A prospective study comparing mini-invasive and conventional canaliculotomy of punctum-sparing canaliculotomy for primary canaliculitis treatment.

PURPOSE: To compare outcomes of mini-invasive canaliculotomy with those of conventional canaliculotomy conducted using the punctum-sparing approach for the treatment of primary canaliculitis. METHODS: A prospective, comparative, and interventional case series study was conducted on 118 individuals with unilateral inferior primary canaliculitis. These patients were randomly divided into two groups, each with 59 cases. Group A underwent mini-invasive canaliculotomy (minor incision ~3 mm), whereas group B received conventional canaliculotomy (long incision ~6-8 mm). Punctum-sparing and canaliculus-reconstructing procedure was used to treat all patients. Both groups had silicone tube intubations and were retained in the lacrimal passages for one month. Both groups' surgical success rates and postoperative complications were measured at the last follow-up of 12 months after surgery. RESULTS: A total of 108 patients were finally included in the study, 53 in group A and 55 in group B. There were 79 females and 29 males with a median age of 57 ± 13.4 years. The anatomical success rates for groups A and B were 96.2% and 92.7% (P = 0.679), respectively. Functional success rate was accomplished by considerably more patients in group A (50/53, 94.3%) compared to group B (45/55, 81.8%) (P = 0.046). No recurrences were seen during follow-up visits in any of the participants. CONCLUSIONS: The two procedures employed in this study to treat primary canaliculitis achieves excellent clinical effects with no incidence of recurrence. The mini-invasive canaliculotomy is worthy to be recommended for its higher functional success rate with mini-invasion of canaliculus and intact lacrimal punctum.

Management of intrascleral chestnut burr spines under ultrasound biomicroscopy guidance.

Purpose: To explore the efficacy of ultrasound biomicroscopy (UBM) as a tool for detecting and localizing intrascleral chestnut burr spines. Methods: Individuals who were diagnosed with definitive or suspected intrascleral chestnut burr injuries between 2019 and 2020 were retrospectively reviewed. All patients underwent UBM to detect potential intrascleral spines. UBM imaging features were recorded and analyzed. Intrascleral spines were removed based upon UBM-guided localization. Patient clinical profiles, management, and treatment outcomes were recorded. Results: A total of 10 eyes (10 patients; 6 males, 4 females) were diagnosed with intrascleral spines over the study period, with an average patient age of 55 years (range: 39-71). Three of these 10 eyes exhibited involvement of the palpebrae and cornea, whereas three exhibited corneal involvement, and the remaining four patients exhibited only intrascleral spine injuries owing to their having undergone previous intracorneal spine extraction procedures. UBM features consistent with chestnut burr spines manifest a hyperechoic spot with a shadow. UBM enabled the precise localization of these spines and thus ensured their successful removal via a single surgery. During follow-up, two patients experienced vitreous hemorrhage due to a penetrating injury into the ciliary body that was gradually absorbed. All patients with eye irritation and red eyes progressed favorably, and no surgical complications were recorded. Conclusion: A retained scleral chestnut burr spine should be suspected if a patient complains of persistent eye irritation following intracorneal spine removal. UBM may be a valuable tool for detecting spines retained in the sclera, enabling the successful removal thereof.

The analgesic efficacy of extracorporeal shock wave combined with percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar compression fractures in postmenopausal women.

BACKGROUND: To explore the analgesic efficacy of extracorporeal shock wave (ESW) combined with percutaneous vertebroplasty (PVP) after reduction in overextension position in the treatment of osteoporotic thoracolumbar compression fractures in postmenopausal women. METHODS: The data of postmenopausal women with osteoporotic thoracolumbar compression fracture admitted in our department from January 2017 to October 2019 were analyzed retrospectively. They were divided into groups of unipedicular percutaneous kyphoplasty (U-PKP n = 21), bipedicular PKP (B-PKP n = 20), and ESW combined with PVP after reduction in overextension position (EP-PVP n = 18). The improvement of pain and vertebral height in three groups was compared. RESULTS: Postoperative compression rate and Cobb angle of vertebral fractures in the three groups were all lower than those before surgery, and the differences between pre-operation and post-operation were statistically significant (P < 0.05). The visual analog scale (VAS) and Oswestry dysfunction index (ODI) scores of the three groups decreased significantly after the operation (P < 0.05). The ODI scores of the EP-PVP group in the third months after the operation were significantly improved compared with the other two groups, and the difference was statistically significant (P < 0.05). CONCLUSIONS: In our small-sample study, all three treatment schemes can treat osteoporotic compression fracture of thoracolumbar vertebrae in postmenopausal women, relieve pain, and improve quality of life. ESW combined with PVP after reduction in overextension position could achieve a good vertebral reduction rate and improve kyphosis, and may reduce the application of analgesic drugs.

Proper mechanical stimulation improve the chondrogenic differentiation of mesenchymal stem cells: Improve the viscoelasticity and chondrogenic phenotype.

Mesenchymal stem cells are ideal seed cell alternatives for articular cartilage tissue engineering, and the methods of the expansion of seed cells need to be improved. The mechanical factors play a significant role in the process of articular cartilage development and regeneration. The aim of this study was to improve the chondrogenic differentiation of mesenchymal stem cells and to expand seed cells for articular cartilage tissue engineering based on mechanical factors. Rabbit bone mesenchymal stem cells were subjected to cyclic dynamic square wave tensile mechanical loading using the FX-4000 tension system. The viscoelasticity of cells was investigated using the micropipette aspiration technique combined with the Kelvin standard linear viscoelastic solid model. The cell chondrogenic phenotype was assessed by detecting characteristic chondrocyte biomarkers; the expression of the GAG and TGF-ß1 was analyzed by ELISA, and the expression of the Col2α1 and Sox9 gene was analyzed by RT-PCR. The results show that proper tensile mechanical stimulation improves the viscoelasticity and chondrogenic phenotype of mesenchymal stem cells such that it is similar to that of chondrocytes. These results suggest that viscoelasticity is a specific marker of chondrogenic differentiation and that proper mechanical stimulation culture methods can be used to expand seed cells and improve the chondrogenic phenotype for articular cartilage tissue engineering.

The viscoelastic behaviors of several kinds of cancer cells and normal cells.

The purpose of this study was to investigate the viscoelastic behaviors of cancer cells and normal cells using the micropipette aspiration technique combined with the standard linear viscoelastic solid model. The viscoelastic behaviors of pairs of cell lines (human skin cells and human skin cancer cells, human fetal lung fibroblasts and human lung cancer cells, human mammary fibroblasts and human breast cancer cells, and human hepatocyte cells and human hepatocellular carcinoma cells) were tested by the micropipette aspiration technique. The cellular viscoelastic parameters (the instantaneous modulus E0, the equilibrium modulus associated with long term equilibrium E∞, and the apparent viscosity µ) were calculated using a Kelvin standard linear viscoelastic solid model. The present results indicate that the cancer cells were easier to deform, and the viscoelastic parameters (E0, E∞, µ) of the cancer cells were significantly lower than their corresponding normal cells (P < 0.0001). The viscoelastic parameters (E0, E∞, µ) among some normal cells showed significant differences (P < 0.05), while the different cancer cells showed no significant differences (P > 0.05). These findings may be relevant for the identification and diagnosis of cancer cells as well as providing an explanation of this occurrence mechanism in cancer cells and cancer treatment.

Iris reconstruction combined with iris-claw intraocular lens implantation for the management of iris-lens injured patients.

AIM: To study the efficiency and safety of iris reconstruction combined with iris-claw intraocular lens (IOL) implantation in the patients with iris-lens injuries. SETTINGS AND DESIGN: Retrospective, noncomparable consecutive case series study. MATERIALS AND METHODS: Eleven patients (11 eyes) following iris-lens injuries underwent iris reconstructions combined with iris-claw IOL implantations. Clinical data, such as cause and time of injury, visual acuity (VA), iris and lens injuries, surgical intervention, follow-up period, corneal endothelial cell count, and optical coherence tomography, were collected. RESULTS: Uncorrected VA (UCVA) in all injured eyes before combined surgery was equal to or <20/1000. Within a 1.1-4.2-year follow-up period, a significant increase, equal to or better than 20/66, in UCVA was observed in six (55%) cases, and in best-corrected VA (BCVA) was observed in nine (82%) cases. Postoperative BCVA was 20/40 or better in seven cases (64%). After combined surgery, the iris returned to its natural round shape or smaller pupil, and the iris-claw IOLs in the 11 eyes were well-positioned on the anterior surface of reconstructed iris. No complications occurred in those patients. CONCLUSIONS: Iris reconstruction combined with iris-claw IOL implantation is a safe and efficient procedure for an eye with iris-lens injury in the absence of capsular support.

Astragalus polysaccharide attenuates lipopolysaccharide-induced inflammatory responses in microglial cells: regulation of protein kinase B and nuclear factor-κB signaling.

OBJECTIVES AND DESIGN: Microglia play an important role in immune and inflammatory responses in the central nervous system. Astragalus polysaccharide (APS) has been reported as an immune stimulant for various inflammation-associated diseases in vivo. The present study investigated the effects of APS on lipopolysaccharide-stimulated inflammatory responses in microglial cells. MATERIALS AND METHODS: Cultured BV2 microglial cells were pre-treated with APS (0-200 µg/ml) prior to lipopolysaccharide (50 ng/ml) stimulation. The production of proinflammatory mediators including inducible nitric oxide synthase (iNOS)/nitric oxide (NO), cyclooxygenase-2 (COX-2)/prostaglandin E (PGE2), tumor necrosis factor-α (TNF-α) and interleukin-1ß (IL-1ß) were evaluated. RESULTS: APS dose-dependently reduced lipopolysaccharide stimulated nitric oxide and PGE2 production, as well as iNOS and cyclooxygenase-2 gene expression. It also attenuated proinflammatory cytokines IL-1ß and TNF-α generation. In addition, APS inhibited nuclear factor-κB translocation by blockade of IκB degradation and suppressed protein kinase B phosphorylation in lipopolysaccharide-stimulated cells. CONCLUSIONS: The inhibitory effects of APS on lipopolysaccharide-stimulated inflammatory mediator production in microglia are associated with suppression of nuclear factor-κB and protein kinase B signaling pathways. APS may offer therapeutic potential for treating inflammatory and neurodegenerative diseases accompanied with microglial activation.

A novel method for the localization and management of traumatic cyclodialysis cleft.

Purpose. To propose a novel surgical method for the localization and management of traumatic cyclodialysis clefts. Methods. Five patients with traumatic cyclodialysis clefts who underwent the innovative surgery were retrospectively reviewed. The new method was introduced to repair a cyclodialysis cleft with two running sutures from the middle to each end of the cleft under the guidance of a probe. Preoperative and postoperative visual acuity (VA), intraocular pressure (IOP), slit lamp and gonioscopic results, ultrasound biomicroscopy (UBM), and optical coherence tomography (OCT) findings were recorded. Results. Cyclodialysis clefts were completely closed postoperatively in four patients (four eyes); this was confirmed by progressively improved VA, restoration into the normal range of the IOP, disappearance of suprachoroidal fluid, and reduced macular edema. Only one patient with multiple clefts had an incomplete reattachment. Conclusions. This clinical study offers a novel and efficient method to localize and repair the cyclodialysis clefts.

Combination surgery for management of perforating eye injury with retained magnetic intraorbital foreign body.

PURPOSE: The objective of this study was to evaluate the feasibility and safety of vitrectomy combined with magnetic intraorbital foreign body (IOrFB) removal in the patients with perforating eye injury and retained magnetic IOrFBs. METHODS: A consecutive series of 7 patients with perforating eye injury and retained magnetic IOrFBs were included to perform secondary combination surgery (vitrectomy combined with IOrFB removal) after primary repair. Clinical data such as age, sex, hours and cause of injury, site and size of penetrating wound and IOrFB, involved intraocular tissues, surgical intervention, interval between surgeries, length of follow-up, anatomic recovery, visual outcome, and so on were recorded. RESULTS: Except for an unsuccessful IOrFB removal in case 6 in which IOrFB was finally extracted after 3 months, the remaining 6 cases had been operated on successfully both in vitrectomy and IOrFB removal. All the cases resulted in not only anatomic recovery but also good visual outcomes. No complications occurred. Seven cases revealed flat retina after silicone oil removal at a 3- to 12-month follow-up. Final best correct visual acuity equal to or better than 0.05 and 0.2 were 6 (85.7%) and 4 (57%) cases, respectively, and only 1 case was without improvement because of macular involvement. CONCLUSIONS: A combination surgery of vitrectomy with IOrFB removal is a highly efficient and safe procedure for the management of perforating eye injury with magnetic IOrFB. Prompt and proper management, such as preoperative exact localization of IOrFB, thoroughly cleaning of vitreous hemorrhage, complete sealing of retinal hole, and so on, is crucial for the successful achievement.

[Endoscopic trans-ethmoid medial orbital wall decompression combined with intraconal fat decompression for Graves' ophthalmopathy].

OBJECTIVE: To present a new mini-invasive surgery for compressive optic neuropathy (CON) in Graves' ophthalmopathy (GO) by adequately decompressing the orbital apex and correcting proptosis, and to analyze its results. METHODS: A retrospective chart was reviewed in 29 patients receiving orbital decompression for the treatment of CON secondary to GO from October 2006 to May 2011. All patients diagnosed CON were in stable and inactive phase of GO at least for 6 months. All patients received endoscopic transethmoid medial orbital wall decompression to reduce the compression on the orbital apex. In the meanwhile, an endoscopic transethmoid intraconal fat-removal orbital decompression was performed to remove parts of intraconal fat with a special aspiration/cutting instrument to further reduce the proptosis. All patients were followed up periodically. RESULTS: of improvement of visual acuity (VA), color vision, and amount of proptosis reduction and incidence of induced diplopia 9 months after surgery was recorded for analysis its feasibility. RESULTS: Forty-five orbits of 29 patients were included in the study. At the 9 months review, 44 of 45 eyes (97.8%) improved their VA from -0.65±0.30 (x±s) preoperatively to -0.24±0.22, with a mean improvement of 0.55±0.17 (t=-13.012, P<0.001), 23 of 29 eyes (79.3%) had improved color vision (P<0.001), and the mean reduction in proptosis was (7.07±1.59) mm (range 4-11 mm). Postoperative symmetry to within 2 mm were achieved in all patients. Except 1 patient complaining of deterioration in diplopia following surgery, no patients presented new on-set diplopia postoperatively. CONCLUSION: The endoscopic transethmoid medial orbital wall decompression combined with the endoscopic transethmoid intraconal fat-removal orbital decompression is an effective treatment with minimal morbidity for both visional recovery and improvement of proptosis for CON in GO.