Intraocular pressure trend following myopic photorefractive keratectomy.

PURPOSE: To evaluate the intraocular pressure (IOP) trend and risk factors for IOP rise after myopic photorefractive keratectomy (PRK). PATIENTS AND METHODS: One eye of each patient undergone PRK for myopia was randomly assigned to this study. All eyes underwent tonometry by CorVis Scheimpflug Technology (CST) tonometer (Oculus Optikgeräte GmbH, Wetzlar, Germany) 1 week, 2 weeks, 1 month, 2 months, 3 months and 4 months after surgery. The eyes with IOP rise more than 5 mmHg and the risk factors were evaluated by Kaplan-Meier graph and multiple Cox regression analysis. RESULTS: A total of 348 eyes of 348 patients were enrolled in this study. Forty-three eyes (12.35%) experienced a steroid-induced IOP rise of more than 5 mmHg. Eyes with IOP rise had higher baseline IOP (Median 19 mmHg (IQR 18-22) versus Median 15 mmHg (IQR 14-16); p < 0.001). Baseline central corneal thickness (CCT) was higher in eyes without IOP rise (Median 520 µm (IQR 509-541) versus Median 535 µm (IQR 518-547); p = 0.009). In multivariate Cox regression analysis, higher baseline IOP was a risk factor for IOP rise (Hazard Ratio (HR) 1.59 (95% CI 1.43-1.77); p < 0.001) while higher baseline CCT was protective (HR 0.97 (95% CI 0.95-0.98); p < 0.001). CONCLUSION: Eyes with higher baseline IOP and lower baseline CCT are at increased risk of IOP rise after PRK and should be monitored more frequently.

Epidemiology of adolescent idiopathic scoliosis in Isfahan, Iran: A school-based study during 2014-2015.

BACKGROUND: Scoliosis is a three-dimensional deformity of the spine with lateral curvature in addition to the rotation of vertebral bodies. The aim of the present study was to determine the prevalence of adolescent idiopathic scoliosis (AIS) in our society and its demographic-related factors. MATERIALS AND METHODS: This was a cross-sectional study that took place from November 2014 to March 2015 in Isfahan, Iran. During the period of study, 24 schools were randomly chosen from six zones by a simple random sampling method. In each school, about 120 students were randomly selected and evaluated. Anterior forward bending test and scoliometry were done in all students and suspicious ones referred to Alzahra spine clinic for further evaluation. The diagnosis of AIS was based on radiographic finding and Cobb angle more than 10°. Data about age, sex, height, body mass index, hand dominancy, and type of schoolbag were recorded. RESULTS: A total number of 3018 children were evaluated and 19 were diagnosed with AIS that showed the prevalence of 0.62%. None of the study variables had a significant relation with the presence of AIS. The cutoff point for the detection of AIS with scoliometry was calculated as 3.5, with a sensitivity of 73.7% and specificity of 86.7%. CONCLUSION: The prevalence of AIS in our area was 0.62%, which was lower than previous reports and did not have a relation with demographic factors; however, screening surveys identify a significant number of children with AIS who could benefit from preventive treatment.

Comparison of Scheuermann's kyphosis correction by combined anterior-posterior fusion versus posterior-only procedure.

INTRODUCTION: Conventional treatment of rigid deformity in Scheuermann's kyphosis (SK) in young patients includes a preliminary anterior spinal release and fusion (ASF) followed by posterior spinal fusion and instrumentation (PSF). However, recently there are more trends to do posterior-only surgery for correction of this deformity. The aim of our study was to compare clinical and radiological outcomes of ASF/PSF and PSF-only procedures in treatment of SK. MATERIALS AND METHODS: In a prospective clinical and radiological review, thirty operated SK patients in two groups were evaluated. Group A: ASF/PSF technique (n: 16) and group B: PSF-only procedure (n: 14) were followed for at least 2 years (average 57.6 months). Two groups were well matched for the following four criteria: average age, flexibility status, posterior fusion levels, and preoperative Cobb's kyphosis angle. Oswestry disability index (ODI) and scoliosis research society questionnaire-30 (SRS-30) and radiological (kyphosis correction, correction loss, sagittal balance) parameters were evaluated before and after surgery and at the final follow-up. RESULTS: In group A, primary thoracic Cobb's kyphosis, immediate post-operative kyphosis, and final follow-up kyphosis angle were 83.6°, 41.4° and 43°, respectively (P < 0.05). Correction rate and correction loss were 50.5 % and 1.6° ± 2.4, respectively. In group B, the corresponding values were 81.9°, 40.1° and 43.2°, respectively (P < 0.05). Correction rate and correction loss were 51 % and 3.1° ± 2.5, respectively. SRS-30 and ODI scores in group A were averaged 68.5 and 21.3 preoperatively and 128.7 and 6.25 at the final follow-up, respectively. In group B, the corresponding values were 64 and 23.2 preoperatively and 133.5 and 5.8 at the final follow-up, respectively. CONCLUSIONS: Clinical and radiological parameters were similar in both groups after surgical correction while, complication rates, operation time and blood loss were significantly higher in ASF/PSF procedure.

Intrusion of episcleral buckles: report of two cases and brief review.

BACKGROUND: The authors report two cases of the scleral buckles intrusion and erosion that presented many years after primary surgery with vitreous haemorrhage in one of them. Although the erosion/intrusion of a silicone scleral buckle (SB) is rare, it may have serious consequences and optimal management can be challenging. Therefore, this diagnosis should be considered if attributable signs and symptoms including vitreous haemorrhage occurred after scleral buckling. The authors briefly review the literature on clinical presentation and management of the episcleral silicone buckling erosion and intrusion. CASE PRESENTATION: Case 1: A 48-year-old woman with a history of scleral buckling for an inferior rhegmatogenous retinal detachment presented with visual loss in her right eye. A vitreous haemorrhage was observed. After Close observation, Partial resolution of haemorrhage revealed an intruded sponge segment in inferior vitreous cavity. Case 2: A 26-year-old man was referred for retinal evaluation. Twenty years earlier, he had undergone lensectomy for bilateral childhood cataract. Ten years ago, he had developed an aphakic RRD in the left eye. The detachment was managed with pars plana deep vitrectomy, endolaser, an encircling silicone band, and silicone oil injection. On examination an eroded band was noted. CONCLUSION: Although the erosion/intrusion of a silicone episcleral buckle is rare, it may have serious consequences and optimal management can be challenging. Unnecessarily destructive techniques may predispose the eye to this complication and should be avoided. Patients who have a history of SB need lifelong follow-up and this diagnosis should be considered if attributable signs and symptoms occurred.

Posterolateral instrumented fusion with and without transforaminal lumbar interbody fusion for the treatment of adult isthmic spondylolisthesis: A randomized clinical trial with 2-year follow-up.

BACKGROUND: Spondylolisthesis is a common cause of surgery in patients with lower back pain. Although posterolateral fusion and pedicle screw fixation are a relatively common treatment method for the treatment of spondylolisthesis, controversy exists about the necessity of adding interbody fusion to posterolateral fusion. The aim of our study was to assess the functional disability, pain, and complications in patients with spondylolisthesis treated by posterolateral instrumented fusion (PLF) with and without transforaminal lumbar interbody fusion (TLIF) in a randomized clinical trial. MATERIALS AND METHODS: From February 2007 to February 2011, 50 adult patients with spondylolisthesis were randomly assigned to be treated with PLF or PLF+TLIF techniques (25 patients in each group) by a single surgeon. Back pain, leg pain, and disability were assessed before treatment and until 2 years after surgical treatment using visual analog scale (VAS) and oswestry disability index (ODI). Patients were also evaluated for postoperative complications such as infection, neurological complications, and instrument failure. RESULTS: All patients completed the 24 months of follow-up. Twenty patients were females and 30 were males. Average age of the patients was 53 ± 11 years for the PLF group and 51 ± 13 for the PLF + TLIF group. Back pain, leg pain, and disability score were significantly improved postoperatively compared to preoperative scores (P < 0.001). At 3 months of follow-up, there was no statistically significant difference in VAS score for back pain and leg pain in both groups; however, after 6 months and 1 year and 2 years follow-up, the reported scores for back pain and leg pain were significantly lower in the PLF+TLIF group (P < 0.05). The ODI score was also significantly lower in the PLF+TLIF group at 1 year and 2 years of follow-up (P < 0.05). One screw breakage and one superficial infection occurred in the PLF+TLIF group, which had no statistical significance (P = 0.373). CONCLUSION: It seems that accompanying TLIF with PLF might lead to better functional improvement and pain reduction in patients with spondylolisthesis.

Clinical Findings and Results of Surgical Resection in 19 Cases of Spinal Osteoid Osteoma.

STUDY DESIGN: Descriptive cases series. PURPOSE: To evaluate clinical findings and results of conventional surgery in patients with spinal osteoid osteoma (OO). OVERVIEW OF LITERATURE: OO is a rare benign tumor with spinal involvement rate of about 10%-20%. METHODS: This descriptive study was conducted on 19 patients (11 males and 8 females with an average age of 19.8 years) with documented histopathological and imaging findings of OO referred to a university hospital. Neurologic symptoms and pain were scored before and after the open surgical excision. Data were analyzed by SPSS ver. 16 software using chi-square and significance level of 0.05. RESULTS: The most common complaint was back or neck pain (84.2%) and in 68.4% spinal deformity (mostly scoliosis) shown with an average cobb angle of 21° at presentation. The sites of involvement were 35% in the lumbar, 35% in the thoracic, 25% in the cervical, and 5% in the sacrum. Lamina was the most common site (50%) of involvement with predilection for the right side (p=0.001). All patients were treated by conventional surgical excision with a complete recovery of pain and deformity. No recurrence occurred after a mean follow up of 44.5 months, but 4 of 19 cases instrumented because of induced instability. In one case there were two levels of involvement (C7-T1) simultaneously. Interestingly, 10 out of 19 of our cases belonged to a specific race (Bakhtiari). CONCLUSIONS: Surgical intra-lesional curettage is potentially an effective method without any recurrence, which can lead to spontaneous scoliosis recovery and pain relief. Race may be a potential risk factor for spinal (OO).