bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating the Utility of Follow-up Radiographs for Isolated Radial Head Fractures Undergoing Initial Nonoperative Treatment
Authors: Fenoglio Amy K. , Stephens Andrew R. , Zhang Chong , Presson Angela P. , Tyser Andrew R. , Kazmers Nikolas H.
Published: July 2019

Objectives:

To evaluate the utility of follow-up radiographs in patients with isolated partial articular radial head fractures (OTA/AO 2R1B1 or 2R1B3).

Design:

Retrospective cohort study.

Setting:

Academic Level 1 Trauma Center.

Patients:

Adult patients (≥18 years) with isolated partial articular radial head fractures indicated for initial nonoperative treatment.

Intervention:

Analysis of elbow radiographs at initial presentation and at postinjury follow-up of 3–8 weeks.

Variables Measured:

Articular gap and step-off.

Main Outcome Measure:

Radiographic articular displacement between initial and follow-up radiographs.

Results:

For 72 included patients, initial radiographs were obtained on average 2.6 days after injury and follow-up radiographs 33.7 days thereafter. Equivalence tests evaluating gap and step-off thresholds of <1 mm were both significant, indicating that the cohort displaced <1 mm for both parameters between initial and follow-up radiographs. No patients proceeded to surgical treatment following the repeat radiographs.

Conclusions:

These fractures do not displace in the early postinjury period, as defined as a <1 mm of change in both intra-articular gap and step-off, as compared to initial radiographs. Routine follow-up radiographs for these injuries is a source of cost, but with limited utility in detecting interval displacement or leading to a change in management. Selective use of radiographs to evaluate specific clinical concerns may lead to cost savings.

Level of Evidence:

Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Ankle Fractures: An Expert Survey of Orthopaedic Trauma Association Members and Evidence-Based Treatment Recommendations
Authors: Coles Chad P. , Tornetta Paul , Obremskey William T. , Spitler Clay A. , Ahn Jaimo , Mirick Gudrun , Krause Peter , Nana Arvind , Rodriguez-Buitrago Andres ,   the Orthopaedic Trauma Association's Evidence-Based Quality Value and Safety Committee
Published: July 2019

Objectives:

To describe current practice patterns of orthopaedic trauma experts regarding the management of ankle fractures, to review the current literature, and to provide recommendations for care based on a standardized grading system.

Design:

Web-based survey.

Participants:

Orthopaedic Trauma Association (OTA) members.

Methods:

A 27-item web-based questionnaire was advertised to members of the OTA. Using a cross-sectional survey study design, we evaluated the preferences in diagnosis and treatment of ankle fractures.

Results:

One hundred sixty-six of 1967 OTA members (8.4%) completed the survey (16% of active members). There is considerable variability in the preferred method of diagnosis and treatment of ankle fractures among the members surveyed. Most responses are in keeping with best evidence available.

Conclusions:

Current controversy remains in the management of ankle fractures. This is reflected in the treatment preferences of the OTA members who responded to this survey.

Level of Evidence:

Therapeutic Level V. See Instructions for authors for a complete description of levels of evidence.
Are Two-Part Intertrochanteric Femur Fractures Stable and Does Stability Depend on Fixation Method?
Authors: Ricci Michael J. , McAndrew Christopher M. , Miller Anna N. , Kamath Ganesh , Ricci William M.
Published: July 2019

Objectives:

To determine stability of 2-part intertrochanteric femur fractures and to determine whether secondary collapse is related to fixation method.

Design:

A retrospective cohort series.

Setting:

Single Level I Trauma Center.

Patients:

One hundred fourteen patients (82 female) older than 50 years (average age 75 years, range 50–100 years) with an acute low-energy standard obliquity 2-part intertrochanteric femur fracture (OTA/AO 31A) identified from an orthopaedic trauma database were studied.

Intervention:

Twenty-three patients were treated with a sliding hip screw (dynamic hip screw [DHS]), 53 with a dual screw trochanteric entry nail (INTERTAN), and 38 with a single-blade or screw trochanteric entry intramedullary nail (trochanteric fixation nail [TFN]) based on surgeon choice by 4 fellowship-trained orthopaedic trauma surgeons.

Main Outcome Measures:

Fracture collapse was measured by comparing immediate postoperative radiographs to those at final follow-up while controlling for magnification and rotation.

Results:

Collapse averaged 6.8 mm in the DHS group, 3.7 mm in the INTERTAN group, and 7.3 mm in the TFN group. When comparing groups, there was significantly more collapse in the DHS group compared with the INTERTAN group (P = 0.021), and significantly more collapse in the TFN group compared with the INTERTAN group (P < 0.001). Six patients (26%) in the DHS group had >10-mm collapse including 4 (17%) with greater than 20-mm collapse (max = 34.2 mm). Four patients (8%) in the INTERTAN group had >10-mm collapse and none had greater than 12.9 mm. Ten patients (26%) in the TFN group had >10-mm collapse and 3 (5%) had greater than 20-mm collapse (max = 30.7 mm).

Conclusion:

Stability of 2-part intertrochanteric femur fractures is dependent on the fixation device. These fractures are not necessarily stable when treated with a sliding hip screw as 26% treated with this method collapsed greater than 10 mm and 17% more than 20 mm. Dual screw intramedullary nail fixation seems to be most effective to maintain stability for patients with this fracture pattern.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Longitudinal Short-, Medium-, and Long-Term Functional Recovery After Unstable Pelvic Ring Injuries
Authors: Neufeld Michael E. , Broekhuyse Henry M. , O'Brien Peter J. , Guy Pierre , Lefaivre Kelly A.
Published: July 2019

Objectives:

Describe the trajectory of functional recovery for patients with surgically treated unstable pelvic ring injuries from baseline to 5 years.

Design:

Prospective cohort study.

Setting:

Level I Trauma Center.

Patients/Participants:

One hundred eight adult patients with surgically treated pelvic fractures (72% OTA/AO 61 B1-B3 and 28% OTA/AO 61 C1-C3) were enrolled into the institutions orthopaedic trauma database between 2004 and 2015. The cohort was 78% men with a mean age of 44.9 years and injury severity score of 16.9.

Intervention:

Surgical pelvic stabilization.

Main Outcome Measurements:

Function was measured at baseline and prospectively at 6 months, 1, and 5 years postoperatively using the Short Form–36 Physical Component Score (SF-36 PCS). The trajectory was mapped, and the proportion of patients achieving a minimal clinically important difference (MCID) between time points was determined.

Results:

The mean SF-36 PCS improved for the entire group between 6 and 12 months (P = 0.001) and between 1 and 5 years (P = 0.02), but did not return to baseline at 5 years (P < 0.0001). The proportion of patients achieving a MCID between 6 and 12 months and 1 and 5 years was 75% and 60%, respectively. The functional level was similar between type B and C groups at baseline (P = 0.5) and 6 months (P = 0.2); however, the type B cohort reported higher scores at 1 year (P = 0.01) and 5 years (P = 0.01). Neither group regained their baseline function (P < 0.0001).

Conclusions:

Functional recovery for patients with surgically treated pelvic fractures is characterized by an initial decline in function, followed by sharp improvement between 6 and 12 months, and continued steady improvement between 1 and 5 years. Type B injuries show better early recovery than type C and reach a higher level of function at the final follow-up. Despite the proportion of patients achieving MCID, patients do not regain the preinjury level of function.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Supplementation of Lateral Locked Plating for Distal Femur Fractures: A Biomechanical Study
Authors: Fontenot Philip B. , Diaz Miguel , Stoops Kyle , Barrick Brett , Santoni Brandon , Mir Hassan
Published: July 2019

Objectives:

To investigate the biomechanical properties of a lateral locked plate alone or in combination with a supplemental medial plate or an intramedullary nail (IMN).

Methods:

Intra-articular distal femur fractures with metaphyseal comminution (OTA/AO 33-C) were simulated with a standardized model in 28 synthetic femora and divided into 4 groups. Group I was instrumented with a 4.5-mm lateral locked distal femoral plate alone, group II with a lateral locked plate plus a low-profile precontoured 3.5-mm medial distal tibial plate, group III with a lateral locked plate plus a medial 3.5-mm reconstruction plate, and group IV with a lateral locked plate plus a retrograde IMN. Specimens were then axially loaded and cycled to failure or runout. Outcomes of interest were baseline stiffness, survivability, and cycles to failure.

Results:

Groups III and IV have a significantly higher baseline stiffness (P < 0.001) when compared with groups I and II. Furthermore, groups III and IV had a higher max load to failure (P < 0.01) when compared with groups I and II. The survivability in groups III and IV was 71% and 100%, respectively, while no specimens in group I or II survived maximum loading. There was no significant difference between group III and IV regarding stiffness, survivability, and cycles to failure.

Conclusion:

When considering fixation for intra-articular distal femur fractures with metaphyseal comminution (OTA/AO 33-C), we found that supplementation of a lateral locked plate with a medial plate or an IMN to be biomechanically superior to lateral locked plating alone regarding stiffness, survivability, and cycles to failure. A low-profile precontoured plate did not add significantly to the construct stiffness in this study.
Temporal Variation of Scores Along the Course of the Ponseti Treatment in Older Children: A Ready Guide to Progress of Treatment
Authors: Agarwal Anil , Shanker Mukesh
Published: July 2019

Purpose:

We aimed to graphically study the correction trend along the course of Ponseti treatment in older children with idiopathic clubfeet.

Methods:

The temporal variation of total Pirani and Dimeglio scores and their individual components at each casting session was represented graphically. Tenotomy correction was accounted for separately. We classified 0 to 4 as early, 4 to 8 as midlevel, and beyond 8 as late casts to describe the sequence of treatment.

Results:

A total of 27 patients (39 feet; bilateral in 12) were studied. The average patient age was 4.78±2.36 years. Rigid equinus was the more severe pretreatment deformity in Pirani system and also the most difficult to treat component. Posterior crease and medial crease were least severe and were treated in early casts. Reducibility of lateral head of talus, curved lateral border of foot, and empty heel were moderately severe and showed a gradual improvement pattern over subsequent casting sessions. For Dimeglio components, equinus was the most resistant deformity, and it persisted until late casts. Adduction, rotation, and varus were moderately severe, and they followed a gradual improvement slope. Several components/scores did not turn 0 after correction for older clubfoot children.

Conclusions:

The treatment graphs for older clubfoot children adequately illustrated the initial severity, number of Ponseti casts used, correction of total scores and their individual components over sequential casting sessions, tenotomy influence, and the residual deformities.
Scoliosis and Cardiopulmonary Outcomes in Osteogenesis Imperfecta Patients
Authors: Bronheim Rachel , Khan Sobiah , Carter Erin , Sandhaus Robert A. , Raggio Cathleen
Published: July 2019

Study Design.

Retrospective clinical study of individuals with osteogenesis imperfecta (OI).

Objective.

To assess the relationship between severity of scoliosis and pulmonary function, and to assess the relationship between restrictive lung disease and self-reported quality of life in individuals with OI.

Summary of Background Data.

OI is a heritable connective tissue disorder characterized by osteopenia and a predisposition to fracture. Respiratory insufficiency is a leading cause of mortality. Literature on pulmonary function in this population has shown a negative correlation between percent-predicted vital capacity and severity of scoliosis. However, it has been suggested that decreased pulmonary function in OI may be due to intrinsic pulmonary disease, in addition to the impact of vertebral compression fractures and scoliosis.

Methods.

Anterior-posterior spine radiographs and pulmonary function tests from 30 individuals with OI were reviewed. Radiographs were evaluated for scoliosis, defined as a curve ≥ 10°. If more than one curve was present, the largest curve was used. Pulmonary function was defined as the forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio. Restrictive pulmonary disease was defined as FEV1/FVC > 80%, while obstructive disease was defined as FEV1/FVC < 70%. Bivariate correlation analysis was performed, using Spearman rho correlation coefficient (P < 0.05). Quality of life was assessed by SF-36.

Results.

The mean age was 27.6 years (range: 12–42 yrs). 57.6% were female. OI type IV was the most common (46.7%), followed by OI type III (33.3%), OI type I (10%), OI type IX (6.67% each), and OI type VIII (3.33%). Pulmonary comorbidity was present in 40% of individuals, while 6.67% had a cardiac comorbidity. The correlation between scoliosis and pulmonary function was weak and not significant (R = −0.059, P = 0.747).

Conclusion.

Pulmonary function is not significantly correlated with scoliosis, supporting the hypothesis that decreased pulmonary function is intrinsic to OI and/or chest wall deformities, rather than secondary to scoliosis.

Level of Evidence: 4
Neurophysiological Effects of High Velocity and Low Amplitude Spinal Manipulation in Symptomatic and Asymptomatic Humans
Authors: Wirth Brigitte , Gassner Antonia , de Bruin Eling D. , Axén Iben , Swanenburg Jaap , Humphreys Barry Kim , Schweinhardt Petra
Published: July 2019

Study Design.

Systematic review.

Objective.

To summarize the evidence of neurophysiological effects of spinal manipulative therapy (SMT) with a high velocity low amplitude thrust (HVLA-SMT) in asymptomatic and symptomatic humans.

Summary of Background Data.

HVLA-SMT is effective in reducing back pain, but its mode of action is not fully understood.

Methods.

A systematic literature search (until July 2018) was conducted by a professional librarian in seven databases (Medline (OvidSP), Premedline (PubMed), EMBASE, Cochrane, CINAHL, PEDro, and Scopus). Two authors selected the studies according to the a priori described criteria and scored study quality. Only controlled studies of at least moderate quality were included. Effects of HVLA-SMT on a particular outcome measure were defined as more than one study showing a significantly greater effect of HVLA-SMT compared with the control intervention.

Results.

From the 18 studies included (932 participants in total), there was evidence only for an association between HVLA-SMT and changes in the autonomic nervous system, reflected in changes in heart rate variability and skin conductance. Most studies focused on healthy volunteers and none related neurophysiologic changes to pain reduction.

Conclusion.

This systematic review points to HVLA-SMT affecting the autonomic nervous system. The effects seem to depend on the spinal level of HVLA-SMT application and might differ between healthy volunteers and pain patients. There is a need for high-quality studies that include patients, well characterized for pain duration and outcome measure baseline values, and address the relation between changes in neurophysiology and pain.

Level of Evidence: 2
Association Between Smoking and Survival Benefit of Immunotherapy in Advanced Malignancies
Authors: Wallis Christopher J.D. , Satkunasivam Raj , Butaney Mohit , Khan Usman A. , Goldberg Hanan A. , Freedland Stephen J. , Patel Sandip P. , Hamid Omid , Pal Sumanta K. , Klaassen Zachary
Published: July 2019

Objectives:

Smoking is associated with an increased tumor mutational burden. As tumor mutational burden has been shown to correlate with response to immunotherapy (IO), we hypothesized that a history of smoking may be associated with better response to IO.

Methods:

We utilized a systematic review with stratified meta-analysis of randomized clinical trials of IO versus standard of care in patients with advanced solid organ malignancies.

Results:

Among 9 relevant studies, we found no significant difference in the benefit of IO, compared with other systemic therapies, between ever smokers (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.58-1.04; P=0.09) and never smokers (HR, 0.75; 95% CI, 0.67-0.86; P<0.0001) (test for difference P=0.83). We also observed no significant difference between current (HR, 0.92; 95% CI, 0.63-1.34; P=0.66; I
2=67%) and never smokers (HR, 0.74; 95% CI, 0.59-0.93; P=0.01; I
2=46%) (test for difference P=0.35).

Conclusions:

Stratified meta-analysis demonstrates that smoking status is not significantly associated with the response to IO in the treatment of advanced solid organ malignancies.
Statins as Potential Therapeutics for Lung Cancer
Authors: Fatehi Hassanabad Ali , McBride Susan A.
Published: July 2019

Lung cancer is the most common cancer worldwide. It also has the highest malignancy-associated mortality rate. Treatment options are limited by cancer and tumor heterogeneity, resistance to treatment options, and an advanced stage at time of diagnosis, all of which are common. Statins are a class of lipid-lowering medications that have been studied for their antitumor effects in various types of cancers. Multiple mechanisms have been proposed to explain their observed off-target effects. Most of these hypotheses focus largely on statin-induced upregulation of proapoptotic signaling pathways and mediators, and the downregulation of antineoplastic factors secondary to statin use. Preclinical and clinical studies support their use for conferring a mortality benefit and improving treatment effect in some chemotherapy-resistant subtypes of lung cancer. However, their exact mechanism of action, class-dependent effect, dose-dependent effect, potential use as adjuvant chemotherapeutics, and markers of statin-sensitivity in specific lung cancer subtypes remain areas of ongoing investigation. Herein, we review the latest literature pertinent to the role statins can play in the management of lung cancers.
An Atypical Fibroxanthoma and Intradermal Nevus Collision Tumor—Potential for Misdiagnosis
Authors: Steel Andrea , Debbaneh Maya , Cassarino David
Published: July 2019

Atypical fibroxanthomas (AFX) are rare cutaneous tumors, which typically present as a solitary ulcerated papule or nodule on sun-damaged skin. Despite malignant-appearing features on histology, AFX typically pursue a benign clinical course. In rare instances, AFX can form collision tumors with other lesions. However, to the best of our knowledge, AFX in collision with a nevus has never been previously reported. In this study, we describe such a lesion for its novelty and challenge in diagnosis, as this case was originally considered to be melanoma arising in a nevus. On histologic examination, there were 2 distinct populations of cells; one composed of markedly atypical and pleomorphic epithelioid and oval to spindled cells, consistent with AFX, and the other, a bland-appearing intradermal nevus with congenital features. The AFX population stained positive with smooth muscle actin, CD10, and CD68 and was negative for S100, SOX10, Melan-A, desmin, pancytokeratin, CK5/6, and p63. Deep to this was a second population of small, bland-appearing melanocytes in a broad, band-like distribution. This unusual collision tumor between AFX and an intradermal nevus highlights the important role immunohistochemistry plays in avoiding the misdiagnosis and potential overtreatment of benign or low-grade lesions, and in identifying potential mimickers.
DBP Evaluations in DBPNet Sites: Is Race/Ethnicity a Significant Factor in Care?
Authors: Augustyn Marilyn , Silver Ellen Johnson , Blum Nathan , High Pamela , Roizen Nancy , Stein Ruth E. K.
Published: July 2019

Objective:

To examine whether there are differences between non-Hispanic white (NHW) and nonwhite (NW) children in referral questions, evaluations, and diagnoses during developmental behavioral pediatrician (DBP) evaluations at academic medical centers and the potential role of socioeconomic factors in any disparities noted.

Design/Methods:

This observational study used survey data from 56 DBPs at 12 sites participating in DBPNet. Child race and ethnicity were obtained from DBP report. Mixed-model logistic and linear regression analyses controlling for site, provider, and socioeconomic proxy variables (insurance type, parent education, and language spoken at home) were used to compare groups on referral concerns, evaluation procedures, and diagnoses.

Results:

Among the patients evaluated, 349 were NHW, 406 were NW (187 Hispanic, 135 black, 58 Asian/Pacific Islander, and 26 other/mixed), and 29 were missing race/ethnicity data. The mean waiting time controlling for site and provider was 20.4 weeks for NHW children and 20.5 weeks for NW children. Reasons for referral were similar in the NWH and NW groups, with only sleep problem concerns being more frequent among NHW children (9.2% vs 3.4% NW, p = 0.01). Patients also had similar evaluations in the 2 groups; the only differences found were that more NHW than NW children had genetic testing (33.1% vs 19.3%, p = 0.02), ophthalmology evaluations (8.7% vs 3.4%, p = 0.03), and psychopharmacologic evaluations (19.1% vs 9.7%, p = 0.008). Numbers and types of diagnoses did not vary by race/ethnicity.

Conclusion:

This study suggests little inequality between NHW and NW children in wait time to care, reasons for referral, workup, or final diagnosis for initial DBP evaluation at these 12 academic DBP centers when socioeconomic factors are considered. Nevertheless, because differences in these related factors may be mechanisms through which racial/ethnic disparities can arise, it will be important to consider them in planning models and care protocols for underserved communities.
Air pollution-associated changes in biomarkers of diabetes risk
Authors: Holliday Katelyn M. , Lamichhane Archana P. , Gondalia Rahul , Stewart James D. , Madrigano Jaime , Shih Regina A. , Yanosky Jeff D. , Liao Duanping , Wellenius Gregory A. , Whitsel Eric A.
Published: July 2019

Background:

Ambient particulate matter (PM) and nitrogen oxide (NOx) air pollution may be diabetogenic.

Objective:

To examine longitudinal associations of short- and longer-term mean PM ≤10 μm (PM10), PM ≤2.5 μm (PM2.5), and NOx concentrations with five biomarkers of diabetes risk.

Methods:

We studied a stratified, random minority oversample of nondiabetic Women’s Health Initiative clinical trials participants with biomarkers and geocoded participant address-specific mean air pollution concentrations available at repeated visits (years = 1993–2004; n = 3,915; mean age = 62.7 years; 84% white). We log-transformed the biomarkers, then used multi-level, mixed-effects, longitudinal models weighted for sampling design/attrition and adjusted for sociodemographic, clinical, and meteorological covariates to estimate their associations with air pollutants.

Results:

Biomarkers exhibited null to suggestively negative associations with short- and longer-term PM10 and NOx concentrations, e.g., −3.1% (−6.1%, 0.1%), lower homeostatic model assessment of insulin resistance per 10 μg/m3 increase in 12-month PM10. A statistically significant interaction by impaired fasting glucose (IFG) at baseline in this analysis indicated potentially adverse effects only among women with versus without IFG, i.e., 1.4% (−3.5%, 6.5%) versus −4.6% (−7.9%, −1.1%), P
interaction < 0.05. In contrast, longer-term PM2.5 concentrations were largely but not statistically significantly associated with higher biomarkers.

Conclusions:

Low-level short-term PM10 and NOx concentrations may have negligible adverse effects on biomarkers of diabetes risk. Although longer-term mean PM2.5 concentrations showed primarily null associations with these biomarkers, results suggestively indicated that PM2.5 exposure over the range of concentrations experienced in the United States may adversely affect biomarkers of diabetes risk at the population level, as may longer-term mean PM10 concentrations among women with IFG.
The NLRP3 Inflammasome as a Pharmacological Target
Authors: Marchetti Carlo
Published: July 2019

NLRP3 is a cytosolic receptor member of the nucleotide-binding oligomerization domain NOD-like receptor family that surveys the intracellular environment for the presence of infection, pathogens, and metabolic alarms. Although the surveillance activity of NLRP3 is required to protect the host from several pathogens, uncontrolled activity can be detrimental to the host. Pharmacological and genetic strategies limiting NLRP3 inflammasome activation have been shown to be beneficial in a wide range of experimental models, from common pathologies such as arthritis, cardiovascular disease, and metabolic syndromes to rare genetic disorders such as cryopyrin-associated periodic syndrome. Thus, compounds that prevent NLRP3 inflammasome activation are of common interest with relevant therapeutic potential. The focus of this review is recent developments in NLRP3 inflammasome inhibitors.
Lymphadenectomy in the Management of Gynecologic Cancer
Authors: BAKKUM-GAMEZ JAMIE N.
Published: July 2019

Among nearly all gynecologic cancers, knowing whether the cancer has metastasized to lymph nodes impacts the ultimate management of the cancer. Lymph node status assists in cancer staging, prognostication, guidance of surgical intervention and adjuvant therapy, and removal of positive lymph nodes may be therapeutic in some cancers. Surgical staging through lymph node removal and pathologist assessment is standard of care for most gynecologic cancers. This section reviews the anatomic lymphatic drainage patterns of each gynecologic organ and the evolution and current practice of surgical lymph node assessment along the spectrum of gynecologic cancers.
Attenuated Acceleration to Leukemia after Ezh2 Loss in Nup98‐HoxD13 (NHD13) Myelodysplastic Syndrome
Authors: Ling Victoria Y. , Saw Jesslyn , Tremblay Cedric S. , Sonderegger Stefan E. , Toulmin Emma , Boyle Jacqueline , Chiu Sung Kai , Lane Steven W. , Ting Stephen B. , Curtis David J.
Published: July 2019

Supplemental Digital Content is available in the text
FIRST FAILED MACULAR HOLE SURGERY OR REOPENING OF A PREVIOUSLY CLOSED HOLE
Authors: Reid Gerard A. , McDonagh Niamh , Wright David M. , Yek John T. O. , Essex Rohan W. , Lois Noemi
Published: July 2019

Purpose:

To evaluate repeated surgery for idiopathic full-thickness macular hole that failed to close (FTC) after first surgery or reopened (RO) once originally closed.

Methods:

Systematic review and meta-analysis. Pubmed.gov and Cochrane Library were searched for studies in English presenting outcomes of idiopathic full-thickness macular hole that FTC or RO (case reports/series of <5 cases excluded).

Outcome Measures:

Anatomical closure, postoperative best-corrected visual acuity, intraoperative/postoperative complications, and patient-reported outcomes. Meta-analysis was performed on aggregate and available individual participant data sets using the metafor package in R.

Results:

Twenty-eight eligible studies were identified. After reoperation, pooled estimates for anatomical closure were 78% (95% confidence interval 71–84%) and 80% (95% confidence interval 66–89%) for FTC and RO groups, respectively. On average, best-corrected visual acuity improved in both groups. However, only 15% (28 of 189 eyes) of FTC eyes achieved best-corrected visual acuity of ≥6/12. The pooled estimated probability of ≥2-line best-corrected visual acuity improvement was 58% in the FTC group (95% confidence interval 45–71%); meta-analysis was not possible in the RO group. The most common complication was cataract.

Conclusion:

Reoperation for FTC or RO idiopathic full-thickness macular hole achieved a clinically meaningful visual acuity improvement in more than half of patients; high levels of vision (≥6/12), however, were uncommon.
SEVERE RECURRENT FIBROVASCULAR PROLIFERATION AFTER COMBINED INTRAVITREAL BEVACIZUMAB INJECTION AND LASER PHOTOCOAGULATION FOR AGGRESSIVE POSTERIOR RETINOPATHY OF PREMATURITY
Authors: Tanaka Shin , Yokoi Tadashi , Katagiri Satoshi , Yoshida Tomoyo , Nishina Sachiko , Azuma Noriyuki
Published: July 2019

Purpose:

To describe the clinical features of severe recurrent fibrovascular proliferation after intravitreal bevacizumab injections and laser photocoagulation for aggressive posterior retinopathy of prematurity.

Methods:

This retrospective, nonrandomized case series reviewed the medical and ophthalmic records in the referral hospital and our hospital.

Patients:

Four patients (seven eyes) with aggressive posterior retinopathy of prematurity.

Results:

The patients were referred for vitrectomy with/without lensectomy for recurrent fibrovascular proliferation with a tractional retinal detachment after combined intravitreal bevacizumab injections and laser photocoagulation. Three patients were born at 22 weeks or 23 weeks' gestational age and one patient at 29 weeks' gestational age. Preoperatively, fluorescein angiography images showed all eyes had tractional retinal detachment from regrowth of fibrovascular proliferation 3 months to 5 months after the intravitreal bevacizumab injection and abnormal retinal vasculature; four eyes had a broad ischemic retina. Postoperatively, four eyes had retinal attachment and three eyes a total retinal detachment. Neovascular glaucoma developed in five of the seven eyes during the clinical course.

Conclusion:

Severe fibrovascular proliferation may recur due to widespread retinal ischemia with capillary dropout and abnormal vasculature after failed combined intravitreal bevacizumab and laser photocoagulation therapy as the initial treatment for aggressive posterior retinopathy of prematurity. Careful follow-up is important especially after anti–vascular endothelial growth factor treatment, with recognition that severe reactivation is possible.
Graft Survival After Penetrating and Endothelial Keratoplasty in Iridocorneal Endothelial Syndrome
Authors: Rotenberg Michael , Downward Lewis , Curnow Elinor , Larkin Daniel F. , Tuft Stephen J. ,   on behalf of the National Health Service Blood and Ocular Tissue Advisory Group and Contributing Ophthalmologists (OTAG Study 27)
Published: July 2019

Purpose:

To compare the survival of a first penetrating keratoplasty (PK) or endothelial keratoplasty (EK) for iridocorneal endothelial (ICE) syndrome with transplant survival in Fuchs endothelial dystrophy (FED) and pseudophakic bullous keratopathy (PBK).

Methods:

We compared graft survival of PK and EK for ICE syndrome for 2 time periods. We then compared graft survival in ICE syndrome with graft survival in FED and PBK. Kaplan–Meier estimates of graft survival up to 5 years posttransplant were calculated with 95% confidence intervals (CI), whereas comparisons between the groups were performed using the log-rank test.

Results:

We included 86 first transplants for ICE syndrome. There was no difference in graft survival between the 58 PKs and the 28 EKs for up to 5 years after surgery (P = 0.717). For the period from 2009 to 2017, the 5-year graft survival rates for ICE syndrome were 64.3% (CI, 21.8%–88.0%) for the 16 PKs and 66.8% (CI, 41.8%–83.0%) for the 26 EKs (P = 0.469). Between 2009 and 2017, the 5-year survival rate for 42 grafts with ICE syndrome was 62.7% (CI, 39.6%–79.0%), which was lower than 75.9% (CI, 74.2%–77.4%) in 7058 transplants for FED but higher than 55.1% (CI, 52.0%–58.0%) in 3320 transplants for PBK, although the numbers of ICE transplants are too small to tell whether this difference was by chance.

Conclusions:

The results indicate no difference in graft survival between PK and EK for ICE syndrome. Graft survival in ICE syndrome is intermediate between that of FED and PBK.
Direct Visualization of Continuous Meibum Secretion From the Orifices of Meibomian Glands to the Tear Film
Authors: Cho Bum-Joo , Jee Dong Hyun , Kim Won Jun , Shin Min Chul , Kim Eun Chul , Kim Man Soo , Hwang Ho Sik
Published: July 2019

Purpose:

To present a new method to directly visualize meibum secretion on the tear film from meibomian gland orifices and show that meibum is continuously secreted between blinking.

Methods:

Eighteen patients with dry eye syndrome and 17 healthy subjects were included in the study. We used the Lipiscanner to evaluate the tear film lipid layer. The lipid layer was classified into thick, normal, and thin lipid layer. The lipid layer on the lower tear meniscus of the right eye was observed after a drop of saline solution was applied to the eye. We recorded continuous meibum secretion onto the tear meniscus surface. We calculated the rate of continuous meibum secretion by analyzing videos. Noncontact meibography was performed for meibomian glands in the lower eyelid. The quality of meibum from the 5 orifices at the same area was then scored.

Results:

The mean continuous meibum secretion rate was 2.7 pL/s in the healthy group and 8.0 pL/s in the dry eye group. The rates were 1.3, 6.7, and 9.4 pL/s in the thin, normal, and thick tear film lipid layer group, respectively. They were 3.4, 3.4, 10.7, and 18.1 pL/s in grade 0, 1, 2, and 3 meibomian gland dropout groups, respectively. The rates were 0.00, 4.7, 10.1, 2.0, and 0.7 pL/s in the normal meibum, yellow without increased viscosity, yellow with increased viscosity, toothpaste, and no meibum groups, respectively.

Conclusions:

We showed how to visualize meibum being secreted into the tear film from the meibomian gland orifices, and we were able to observe the continuous secretion of meibum between blinks.
Sex Disparity in How Pain Sensitivity Influences Dry Eye Symptoms
Authors: Li Wing , Lin Meng C.
Published: July 2019

Purpose:

Women have a higher dry eye disease prevalence compared with men, although only relatively minor differences in the ocular surface have been observed. Interestingly, a sex difference in pain sensitivity is known, and recent research suggests that pain sensitivity is associated with dry eye symptoms. This study attempts to discern whether the association between pain sensitivity and dry eye symptoms varies between women and men.

Methods:

In this prospective cross-sectional study, subjects were seen for one visit where they were asked to fill out a set of questionnaires consisting of the Pain Sensitivity Questionnaire, Ocular Surface Disease Index (OSDI), and other dry eye questionnaires. This was followed by an ocular surface assessment on both eyes.

Results:

Two hundred eighty-seven subjects (194 women, 93 men) completed the study. Intersex differences in the ocular surface were noted. Even after accounting for these differences, an interaction effect between sex and Pain Sensitivity Questionnaire-minor score on dry eye symptoms was observed, with only women noting increased symptoms on the OSDI (P < 0.005) and other dry eye questionnaires (P values ranging from 0.01 to <0.005) with greater pain sensitivity. After controlling for other variables, women with the highest pain sensitivity had a 17-point higher OSDI score and greater symptoms, as reported by all the other dry questionnaires compared with their male counterparts.

Conclusions:

The role of pain sensitivity on dry eye symptoms appears to vary between women and men. This difference provides insight into why women have a significantly higher dry eye disease prevalence than men.
Pediatric Microbial Keratitis in Queensland, Australia (2005 to 2015)
Authors: Green Matthew , Apel Andrew , Stapleton Fiona
Published: July 2019

Purpose:

To estimate the incidence and define the demographic and microbiological profile of pediatric microbial keratitis (MK) in Queensland, Australia.

Methods:

This is a retrospective study based on the multicenter database of all patients with positive corneal scrapes in Queensland, Australia, between 2005 and 2015. Pathology organizations in Queensland were identified by online and local directory search and were requested to provide digital records of the corneal scrapes, including patient demographics and culture and antibiotic sensitivity results. Patient demographics, yearly incidence (based on state population data), cultured organisms, and antibiotic sensitivities in MK in patients 16 years old or younger with keratitis were reported and compared with adults.

Results:

Pediatric cases comprised 125 cases of a total 3182 (3.9%) included in the database. The yearly incidence of MK in children was estimated to be 0.11 cases per 10,000 people 16 years old or younger (95% confidence interval, 0.086–0.134), which was significantly lower than the estimated incidence in people older than 16 years (0.82 per 10,000 people; 95% confidence interval, 0.72–0.92; P < 0.0001). The average age of pediatric patients was 9.2 years (SD 5.5). Culture results showed Gram-positive organisms were the most common causative organisms (84%; 67.2%), Pseudomonas aeruginosa was the most common single organism (24%; 19.2%), and fungal recovery was low (4%; 3.2%). Cultures positive for Streptococcus pneumoniae (17%; 13.6%; P < 0.001) and bacteria sensitive to all recorded antibiotics (96.8%; P < 0.001) were significantly more common in children.

Conclusions:

MK in pediatric patients is less common than in adults. Although Streptococcus pneumoniae was more common in children, P. aeruginosa was the most common isolate.
Keratoconus Prevalence Among High School Students in New Zealand
Authors: Papali'i-Curtin Alistair T. , Cox Rachel , Ma Tiffany , Woods Lisa , Covello Albie , Hall R. C.
Published: July 2019

Purpose:

To determine the prevalence of keratoconus among high school students in Wellington, New Zealand.

Method:

The Wellington Keratoconus Study was a population-based prospective cross-sectional study of 2 cohorts in Wellington: cohort 1 (year 9 students, mean age 13.9 years) and cohort 2 (year 11 students, mean age 15.5 years).

Results:

A total of 1916 students with a mean age of 14.6 years participated from 20 schools in the region. Keratoconus was found in 1:191 (0.52%) participants overall and in 1:45 (2.25%) Maori participants. Pentacam mean Kmax of 48.7 diopters (D) (cohort 1, 45.5 D; cohort 2, 49.9 D), thinnest pachymetry of 494.05 μm (cohort 1, 479.0 μm; cohort 2, 499.5 μm), posterior elevation at the thinnest point of 23.4 (cohort 1, 15.2; cohort 2, 26.6), Belin/Ambrosio enhanced ectasia display overall D value of 4.30 (cohort 1, 3.2; cohort 2, 4.7) were noted in participants with keratoconus. In those with keratoconus, 8 of 10 had visual impairment of 0.2 Logarithm of the Minimum Angle of Resolution (LogMAR) or worse in the better eye; 7 of 10 did not use visual aids; 7 of 10 had atopy; and 6 of 10 were from a low school decile. In those without keratoconus, 43.8% had atopy.

Conclusions:

Keratoconus may affect up to 1 in 191 New Zealand adolescents and 1 in 45 Maori adolescents. Keratoconus appeared to be associated with Maori ethnicity, atopy, lower school decile, visual impairment, and the underutilization of visual aids. Nationwide screening programs may have a role in reducing the burden of disease associated with keratoconus.
Outcomes of Descemet Stripping Endothelial Keratoplasty in Eyes With Pars Plana Versus Anterior Chamber Glaucoma Drainage Devices
Authors: Kang Joann J. , Rittterband David C. , Lai Kevin , Eisenberg Ruth E. , Liebmann Jeffrey M. , Seedor John A.
Published: July 2019

Purpose:

To compare visual outcomes and complications of Descemet stripping endothelial keratoplasty (DSEK) in eyes with anterior chamber (AC) versus pars plana (PP) glaucoma drainage devices (GDDs).

Methods:

A retrospective chart review was conducted of 85 eyes that underwent DSEK and had previous or concurrent AC (37 eyes) or PP (48 eyes) GDD implantation. Outcome measures examined included visual acuity, donor dislocation rate, intraocular pressure, and secondary graft failure (SGF).

Results:

The mean logarithm of the minimum angle of resolution vision improved from 1.50 (SD = 0.64) to 0.88 (SD = 0.71) in the AC group and from 1.37 (SD = 0.59) to 1.20 (SD = 0.76) in the PP group, with no significant group difference. Intraocular pressure did not differ between the groups preoperatively but was higher in the AC group compared with the PP group postoperatively [mean (SD) 14.5 (6.28) versus 11.5 (5.54) mm Hg, P = 0.03]. Graft dislocation occurred in 35.1% and 29.2% of eyes in the AC and PP groups, respectively. SGF occurred in 18.9% and 41.7% with median time 17.1 (interquartile range [IQR] 4.6–32.1) and 27.9 (IQR 15.1–34.7) months to development in the AC and PP groups, respectively. Multivariable logistic and Cox proportional hazards regression models found no statistically significant factors (tube location, age, sex, concurrent tube revision, new tube insertion) associated with either donor dislocation or SGF.

Conclusions:

There was no reduction in donor dislocation or SGF in eyes with PP compared with AC GDD, despite the decreased proximity of the shunt from the endothelial graft. Overall, GDD has a significantly adverse effect on long-term graft survival and close follow-up is warranted.
In Vitro Antifungal Effect of Acrylic Corneal Glue (N-Butyl-2-Cyanoacrylate)
Authors: Dogan Cezmi , Aygun Gokhan , Bahar-Tokman Hrisi , Yazgan Zeynep , Mergen Burak , Ozdamar Akif , Arslan Osman Sevki
Published: July 2019

Purpose:

The purpose of this study was to evaluate the in vitro antifungal effects of n-butyl-2-cyanoacrylate (nB2CA; Histoacryl Blue; B. Braun, Melsungen, Germany) against a variety of different fungal species.

Methods:

Inocula taken from suspensions prepared with Aspergillus flavus, Aspergillus fumigatus, Aspergillus niger, Aspergillus ochraceus, Aspergillus oryzae, Fusarium solanii, Fusarium oxysporum, Trichoderma spp., Rhizomucor spp., Scedosporium apiospermum, Penicillium commune, Phoma glomerata, and Chrysosporium spp. molds and Candida albicans, Candida glabrata, Candida parapsilosis, Candida kruzei, Candida dubliniensis, Candida tropicalis, Candida kefyr, and Trichosporon asahii yeasts were spread on the surface of RPMI1640 agar media. Then, 50 μL of nB2CA was dropped on the surface of these media and they were incubated at 35°C. Observation of a clear zone of inhibition around the nB2CA was regarded as an indicator of the susceptibility of the fungi to nB2CA, and the absence of this zone was interpreted as an indicator of nonsusceptibility. The inhibition zone diameter was measured across the largest clear zone.

Results:

A zone of inhibition was observed around nB2CA for all of the yeast and mold species except A. flavus, A. oryzae, and Chrysosporium spp. Among molds, the largest zone of inhibition was observed with P. glomerata (25.7 ± 0.6 mm), whereas among yeasts, the largest zone of inhibition was observed with C. kruzei (19.3 ± 1.5 mm).

Conclusions:

nB2CA has shown antifungal activity against 18 different mold and yeast species, but not against A. flavus, A. oryzae, and Chrysosporium spp. molds.
Cyclophotocoagulation in the Control of Glaucoma in Patients With the Boston Keratoprosthesis Type 1
Authors: Jabbour Samir , Harissi-Dagher Mona , Agoumi Younes , Singh Harmanjit , Robert Marie-Claude
Published: July 2019

Purpose:

To evaluate the outcomes of transscleral cyclophotocoagulation (CPC) in the control of glaucoma in eyes with a Boston keratoprosthesis (KPro) type 1.

Methods:

This study is a retrospective case series of patients who have undergone at least 1 CPC treatment after KPro implantation. Eighteen eyes of 17 patients were included. Intraocular pressure (IOP) (assessed by digital palpation) and the number of classes of glaucoma medications were recorded at 1 week, 1 to 3 months, 4 to 6 months, and 1 year postoperatively. Optic nerve status, visual field parameters, and perioperative and postoperative complications were recorded.

Results:

Twenty-one CPC sessions were administered overall. Seven eyes (39%) had IOP < 20 mm Hg preoperatively, and this increased to 15 eyes (83%) at the 1-year postoperative follow-up. The mean number of glaucoma medications used was 3.9 preoperatively and did not change significantly after treatment. Seven eyes (39%) had glaucoma progression despite CPC treatment. Three eyes (17%) initially responded to CPC but later failed at 3, 6, and 12 months. Two of them responded to repeat CPC, and 1 continued to progress despite retreatment. Two eyes (11%) developed early postoperative hypotony, 1 eye (6%) developed cystoid macular edema, 1 eye (6%) developed bacterial endophthalmitis with subsequent enucleation, and 1 eye (6%) lost light perception because of glaucoma.

Conclusions:

CPC was useful to control IOP in some KPro eyes with refractory glaucoma, although it did not significantly reduce concurrent medical therapy. In addition, caution must be taken because microbial infection can occur after CPC because of the lack of biointegration between the host cornea and the device.
Cornea Findings of Spectral Domain Anterior Segment Optical Coherence Tomography in Uveitic Eyes of Various Etiologies
Authors: Hashida Noriyasu , Asao Kazunobu , Maruyama Kazuichi , Nishida Kohji
Published: July 2019

Purpose:

To evaluate the morphologic appearance of keratic precipitates (KPs) with spectral domain anterior segment optical coherence tomography (AS-OCT) for the diagnosis of uveitic eyes of various etiologies.

Methods:

In all, 153 eyes of 153 patients with different types of uveitis were examined to investigate the morphologic appearance of KPs. The study included 63 eyes with herpetic iridocyclitis/endotheliitis, 58 eyes with ocular sarcoidosis, 5 eyes with Fuchs heterochromic iridocyclitis, and 27 eyes with masquerade syndrome with primary intraocular lymphoma (PIOL). AS-OCT was used to analyze the different KP types among various uveitic groups.

Results:

KPs were observed in 30 eyes (51.7%) from the ocular sarcoidosis group and in 15 eyes (55.6%) from the PIOL group. In the herpetic iridocyclitis/endotheliitis group, all cases showed KPs (16 cases were positive for herpes simplex virus, 22 cases for varicella zoster virus, and 27 cases for cytomegalovirus). The reflectivity and morphology of the KPs in the AS-OCT images demonstrated different patterns depending on the causative virus. Hemispheric and relatively large KPs were observed in ocular sarcoidosis cases. KPs with Fuchs heterochromic iridocyclitis appeared as small dots. By contrast, relatively high-intensity and dense KPs were observed in PIOL cases. The morphologic features of the KPs in different types of uveitis also showed other patterns such as hemispheric and rectangular-shaped KPs protruding from the retrocornea.

Conclusions:

AS-OCT images showed characteristic and specific morphological patterns. AS-OCT examination is a noninvasive and repeatable method for the diagnosis of uveitis by evaluating the morphologies of KPs and treatment effectiveness.