Comparing Open and Arthroscopic Grafting for Scaphoid Nonunion: Is There Truly a Noticeable Difference?

BACKGROUND: Scaphoid nonunion remains a challenging injury with no clear consensus on treatment. Surgical options, such as bone grafting procedures, are available for the treatment of scaphoid nonunions. While open grafting provides direct visualization, it is theoretically believed to lead to several problems due to the complex ligamentous structure responsible for wrist stability and challenges in the vascular supply of the scaphoid. On the other hand, despite its technical challenges, arthroscopic grafting is thought to avoid complications by preserving surrounding tissues. QUESTIONS/PURPOSES: (1) Do patients undergoing bone grafting via arthroscopy for scaphoid nonunion report better function than patients undergoing an open procedure? (2) Do patients undergoing bone grafting via arthroscopy for scaphoid nonunion demonstrate better objective outcomes, such as ROM, extremity strength, and bony union? METHODS: Between January 2012 and January 2022, we operated on 141 patients with scaphoid nonunion. The following patients were excluded from this study: 33 patients with scaphoid nonunion advanced collapse and arthritis, 18 patients with proximal pole fractures, 5 patients with previous surgeries, 16 patients with avascular necrosis, and 8 patients with the radius used as a graft source. In total, 28 patients underwent open grafting, and 33 patients underwent arthroscopic grafting; for both groups, the iliac crest was used as the graft source. Two patients with nonunion were observed in each treatment group, and they were excluded from the study. Results from the remaining 26 patients treated with open grafting and 31 patients treated with arthroscopic grafting (totaling 57 patients) were analyzed. The decision to treat patients with open or arthroscopic methods was not based on a particular reason. In our clinic, we initially preferred open grafting for treating nonunion of the scaphoid. Subsequently, we began to prefer arthroscopic methods for the treatment of these injuries. Twenty patients in the arthroscopic group had additional ligamentous injuries, which were simultaneously treated arthroscopically. All patients in both groups had at least 1 year of follow-up, but 48% of patients treated arthroscopically and 42% of those treated with open approaches were lost before 2 years of follow-up. The remaining patients had follow-up periods longer than 24 months. Our primary analysis was performed at 1 year, and we did a secondary analysis at 2 years. We compared the Patient-Rated Wrist Evaluation (PRWE), QuickDASH, and VAS scores of the patients. We also compared ROM and grip and pinch strength in patients' contralateral wrists. We used predefined, evidence-based thresholds for the minimum clinically important differences for these outcome measures. RESULTS: According to the 1-year functional analysis, we found no clinically important difference between the open surgery group and the arthroscopic surgery group in terms of PRWE score (median [IQR] 19 [25] versus 8 [9], difference of medians 11; p = 0.001), QuickDASH (median 14 [23] versus 7 [11], difference of medians 7; p = 0.004), and VAS scores (median 2 [2] versus 1 [1], difference of medians 1; p = 0.02). At 1 year, there were no differences in objective measurements, including grip strength (median 81 [16] versus 85 [14], difference of medians 4; p = 0.60), pinch strength (median 82 [18] versus 81 [15], difference of medians 1; p = 0.85), and ROM (flexion-extension median 83 [22] versus 85 [13], difference of medians 2; p = 0.74; radial deviation-ulnar deviation median 80 [36] versus 85 [14], difference of medians 5; p = 0.61). In the 2-year analysis, no clinically important difference was observed in terms of PRWE score, and no differences were found in terms of QuickDASH, VAS, strength tests, and ROM between the open and arthroscopic groups. No difference was observed in the union rates between the open group and the arthroscopic group (93% [26 of 28] versus 94% [31 of 33], OR 1.19 [95% CI 0.16 to 9.06]; p = 0.86). CONCLUSION: In comparing open surgical procedures with arthroscopic techniques for the treatment of scaphoid nonunions, the present study revealed no differences in functional outcomes and objective measures such as ROM and strength tests at both the 1-year and 2-year follow-up visits. Although technically more challenging, arthroscopy provides a potential advantage, such as addressing concomitant ligament injuries simultaneously. However, patients did not perceive a difference between the two surgical methods. In future studies, investigating long-term outcomes in a larger population will contribute to better elucidating this issue. LEVEL OF EVIDENCE: Level III, therapeutic study.

The Impact of the Number of Sutures on Regeneration in Nerve Repair.

PURPOSE: The ideal number of sutures for epineural nerve repair is still unclear. Increased number of sutures increases secondary damage and inflammation to the nerve tissue, which negatively affects nerve regeneration. When the number of sutures decreases, the strength of the nerve repair site decreases and nerve endings are fringed, which also negatively affects nerve regeneration. Therefore, each additional suture is not only beneficial but also detrimental. The aim of this study was to find out the ideal number of sutures for nerve repair. METHODS: Seventy rats were randomly divided into 5 groups. One of the groups was used as a control group, and right sciatic nerves of the rats in other 4 groups were repaired by using 2, 3, 4, or 6 epineural sutures, respectively, after nerve transection. Biomechanical assessment was performed on the nerves collected from these rats at 5 days of follow-up. Functional and histological analyses were evaluated after 12 weeks of follow-up. RESULTS: It was found that an increase in the number of sutures enhances resistance to tensile force in general. However, there was no significant biomechanical difference between the 6-sutured group in which the most sutures were used and the 4-sutured group. In functional examinations, overall successful results were obtained in the group with 4 sutures. In histological examinations, there was no statistical difference between the control group, 2-sutured groups, and 4-sutured groups in terms of connective tissue index. However, it was observed that the group with 6 sutures had a higher connective tissue index than the control group and groups with 2 and 4 sutures. In terms of regeneration index, it was found that repair with 4 sutures was superior to repair with 2 and 6 sutures. No difference was found between any of the suture groups according to the diameter change index. CONCLUSIONS: These results indicate that repair with 4 sutures is the best method of epineural repair that provides both strength and regeneration. These findings will contribute to both the repair of clinically similar nerves and the standardization of rat nerve studies.

Can Serum ACE Level Be Used as a Prognostic Indicator in COVID-19?

BACKGROUND: SARS-COV-2 virus that causes COVID-19 binds to the host cell with angiotensin converting enzyme-2 causing acute respiratory distress syndrome (ARDS) and severe mortality and morbidity. There are studies in the literature conducted on the importance of serum angiotensin converting enzyme (ACE) and ACE-2 enzymes in ARDS pathogenesis. Serum ACE levels are higher in children and adolescents than in adults, and COVID-19 has a milder progression. All these reasons suggest that there may be a relationship between serum ACE levels and COVID-19 prognosis. METHODS: The serum ACE levels were determined at the time of hospitalization due to COVID-19 diagnosis in this single-centered, prospective study. According to discharge status, patients were divided into three groups as "Discharge with Healing", "Intensive Care Need" and "Mortality", and the effect of serum ACE levels on disease prognosis was investigated. RESULTS: The present study comprised a total of 103 patients, of whom 42.7% (n = 44) were female, and 57.3% (n = 59) were male. The mean age was 59.48 ± 16.47; 91.3% (n = 94) of them were discharged with healing, 5.8% (n = 6) needed intensive care, and 2.9% (n = 3) resulted in mortality. No differences were detected in terms of serum ACE levels between the groups. CONCLUSIONS: No relationships were detected between serum ACE levels at the time of hospitalization and COVID-19 prognosis.

Arthroscopic dorsal capsulodesis for isolated lunotriquetral interosseous ligament injuries.

We assessed the outcomes of isolated lunotriquetral ligament injuries in ten patients who underwent arthroscopic dorsal capsulodesis. Data from patient records, radiologic images and arthroscopic video records were evaluated. The patients were evaluated for ulnar-sided wrist pain with history and physical examination. Preoperative radiographs and MRIs for pain aetiology were assessed. The patients underwent arthroscopic dorsal capsulodesis and were evaluated 29 months (range 19-45) after surgery. Nine patients returned to their original jobs. In one patient pain was aggravated with heavy activities. Mean scapholunate angle was 44°. There were significant improvements postoperatively in pinch and grip strength and MAYO wrist, patient-reported wrist evaluation and pain scores. The wrist flexion-extension and the radial ulnar deviation were significantly improved compared with the contralateral hand. We conclude that arthroscopic dorsal capsulodesis offers effective management for isolated lunotriquetral interosseous ligament injuries.Level of evidence: IV.

Comparison of monoplanar versus biplanar medial opening-wedge high tibial osteotomy techniques for preventing lateral cortex fracture.

PURPOSE: The purpose of this study was to investigate the mechanical strength of both monoplanar and biplanar medial opening-wedge high tibial osteotomy (MOWHTO) procedures and assess the risk of lateral cortex disruption for both techniques. METHODS: Twelve synthetic tibia models with cortical shells were used as test models. Saw cuts for monoplanar MOWHTO and biplanar MOWHTO were generated on the test models in equal numbers (n = 6 for both groups). Wedge opening load and wedge gap distance were evaluated via compressive tests. RESULTS: The mean gap distance just before the lateral cortex fracture in the monoplanar group was 14.7 ± 2.9 mm, which was significantly narrower than that in the biplanar group of 19.1 ± 2.0 mm (p = 0.015). The mean load just before the occurrence of lateral cortex fracture of 32.4 ± 3.2 N in the monoplanar osteotomy group was significantly lower than that in the biplanar osteotomy group of 111.8 ± 9.3 N (p = 0.009). CONCLUSION: Performing a MOWHTO via the biplanar rather than the monoplanar technique allows larger-sized wedges to be opened with less risk of lateral cortical fracture. Thus, larger gaps can be opened and higher angle corrections can be achieved using the biplanar osteotomy procedure. From a clinical viewpoint, the biplanar osteotomy technique reduced the risk of lateral cortical hinge fracture during MOWHTO.

Pars plana vitrectomy with silicone oil tamponade in failed scleral buckle surgery.

OBJECTIVE: This study aimed to evaluate the anatomical and functional outcomes of secondary pars plana vitrectomy (PPV) after failed scleral buckling (SB) surgery and to compare it with primary PPV for rhegmatogenous retinal detachment (RRD), including complicated proliferative vitreoretinopathy cases. DESIGN: Retrospective series in a tertiary care centre. PARTICIPANTS: One hundred and twenty consecutive patients. METHODS: The medical records of patients who underwent PPV with silicone oil tamponade for RRD were reviewed. Forty-four eyes were operated on for primary RRD (primary PPV group), and 76 eyes were operated on for failed SB surgery (secondary PPV group). The single-operation anatomical success rate, final anatomical success rate, and best-corrected visual acuity preoperatively, at 6 months, at 1 year, and at final follow-up were analyzed. RESULTS: The single-operation anatomical success rate was 74.2% in the primary PPV group and 77% in the secondary PPV group (p = 0.48). The final anatomical success rate was 90.3% in the primary PPV group and 91.8% in the secondary PPV group (p = 0.55). The number of cases with visual acuities of 3 visual categories (20/50 or better, 20/200 to 20/50, less than 20/200) was not statistically different at each time point. CONCLUSIONS: Consequent PPV with silicone oil tamponade for failed SB surgery seems not to have inferior anatomical and functional outcomes when compared with primary PPV for RRD.

Safety of modified Stoppa approach for Ganz periacetabular osteotomy: A preliminary cadaveric study.

OBJECTIVE: The aim of this cadaveric study was to investigate the efficacy of the modified Stoppa approach in Ganz periacetabular osteotomy (PAO). METHODS: The Ganz PAO was performed on 10 hemipelvises with normal hips, from 5 cadavers using the modified Stoppa approach through the Pfannenstiel incision. All of the osteotomies were performed under fluoroscopic control and direct visualizing the osteotomy site from the same incision. After the osteotomy, the acetabulum was medialized and redirected anterolaterally, and fixed with 2 screws. The neurovascular structures and the joints were examined by dissecting the soft tissues after fixation of the osteotomies. Outcome parameters were center-edge (CE) angle, the distances between the osteotomy and anterior superior iliac spine (ASIS), and between the osteotomy and the sciatic notch, neurovascular and joint penetrations. RESULTS: After the osteotomy, the mean CE angle was improved from 19.8° to 25.2°, mean distance between the osteotomy and ASIS was 3.1 cm, and the mean distance between the osteotomy and the sciatic notch was 10.2 mm. The neurovascular structures and the joints were examined by dissecting the soft tissues after fixation of the osteotomies. No damage to the joint, surrounding arteries, veins or nerves was detected in any of the cadavers. CONCLUSIONS: Bilateral dysplastic hips can be treated with a 10 cm, cosmetically more acceptable incision in the same session using this approach. Quadrilateral surface of the acetabulum can be directly seen using this approach and the osteotomy can be safely performed.

A new diagnostic parameter for patellofemoral pain.

PURPOSE: Q-angle measurement procedure have not been well standardised. There is a lack of consensus about subject position and knee flexion angle while measuring the Q-angle. Morover Q-angle value which obtained in a single position is a static value and gives an information about the subject's current position. The aim of this study is to obtain a more significant parameter which includes different postures (supine, standing, sitting) and different knee flexion angles instead of a single Q-angle in a fixed position. At the same time this parameter must be functional and dynamic,not a static value like Q-angle. We named this parameter as ΔQ. METHODS: Our study was applied on case and control groups. All subjects in both groups were male. Case group was consisted of 14 subjects who had patellofemoral pain. Control group was consisted of 14 subjects who had normal knees and normal lower extremities with no reported knee problems. We obtained 3 different Q-angle values and 3 different ΔQ values for each subject in both groups. Pearson correlation analysis was used for investigation of continuous variables in normal distribution, Spearman correlation analysis was used in abnormal distribution. t test was used in the comparison of values. Logistic regression analysis(forward conditional mod) was used for detecting of determinants of pain. RESULTS: ΔQ1s of both groups were found as the only statistical significant predictive value for patellofemoral pain. CONCLUSION: There is not an agreement about a standardised q-angle measurement procedure in the literature. Moreover, present procedures provide information about a single and fixed position. In this situation Q-angles which obtained in these fixed positions are static values. We think that we can overcome these problems with this new value. ΔQ contains multiple q-angles and gives information about all. Also it is a dynamic value for being oriented to position change. Therefore, ΔQ is an useful indicator for evaluating patellofemoral pain.

The need for Achilles tenotomy in the Ponseti method: Is it predictable at the initiation or during the treatment?

The aim of this study was to determine whether the need for tenotomy can be predicted at the initiation or during the treatment of the clubfoot treatment according to the Ponseti method. One hundred and eight feet of 77 babies who required tenotomy and who did not were compared statistically according to the parameters of sex, side, bilaterality, presentation day, number of casts, Pirani scores, and the percentage change in Pirani scores, respectively. The mean number of casts required, the initial Pirani scores, and the percentage change in Pirani scores were significantly different between the groups that required tenotomy and the groups that did not (P=0.0001). Pirani scores at the beginning and the percentage change in Pirani scores during the treatment can be used to estimate the need for Achilles tenotomy.

Reconstruction of multiple fingertip injuries with reverse flow homodigital flap.

AIM: Hand trauma may lead to multiple fingertip defects, causing functional restrictions. We evaluated the use of reverse-flow homodigital flap reconstruction of the distal phalanx and pulp defects associated with multiple finger injuries. METHODS: We retrospectively evaluated 11 male patients who presented at our emergency department (January 2011-March 2013) with multiple fingertip injuries and who were treated with a reverse-flow homodigital flap. Evaluations included age, sex, defect size, flap survival rate, complications, cold intolerance, two-point discrimination, range of motion (ROM), quick disabilities of the arm, shoulder, and hand (DASH) score, and return to work time. RESULTS: Completely, 22 reverse-flow homodigital flaps were applied to at least two fingertip injuries at the distal phalanx. Ten flaps survived postoperatively. The exception was partial flap loss on one finger. The mean follow-up was 14.2 months. At the final follow-up, the mean static two-point discrimination value was 10.3mm. Mean ROMs of interphalangeal joints were 65.31° (distal) and 105.77° (proximal). Donor sites were covered with full-thickness skin grafts from the wrist or antecubital area. There were no complications related to the donor site and no development of cold intolerance in any finger. The mean quick DASH score was 4.12. All patients returned to work in an average of 8.3 weeks. CONCLUSIONS: The reconstruction of multiple fingertip injuries with reverse-flow homodigital flaps is a safe, effective method that can be combined with other local finger flaps. These flaps can be applied to two consecutive fingers without reducing finger length or function.

Treatment of posttraumatic cubitus varus with corrective supracondylar humeral osteotomies using the methyl methacrylate external fixator.

BACKGROUND: In upper and lower extremity fractures and osteotomy fixation, the use of methyl methacrylate (MM) as an external fixator presents an alternative method. The primary aim of this retrospective study was to evaluate the midterm outcome of pediatric patients who underwent corrective humeral supracondylar lateral closing-wedge osteotomy, with the external fixation system composed of MM and multiplane K-wires. METHODS: Fourteen consecutive cases with cubitus varus, who underwent corrective osteotomy with a limited lateral approach stabilized with MM and the multiplane K-wires external fixator system between January 2006 and May 2010, were retrospectively evaluated. Time of union, preoperative and postoperative elbow range of motion, and humeroulnar angle were measured. Results were rated as excellent, good, or poor, according to Bellemore criteria. RESULTS: There were a total of 6 female patients and 8 male patients with a mean age of 5.7 years (range, 3 to 9 y). The mean follow-up period was 28.2 months (range, 24 to 48 mo). The mean humeroulnar angle was (-) 18.6 degrees preoperatively, and (+) 16.3 degrees at the final follow-up. Thirteen patients were evaluated as excellent and 1 patient as good, according to Bellemore criteria. Union was seen in all patients at mean 7 weeks (range, 6 to 8 wk). Pin tract infection was observed in 1 patient and treated with oral antibiotics. Loss of correction was not observed in any patient during follow-up. CONCLUSIONS: External fixation of corrective supracondylar humeral osteotomy with MM and multiplane K-wires is a practical, effective, reliable, and cheap alternative method that can be applied. LEVEL OF EVIDENCE: Level IV. Retrospective study.

Role of posterior vitreous detachment on outcome of anti-vascular endothelial growth factor treatment in age-related macular degeneration.

PURPOSE: The aim of this study was to determine the effect of posterior vitreous detachment on outcome of anti-vascular endothelial growth factor injection. METHODS: Sixty-one eyes with age-related macular degeneration that had received intravitreal bevacizumab or ranibizumab injections were retrospectively reviewed. The vitreomacular interface was evaluated, and eyes were grouped according to the presence of posterior vitreous detachment (Group 1, n = 25) or vitreomacular adhesion (Group 2, n = 36). All patients received three loading doses of intravitreal anti-vascular endothelial growth factor injections at monthly intervals, and subsequently, pro re nata regimen was performed. Best-corrected visual acuity and central foveal thickness measurement at follow-up were evaluated. The development of posterior vitreous detachment during the follow-up was also reported. RESULTS: The best-corrected visual acuity changes at each visit compared with baseline were significantly better in Group 1 (P = 0.01, 0.02, 0.02, 0.009, 0.009, respectively at third, sixth, ninth, 12th month, and last visit). When best-corrected visual acuity was classified according to the change in visual acuity of 10 letters or more, the rate of improved or stable best-corrected visual acuity was greater in Group 1 (P = 0.02). During the follow-up, 5 eyes (14.3%) developed posterior vitreous detachment. CONCLUSION: Vitreomacular adhesion seems to have an adverse effect on the visual prognosis of anti-vascular endothelial growth factor treatment for age-related macular degeneration.

Conventional surgery for complicated retinal detachment in silicone oil-filled eyes.

PURPOSE: To evaluate the anatomic and functional outcomes of conventional surgery in silicone oil (SO)-filled eyes with complicated retinal detachment (RD). METHODS: The records of patients who underwent scleral buckling surgery for complex RD in SO-filled eyes were retrospectively reviewed. Conventional RD surgery involved a 2.5-mm encircling band, 6-mm silicone strip for the inferior quadrants or local sponge implant, subretinal fluid (SRF) drainage, and/or SO aspiration with a 27-G needle. Cryotherapy and/or laser photocoagulation was applied around the tears and 360° of the peripheral retina. RESULTS: In all, 4 of the cases had retinal breaks in the lower quadrants, 1 of which had a macular hole; recurrence was due to proliferative vitreoretinopathy (PVR) in the 3 other cases. Three cases were treated with external SRF drainage, 3 cases with SO aspiration, and 1 case with both external drainage and SO aspiration. The retina was attached at the last follow-up visit in 6 (85.7%) of the 7 eyes. One of the cases required secondary vitreoretinal surgery for recurrent RD due to PVR and still had SO tamponade at last follow-up visit. Mean follow-up period was 17.28 ± 8.64 months. Mean logMAR visual acuity was 1.47 ± 0.47 preoperatively and 1.4 ± 0.97 postoperatively. CONCLUSIONS: Inferior RD in eyes treated with silicone oil tamponade, with or without a retinal break, can be treated with scleral buckling surgery, external SRF drainage, and/or pars plana SO aspiration with satisfactory functional and anatomic outcomes in selected complicated RD cases.

Penetration of topically applied diclofenac and ketorolac into the aqueous humour and subretinal fluid: randomized clinical trial.

OBJECTIVE: To determine the level of intraocular penetration of diclofenac sodium and ketorolac tromethamine into the aqueous humour and subretinal fluid. DESIGN: Prospective randomized clinical trial. PARTICIPANTS: Twenty eyes scheduled for retinal detachment surgery and 17 eyes scheduled for cataract surgery. METHODS: Patients with retinal detachment were randomly assigned to receive either topical ketorolac (n = 11) or topical diclofenac (n = 9). Subretinal fluid samples were collected 30-60 minutes after the administration of the last dose. In addition, 17 patients with cataract were randomly assigned to receive topical ketorolac (n = 9) or topical diclofenac (n = 8). The aqueous humour samples were collected 30 minutes after the administration of the last dose. Drug concentrations were determined by high-performance liquid chromatography fluorescence. RESULTS: The mean diclofenac concentration in the subretinal fluid was 42.31 (SD 24.89) ng/µL. Ketorolac was undetectable in the subretinal fluid in all patients who received it because ketorolac tromethamine levels were under the limit of detection. In the aqueous humour, mean diclofenac concentration was 4.98 (SD 4.56) ng/µL, and mean ketorolac concentration was 20.17 (SD 12.21) ng/µL. Topical administration of diclofenac sodium yielded 8.4 times greater drug concentration in the subretinal fluid than in the aqueous humour. Aqueous humour concentrations of ketorolac were higher than those of diclofenac (p = 0.019). CONCLUSIONS: The concentration in the subretinal fluid of topically applied diclofenac was higher than that of ketorolac; and topical ketorolac penetrated into the aqueous humour better than diclofenac did. This suggests that diclofenac can be used more effectively in events related to posterior segment and ketorolac in anterior segment events.

Takayasu's disease and secondary ocular ischemic syndrome.

Takayasu's, or "pulseless," disease is a rare, idiopathic, chronic granulomatous vasculitis that affects large arterial blood vessels. Ocular manifestations occur as a consequence of obliteration of the carotid artery, and ocular ischemia may develop. A 14-year-old girl with progressive visual loss and ocular ischemic syndrome secondary to Takayasu's disease is described.

Retinal nerve fiber layer thickness in chronic renal failure without diabetes mellitus.

PURPOSE: To evaluate the retinal nerve fiber layer (RNFL) thickness in patients with chronic renal failure (CRF) without diabetes mellitus by using optical coherence tomography (OCT). METHODS: Sixty-six eyes of 33 patients with CRF were evaluated. Eighteen patients have been treated with hemodialysis (group 1) and 15 patients have been treated with peritoneal dialysis (group 2). The RNFL thicknesses were assessed before and after the hemodialysis in group 1. None of these patients had diabetes mellitus. Forty eyes of 20 age-matched normal control subjects were assessed in group 3. An RNFL thickness protocol was used to acquire circular scans of 3.4 mm in diameter around the optic nerve. For each eye, RNFL thicknesses were evaluated in 4 quadrants. All of the measurements were automatically calculated by the existing OCT software. All normal subjects and CRF patients underwent comprehensive ophthalmologic examination. The mean and quadrantal RNFL thickness values in patients with CRF were compared with the control group. RESULTS: The mean RNFL thickness values in patients with CRF were statistically significantly lower than the control group. Differences between the RNFL thickness values in group 1 and group 2 and the predialysis and postdialysis measurements were not statistically significant. CONCLUSIONS: The RNFL thickness in CRF without DM, which was measured by OCT-3, was found to be significantly decreased. The presence of CRF can be a source of false positive results and lead to overestimation of glaucomatous optic neuropathy.

Macular edema and iridocorneal endothelial syndrome: a case report.

PURPOSE: To report a case of cystoid macular edema (CME) in iridocorneal endothelial syndrome. METHODS: Case report. RESULTS: The authors describe the clinical history and ocular examination of a 38-year-old woman with iridocorneal endothelial syndrome and CME. This association has never been reported before. The mechanism of CME is unknown. CONCLUSION: CME may cause visual deterioration in iridocorneal endothelial syndrome. We emphasize the importance of posterior segment examination in these cases.

Outcome of complex retinal detachment surgery after silicone oil removal.

BACKGROUND AND OBJECTIVE: To evaluate anatomical prognosis after silicone oil removal. PATIENT AND METHODS: Sixty-eight eyes which underwent silicone oil removal were enrolled into the study. The underlying ocular pathology for pars plana vitrectomy, surgical methods, and time of silicone oil removal were analysed. RESULTS: Sixteen of 68 eyes (23.5%) redetached following the removal of silicone oil. According to etiology redetachment rates: PVR C 9.5% (2/21), PVR D 25% (4/16), trauma without intraocular foreign body 27.3% (3/11), with intraocular foreign body 33.3% (2/6), giant retinal tear 37.5% (3/8), and proliferative diabetic retinopathy with tractional retinal detachment 33.3% (2/6). The rate of redetachment was 22% in patients with encircling band and 27.8% without encircling band. Retina was redetached in the first 10 days in 81.3% of patients after silicone oil removal. CONCLUSION: The residual vitreoretinal traction especially at the vitreous base is the most likely reason for retinal redetachment after silicone oil removal, which is most commonly seen during the first 10 days.

Intraocular intrusion of a scleral sponge implant.

A patient with intrusion of a scleral sponge implant after retinal reattachment surgery is described. Retinal incarceration occurred during primary retinal reattachment surgery and the patient underwent additional cryopexy and radial sponge implant. However, the retina remained detached and pars plana vitrectomy was performed with silicone oil endotamponade to reattach the retina. The interval between placement of the sderal buckle and development of intrusion was 3 months. The buckle was sutured to the sclera with mattress sutures. During the postoperative follow-up period, the intraocular pressure was elevated and controlled with topical antiglaucomatous medication. The encircling band was cut but left in place to avoid perforation, and the retina remained attached. Intrusion of a buckle after retinal reattachment surgery is a rare complication that usually does not require surgical intervention. Cutting the silicone band without removing it may be a treatment option.