[Total knee replacement in patients under 60 years with high functional demand: functional outcomes and return to sports after an average 2-year follow-up]. / Reemplazo total de rodilla en pacientes menores de 60 años con demanda funcional elevada: resultados funcionales y retorno al deporte después de un promedio de dos años de seguimiento.

INTRODUCTION: a common concern in presurgical medical appointment of total knee replacement medical appointment is return to exercise. The purpose of this study was to analyze functional results and return to sport in patients under 60 years of age after this surgery. MATERIAL AND METHODS: we retrospectively analyzed 41 total knee replacements in 36 athletic patients (average age: 53 years [46-60]). Average follow-up of two years (6 months-5 years). Diagnoses: 37 osteoarthritis, three sequelae of Rheumatoid Arthritis, 1 extra-articular deformity. Functional and radiographic outcomes assessed using modified Knee Society and High Activity Arthroplasty Scores. RESULTS: average improvement from 31.95 to 91.61 in KSS and average from 7.95 to 13.73 in HAAS. Return to sport in 3.5 months average (range 2-6 months). Three patients did not return to sport. CONCLUSIONS: we consider that delaying surgery in these patients will cause progression in their osteoarthritis pathology and cessation of their sports activities. This makes the surgical technique difficult in addition to reducing the patient's physical performance. Analyzing the survival rate of implants in young patients, more than 80% is reported in a 25-year follow-up.

INTRODUCCIÓN: una inquietud frecuente en consultas prequirúrgicas de reemplazo total de rodilla es el regreso al ejercicio. El propósito de este estudio fue analizar resultados funcionales y retorno al deporte en pacientes menores de 60 años posterior a esta cirugía. MATERIAL Y MÉTODOS: analizamos retrospectivamente 41 reemplazos totales de rodilla en 36 pacientes deportistas (edad promedio: 53 años [46-60]). Seguimiento promedio de dos años (6 meses-5 años). Diagnósticos: 37 gonartrosis, tres secuelas de artritis reumatoidea, una deformidad extraarticular. Resultados funcionales y radiográficos evaluados mediante Knee Society modificado y High Activity Arthroplasty Score. RESULTADOS: mejoría promedio de 31.95 a 91.61 en KSS y promedio de 7.95 a 13.73 en HAAS. Retorno al deporte en 3.5 meses promedio (rango: 2-6 meses). Tres pacientes no retornaron al deporte. CONCLUSIONES: consideramos que el retraso de la cirugía en estos pacientes producirá progresión en su patología artrósica y cese de sus actividades deportivas. Esto dificulta la técnica quirúrgica además de disminuir el rendimiento físico del paciente. Analizando la tasa de supervivencia de implantes en pacientes jóvenes, se reporta más de 80% en seguimientos de 25 años.

[Avascular necrosis of the femoral head after COVID-19: clinical presentation and management. Clinical-functional outcomes of decompression and supplementation with bone marrow cell aspirate]. / Necrosis avascular de la cabeza femoral tras COVID-19: presentación clínica y manejo. Resultados clínico-funcionales de descompresión y suplementación con aspirado de células de médula ósea.

INTRODUCTION: the pandemic of COVID-19 has led to clinical complications such as avascular necrosis of the femoral head (AVNFH) associated with the use of corticosteroids. The aim of the study is to report the functional and radiographic results of 13 patients with post-COVID-19 ANFH after decompression using Forage and bone marrow aspirate concentrate (BMAC). MATERIAL AND METHODS: single-center, prospective, uncontrolled clinical study. From April 2020 to September 2021, 13 patients (21 hips) with post-COVID-19 ANFH were treated. All received corticosteroids during infection (average daily dose: 480 mg). Clinical, radiographic and magnetic resonance imaging evaluations were performed; the Ficat classification was applied for the classification of AVNFH. The surgical technique used was decompression with Forage and ACMO. RESULTS: the mean age was 47 years, with a follow-up of 30.4 months. Symptoms appeared with a mean of 4.2 months after COVID-19 infection. Harris score improved from 41.2 ± 5.2 to 86.6 ± 3.4. Radiographic evaluation showed that 14.3% of the sample experienced femoral head collapse and underwent total hip arthroplasty. CONCLUSIONS: post-COVID-19 ANFH is a clinical entity with rapid progression and different degrees of severity. Decompression with Forage and ACMO seems a promising initial treatment, however, the variable response and the probability of collapse emphasize the importance of long-term follow-up and identification of patients who may require additional interventions.

INTRODUCCIÓN: la pandemia de COVID-19 ha dado lugar a complicaciones clínicas como la necrosis avascular de la cabeza femoral (NAVCF) asociada con el uso de corticoesteroides. El objetivo del estudio es reportar los resultados funcionales y radiográficos de 13 pacientes con NAVCF post-COVID-19, después de la descompresión utilizando Forage y aspirado de células de medula ósea (ACMO). MATERIAL Y MÉTODOS: estudio clínico unicéntrico, prospectivo, no controlado. Desde Abril de 2020 hasta Septiembre de 2021, se trataron 13 pacientes (21 caderas) con NAVCF post-COVID-19. Todos recibieron corticoesteroides durante la infección (dosis promedio diaria: 480 mg). Se realizaron evaluaciones clínicas, radiográficas y por resonancia magnética nuclear; se aplicó la clasificación de Ficat para la clasificación de NAVCF. La técnica quirúrgica empleada fue descompresión con Forage y ACMO. RESULTADOS: la edad promedio fue 47 años, con un seguimiento de 30.4 meses. Los síntomas aparecieron con una media de 4.2 meses después de la infección por COVID-19. La escala de Harris mejoró de 41.2 ± 5.2 a 86.6 ± 3.4. La evaluación radiográfica demostró que 14.3% de la muestra experimentó colapso de la cabeza femoral por lo que se les realizó artroplastía total de cadera. CONCLUSIONES: la NAVCF post-COVID-19 es una entidad clínica con rápida progresión y diferentes grados de severidad. La descompresión con Forage y ACMO parece un tratamiento inicial prometedor; sin embargo, la respuesta variable y la probabilidad de colapso, enfatizan la importancia de seguimiento a largo plazo e identificación de los pacientes que puedan requerir intervenciones adicionales.

Income and education level trajectories and changes in the daily consumption of vegetables after thirteen years of follow-up: the Pró-Saúde Study.

OBJECTIVE: This study aimed to examine whether education level and income trajectories influence vegetable consumption changes over 13 years among civil servants at different campuses of a university in the state of Rio de Janeiro, Brazil. METHODS: Vegetable intake frequency (daily and non-daily consumption), income (per capita), and education level (maintenance of low schooling/ upward mobility/maintenance of high schooling) were assessed at baseline (1999) and in the fourth wave (2011-12) of the Pró-Saúde (Pro-Health) cohort study. A total of 2,381 participants were analyzed. The association between educational and income trajectories and variation in vegetable consumption was assessed via crude and age-adjusted generalized linear models, stratified by sex. RESULTS: Men in upward educational mobility showed a 0.5% increase in vegetable consumption (p=0.01), while women in this group demonstrated a 2.5% increase (p=0.05). Adjusted models showed that women who reduced their income had a lower likelihood of consuming vegetables (odds ratio [OR] 0.93; 95% confidence interval [CI] 0.89-0.97). CONCLUSIONS: The findings highlight the influence of social inequalities on vegetable consumption in adults.

Understanding post-operative refractive outcome in pediatrics after IOL implementation: factors and predictors.

BACKGROUND: In pediatric ophthalmology, calculating intra-ocular lens (IOL) power can be challenging. It is important to predict if the post-surgery refractive error (RE) will meet the intended refractive goal. In this study, we aimed to investigate the factors and predictors influencing RE outcomes in children undergoing IOL implantation. METHODS: This was a retrospective cross-sectional cohort study that involved 47 eyes with congenital cataracts underwent IOL implantation. Each patient underwent follow-up visits at two months and two years' post-surgery. The IOL power calculations were conducted using the Holladay 1 formula, and both the prediction error (PE) and absolute prediction error (APE) were calculated. RESULTS: The mean age was 6.52 ± 4.61 years, with an age range of 1-15 years. The mean IOL power was 20.31 ± 6.57 D, and the mean post-operative refraction was 1.31 ± 2.65 D. The mean of PE and APE were 0.67 ± 1.77 and 1.55 ± 1.06 D, respectively. Whereas PE was correlated to axial length with an R-value of - 0.29 (P = 0.04). The calculation method had a significant negative relationship with APE and PE, with coefficients of - 1.05 (P = 0.009) and - 1.81 (P = 0.009), respectively. CONCLUSION: High astigmatism was associated with greater errors in the refractive outcome. The calculation methods had the most considerable impact on the post-operative RE. The customization of surgical approaches to accommodate individual characteristics is crucial. Further research with diverse subgroups is needed to comprehensively understand the influence of each factor.

Genetic markers of late radiation toxicity in the era of image-guided radiotherapy: lower toxicity rates reduce the predictive value of γ-H2AX foci decay ratio in patients undergoing pelvic radiotherapy.

BACKGROUND: A predictive assay for late radiation toxicity would allow more personalized treatment planning, reducing the burden of toxicity for the more sensitive minority, and improving the therapeutic index for the majority. In a previous study in prostate cancer patients, the γ-H2AX foci decay ratio (γ-FDR) was the strongest predictor of late radiation toxicity. The current study aimed to validate this finding in a more varied group of patients with pelvic cancer. Additionally, the potential correlation between the γ-FDR and patient-reported outcomes was investigated. METHODS: Prostate and gynecological cancer patients with ≥ 24 months of follow-up were included in the current analysis. Toxicity was evaluated by physician (CTCAE version 4) and patient (EORTC questionnaires). γ-FDRs were determined in ex vivo irradiated lymphocytes. Correlation between γ-FDR and toxicity was assessed using both linear and logistic regression analyses. The highest toxicity grade recorded during follow-up was used. The association between global quality of life and γ-FDR was tested by comparing the change in quality of life over time in patients with γ-FDR < or ≥ 3.41, a previously established threshold. RESULTS: Eighty-eight patients were included. Physician-assessed and patient-reported cumulative grade ≥ 2 toxicity was 25% and 29%, respectively; which is much lower than in the previous cohort (i.e., 51% CTCAE grade ≥ 2). Patients with toxicity exhibited less favorable dose-volume parameters. In men, these parameters showed significant improvement compared to the previous cohort. The proportion of patients with a low γ-FDR increased with severity of toxicity, but this trend was not statistically significant. In addition, a γ-FDR < 3.41 was not correlated with the development of moderate to severe toxicity. Post-treatment decline in global quality of life was minimal, and similar for patients with γ-FDR < or ≥ 3.41. CONCLUSIONS: In the present study, the γ-H2AX foci decay ratio could not be validated as a predictor of late radiation toxicity in patients with pelvic cancer. Improved radiotherapy techniques with smaller irradiated bladder and bowel volumes have probably resulted in less toxicities. Future studies on genetic markers of toxicity should be powered on these lower incidences. We further recommend taking persistency, next to severity, into consideration.

An effective strategy for treatment of severe kyphosis secondary to ankylosing spondylitis: one-level modified osteotomy combined with shoulders lifting correction method.

BACKGROUND: Severe kyphosis is a common condition in patients with advanced ankylosing spondylitis (AS). Although two-level osteotomy may serve as a potential alternative, it is often associated with increased blood loss and elevated surgical risks. To date, the optimal treatment for the challenging condition remains unclear. This study aims to introduce an effective strategy for the treatment of severe kyphosis secondary to AS, using one-level modified osteotomy combined with shoulders lifting correction method. METHODS: Seventy AS kyphosis who were treated with the strategy from 2012 to 2022, were reviewed retrospectively. All patients were followed up for a minimum duration of 2 years. Spinal and pelvic parameters were measured, including pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), lumber lordosis (LL), PI and LL mismatch (PI-LL), thoracic kyphosis, global kyphosis (GK), T1 pelvic angle (TPA), sagittal vertical axis (SVA), osteotomized vertebral angle (OVA), and chin-brow vertical angle (CBVA). Parameters of local osteotomized complex were measured and calculated, including the height of osteotomized complex and the length of spinal cord shortening. Clinical outcome was evaluated using Scoliosis Research Society-22 and Oswestry Disability Index scores. RESULTS: Seventy patients with average age of 39.8 years were followed-up for 29.3 months. Average operation time was 373.5 min, and average blood loss was 751.0 ml. Postoperatively, sagittal balance was successfully restored. GK decreased from 90.6° to 35.6°, LL decreased from 8.0° to -35.1°, TPA decreased from 56.8° to 27.8°, and SVA decreased from 24.4 cm to 8.7 cm (P < 0.05). A harmonious and matched spinopelvic alignment was achieved. PT decreased from 37.2° to 26.3°, PI-LL decreased from 54.1° to 10.2°, and SS increased from 9.2° to 19.7°(P < 0.05). Horizontal vision was obtained with postoperative CBVA of 8.8°. Average OVA correction was up to 47.3°, and the spinal cord was shortened by 24.3 mm, with a shortening rate of 36.0%. All patients demonstrated a favorable clinical outcome. No permanent nerve damage, screw loosening, rod breakage and main vascular injury were observed. One case required revision surgery due to screw cap loosening and delayed union. Solid bone fusion was achieved in all other patients. CONCLUSIONS: One-level modified osteotomy combined with shoulders lifting correction method is a safe and effective strategy for the treatment of severe AS kyphosis. This strategy offers a promising alternative for managing severe AS kyphosis, and may be particularly well-suited for individuals with concurrent osteoporosis. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Role of unilateral partial facet joint preservation in postero-lateral approach lumbar interbody fusion for patients with degenerative lumbar spinal stenosis presenting bilateral lower limb symptoms: a retrospective study.

BACKGROUND: Posterolateral decompression and fusion with internal fixation is a commonly used surgical approach for treating degenerative lumbar spinal stenosis (DLSS). This study aims to evaluate the impact of preserving a portion of the unilateral facet joint during decompression on surgical outcomes and long-term recovery in patients. METHODS: This study analyzed 73 patients with DLSS accompanied by bilateral lower limb neurological symptoms who underwent single-level L4/5 posterolateral decompression and fusion surgery from January 2022 to March 2023. Patients were categorized into two groups based on the type of surgery received: Group A comprised 31 patients who underwent neural decompression without facet joint preservation, while Group B consisted of 42 patients who underwent neural decompression with preservation of partial facet joints on one side. Regular follow-up evaluations were conducted, including clinical and radiological assessments immediately postoperatively, and at 3 and 12 months thereafter. Key patient information was documented through retrospective chart reviews. RESULTS: Most patients in both groups experienced favorable surgical outcomes. However, four cases encountered complications. Notably, during follow-up, Group B demonstrated superior 1-year postoperative interbody fusion outcomes (P < 0.05), along with a trend towards less interbody cage subsidence and slower postoperative intervertebral disc height loss. Additionally, Group B showed significantly reduced postoperative hospital stay (P < 0.05). CONCLUSION: Under strict adherence to surgical indications, the posterior lateral lumbar fusion surgery, which preserves partial facet joint unilaterally during neural decompression, can offer greater benefits to patients.

23-year review of spheno-orbital meningioma: clinical, radiological, and pathological insights from 100 cases.

BACKGROUND: Spheno-orbital meningioma (SOM) represents a unique variant of sphenoid wing meningiomas, distinguished by its propensity for bone infiltration and cranio-orbital involvement. SOM exhibits a considerable incidence of misdiagnosis and recurrence. PURPOSES: To elucidate the clinical, radiological, and pathological characteristics of SOM. METHODS: Review of electronic medical records, histopathology, radiological images and follow-up information of 100 SOM patients. RESULTS: Of the 100 patients (28 males, 72 females) with SOM, mean age was 46.8 ± 12.6 years and prevalent symptoms were proptosis (99%). All the CT scans showed hyperostosis with 89.3% of the hyperostosis having an irregular edge. In MRI scans, dural tail sign was observed across all patients and the cranio-orbital tumors often penetrated temporal muscle (74.1%), extraocular muscle (74.1%) and lacrimal gland (63%). All the 100 patients underwent surgical intervention, and among them, 62 individuals received postoperative radiotherapy. Grade I resections had a lower recurrence rate(16.7%), which further decreased with the addition of radiotherapy(13.9%). In contrast, all patients with grade II or higher grade resections without radiotherapy experienced recurrence, indicating a higher risk associated with less complete tumor removal. The pathological examination revealed that intraorbital sections exhibited comparable tumor density to intraorbital SOM tumors, along with increased fibrous density but decreased vascular distribution. CONCLUSIONS: Radiological characteristics of SOM included cranio-orbital tumors, hyperostosis of the sphenoid wing with an irregular edge, and dural tail sign. Combination of gross total resection and adjuvant radiotherapy was recommended to minimize recurrence rate. Intracranial SOM tumors tended to be softer and more bleed-prone than intraorbital sections, necessitating surgical precision.

Comparison of postoperative analgesia by thoracoscopic-guided thoracic paravertebral block and thoracoscopic-guided intercostal nerve block in uniportal video-asssited thoracic surgery: a prospective randomized controlled trial.

BACKGROUND: Thoracoscopic-guided thoracic paravertebral nerve block (TG-TPVB) and thoracoscopic-guided intercostal nerve block (TG-INB) are two postoperative analgesia technology for thoracic surgery. This study aims to compared the analgesic effect of TG-TPVB and TG-INB after uniportal video-asssited thoracic surgery (UniVATS). METHODS: Fifty-eight patients were randomly allocated to the TG-TPVB group and the TG-INB group. The surgical time of nerve block, the visual analog scale (VAS) scores, the consumption of sufentanil and the number of patient-controlled intravenous analgesic (PCIA) presses within 24 h after surgery, the incidence of adverse reactions were compared between the two groups. RESULTS: The VAS scores were significantly lower during rest and coughing at 2, 6, 12, and 24 h in the TG-TPVB group than in the TG-INB group (P < 0.05). The consumption of sufentanil and the number of PCIA presses within 24 h after surgery were significantly lower in the TG-TPVB group than in the TG-INB group (P < 0.001).The surgical time of nerve block was significantly shorter in the TG-TPVB group than in the TG-INB group (P < 0.001). The incidence of bleeding at the puncture point was lower in the TG-TPVB group than that in the TG-INB group (P < 0.05). CONCLUSION: TG-TPVB demonstrated superior acute pain relieve after uniVATS, shorter surgical time and non-inferior adverse effects than TG-INB.

Short-term outcomes of Transrectal Natural Orifice Specimen extraction compared with conventional minimally invasive surgery for selected patients with colorectal cancer: a propensity score matching analysis and literature review.

PURPOSE: Conventional minimally invasive surgery requires mini-laparotomy to extract the pathological specimen. However, by using a natural orifice as the delivery route, natural orifice specimen extraction (NOSE) surgery avoids the need for a large incision. This study analyzed the short-term outcome of NOSE compared with conventional mini-laparotomy (CL) for colorectal cancer surgery. METHODS: We conducted a retrospective analysis of 1,189 patients who underwent surgery for primary colorectal cancer between the cecum and upper rectum. Propensity score analyses were applied to the NOSE and CL groups in a 1:1 matched cohort. RESULTS: After propensity score matching, each group included 201 patients. The NOSE group and CL group did not differ significantly in terms of baseline characteristics. Postoperative morbidity and mortality rates were comparable. Compared with the CL group, the NOSE group experienced a shorter time to first flatus (1.6 ± 0.8 vs. 2.0 ± 1.2 days, p < 0.001), first stool (2.7 ± 1.5 vs. 4.1 ± 1.9, p < 0.001), liquid diet (2.3 ± 1.3 vs. 3.6 ± 1.8 days, p < 0.001), soft diet (3.9 ± 2.0 vs. 5.2 ± 1.9 days, p < 0.001) and a shorter hospital stay (5.1 ± 3.5 vs. 7.4 ± 4.8 days, p < 0.001). The NOSE group exhibited lower mean pain intensity and lower highest pain intensity on postoperative days 1, 2, and 3. CONCLUSION: NOSE has several advantages over conventional mini-laparotomy following minimally invasive surgery for colon cancer. These advantages include reduced time to oral intake, shorter hospital stays, and less postoperative pain. NOSE can be adopted and applied to highly selective patients without additional risk of short-term complications.

Effect of anti-vascular endothelial growth factor on early-stage post-vitrectomy macular edema in patients with proliferative diabetic retinopathy.

PURPOSE: To investigate the effectiveness of anti-vascular endothelial growth factor (VEGF) therapy on post-vitrectomy macular edema (PVME) and determine the risk factors for PVME recovery. METHODS: This retrospective study included 179 eyes of 179 patients who underwent pars plana vitrectomy for proliferative diabetic retinopathy and developed PVME within 3 months after surgery. Eyes were grouped according to postoperative anti-VEGF treatment. RESULTS: Central retinal thickness (CRT) decreased significantly from baseline to 3-month follow-up in groups with (509.9 ± 157.2 µm vs. 401.2 ± 172.1 µm, P < 0.001) or without (406.1 ± 96.1 µm vs. 355.1 ± 126.0 µm, P = 0.008) postoperative anti-VEGF treatment. Best-corrected visual acuity (BCVA) did not differ between the two groups during follow-up. In the group not receiving anti-VEGF therapy, BCVA was significantly improved at 1, 2, and 3 months (P = 0.007, P < 0.001, and P < 0.001, respectively), while in the anti-VEGF group, BCVA was significantly improved at 1 and 3 months (P = 0.03 and P < 0.001). A thicker baseline CRT (ß = 0.44; 95% confidence interval, 0.26-0.61; P < 0.001) was significantly associated with decreasing CRT. CONCLUSION: PVME tends to spontaneously resolve in the early postoperative period. The effect of anti-VEGF therapy in the first 3 months after diagnosis appears to be limited.

A novel nomogram based on the number of positive lymph nodes can predict the overall survival of patients with pancreatic head cancer after radical surgery.

BACKGROUND: This study aimed to construct a novel nomogram based on the number of positive lymph nodes to predict the overall survival of patients with pancreatic head cancer after radical surgery. MATERIALS AND METHODS: 2271 and 973 patients in the SEER Database were included in the development set and validation set, respectively. The primary clinical endpoint was OS (overall survival). Univariate and multivariate Cox regression analyses were used to screen independent risk factors of OS, and then independent risk factors were used to construct a novel nomogram. The C-index, calibration curves, and decision analysis curves were used to evaluate the predictive power of the nomogram in the development and validation sets. RESULTS: After multivariate Cox regression analysis, the independent risk factors for OS included age, tumor extent, chemotherapy, tumor size, LN (lymph nodes) examined, and LN positive. A nomogram was constructed by using independent risk factors for OS. The C-index of the nomogram for OS was 0.652 [(95% confidence interval (CI): 0.639-0.666)] and 0.661 (95%CI: 0.641-0.680) in the development and validation sets, respectively. The calibration curves and decision analysis curves proved that the nomogram had good predictive ability. CONCLUSIONS: The nomogram based on the number of positive LN can effectively predict the overall survival of patients with pancreatic head cancer after surgery.

Long-Term Changes in Lamina Cribrosa Curvature Index After Trabeculectomy in Glaucomatous Eyes.

Purpose: This study aimed to evaluate both short-term and long-term changes in the lamina cribrosa curvature index (LCCI) following trabeculectomy and investigate the factors influencing these changes. Methods: In this retrospective, observational study, 40 eyes of 40 patients with glaucoma who underwent trabeculectomy and had a follow-up of at least 2 years were included. Optic nerve head area was scanned by using spectral-domain optical coherence tomography before surgery (Pre_OP), within 6 months postoperatively (Post_OP1), and at the last visit (Post_OP2). LCCI values calculated from B-scan images at six different planes (0°, 30°, 60°, 90°, 120°, and 150°) and their mean values were compared. Univariate and multivariate linear regression analyses were used to identify the clinical factors associated with the amount of LCCI changes. Results: The mean follow-up time was 38.3 ± 16.8 months. At Post_OP1, the mean LCCI decreased from 9.28 ± 2.58 to 7.91 ± 2.57 (P < 0.001), and the mean intraocular pressure decreased from 22.0 ± 7.6 mm Hg to 12.2 ± 3.8 mm Hg (P = 0.001). At Post_OP2, the mean LCCI was maintained at 7.74 ± 2.49 (P = 0.56 when compared to Post_OP1 and P < 0.001 when compared to Pre_OP). The mean intraocular pressure was 12.6 ± 5.4 mm Hg (P = 0.67 when compared to Post_OP1 and P < 0.001 when compared to Pre_OP). Long-term LCCI changes were associated with baseline age (P = 0.04), spherical equivalent (P = 0.02), mean IOP during follow-ups (P = 0.02), and preoperative LCCI (P = 0.04). Conclusions: Glaucomatous eyes undergoing trabeculectomy demonstrated reductions in the LCCI after a mean follow-up of over 3 years. Greater long-term LCCI reduction was associated with younger age, lower mean IOP during follow-up period, greater spherical equivalent refractive error, and preoperative LCCI.

Hydrodissection and femtosecond laser assisted surgery in posterior polar cataract.

PURPOSE: To present our clinical experience using femtosecond laser-assisted cataract surgery (FLACS) and cortical cleavage hydrodissection in eyes with posterior polar cataract. METHODS: Medical records of consecutive10 eyes of 6 patients with clinical diagnosis of posterior polar cataract (PPC), were retrospectively reviewed. All surgeries were done by using femtosecond laser-assisted cataract surgery. In all cases careful hydrodissection was done to separate the lens material from the posterior capsule. RESULTS: There were 3 males and 3 females, ages 39-73 years (average 52.5 years), two of them were implanted with toric lenses. In all eyes hydrodissection was successfully performed and the lens material was separated from the lens capsule. The posterior capsule remained intact during nucleus removal in all cases. In one eye the posterior capsule broke during cortical cleaning and the tear was converted to posterior capsulorhexis (PCCC). No postoperative complications were recorded during follow-up in all eyes. CONCLUSIONS: Hydrodissection can be safely performed in combination (but not exclusively) with FLACS, in eyes with posterior polar cataract with no evidence of a preexisting posterior capsule rent. Hydrodissection is regarded by most surgeons as contraindicated in these eyes however apparently it is more gentile to the capsule than any other surgical maneuver and allows clean and efficient separation of the lens material from the thinned posterior capsule. Femtosecond laser capsulotomy and lens fragmentation is effective and may further assist surgery by pneumo-separation of the lens material. Anterior chamber maintainer may further aid to the stability of the chamber and safety of surgery.

Switch to faricimab after initial treatment with aflibercept in eyes with neovascular age-related macular degeneration.

PURPOSE: To investigate the efficacy and outcomes of switching neovascular age-related macular degeneration (nAMD) patients from aflibercept to faricimab, focusing on visual acuity, retinal fluid management, and treatment intervals. The primary aim was to assess the early outcomes in nAMD patients refractory to aflibercept and explore faricimab's potential as a longer-lasting therapeutic alternative. METHODS: A single-center retrospective study was conducted on 50 refractory nAMD patients at Cleveland Clinic Abu Dhabi from September 2022-May 2023. Patients were switched from aflibercept to faricimab, having met specific criteria for refractory nAMD. The study analyzed best-corrected visual acuity (BCVA), central subfield thickness (CST), and fluid changes post-switch, using Optical Coherence Tomography (OCT). RESULTS: After three faricimab injections, significant reductions in CST were observed, with a notable decrease in retinal fluid. The mean BCVA remained stable throughout the study period. Although there was a decrease in the maximum pigment epithelial detachment (PED) height, it was not statistically significant. Treatment intervals post-switch showed that the majority of patients maintained or extended their treatment intervals, with a significant proportion achieving resolution of intraretinal fluid (IRF) and subretinal fluid (SRF). CONCLUSIONS: Switching to faricimab from aflibercept in refractory nAMD patients led to significant improvements in retinal fluid management and CST, with stable BCVA outcomes. Faricimab presents a promising alternative for patients requiring frequent aflibercept injections, potentially offering a more manageable treatment regimen with extended dosing intervals. This study highlights the need for personalized therapeutic strategies in nAMD treatment, though further research is necessary to optimize treatment switches.

Study of corneal and retinal thicknesses at five years after FS-LASIK and SMILE for myopia.

BACKGROUND: This study aimed to observe corneal and retinal thicknesses at 5 years after femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE) for myopia, investigate the effect of epithelial remodeling on refractive status and visual quality, and compare retinal thicknesses among fundus tessellation grades. METHODS: Patients who received FS-LASIK or SMILE 5 years before were enrolled in this cross-sectional study. After 1:1 propensity score matching, each surgical group obtained 177 patients (177 eyes). Examinations including visual acuity, refraction, corneal and retinal thicknesses, corneal higher-order aberrations (HOAs), and fundus photography were performed in this visit at 5 years after surgery. The Quality of Vision (QoV) questionnaire was used to assess visual symptoms and overall satisfaction. Corneal and retinal thicknesses between groups were compared, contributing factors were analyzed, and correlations with postoperative refractive status, HOAs, QoV scores and overall satisfaction were evaluated. RESULTS: The discrepancy of epithelial thickness between central and pericentral zones in FS-LASIK group was larger than that in SMILE group, which was negatively correlated with postoperative spherical equivalent (SE), positively correlated with spherical aberration (all P < 0.05), but not correlated with QoV scores and overall satisfaction (all P > 0.05) in both surgical groups. There was no statistical difference in stromal thickness and total corneal thickness (all P > 0.05). Most annuluses of epithelial and stromal thicknesse were linearly related to preoperative SE (all P < 0.05). The macular thickness, ganglion cell complex thickness, and retinal nerve fiber layer thickness exhibited comparable values between two surgical groups and four fundus tessellation grades, with no significant association observed with postoperative SE (all P > 0.05). CONCLUSION: The tendency that epithelial thickness in central zone was thicker than peripheral zone was more obvious at 5 years after FS-LASIK compared to SMILE. This uneven distribution of epithelial thickness might play a role in myopic regression and the changes in HOAs, especially in patients with high myopia, but it had little effect on patients' subjective visual quality and satisfaction. Retinal thicknesses were not affected by these two surgical methods, and they did not appear to be the clinical indicators for myopic regression or fundus tessellation progression.

Comparative efficacy of unilateral biportal and percutaneous endoscopic techniques in unilateral laminectomy for bilateral decompression (ULBD) for lumbar spinal stenosis.

BACKGROUND: Unilateral laminotomy for bilateral decompression (ULBD) has yielded positive results in the treatment of lumbar spinal stenosis (LSS). Unilateral biportal ULBD (UB-ULBD) and percutaneous endoscopic ULBD (PE-ULBD) are gaining popularity because of the progress that has been made in minimally invasive surgery (MIS). The objective of this study was to evaluate and compare the radiographic and clinical results of UB-ULBD and PE-ULBD. METHODS: This study retrospectively enrolled patients who underwent ULBD surgery for LSS. The patients were categorized into two groups on the basis of the surgical method: the UB-ULBD group and the PE-ULBD group. Data on the general demographic data, surgical details, clinical efficacy, radiography and complications were compared between the two groups were compared. The minimum follow-up duration was 12 months. RESULTS: A total of 113 LSS patients who had undergone ULBD at our institution were included, of whom 61 patients underwent UB-ULBD surgery and 52 underwent PE-ULBD surgery. The UB-ULBD group had a significantly shorter operation time (P < 0.05). The facet was significantly better preserved in the UB-ULBD group than in the PE-ULBD group, and the angle of ipsilateral facet joint resection in the UE-ULBD group was significantly smaller (P < 0.05). The ODI score, VAS score and modified Macnab criteria improved postoperatively in both groups. The UB-ULBD group had a 95.08% rate of excellent or good patient outcomes, whereas the PE-ULBD group had a 92.30% rate. CONCLUSION: Both UB-ULBD and PE-ULBD can provide favourable clinical outcomes when used to treat LSS. UB-ULBD is beneficial because of its shorter operation time, smaller angle of ipsilateral facet joint resection and better facet preservation, making it a viable and safe option for treating LSS while ensuring spinal stability.

The clinical effect of different vertebral body height restoration rates after percutaneous kyphoplasty for osteoporotic vertebral compression fractures.

OBJECTIVE: This study aimed to evaluate the clinical effect of different vertebral body heights restoration rate after percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fractures (OVCF). METHODS: The patients were divided into two groups according to the height restoration rate of the anterior edge of the vertebral body fracture after PKP operation using X-Ray imaging. The group A was below 80%, and the group B was above 80%. Clinical preoperative and postoperative efficacy (1st day, 1st month, 6th month, and 12th month after surgery) were evaluated according to VAS, Oswestry Disability Index(ODI), Quality of Life Questionnaire of the European Foundation for Osteoporosis(QUALEFFO), and Back Pain Life Disorder Questionnaire(RQD). Simultaneously, the preoperative and postoperative local Cobb angles and changes in the injured vertebrae in the two groups were calculated and analyzed. RESULTS: The postoperative Cobb angle in group A was significantly higher than that in group B. The correction rate in group B was significantly better than that in group A. The VAS, ODI, QUALEFFO, and RQD scores of group B patients were significantly lower than those of patients in group A at each follow-up time point. The correlation coefficients of vertebral body height restoration rate and VAS, ODI, QUALEFFO, and RQD scores at the last follow-up were - 0.607 (P < 0.01), -0.625 (P < 0.01), -0.696 (P < 0.01), and - 0.662 (P < 0.01), respectively. CONCLUSIONS: The results of the correlation analysis between the vertebral body height restoration rate and the above clinical efficacy scores show that increasing the vertebral body anterior height restoration rate is beneficial for pain relief and improves the clinical efficacy of patients. Simultaneously, improving the height restoration rate of the anterior edge of the vertebral body and restoring the normal spinal structure is beneficial for reducing the incidence of refracture of the adjacent vertebral body.

Long-term outcome of robotic-guided closed reduction internal fixation for Delbet II femoral neck fractures in children.

OBJECTIVE: To retrospectively analyze and assess the long-term effectiveness of robotic navigation and traditional closed reduction internal fixation in the treatment of Delbet type II femoral neck fracture in children. METHODS: A total of fifty-five patients diagnosed with pediatric Delbet type II femoral neck fracture, who were admitted to Foshan Hospital of Traditional Chinese Medicine between January 2018 and June 2022, were included in this study. Among them, 22 cases of nailing under robotic navigation were set as the observation group, and 33 cases of nailing under fluoroscopy of the C-arm machine were set as the control group. All patients had their femoral neck fractures closed and repositioned first. After confirming the satisfactory fracture repositioning under the fluoroscopic view of the C-arm machine, internal fixation was performed by inserting hollow compression screws in the corresponding surgical way.A comparative analysis was conducted between the two groups to assess the disparity in the amount of X-ray exposure during surgery, the number of guide pins inserted, and the duration of the surgical procedure. The quality of comparative fracture reduction was assessed according to the Haidukewych criteria on the first postoperative hip X-ray, and the parallelism and distribution of the comparative screws were measured. The incidence of hip function and postoperative complications according to the Ratliff criteria were evaluated between each of the subgroups at the final follow-up. RESULTS: Comparison of general information, operation duration, and quality of fracture reduction between the two groups failed to reveal statistically significant results (P > 0.05). The observation group had a lower number of X-ray exposures and guide pin placements compared to the control group, and this difference was statistically significant (P < 0.05).At the last follow-up, the observation group exhibited superior screw parallelism and distribution, as well as hip joint function, compared to the control group, and this difference was statistically significant (P < 0.05). The incidence of complications in the observation group was lower than that in the control group; however, the difference was not statistically significant (P > 0.05). CONCLUSION: Closed reduction and internal fixation under orthopedic robot navigation can achieve better long-term efficacy in treating Delbet type II femoral neck fracture in children.

Female sex as a negative predictor of outcomes of ankle arthrodesis: a retrospective comparative monocentric study.

BACKGROUND: End-stage post-traumatic osteoarthritis of the ankle joint may require arthrodesis if conservative treatment fails and a decision against total ankle replacement is made. We aimed to compare the sex-specific differences in outcomes and objectify them using validated specific scores. METHODS: Between 2010 and 2021, 221 patients underwent ankle arthrodesis at our institution, including 143 men (MAA) and 78 women (FAA). In addition to demographic data, the aetiology of osteoarthritis, the Foot Function Index (FFI-D), the Olerud-Molander Score (OMAS), and the Short Form-12 questionnaire (SF-12) were collected in this monocentric study. The mean follow-up time was 5.8 years. End-stage osteoarthritis was mostly due to ankle fractures as a result of sprains, falls, and road traffic accidents. RESULTS: Post-operatively, the mean FFI-D for pain was 17.3 (MAA: 14.7; FAA 22.2) and 43.9 for function (MAA: 41.1; FAA 49.5); the mean OMAS was 58.2; and the mean SF-12 physical component score was 42.5. Women achieved significantly worse results in all scores; only the mental component summary of the SF-12 did not differ between the sexes (p > 0.05). Approximately 34% of women stated that the result in terms of gait pattern was worse than expected (MAA 16.1%; p < 0.05). Again, significantly more men stated that the result was better than expected (MAA: 48.3%; FAA: 31.5%, p < 0.05). CONCLUSIONS: The fact that the clinical results were significantly worse in women after ankle arthrodesis should be considered when determining the indication. However, the expectations of men and women also need to be individually adjusted.