Novel Findings of Polypoidal Choroidal Vasculopathy via Optical Coherence Tomography Angiography.

PURPOSE: To introduce novel findings of polypoidal choroidal vasculopathy (PCV) via optical coherence tomography angiography (OCTA). METHODS: This study is a retrospective chart review of 16 patients (16 eyes) with PCV. OCTA (Avanti RTVue XR) findings were evaluated and selected for analysis after agreement by two retina specialists . RESULTS: Twenty one polyps in 16 eyes (16 patients) with PCV were included in this study. The mean patient age was 67 years (13 men and three women). The shape of polypoidal lesions on OCTA at initial were halo (five polyps), rosette (seven polyps), and vascular network (nine polyps). Eight months after anti-vascular endothelial growth factor treatment, in a total of four eyes, seven polyps could be followed up completely, the two halo type polypoidal lesions changed to rosette and vascular network type. The lesions of three rosette and two vascular network type lesions did not change in shape. In addition, the size of the polypoidal lesions (one among two halo types, two among three rosette types, and two among two vascular network types) decreased, but one halo type did not change and one rosette type increased in size on OCTA. CONCLUSIONS: En-face OCTA enabled us to categorize novel types of PCV with polypoidal lesions.

A case of ocular toxocariasis successfully treated with albendazole and triamcinolon.

We present a case of ocular toxocariasis treated successfully with oral albendazole in combination with steroids. A 26-year-old male visited the authors' clinic with the chief complaint of flying flies in his right eye. The fundus photograph showed a whitish epiretinal scar, and the fluorescein angiography revealed a hypofluorescein lesion of the scar and late leakage at the margin. An elevated retinal surface and posterior acoustic shadowing of the scar were observed in the optical coherence tomography, and Toxocara IgG was positive. The patient was diagnosed with toxocariasis, and the condition was treated with albendazole (400 mg twice a day) for a month and oral triamcinolone (16 mg for 2 weeks, once a day, and then 8 mg for 1 week, once a day) from day 13 of the albendazole treatment. The lesions decreased after the treatment. Based on this study, oral albendazole combined with steroids can be a simple and effective regimen for treating ocular toxocariasis.

Treatment of Schatzker Type V and VI Tibial Plateau Fractures Using a Midline Longitudinal Incision and Dual Plating.

PURPOSE: The purpose of this study was to evaluate the results of the treatment of Schatzker type V and VI tibial plateau fractures using a midline longitudinal incision and dual-plate fixation. MATERIALS AND METHODS: Ten patients with Schatzker type V and VI tibial plateau fractures treated with a midline longitudinal incision and dual plating were analyzed. The patients were followed for a minimum of one year. Clinical outcomes were evaluated using range of motion, visual analogue scale (VAS) and Knee Society Score. Radiological outcomes were evaluated using the bony union time, medial proximal tibial angle (MPTA) and posterior proximal tibial angle (PPTA). RESULTS: The mean VAS score was 2.2 points, and the mean Knee Society function score was 85 points at the final follow-up. The mean flexion contracture was 2.5° and the mean further flexion was 125°. It took an average of 4 months until bony union occurred. The mean MPTA and PPTA were 90.5° and 4.4°, respectively. There was one case of delayed wound healing, but no other complications were observed. CONCLUSIONS: The treatment of Schatzker type V and VI tibial plateau fractures with a midline longitudinal incision and dual-plate fixation resulted in satisfactory clinical and radiological outcomes. This can be an option when treating Schatzker type V and VI tibial plateau fractures.

Assessment of pedicle perforation by the cervical pedicle screw placement using plain radiographs: a comparison with computed tomography.

STUDY DESIGN: A retrospective study. OBJECTIVE: To suggest methods for detecting pedicle perforation on the basis of cervical pedicle screw (CPS) position on plain radiographs. SUMMARY OF BACKGROUND DATA: No studies have reported correlations between CPS position and pedicle perforation as observed on plain radiographs. This study was performed under the assumption that the detection of pedicle perforation would help to minimize the risks of neurovascular injury and help to obtain stable fixation. METHODS: A total of 48 subjects (with 205 screws) who had undergone CPS placement from C3 to C7 were enrolled in this study. To evaluate CPS position, the positions of the screw heads (neutral; the lateral margin of lateral mass cross the polyaxial screw head core, medial, or lateral) and tips (medial to uncovertebral joint [UVJ], within UVJ, or lateral to UVJ) on anteroposterior (AP) radiographs were analyzed. On the postoperative computed tomography, we analyzed the grade of pedicle perforation (grade 0: no PF; 1: < 25%; 2: 20%-50%; 3: > 50% of the screw diameter violation). Grades 0 and 1 were considered to be the correct position. RESULTS: Correct positioning was found for 174 screws (84.9%), and incorrect positioning was found for 31 screws (15.1%). The screw head was placed in a neutral position for 182 screws (88.8%), in the lateral position for 15 screws (7.3%), and in the medial position for 8 screws (3.9%). Of the 182 screws whose heads were in neutral position, 151 (83%) screws whose tips were located medial to the UVJ area were correctly positioned (sensitivity 0.89, specificity 1.0). A significant correlation was observed between the position of the screw tip and the grade of pedicle perforation (P = 0.000). CONCLUSION: A screw with a head that is located in a neutral position and a tip that is placed medial to the UVJ area on plain radiographs is considered to be in the safest position. A tip positioned lateral to the UVJ area or a head located out of the neutral position is expected to increase the risk of perforation. The use of intraoperative radiographs during CPS placement will help to identify the screws that are expected to cause pedicle perforation and allow the appropriate corrections to be made.