MACULAR HOLE ASSOCIATED WITH AGE-RELATED MACULAR DEGENERATION: Pathogenesis and Surgical Outcomes.

PURPOSE: To ascertain the pathogenesis of macular hole (MH) associated with age-related macular degeneration (AMD) and its surgical outcomes. METHODS: Patients with full-thickness MH associated with AMD (higher grades than intermediate) were enrolled. The mechanism of MH formation and closure rate after vitrectomy (surgical outcome) were determined using optical coherence tomography imaging. RESULTS: The mechanism of MH formation (35 eyes) associated with AMD was classified into four types: vitreomacular traction (42.9%), gradual retinal thinning caused by subretinal drusen or pigment epithelial detachment (22.9%), massive subretinal hemorrhage (20.0%), and combined (14.3%). In the 41 eyes that underwent vitrectomy, the logarithm of the minimum angle of resolution best-corrected visual acuity improved from 0.82 (0.10-2.30) preoperative to 0.69 (0.10-2.30) postoperative (P = 0.001). Successful closure of the MH was achieved in 33 eyes (80.5%) after vitrectomy. No significant association was observed between the closure rate of MH after vitrectomy and mechanism of MH formation (P = 0.083). CONCLUSION: The mechanism of MH formation associated with AMD was classified into four types and was not related to its surgical outcome. Considering visual improvement and surgical outcome after vitrectomy in our study, active surgical treatment can be considered for MH associated with AMD.

Influence of Phosphoric Acid Etching on Bond Strength for Calcium Silicate-Based Sealers.

INTRODUCTION: This study evaluated the microtensile bond strength of calcium silicate-based sealers and epoxy resin-based sealer, depending on the use of phosphoric acid (PA) etching before immediate resin restoration. METHODS: Exposed dentin surfaces of extracted human third molars were randomly assigned to 3 groups depending on sealer type (AH Plus [Dentsply DeTrey], CeraSeal [Meta Biomed Co.], and EndoSeal MTA [Maruchi]). Half of the samples were treated with PA for 30 seconds, and the other half were cleaned with water. Completely untreated specimens were used as controls. Self-etching adhesive (Clearfil SE Bond, Kuraray) was applied and composite resin (Tetric N-Ceram, Ivoclar Vivadent) was used to create build-ups. After 24 hours, the microtensile bond strength was measured (EZ Test, Shimadzu Co.). The failure mode was determined by light microscopy and scanning electron microscopy. One-way analysis of variance with the Bonferroni correction was used to analyze the data (P < .05). RESULTS: The bond strength of the water-washed dentin surfaces in the calcium silicate-based sealer groups did not differ significantly from those of the control surfaces but the PA-pretreated surfaces exhibited relatively low-bond strength. The AH Plus-treated group had lower bond strength than the control group when no PA treatment was applied, but PA treatment restored the bond strength. The adhesive failure mode was most frequently found in the AH Plus group without PA etching. CONCLUSIONS: When a water-soluble calcium silicate-based sealer is used, sufficient bond strength can be obtained by washing with water alone, with no need for PA use.

Laparoendoscopic single-site renal cyst marsupialization using a homemade single-port device has a role as a feasible treatment option.

AIM: In patients with a renal cyst and concurrent symptoms, we examined the effectiveness and safety of laparoendoscopic single-site surgery (LESS) for renal cyst marsupialization using a homemade single-port device (HSPD) by a single surgeon (S.W.L.). PATIENTS AND METHODS: The present study was conducted on a total of 31 patients with a renal cyst. A LESS renal cyst marsupialization was performed using a HSPD based on the Alexis® wound retractor and a powder-free surgical glove. In our study, the mean age was 55.29 ± 10.86 (range 31-73) years and the mean size of the renal cyst was 6.83 ± 1.09 cm. RESULTS: All the surgical procedures were successfully performed. The mean operative time was 101.35 ± 16.04 min. Of the patients who underwent the procedure, none presented with major complications. In 7 patients who had pain preoperatively, there was a significant difference in the visual analogue pain scale score at 6.86 ± 0.69 preoperatively and 1.71 ± 0.49 at postoperative week 4 (p < 0.001). The number of patients who were satisfied with the postoperative outcome was 29 (93.5%). CONCLUSIONS: In patients with a simple renal cyst, LESS renal cyst marsupialization using a HSPD might be considered as a feasible, safe surgical treatment option.

Midpalatal miniscrews for orthodontic anchorage: factors affecting clinical success.

INTRODUCTION: The purpose of this study was to investigate the success rate of midpalatal miniscrews used for orthodontic anchorage and the factors affecting clinical success. METHODS: One hundred twenty-eight consecutive patients (101 female, 27 male; mean age, 23.4 years), who received a total of 210 miniscrews in the midpalatal suture area, were examined. Success rates were determined according to 10 clinical variables. RESULTS: The overall success rates were 88.20% for the total number of patients and 90.80% for the total number of miniscrews. There were no significant associations among success rate and sex, total period of treatment with miniscrews, diameter of miniscrews, types of tooth movements, and variables that represent sagittal and vertical skeletal relationships (ANB, FMA, and Sn-GoGn). The operator's learning curve, patient's age, area (midpalatal or parapalatal), and splinting significantly influenced the success rates. After adjusting for other variables, only 1- splinting-showed a significant effect on the success rate. CONCLUSIONS: The joining of 2 miniscrews by splinting, placement of the miniscrew in the midpalatal suture, patient's age (especially >15 years), and operator's skill were factors influencing the clinical success of orthodontic miniscrews in the palate.

Distalization of the entire maxillary arch in an adult.

Many appliances are available to move maxillary molars distally. First molars have routinely been moved distally with nickel-titanium coil springs and nickel-titanium wire before the eruption of the second molars. However, when first molars are moved distally after the eruption of the second molars, they tend to move slowly, and anchorage loss increases. In adults, the midpalatal area is appropriate for placing titanium miniscrews for orthodontic anchorage. This case report demonstrates the ability of midpalatal miniscrews to control anchorage while distalizing the entire maxillary dentition in an adult, with improvements in lip profile resulting from the retraction of anterior teeth followed by a good response of the lips. This report suggests that absolute anchorage can be established by placing miniscrews in the palate and that miniscrew anchorage can serve as anchorage for the distal movement of an entire arch.

Microincision vitrectomy surgery for myopic foveoschisis.

OBJECTIVE: To evaluate the technical feasibility and surgical outcome of microincision vitrectomy surgery (MIVS) in patients with myopic foveoschisis (MF). METHODS: In total, 33 eyes of 29 patients who underwent surgical intervention due to MF were included. The patients were diagnosed with MF by spectral-domain optical coherence tomography (SD-OCT) and followed up for 6 months after MIVS that included internal limiting membrane (ILM) peeling with or without intraocular gas tamponade. To identify factors affecting visual outcome, the best-corrected visual acuity, axial length, and SD-OCT findings were analysed. RESULTS: After surgery, the mean BCVA improved from 1.01 ± 0.46 logMAR to 0.76 ± 0.64 logMAR (p=0.004). Central subfield thickness in SD-OCT decreased from 431 ± 256 µm to 231 ± 72 µm after surgery (p<0.001). SD-OCT showed complete resolution of MF with complete foveal reattachment in 96% of patients (27/28). The accompanying macular hole was successfully closed in all four cases. Hypotony <6 mm Hg was seen in one eye only. At the end of surgery, eight of 24 eyes (33.3%) undergoing 25-gauge MIVS and four of nine eyes (44.4%) undergoing 23-gauge MIVS required sutures to close at least one sclerotomy site. Postoperative development of a macular hole was seen in one patient. It was successfully treated by reoperation using silicone oil tamponade. CONCLUSIONS: MIVS with ILM peeling appeared to yield favourable visual and anatomical outcomes for MF in highly myopic eyes.

Clinical results of modified anterior chamber tube shunt to an encircling band surgery for uncontrolled intraocular pressure.

PURPOSE: To evaluate the clinical outcome of a modified anterior chamber tube shunt to an encircling band (ACTSEB) procedure in eyes with uncontrolled intraocular pressure (IOP) after scleral encircling band (EB) implantation for treatment of retinal detachment. METHODS: Eight eyes of 7 consecutive patients were analyzed. Silicone tube (external/internal diameter, 0.64/0.30 mm) with 3 to 4 side ports around the distal portion was prepared. Temporary partial ligation of the tube was performed. The fibrous capsule around the EB was incised and the distal portion of each tube was placed under the EB and anchored to the sclera. The proximal part of the tube was inserted into the anterior chamber. IOP, use of antiglaucoma medication, and complications were recorded for 1 year after surgery. Success was defined as an IOP of 8 to 21 mm Hg and no requirement for an additional procedure; complete success was defined as control of IOP without use of antiglaucoma medication; and qualified success as control of IOP with the use of medication. RESULTS: Mean preoperative IOP was 40.1 mm Hg under maximum tolerated medical therapy. Mean IOP was 10.6 mm Hg at 1 day and 16.9 mm Hg at 1 year after surgery. Antiglaucoma medication was used in 3 eyes during follow-up. Tube exposure was detected in 1 eye at 10 months after surgery. The complete success rate was 50% (4 eyes) and the qualified success rate 37.5% (3 eyes). CONCLUSION: Our modification of the ACTSEB procedure resulted in good clinical outcomes, with favorable control of IOP and a low rate of complications.