Changes in the Ganglion Cell Complex after Inner Limiting Membrane Peeling for Epiretinal Membrane in Glaucoma Patients.

BACKGROUND: Epiretinal membrane (ERM) is a disease that affects the vitreoretinal interface and causes metamorphopsia, anorthopia, and decreased visual acuity. In this study, ERM patients who underwent internal limiting membrane (ILM) peeling were classified as those with glaucoma (Group G) and a control group (Group C). Changes in ganglion cell complex (GCC) thickness were compared between these groups to investigate whether such changes had an effect on progression of glaucoma from structural change. METHODS: This was a retrospective, observational study that included 27 eyes of 27 patients. Group C included 22 eyes, and Group G included 5 eyes. Patients underwent ILM peeling, and cataract surgery was combined with vitrectomy for 16 phakic eyes; 2 phakic eyes and 9 aphakic eyes were treated only with vitrectomy. GCC thickness was measured preoperatively and at 2 weeks and 1, 3, and 6 months postoperatively, and these values and the rates of thinning were compared between the two groups. RESULTS: The mean age of patients was 66.7±12.8 years (range 30-84 years). There was no significant difference between groups in the thickness of the GCC or its rate of thinning after ILM peeling. CONCLUSIONS: The present results suggest that this procedure does not cause structural exacerbation of glaucoma in glaucoma patients. Although further studies of the functional effects of ILM peeling are required, the present results suggest that there is no significant difference between the two groups.

Effects of Hydrogen in Prevention of Corneal Endothelial Damage During Phacoemulsification: A Prospective Randomized Clinical Trial.

PURPOSE: Hydrogen (H2) has been reported to scavenge free radicals, particularly the hydroxyl radical (·OH). Ultrasound oscillation in an aqueous solution produces ·OH. Our recent study demonstrated that H2 dissolved in an irrigation solution prevented corneal endothelial damage during phacoemulsification in an animal model. We examined the effects of H2 during clinical phacoemulsification. DESIGN: A single-center, prospective, randomized, double-masked clinical trial. METHODS: Thirty-two patients who had cataracts of similar nucleus hardness in both eyes (age: 75.4±7.68 years; 17 males, 15 females) were recruited. Phacoemulsification was performed using a solution of dissolved H2 in one eye, and a conventional solution in the contralateral eye. Endothelial cell density (ECD) at the center of the cornea was measured using noncontact specular microscopy preoperatively and at 1 day, 1 week, and 3 weeks postoperatively. RESULTS: Reduction rates of ECD (mean ± standard deviation) were 16.0%±15.7% at 1 day, 15.4%±16.1% at 1 week, and 18.4%±14.9% at 3 weeks in the control group, compared to 6.5%±8.7% at 1 day (P = .003), 9.3%±11.0% at 1 week (P = .039), and 8.5%±10.5% at 3 weeks (P = .004) in the H2 groups. These rates were significantly smaller in the H2 group at all time points. CONCLUSIONS: H2 dissolved in irrigation solution reduced corneal endothelial damage during phacoemulsification. This suggests that a considerable part of the corneal endothelial damage during phacoemulsification is caused by oxidative stress, and that H2 is useful in clinical phacoemulsification.

Clinical results of unicompartmental arthroplasty for knee osteoarthritis using a tibial component with screw fixation.

PURPOSE: Unicompartmental knee prostheses with screw fixation into the proximal tibia were employed and postoperative clinical results for osteoarthritis of the knee, especially regarding relief of pain, range of motion and satisfactory limb alignment are reported and discussed. METHODS: A total of 140 knees (131 medial and 9 lateral) of 85 patients (21 men and 64 women) were followed up for two to 17 years with an average of 7.0 ± 3.0 years. RESULTS: In spite of loss to follow-up in three knees of two patients and revision to total knee arthroplasty in one knee of one patient, in the remaining 136 knees (82 patients) the mean knee score of the Knee Society Clinical Rating System was 41.0 ± 14.7 pre-operatively, which improved to 93.1 ± 5.7 at follow-up, while the mean functional score similarly improved from 36.9 ± 8.1 to 88.5 ± 6.3 (p < 0.001 respectively). One knee developed a fracture in the medial proximal part of the tibia, but no knee developed loosening of the prosthesis or infection. The mean pre-operative knee flexion was 122.6 ± 15.9°, which improved to 132.9 ± 13.4° (p < 0.001) at follow-up. The limb alignment showed 4.8 ± 4.5° anatomical varus angulation pre-operatively, which was corrected to 5.8 ± 3.3° valgus at follow-up in the medial unicompartmental replacement group (127 knees), and 19 ± 6.1° valgus pre-operatively, which was corrected to 6.7 ± 3.0° valgus at follow-up in the lateral unicompartmental replacement group (nine knees). CONCLUSIONS: The clinical results of arthroplasty with screw fixation were concluded to be promising.

Imaging of a rat osteoarthritis model using (18)F-fluoride positron emission tomography.

OBJECTIVE: Currently, conventional radiography is the standard method for the diagnosis and evaluation of the severity of osteoarthritis (OA), but it takes a couple of years to detect cartilage loss. Magnetic resonance imaging can delineate articular cartilage and accurately assess cartilage volume and thickness, but its reliability for very early diagnosis of OA is still controversial. The purpose of this study was to confirm the potential of (18)F-fluoride PET for the early diagnosis of OA by using a surgically induced rat OA model. METHODS: Seventeen 16-week-old male Sprague-Dawley rats underwent anterior cruciate ligament transection (ACLT) in the right knee to induce OA. The left knee underwent sham operation. At 2, 4, and 8 weeks after operation, the rats were injected with 2.5 MBq/kg of (18)F-fluoride, and 30 min after injection, each rat was killed and the bilateral knees were resected. The femur and tibia were cut horizontally, approximately 2 mm from the joint surface excluding the growth plate, and were cut into the medial and lateral condyles. The patella was also resected and blood samples were collected. The radioactivity of each sample was measured by gamma counting. Assays for serum cartilage oligomeric matrix protein and serum C-telopeptide of type II collagen were performed. Histopathological grading was performed according to a modified Mankin's scoring system. Two rats underwent PET scans at 2, 4, and 8 weeks after operation. The rats were injected with 30 MBq of (18)F-fluoride, and 30 min after injection, bilateral knee images with a 30-min acquisition time were obtained with an animal PET system. RESULTS: The uptake of (18)F-fluoride was significantly higher in ACLT knees than sham-operated knees in the medial femur and medial tibia at 2 weeks after operation. At 4 weeks after operation, the medial femur, medial tibia, and lateral tibia of OA knees showed significantly higher uptake of (18)F-fluoride compared with sham-operated knees. At 8 weeks, all sections showed significant differences. The uptake of (18)F-fluoride significantly increased as time elapsed in all sections. Uptake showed a significant correlation with histological scores. CONCLUSION: Our results suggest that (18)F-fluoride is potentially useful for the early detection of osteoarthritic changes.

A mid term comparison of open wedge high tibial osteotomy vs unicompartmental knee arthroplasty for medial compartment osteoarthritis of the knee.

BACKGROUND: The choice of surgical treatments for unicompartmental osteoarthritis (OA) of the knee is still somewhat controversial. Midterm results from cases treated using unicompartmental knee arthroplasty (UKA) or open wedge high tibial osteotomy (OWHTO) were evaluated retrospectively. METHODS: Twenty-seven knees of 24 patients with varus deformities underwent OWHTO and 30 knees of 18 patients underwent UKA surgeries for the treatment of medial compartmental osteoarthritis (OA). The KSS score, FTA, range of motion and complications were evaluated before and after surgery. RESULTS: The preoperative mean KSS scores were 49 points in the OWHTO group and 62 in the UKA group which improved postoperatively to 89 (excellent; 19 knees, good; 8 knees), and 88 (excellent; 25, good; 4, fair; 1), respectively. There was no significant difference between the OWHTO and UKA scores. Seventeen patients in the OWHTO group could sit comfortably in the formal Japanese style after surgery. The preoperative mean FTA values for the OWHTO and UKA groups were 182 degrees and 184, and at follow-up measured 169 and 170, respectively. In the UKA group, the femoral component and the polyethylene insertion in one patient was exchanged at 5 years post-surgery and revision TKAs were performed in 2 cases. In the OWHTO group, one tibial plateau fracture and one subcutaneous tissue infection were noted. CONCLUSIONS: Treatment options should be carefully considered for each OA patient in accordance with their activity levels, grade of advanced OA, age, and range of motion of the knee. OWHTO shows an improved indication for active patients with a good range of motion of the knee.