Microcystic Macular Changes in Primary Open-angle Glaucoma.

PURPOSE: To describe microcystic macular changes in patients with moderate to advanced primary open-angle glaucoma. PATIENTS AND METHODS: Eleven eyes of 6 unrelated patients were retrospectively identified based on a disproportionately preserved macular thickness on optical coherence tomography (OCT) despite severe peripapillary retinal nerve fiber layer thinning. Patient demographic, history, and examination findings were reviewed. RESULTS: All identified patients were African American, relatively young (mean age, 43.8 y) and 5 of the 6 patients were males. Examination of individual macular OCT sections through areas of disproportionately preserved macular thickness invariably demonstrated numerous small cystic cavities within the inner nuclear layer. These microcystic changes were seen in areas of the macula that corresponded with areas of glaucoma-related ganglion cell loss, therefore mimicking the normal appearance of retinal thickness in the macular region. No other retinal pathologies were identified on the macular OCT to account for these changes. CONCLUSIONS: This study describes microcystic macular changes in mostly young, African American males with moderate to advanced primary open-angle glaucoma. Vitreous adherence to the internal limiting membrane preventing retinal collapse is a proposed mechanism. The disproportionately preserved macular volume may confound the diagnosis of glaucoma in these patients.

Phonosurgery of vocal fold polyps, cysts and nodules is beneficial.

INTRODUCTION: This study reports our experience with microscopic phonosurgery (PS) of benign lesions of the vocal folds. MATERIAL AND METHODS: During the five-year period from 2003 to 2007, a total of 97 patients had PS for vocal fold polyps (n = 63), vocal fold cysts (n = 17), vocal fold nodules (n = 12) or vocal fold oedema (n = 5). Their average age was 41 years; 62% were women and 69% were smokers. Post-operative voice therapy was given to 45 patients. Post-operative clinical evaluation was available for data analysis in 89 patients (92%). Voice quality was assessed using the Multi-Dimensional Voice Program (MDVP), video-stroboscopy and self-reported assessment. The median follow-up time was 3.9 months. RESULTS: Post-operative voice quality was reported as unaffected in 85%, improved but moderately affected in 13%, and severely affected in one patient with a cyst and vocal fold sulcus. Unaffected voice quality was obtained in 91% of patients not receiving voice therapy and in 77% of patients receiving voice therapy. All lesions except one polyp in the anterior commissure were completely removed. MDVP was performed both pre- and post-operatively in 22% of patients. The effect was a significant improvement of jitter (p = 0.013), shimmer (p = 0.001) and Soft Phonation Index (p = 0.013). CONCLUSION: PS is a quick and effective treatment with uncommon and transient post-operative complications. Objective assessment of the voice pre- and post-operatively should be used consistently and applied in controlled studies evaluating the additional impact of pre- and post-operative voice therapy. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

Bone regeneration after removal of a mandibular cyst and following prosthetic rehabilitation with implants. Case report.

This study shows the spontaneous bone regeneration after a Partch II surgical operation without using filling materials. The following functional and esthetic rehabilitation was made with overdenture on implants even in the recovery zone. A male patient, 59 years old, with a cystic lesion of 3.5 mm diameter in the mandibular bone was submitted to surgical enucleation of this neoformation. Postoperative radiological examinations, orthopantomography and TC DentaScan were performed to value the bone regeneration. Four implants of 10 mm diameter and 4.1 mm length were subsequently fixed in the mandibular bone and also in the regeneration area. Then, the rehabilitation of the patient with an overdenture on implants was possible. Radiographic controls after cystic enucleation showed a good recovery of the region occupied by the neoformation. The implants fixed proved to be solid and it was possible to carry out an overdenture on them. The cystectomy alone, performed with conservative technique, without subsequent filling of the remaining cavity with biointegrative materials, permitted bone regeneration also in a large remaining cavity. This regeneration was sufficient to guarantee the success of the subsequent overdenture on implants, and very good functional and esthetic results in a patient totally edentulous in the mandibular bone.