Outcomes of viscocanalostomy and phaco-viscocanalostomy in patients with advanced glaucoma.

PURPOSE: To determine the medium-term outcomes for patients with advanced glaucoma undergoing viscocanalostomy. METHODS: All patients with advanced glaucoma (mean deviation (MD) - 12.00 dB or above) and patients with poor visual acuity secondary to advanced glaucoma which precluded formal visual field assessment undergoing viscocanalostomy (VC) and phaco-viscocanalostomy between 2010 and 2014 under the care of a single surgical team were included. Intraocular pressure (IOP), visual acuity (VA) and visual field outcomes were assessed from data prospectively collected into a surgical outcome database. Success was defined at two IOP cut-off points: IOP ≤ 21 and ≤ 16 mmHg with (qualified) or without (complete) medications. RESULTS: One hundred thirty-five patients were included. Mean IOP changed from 23.6 ± 6.4 mmHg pre-operatively to 15.3, 15.8 and 14.8 mmHg at 1, 2 and 3 years, a change of 35, 33.5 and 39% respectively. Qualified success for an IOP ≤ 21 mmHg was achieved in 95.66, 90.6 and 80% and complete success in 52.5, 48.6 and 30.6% at year 1, 2 and 3. Qualified success for an IOP ≤ 16 mmHg was achieved in 66.6, 66.05 and 60% and complete success in 44.8, 37.6 and 30.6% at year 1, 2 and 3. The cumulative probability for achieving an IOP ≤ 21 mmHg with or without drops was 86.1, 81.4 and 81.4% at 12, 24 and 36 months. Eleven patients (8.1%) failed to achieve adequate IOP control and needed further surgical intervention. Eleven (8.1%) patients needed an intervention (Yag goniopuncture) following VC. Four patients (2.9%) had some post-operative complications, which resolved within 2 weeks following surgery. Nine patients (6.7%) lost more than 2 Snellen lines. There was no significant change in the MD across time points. CONCLUSION: Viscocanalostomy and viscocanalostomy combined with phacoemulsification is a safe and effective method of controlling IOP in the medium term in patients with advanced glaucoma.

Mechanisms of head stability during gait initiation in young and older women: A neuro-mechanical analysis.

Decreased head stability has been reported in older women during locomotor transitions such as the initiation of gait. The aim of the study was to investigate the neuro-mechanical mechanisms underpinning head stabilisation in young and older women during gait initiation. Eleven young (23.1 ±â€¯1.1 yrs) and 12 older (73.9 ±â€¯2.4 yrs) women initiated walking at comfortable speed while focussing on a fixed visual target at eye level. A stereophotogrammetric system was used to assess variability of angular displacement and RMS acceleration of the pelvis, trunk and head, and dynamic stability in the anteroposterior and mediolateral directions. Latency of muscle activation in the sternocleidomastoid, and upper and lower trunk muscles were determined by surface electromyography. Older displayed higher variability of head angular displacement, and a decreased ability to attenuate accelerations from trunk to head, compared to young in the anteroposterior but not mediolateral direction. Moreover, older displayed a delayed onset of sternocleidomastoid activation than young. In conclusion, the age-related decrease in head stability could be attributed to an impaired ability to attenuate accelerations from trunk to head along with delayed onset of neck muscles activation.

An investigation into the physical determinants of change of direction speed.

AIM: Change of direction speed (CODS) is an important attribute for many sports and is believed to be influenced by a variety of physical factors. However, there is a lack of consensus as to which physical attributes relate to CODS. The aim of this study was to examine the relationship of several physical attributes to CODS. METHODS: Thirty-eight subjects (mean+/-SD: age, 21.5+/-3.8 years; height, 1.77+/-0.07 m; mass, 77.5+/-13.9 kg) undertook tests of speed, CODS, strength and power. Running speed was assessed via a 25 m sprint with split times taken at 5, 20 and 25 m. CODS was assessed by a 505-test, which involves measuring the time to complete a 5 m out and back course. The strength and power tests included unilateral isokinetic concentric and eccentric knee extensor and flexor strength at 60 degrees /s and bilateral leg press, countermovement and drop jumps. Pearson's product moment correlation and co-efficients of determination were used to explore relationships amongst all variables. Multiple regression was used to determine the combined effects of significantly correlated variables on CODS. RESULTS: Stepwise multiple regression revealed that running speed explained 58% of the variance in CODS (F(1,33)=45.796, P<0.001) with the addition of eccentric knee flexor strength raising the value to 67% (F(1,32)=8.781, P=0.006). CONCLUSIONS: The results suggest that for basic improvements in CODS, athletes should seek to maximise their sprinting ability and enhance their eccentric knee flexor strength to allow effective neuromuscular control of the contact phase of the CODS task.