ABSTRACT
Purpose: To compare results after ILM peeling and ILM inverted flap technique utilized the repair of full thickness macular holes, irrespective of their size. Patients and Methods: Pre- and postoperative data of 109 patients who suffered from a full thickness macular hole were retrospectively analyzed. Forty-eight patients were treated with an inverted ILM flap technique, 61 patients were treated with ILM peeling. All patients received a gas tamponade. The primary endpoint was macular hole closure as demonstrated by OCT scanning. Secondary endpoints were best corrected visual acuity and clinical complication rates. Results: For small and medium-sized macular holes the closure rates in the ILM flap technique group were 100% and 94%, respectively. For ILM peeling, the closure rate was identical (95%). For large macular holes, the closure rate was 100% in the flap versus 50% in the ILM peeling group, but visual acuity improved in both groups (ILM flap p=0.001, ILM peeling p=0.002). In both treatment groups, larger holes were associated with a reduced final visual outcome. For medium-sized macular holes, visual acuity significantly improved only in the ILM peeling group. Both techniques were associated with minimal and comparable side effects. Conclusion: In our limited series, the inverted ILM flap technique for repair of macular holes demonstrated a high closure rate. For large MHs, we saw a trend towards a better closure rate in the flap technique compared to ILM peel only. However, final visual acuity showed no significant difference between the groups. Clinical results and complications appeared to be comparable in both groups.
ABSTRACT
BACKGROUND: In trauma patients, acute respiratory distress syndrome (ARDS) is associated with high morbidity and mortality. Changes in diagnostics, management, and treatment may have influenced the incidence of ARDS. Therefore, the purpose of this article is to evaluate whether there is a difference in the incidence of posttraumatic ARDS (1) over time, (2) attributable to geographic distribution, and 3) related to admitting surgical subspecialities. METHODS: A comprehensive search of articles published in English and German language was conducted using PubMed, MEDLINE, and the ISI Web of Science. Search terms included ARDS, acute respiratory distress syndrome, multiple trauma, polytrauma, and surgery. A meta-regression was performed to analyze differences between several decades of patient recruitment (decade 1, 1981-1990; decade 2, 1991-2000; decade 3, 2001-2010), geographic location (North America and Europe), and the type of admitting surgical service (general vs. orthopedic trauma), respectively. Statistical analyses were performed with R (version 3.1.2, metafor package). RESULTS: The search included studies between January 1, 1980, and December 31, 2015 and revealed 43 trials from 40 publications (117,951 patients, 7,816 with posttraumatic ARDS). The median incidences over the last three decades were similar between decade 1 (10.4%), decade 2 (7.7%), and decade 3 (8.0%) (p = 0.8322). Geographical observations comparing central Europe and North America revealed no statistically significant difference (Europe 13.0%) and North America (6.9%), (p = 0.0696). The ARDS incidence in patients published based on a general surgery service (9.8%) was comparable to those published by orthopedic trauma surgeons (7.0%) (p = 0.3436). CONCLUSION: The results of this meta-analysis discard the assumption that the following factors have influenced the incidence of posttraumatic ARDS: There was neither a change in the incidence over the last decades, nor a geographical difference within western societies, nor associated with the admitting surgical subspeciality. LEVEL OF EVIDENCE: Systematic review, level III.
