, 8.2 and 7.7 mm in group B, and 6.3 and 6.1 mm in group C, respectively. Mean surgery time was 8.3 min in group A, 8.1 min in group B, and 12.3 min in group C (p<0.05). The mean subjective iris stability score was 8.7/10 in group A, 9.3/10 in group B, and 6.1/10 in group C (p<0.05). Systolic blood pressure was greater than 180 mmHg in 9 (30%) patients in group A, 3 (10%) in group B, and 2 (6.6%) in group C. Antihypertensive medication was administered to 8 (26.6%) cases in group A, 2 (6.6%) in group B, and 0 (0%) in group C (p<0.05).

Conclusions

The most effective mydriasis was obtained within the Mydriasert group, followed by the topical mydriasis group. From the cardiovascular point of view, intracameral mydriasis was the safest and topical mydriasis the least safe.
Is There Any Difference in Target Intraocular Pressure for Exfoliative Glaucoma Patients with Cardiovascular Disease History?
Authors: Holló Gábor , Cvenkel Barbara , Teus Miguel A. , Irkec Murat T. , Astakhov Yuri S. , Chiselita Dorin , Petkova Nataliya , Liehneová Ivana , Kaluzny Bartlomiej J. , Kóthy Péter , Bozkurt Banu , Akopov Evgeny L , Stewart Jeanette A. , Kristoffersen Michael S. , Kristoffersen Caroline J. , Stewart William C.
Published: January 2018

Purpose

To investigate if patients with exfoliation glaucoma (XFG) with cardiovascular disease (CVD) require different target intraocular pressure (IOP) compared to patients with XFG with no CVD for long-term stability.

Methods

A retrospective, multicenter, observational cohort analysis included consecutive patients with XFG from 9 European academic centers, with a minimum of 5 years follow-up.

Results

In 201 patients, there was a statistical difference between progressed and nonprogressed patients in mean (p=0.0049) and peak (p=0.015) IOP, variance of IOP (p=0.028), and number of medicine changes/year (p=0.0037). At a mean IOP ≥22 mmHg, patients progressed in 84% (32/38), between 14 and 21 mmHg in 54% (81/151), and at ≤13 mmHg in 33% (4/12). There was no difference in the rate of progression between groups based on CVD history (p=0.65). However, IOP that allowed ≤50% progression rate for patients with mild or no CVD was ≤20–21 mmHg and ≤18 mmHg for patients with severe disease. Further, at IOP ≥20 mmHg, 8% (1/12) of patients with severe CVD remained stable in contrast to 38% (16/42) of patients with mild and 21% (4/19) with no CVD history (p=0.0093). By multivariant regression analysis of the IOP and CVD measures, mean IOP was a risk factor for progression (p=0.0097).

Conclusions

Although IOP is the main determinant of progression in XFG under treatment, history of severe CVD should be further investigated as potential risk factor for glaucomatous progression.
Single Needle Revision of Failing Filtration Blebs: A Retrospective Comparative Case Series with 5-Fluorouracil and Mitomycin C
Authors: Palejwala Neal , Ichhpujani Parul , Fakhraie Ghasem , Myers Jonathan S. , Moster Marlene R. , Katz L. Jay
Published: January 2018

Purpose

To assess the success of needling in failed filtration blebs and the potential benefit of using either 5-fluorouracil (5-FU) or mitomycin C (MMC).

Methods

In this retrospective, comparative observational case series, 107 eyes that underwent needle revision with either 5-FU or MMC between July 2003 and May 2008 at Wills Eye Institute were selected. Exclusion criteria included follow-up less than 1 month and a history of glaucoma drainage device. Intraocular pressure (IOP) and number of glaucoma medications were recorded preoperatively and postoperatively. Success was defined as >20% decrease in IOP if glaucoma medications were resumed or <10% decrease in IOP if medications were not resumed post needling or fewer medications than pre needling.

Results

Sixty-five patients received 5-FU and 42 patients received MMC for needling. Mean IOP changed from 23.9 mmHg to 13.8 mmHg in the MMC group and from 23.3 mmHg to 13.02 mmHg in the 5-FU group (both p<0.001). Mean glaucoma medications changed from 1.7 to 0.7 in the MMC group and 2.0 to 0.8 in the 5-FU group (both p<0.001) at the end of follow-up. After a mean follow-up of 14.5 months, overall survival was 49.5%. Mean time to failure was 7.7 months. There was a moderately weak association between survival and the immediate postoperative IOP (r=0.262, p=0.01). In comparing MMC and 5-FU, there was no statistically significant difference in survival rate (p=0.267).

Conclusions

Bleb needling may be a safe and effective means of prolonging bleb survival. The only factor associated with success was the immediate postoperative IOP There was no apparent difference between the use of 5-FU and MMC in this population. A prospective study may provide further confirmation of this finding.
Polymethylmethacrylate Venogram after Cemented Arthroplasty of the Hip. A Report of Seven Cases and Review of the Literature
Authors: Valle A. González Della , Piccaluga F. , Alfie V. , Salvati E.A.
Published: January 2018

We present seven patients with polymethylmethacrylate (PMMA) filling the veins accompanying the second perforating branch of the profunda femoris artery detected after primary cemented hip arthroplasty. All implants were cemented utilizing retrograde canal filling with a cement pistol and pressurization. No haemodynamic changes were observed throughout any of the procedures and all patients had an uneventful recovery and evolution. The presence of a PMMA venogram is an infrequent finding after cemented hip arthroplasty. In our seven cases it was not associated with higher peri-operative morbidity. Differential diagnoses must be made with cement extruded through incomplete fractures or through femoral screw holes, as treatment and weightbearing status may differ.
Bone Remodelling in a Conservative Femoral Component for Hip Replacement Surgery
Authors: Shoeb M. , Coathup M.J. , Witt J.D. , Walker P.S. , Blunn G.W.
Published: January 2018

This study investigated a conservative femoral component for hip replacement surgery. Re-surfacing implants with two hydroxyapatite-coated pins were inserted into the right femoral necks of eight adult goats for one year. Radiographic analysis revealed bone loss directly beneath the prosthetic cup with increased amounts of bone at the distal end of the pins. Microscopic analysis revealed localised areas of bone formation adjacent to the implant. Oxytetracycline bone markers demonstrated significantly decreased bone formation rates (p<0.05) in bone adjacent to the implant in the operated compared to the control hips. Image analysis results demonstrated an average bone attachment of 30.94% to the implant surface. Attachment varied regionally, with greatest bone attachment at the end of the pins (78.99%) contributing 22% of total bone attachment to the implant. Least bone attachment (13.82%) was measured beneath the prosthetic cup and adjacent to the medial aspect of the pin. This contributed 4% of total bone attachment. Image analysis results demonstrated that in four of five comparable regions of operated and control hips, bone area was greater in control hips. Values were significant in three regions adjacent to the implant (p=0.002, p=0.008, p<0.05). Results revealed no significant correlation between bone attachment to the implant pins and bone area beneath the prosthetic cup. However, these findings do suggest that this conservative design led to stress shielding resulting in unfavourable bone remodelling despite the osteoconductive hydroxyapatite coating.
Bone mineral density 10 years after a Zweymüller uncemented stem prosthesis
Authors: Vervest T. M.J.S. , Van Heeswijk W. H.J.C. , Anderson P. G. , Van Limbeek J.
Published: January 2018

The effect of a Zweymüller uncemented stem prosthesis on the long-term bone remodelling of femoral bone was examined using dual-energy X-ray absorptiometry (DEXA). Thirty-two patients (11 males, 21 females) with a unilateral prosthesis (18 Hochgezogen and 14 Stepless) were scanned at an average of 129.8 months after the initial operation. The average follow-up Harris Hip Score was 93.7: ten patients were classified as Charnley Class A, two patients as class B and 20 patients as class C. The group as a whole showed a moderate activity level and most patients were satisfied with the result of the operation. All stem prostheses were osseo-integrated.

The non-operated contralateral femur was used as a control for the bone mineral density (BMD) changes in the femur around the prosthesis. A decrease of bone mineral density on the prosthesis side was found at the region of the calcar femoris, without any clinical decline or any radiographic anomalies.
Ultrastructural Analysis of Retrieved Ceramic Ball Heads
Authors: Maccauro G. , Pilloni L. , Petrella L. , Proietti L. , De Santis V. , Muratori F. , Piconi C.
Published: January 2018

Surface modification of alumina heads retrieved for aseptic loosening (6 cases) has been analysed using scanning electron microscopy, coupled with energy dispersive X-ray microanalysis. Ultrastructural analysis showed the presence of voids with grain detachment on all the retrieved cups and also in those cases in which macroscopic signs of wear were absent. The preservation of the macroscopic integrity of ceramic structure is an essential condition for long-time survival of total hip replacement, even if ceramic may also play a role in PE damage for the abrasive effects of grains. Macroscopic wear observed in two cases is not related to degradation of ceramic material but to other factors connected to surgery.
Avascular necrosis in five patients with human immunodeficiency virus (HIV) infection
Authors: Clark B.M. , Zenios M. , Wilkins E.G.L. , Sochart D.H.
Published: January 2018

Avascular necrosis (AVN) of bone occurring in patients infected with Human Immunodeficiency Virus (HIV) has been well documented in recent literature. Contributing factors may include drug treatment (steroids and protease inhibitors), hyperlipidaemia, hyperviscosity, antiphospholipid antibodies, or the virus itself. We have retrospectively reviewed case notes of all patients seen in our department with AVN (n=5). We conclude that although steroids play an important role, the aetiology of AVN in HIV is multifactoral. The orthopaedic surgeon should consider AVN in the differential diagnosis of patients with HIV infection presenting with painful joints.
Valgus slipped capital femoral epiphysis: Case report and review of the literature
Authors: Rajan R.A. , Ibrahim T. , Asirvatham R. , Aster A.
Published: January 2018

Slipped capital femoral epiphysis (SCFE) usually occurs in children around the time of the growth spurt. There is a shearing force across the epiphysis at the hypertrophic zone allowing the slip. In the vast majority of cases, the slip occurs in the varus direction. Valgus slipped capital femoral epiphysis (SCFE) is an uncommon entity. Although there are a few isolated cases reported in the literature, to date this entity has not been sufficiently reviewed and understood. Such a case is presented and a review of the published literature on this subject is carried out.
Primary total hip replacement for acute displaced subcapital femoral fractures with a minimal three-year follow-up
Authors: Sharma S. , Draviraj K.P. , Bhamra M.S.
Published: January 2018

The aim of the study was to review the results of total hip replacement (THR) in relatively fit and mobile patients with Garden 3 and 4 fractures of the neck of femur. Forty-one patients who underwent THR for displaced intracapsular hip fractures from 1993 to 2001 were reviewed. Only those patients with three years or more follow-up were reviewed. Average follow-up was 5.8 years (3–9.6 years).

Complications encountered were: minor wound dehiscence (1), DVT (3), pulmonary embolism (1), dislocation (1), per-operative femur fracture (1), periprosthetic fracture following repeat fall (2), stem loosening (1). Average Harris Hip score at follow-up was 91 (66–100).

We recommend total hip replacement as the primary treatment in relatively fit and mobile patients with displaced intracapsular fractures of the hip.
Incorrect use of walking aids in patients with hip pathology
Authors: Shepherd A.J.
Published: January 2018

A study was performed to assess if patients with hip pathology are using their walking aids in the correct hand. From the literature it has been concluded that the contralateral hand to the hip pathology should be used with a walking aid. A questionnaire was given to patients attending orthopaedic clinics with solely hip pathology. Four questions were asked. Firstly, are you left or right handed? Secondly, which hip is the worst /most painful? Thirdly, in which hand do you hold your stick? Finally, has a doctor or physiotherapist ever told you which hand to use? Ninety-four correctly completed questionnaires were returned. Forty-seven per cent of patients were using the aid in the incorrect hand and of this group 64% were using their dominant hand. Sixty-six per cent claimed they had never been told which hand to use. This study shows that a large percentage of patients use walking aids incorrectly, mainly with their dominant hand. This may be due to poor education. Changing hands may be a simple measure to reduce symptoms from the hip with little or no complications.
Septic Hip after a Fractured Neck of Femur in a Rheumatoid Patient: A Case Report
Authors: Anwar R. , Cranston C. , Botchu R. , Ravikumar K.J.
Published: January 2018

A 63-year-old rheumatoid patient presented with severe pain in her left hip without a preceding history of trauma. An initial clinical and radiological examination revealed no “obvious” abnormality and the patient was symptomatically treated.

The patient presented again five weeks later as weightbearing became increasingly difficult due to worsening pain. Inflammatory markers were found to be elevated and a repeat radiological examination revealed a displaced un-united fracture of the neck of femur. Isotope imaging suggested increased activity around the hip. A formal arthrotomy revealed pus in the joint. She continued to deteriorate and subsequently died due to sepsis.

Spontaneous fractures without any history of trauma have been described in patients with rheumatoid arthritis. The fracture haematoma serves as a good culture medium for micro-organisms in immuno-compromised rheumatoid patients. Any hip pain arising in a rheumatoid patient should be thoroughly investigated and a high index of suspicion is necessary for both sepsis and fracture.
The Uncemented, Titanium-Coated RM Cup: Survival and Analyses of Failures
Authors: Diks M.J.F. , Van Den Broek C.M. , Anderson P.G. , Van Limbeek J. , Spruit M.
Published: January 2018

This study evaluates the incidence of revision of the monoblock, uncemented, titanium-coated RM (Robert Mathys) cup (Mathys Medical, Bettlach, Switzerland) in primary total hip arthroplasty. Between 1991 and 1995 a total of 630 RM cups were implanted in 462 patients. A Kaplan-Meier survival analysis was performed with failure defined as acetabular revision for any reason. The mean follow-up was 8.2 years. A total of 34 acetabular revisions (5%) were carried out: 15 for recurrent dislocation due to cup malposition, nine for wear caused by impingement of a loose femoral component, five for aseptic loosening, only one cup was revised for articular polyethylene wear, and four for other causes. The cumulative survival rate of the RM cup is 91% at 10.7 years, with a worst case scenario of 87%. The cumulative survival rate for aseptic loosening was calculated: 99% at 10.7 years. The titanium-coated RM cup shows an impressive survival rate with revision for aseptic loosening as endpoint. Correct cup positioning is the key to success and requires experience and meticulous surgical technique.
Reducing Blood Loss after Total Hip Arthroplasty: A Prospective Randomised Controlled Trial to Evaluate the Efficacy of Temporarily Clamping Drains
Authors: Clifton R. , Norrish A.R. , Howell F.R.
Published: January 2018

The purpose of the study is to primarily answer the question as to whether temporarily clamping the drain for one hour after total hip replacement reduces blood loss. Many surgeons use this technique, as it is perceived that it creates a tamponade effect in the closed wound, promoting clotting and thereby reducing blood loss. There are no studies to support this practice after hip replacement. We have designed and conducted a randomised controlled trial. Fifty-six patients undergoing total hip replacement had drains placed in their wounds. They were randomised into two groups: half had their drain temporarily clamped for one hour and then the drain opened. The other half had the drain opened immediately after wound closure. The primary outcome measure was volume of drainage at 24 hours and the secondary outcome measures were transfusion requirements and postoperative haemoglobin reduction.

No differences were seen between controlled groups for the volume of drainage (413±152 mL vs. 378±141 mL, standard deviation, SD; p=0.38), the transfusion requirement (8/28 in each group received 2 units of packed red cells), or the postoperative haemoglobin drop (not transfused: 3.1±1.3 vs. 3.6±1.5 g/dL, SD, p=0.29; and transfused 2 units: 0.8±1.4 vs. 1.4±1.2 g/dL, SD, p=0.38). The data from this trial suggests that the practice of clamping drains does not give a beneficial effect in terms of reduced blood loss. This is the first trial of its kind to explore this question in total hip replacement surgery.
Hip resurfacing following previous proximal femoral osteotomy
Authors: Hart A.J. , Scott G.
Published: January 2018

Until recently, the options for patients with a degenerative hip and a previous femoral osteotomy included arthrodesis, total hip arthroplasty with osteotomy or CADCAM total hip arthroplasty. Technological improvements have allowed the reintroduction of hip resurfacing. We report the results of hip resurfacing in four patients with previous valgus or extension proximal femoral osteotomies. Patients were assessed for pre and post-operative pain, walking distance and range of movement. All patients had an abnormal angulation, of the femoral neck, of 30 degrees or more in either coronal or sagittal plane. They are within the severe group of disordered proximal femoral anatomy according to Harris et al. The mean age at operation was 32 years (range 30 - 34). The mean follow-up was 3 years (range 1 - 8). Postoperatively no patient required analgesia and all patients had a minimum uninterrupted walking ability of 30 or more minutes with the exception of the patient who had undergone previous leg lengthening. We recommend this comparatively straightforward operation compared to current alternatives.
Early rehabilitation comparing hip resurfacing and total hip replacement
Authors: Lilikakis A.K. , Arora A. , Villar R.N.
Published: January 2018

Hip resurfacing arthroplasty (RS) is said to be an operation that is suitable for the younger osteoarthritic population, allowing them to rehabilitate more rapidly. We wished to establish whether this was true and compared 35 consecutive RS (33 patients) with 41 consecutive total hip replacements (THR) (40 patients) and looked specifically at postoperative pain, speed of rehabilitation and length of hospital stay. A rehabilitation score was used. RS patients were significantly younger than THR patients (mean 53.0 years for RS, 64.7 years for THR; p<0.0001). However, no significant difference was found in the mean rehabilitation score at any stage after surgery or in the speed of rehabilitation between the two groups. Neither postoperative pain nor the length of hospitalisation was significantly different between the two groups. We conclude that resurfacing arthroplasty has no evidence of an advantage over total hip replacement in the speed of postoperative rehabilitation.
Intraoperative evaluation of limb length in hip arthroplasty using a single AP radiograph
Authors: Deorio J.K.
Published: January 2018

Previous methods for determining limb length during hip arthroplasty have depended on physical examination and direct measurement techniques. A radiographic technique for assessing limb length intraoperatively with a single anteroposterior (AP) pelvis radiograph was studied in 46 consecutive hip arthroplasties in 41 patients (five with bilateral arthroplasties). Of the 41 patients, 97.6% had either an average postoperative limb length discrepancy of 2.9 mm (-1 mm to +7 mm), or the limb was lengthened no more than 7 mm. This radiographic method has led to one of the most successful results reported in the literature with regard to minimizing significant limb length discrepancy or limb lengthening (maximum of 7 mm) following total hip arthroplasty. The single AP radiograph made intraoperatively with the trial implant in place is a valuable aid in determining limb length in total hip arthroplasty.
Knitted Outer Gloves in Primary Hip and Knee Arthroplasty
Authors: Tanner J. , Wraighte P. , Howard P.
Published: January 2018

A randomised trial was carried out to determine the rate of perforation to inner gloves when comparing latex with knitted gloves during hip and knee arthroplasty.

Members of the surgical team were randomised to wear either two pairs of latex gloves (standard double gloving) or a knitted glove on top of a latex glove. In addition, participants completed a visual analogue assessment of their overall satisfaction with the gloves.

A total of 406 inner gloves were tested for perforations over a four-month period: 23% of inner gloves were perforated when latex outer gloves were used and 6% of inner gloves were perforated when knitted outer gloves were used. In total, there were 64 perforations to the inner gloves; only one of these perforations was detected by the glove wearer.

Wearing knitted outer gloves during hip and knee arthroplasty statistically significantly reduces the risk of perforation to inner latex gloves (p<0.0001).
Triple Pelvic Osteotomy for the Management of Painful Developmental Hip Dysplasia in the Young Adult
Authors: Hart W.J. , Roberts A.R. , Evans G.A.
Published: January 2018

We present a consecutive series of 24 adolescent and young adult patients who have undergone a triple pelvic osteotomy as treatment for symptomatic developmental dysplasia of the hip. With a mean duration of follow-up of 6.5 years (range 2 - 16 years) we report good improvements with regard to pain and function in 22 of the 24 patients. Radiological improvements were consistently demonstrated in the centre edge angle and the acetabular index. There were no major complications. When dealing with this difficult problem in young patients we maintain that a re-directional pelvic osteotomy is an appropriate means of treatment in symptomatic patients with a congruent joint.