Intrastromal keratoplasty with intracorneal ring segments implantation as an independent method of visual rehabilitation in patients with keratoconus

2021 ◽  
pp. 137-142
Author(s):  
A.N. Kulikov ◽  
◽  
E.V. Kudryashova ◽  
P.P. Mikhailov ◽  
A.R. Suleimanova ◽  
...  
Keyword(s):  
Independent Method ◽  
Visual Rehabilitation ◽  
Spherical Component ◽  
Treatment Techniques ◽  
Cylindrical Component ◽  
Quality Of Vision ◽  
Independent Technique ◽  
High Level

Purpose. To assess the possibility of using intrastromal keratoplasty with intracorneal ring segments implantation as an independent technique to achieve visual rehabilitation in patients with keratoconus of the stages I and II. Material and methods. There were examined and operated 14 eyes (10 patients) with keratoconus of the stages I and II (classification by Izmailova SB, 2014). Patients were divided into two groups depending on the keratoconus stage. All patients underwent intrastromal keratoplasty with intracorneal ring segments implantation using the femtosecond technology. The on average follow-up was 5.7 months. Results. In the first group: the average UCVA value increased with from 0.31±0.21 to 0.81±0.31 (p<0.05); the BCVA increased from 0.89±0.08 to 0.94±0.10 (p>0.05); the spherical component of refraction decreased from 0.96±1.25 to 0.08±0.20 (p<0.05); the cylindrical component of refraction decreased from 4.25±1.73 to 0.50±1.22 (p<0.05). In the second group: UCVA increased from 0.51±0.40 to 0.61±0.28 (p<0.05); the BCVA increased from 0.70±0.17 to 0.81±0.26 (p>0.05); the spherical component of refraction decreased from 4.88±2,61±0.53±0.63 (p<0.05); the cylindrical component of refraction decreased from 2.69±1.65 to 1.41±1.02 (p<0.05). Conclusion. 1. After implantation of intracorneal ring segments, both in patients with I and in patients with the II stage of keratoconus, there was an increase in the UCVA and BCVA, as well as a significant reduction in maximal keratometry and coma, which provides the improving of the quality of vision. 2. In all cases the UCVA and BCVA that were obtained after the treatment reached a sufficiently high level to ensure the possibility of performing their professional functions, without resorting to additional surgical treatment techniques. That characterizes this method as an independent and sufficient to achieve high visual acuity in patients with I and II stages of keratoconus. Key words: keratoconus, corneal intrastromal segments, femtosecond laser, visual rehabilitation.

scholarly journals PO 18213 - Evaluation of hallux valgus treatment through percutaneous

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 46S
Author(s):  
Jorge Eduardo De Schoucair Jambeiro ◽  
Antero Tavares Cordeiro Neto ◽  
Fernando Delmonte Moreira ◽  
José Augusto De Oliveira ◽  
Clara Cristiane Miguelino Sousa ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Surgical Trauma ◽  
Complication Rates ◽  
Percutaneous Surgery ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Percutaneous Procedures ◽  
High Level

Introduction: Hallux valgus (HV) is characterized by the lateral deviation of the first finger, associated with pain and medial exostosis of the first metatarsus. The cause is usually multifactorial. The treatment varies with the degree of deformity and can be conservative or surgical. Percutaneous techniques have gained interest, offering less surgical trauma, fewer complications and faster recovery. The present study aims to evaluate the results of the surgical treatment of hallux valgus through percutaneous surgery.  Methods: A search was performed in PubMed / Medline and BVS, from 2013 to 2018, using as descriptors "hallux valgus" and "percutaneous surgery". Original articles in English, Portuguese and Spanish were included. We excluded systematic reviews, descriptions of surgical technique and publications older than 5 years. The quality of the methodology was evaluated with the help of the STROBE tool, with an emphasis on hallux valgus (HVA), intermetatarsal angle (IMA) and the AOFAS score.  Results: We found 185 references. After applying the inclusion and exclusion criteria, and STROBE tool, 5 articles were eligible, comprising a total of 290 percutaneous procedures. The follow-up time ranged from 6 months to 10 years. We found a reduction of IMA between 3.9º and 9.5º and a reduction of HVA between 12.5º and 26.8º. The AOFAS score ranged from 85 to 97.1 points in the evaluated works.  Discussion: In general, we found a good correction of HV deformity with improvement of HVA, IMA, DMAA and clinical improvement by the postoperative AOFAS score, with low complication rates. However, the heterogeneity of the studies, with variation of techniques and samples did not allow us to generalize the findings. Conclusion: It was possible to note that percutaneous surgery for HV treatment produces good outcomes with low complication rates, but few studies had a high level of evidence demonstrating the efficacy of these techniques, despite encouraging preliminary results.

scholarly journals Keratorefractive Surgery for Residual Refractive Error Correction in Pseudophakic Patients

2020 ◽  
Vol 17 (2) ◽  
pp. 209-215
Author(s):  
Е. P. Gurmizov ◽  
К. B. Pershin ◽  
N. F. Pashinova ◽  
А. Iu. Tsygankov
Keyword(s):  
Refractive Error ◽  
High Efficiency ◽  
Group Iii ◽  
Spherical Component ◽  
Cylindrical Component ◽  
Group I ◽  
Keratorefractive Surgery ◽  
Group Ii ◽  
Target Refraction

Purpose. Evaluation of the visual and refractive results of additional correction using LASIK and PRK methods in patients with residual refractive error after previous cataract surgery. Patients and methods. The prospective open study included 57 patients (79 eyes) who previously underwent cataract phacoemulsification (n = 37) or refractive lensectomy (n = 42) with various IOL models implantation (2012–2017). The average age of patients was 50.8 ± 13.9 (19–79) years. Operations LASIK (91.1 %) and PRK (8.9 %) were carried out according to standard methods. In 6 cases, femtosecond laser supported by laser correction. The target refraction ranged from –0.25 to 0.25 D in most (97.5 %) cases. The follow-up period ranged from 6 to 9 months. Results. The patients were divided into groups according to the type of residual refractive error (Group 1 — myopia, group II — emmetropia and group III — hyperopia). Statistically significant differences were determined for the species of previously implanted IOLs — in group II, the frequency of monofocal IOLs was significantly higher (p < 0.05). In group II, the values of the cylindrical component of refraction were significantly higher compared with groups I and III (p < 0.05). In group I, a significant (p < 0.05) decrease in the spherical component of refraction from –1.36 ± 0.92 to –0.2 ± 0.8 D was observed. In patients of group II, there was a slight increase in the spherical component of refraction from 0 ± 0.20 to 0.25 ± 0.29 D (p > 0.05). In group III, a significant (p < 0.05) decrease was observed in the spherical component of refraction from 1.27 ± 0.69 to 0.43 ± 0.49 D. When analyzing the cylindrical component of refraction in group I, its decline was noted from –0.69 ± 0.5 to –0.38 ± 0.46 D (p > 0.05). In group II, the largest decrease in the cylindrical component was observed from –1.6 ± 1.0 to 0.03 ± 1.10 Dptr (p < 0.01). In all the studied groups, a statistically significant (p < 0.05) increase in UCFVA was revealed in the postoperative period. Indicators K1 and K2 did not significantly change. Conclusion. The high efficiency of the correction using the LASIK, PRK and femtoLASIK methods on pseudophakic eyes with the achievement of the target refraction in most of the studied cases was shown. This method can be used as an alternative to spectacle and contact correction in patients with residual refractive error after cataract phacoemulsification and refractive lensectomy with IOL implantation.

When Your Ankle Becomes a Knee – Long-Term Functional Outcome and Quality of Life with a Rotationplasty after Resection of Malignant Limb Tumors

2021 ◽  
Author(s):  
Jennifer Gotta ◽  
Stefan Bielack ◽  
Stefanie Hecker-Nolting ◽  
Benjamin Sorg ◽  
Matthias Kevric ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Functional Outcome ◽  
Bone Cancer ◽  
Activity Level ◽  
Long Term Results ◽  
Level Scale ◽  
High Level

Abstract Background Increasing numbers of patients surviving malignant bone tumors around the knee joint have led to an increasing importance to investigate long-term results. This study assessed the long-term results of rotationplasty after resection of malignant bone tumors regarding functional outcome and quality of life to allow better comparison with other treatment options in bone cancer treatment. Procedure 60 participants who underwent rotationplasty due to bone cancer took part in this multicentric questionnaire-based study. The long-term functional outcome was measured by the Musculoskeletal tumor society score (MSTS) and the Tegner activity level scale. The health-related quality of life (HRQL) was assessed by using the Short Form Health Survey (SF-36). Results Patients treated with rotationplasty (median follow-up of 22 years, range 10–47 years) regained a high level of activity (median MSTS score of 24). Even a return to high level sports was possible (mean Tegner activity level scale of 4). Duration of follow-up did not influence the functional outcome. HRQL scores were comparable to the general German population. Concerns of psychological problems due to the unusual appearance of the rotated foot have not been confirmed. Conclusion Rotationplasty can be a good alternative to endoprosthetic replacement or amputation, either as primary surgery or as a salvage procedure. Especially for growing children and very active patients rotationplasty should be considered.

scholarly journals About the Possible Mechanisms of the Influence of Optical Intraocular Implants on the Characteristics of Neurosensory Rehabilitation and Adaptation in Patients with Pseudophakia. Literature Review

2021 ◽  
Vol 18 (1) ◽  
pp. 30-35
Author(s):  
L. Sh. Ramazanova ◽  
O. A. Napylova ◽  
R. Z. Shamratov
Keyword(s):  
Literature Review ◽  
Cataract Surgery ◽  
Intraocular Lenses ◽  
Scientific Publications ◽  
Visual Rehabilitation ◽  
Wavefront Aberrations ◽  
Target Indicator ◽  
Quality Of Life Indicators ◽  
Quality Of Vision

This literature review analyzed the possible mechanisms of the influence of the design features and optical characteristics of monofocal intraocular lenses (IOLs) on the characteristics of sensorineural adaptation and visual rehabilitation in patients after cataract phacoemulsification. Bibliographic research of scientific publications was carried out in the following databases: Medline, Pubmed, Cochrane, eLibrary. Languages of publications: Russian and English. The literature review reflects research data on the physicochemical properties, optical surface and color of the IOL filter, spatial contrast sensitivity and wavefront aberrations. Analysis of domestic and foreign literature has demonstrated the absence of a systematic approach to the study of sensorineural adaptation in patients after implantation of monofocal IOLs, which would make it possible to reasonably develop requirements for qualitative and constructive characteristics in the production of intraocular lenses to improve the quantitative and qualitative indicators of their visual functions in order to reduce the terms of rehabilitation and improvement of quality of life indicators in patients with pseudophakia. At the same time, there is an obvious need for research on the influence of the design and quality characteristics of optical intraocular implants on the subjective “quality of vision” of patients with pseudophakia, which is, ultimately, the target indicator of cataract surgery at the present stage. Also, the key mechanisms of neurosensory rehabilitation and adaptation of patients who underwent cataract surgery need to be studied and clarified in order to develop recommendations for the production of intraocular implants.

Primary care based psychiatric clinics: observations on a one year cohort of referrals

1992 ◽  
Vol 9 (1) ◽  
pp. 13-16 ◽  
Author(s):  
Stephen J Cooper ◽  
Andrew Gilliland ◽  
Sinead McGilloway ◽  
Michael Doherty ◽  
Elizabeth Cormac
Keyword(s):  
Primary Care ◽  
General Practitioner ◽  
Health Centre ◽  
Psychiatric Clinic ◽  
Admission Rates ◽  
Psychiatric Intervention ◽  
One Year ◽  
High Level

AbstractA one year cohort of referrals (n=178) to a primary care based psychiatric clinic in a large Health Centre is described. Fears that such a clinic might detract from treatment provided for psychotic patients seemed unfounded. Waiting time for assessment was short and patients were more likely to attend than at hospital based clinics. Admission rates were considerably reduced. Contact between patients and their general practitioner seems to continue at a high level even during psychiatric intervention but half of the “frequent attender” group cease contact. The pattern of attendance on follow-up suggests that many patients may receive unnecessarily long out-patient care.The evidence to date suggests that such clinics provide a useful service but other aspects of quality of care require evaluation.

scholarly journals Scleral gas permeable contact lenses as a possible way of visual rehabilitation of patients with age-related macular degeneration

The Eye ◽  
2019 ◽  
Vol 125 (2019-1) ◽  
pp. 33-40
Author(s):  
Alexander Myagkov ◽  
Maria Kovalevskaya ◽  
Oksana Pererva
Keyword(s):  
Macular Degeneration ◽  
Contact Lenses ◽  
Gas Permeability ◽  
Age Related Macular Degeneration ◽  
Central Visual Field ◽  
Optimal Method ◽  
Visual Rehabilitation ◽  
Age Related ◽  
Quality Of Vision

Low visual acuity, loss of the central visual field, metamorphopsia, distortion of lines and decreased contrast sensitivity cause reduced quality of vision in patients with age-related macular degeneration (AMD). Currently existing methods of visual rehabilitation for patients with AMD, such as telescopic intraocular and scleral lenses, are functionally and cosmetically unacceptable. The use of intraocular telescopic lenses is limited by the high risk of postoperative complications, low functional parameters, as well as by difficult ophthalmoscopy and lasting adaptation of patients. Telescopic scleral lenses have а low resolution, contain impermeable to oxygen parts and require wearing special switching glasses. However, scleral lenses have potential in developing an optimal method for vision correction in patients with AMD due to the presence of following advantages: wide optical zone, gas permeability, correction of refractive astigmatism in presbyopic patients and alleviation of dry eye symptoms. In conclusion, further clinical researches are required to develop a method for improving the quality of vision in patients with AMD by using scleral lenses with an objective test for evaluating the effectiveness of correction – the 3D computer-automated threshold Amsler grid test (3D-CTAG).

scholarly journals Visual Outcomes with Contact Lenses Previous Keratoplasty

2012 ◽  
Vol 1 (3) ◽  
pp. 196-200
Author(s):  
Gonzalo Carracedo
Keyword(s):  
Contact Lens ◽  
Contact Lenses ◽  
Low Vision ◽  
Corneal Epithelial ◽  
Visual Outcomes ◽  
Quality Of Vision ◽  
The Right ◽  
Interim Period

ABSTRACT We describe a case of a 22-year-old patient, with severe keratoconus in both eyes. Penetrating keratoplasty in left eye was performed in August 2011. The patient was awaiting postoperative stabilization of this eye prior to surgery on the right eye. Therefore, a Clearkone® hybrid contact lens was fitted on the right eye to maintain corneal epithelial integrity, improve quality of vision and therefore qualify of life during this interim period. Visual acuity with the contact lens was +0.1 logMAR. Comfort was excellent and the patient was able to wear the Clearkone® lens up to 12 hours per day. Similar outcomes regarding vision and comfort were obtained at follow-up visits through 9 months. In conclusion, new hybrid contact lens designs for keratoconus are an excellent option for vision rehabilitation in severe cases of keratoconus which would otherwise be left with low vision for several months while waiting for keratoplasty. How to cite this article Carracedo G. Visual Outcomes with Contact Lenses Previous Keratoplasty. Int J Kerat Ect Cor Dis 2012;1(3):196-200.

scholarly journals When your ankle becomes a knee - a clinical study on long-term functional outcome and quality of life with a rotationplasty after resection of malignant limb tumors

2021 ◽  
Author(s):  
Jennifer Gotta ◽  
Stefan Bielack ◽  
Stefanie Hecker Nolting ◽  
Benjamin Sorg ◽  
Matthias Kevric ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Functional Outcome ◽  
Bone Cancer ◽  
Activity Level ◽  
Long Term Results ◽  
Level Scale ◽  
High Level

Background Increasing numbers of patients surviving malignant bone tumors around the knee joint have led to an increasing importance to investigate long-term results. This study assessed the long-term results of rotationplasty after resection of malignant bone tumors regarding functional outcome and quality of life to allow better comparison with other treatment options in bone cancer treatment. Procedure 60 participants who underwent rotationplasty due to bone cancer took part in this multicentric questionnaire-based study. The long-term functional outcome was measured by the Musculoskeletal tumor society score (MSTS) and the Tegner activity level scale. The health-related quality of life (HRQL) was assessed by using the Short Form Health Survey (SF-36). Results Patients treated with rotationplasty (median follow-up of 22 years, range 10-47 years) regained a high level of activity (median MSTS score of 24). Even a return to high level sports was possible (mean Tegner activity level scale of 4). Duration of follow-up did not influence the functional outcome. HRQL scores were comparable to the general German population. Concerns of psychological problems due to the unusual appearance of the rotated foot have not been confirmed. Conclusion Rotationplasty can be a good alternative to endoprosthetic replacement or amputation, either as primary surgery or as a salvage procedure. Especially for growing children and very active patients rotationplasty should be considered.

Part VII Structure and Operations, Ch.40 High-Level Panels

2016 ◽  
Author(s):  
Thakur Ramesh
Keyword(s):  
Global Governance ◽  
International Organizations ◽  
Full Range ◽  
Agents Of Change ◽  
International Diplomacy ◽  
High Level ◽  
Operational Impacts ◽  
Operational Impact

This chapter first situates international organizations (IOs) in the context of the changing nature of international diplomacy, including in particular summits and conferences as modes of contemporary diplomacy. It then describes the proliferating number and types of high-level panels as instances of commission diplomacy. Third, it discusses the ideational, normative, institutional, and operational impacts of panels. Finally, it provides a menu of the ingredients for successful commission diplomacy, including the different types of norm actors. The factors that determine the success and failure of high-level panels include their structural and operational features; the quality of leadership provided by their chairs; the breadth, depth, and diversity of expertise of their members; the organization of adequate financial and personnel resources to enable the necessary research and consultations to be undertaken; mission clarity and focus; and the full range of follow-up dissemination, advocacy, and championing of the recommendations. While their operational impact can be diffuse, uncertain, and spread thinly over considerable periods of time, they can be important agents of change in global governance for projecting the power of ideas and processing them into new and improved policy, normative, institutional, and operational outcomes.

Remote assessment of burns

2019 ◽  
pp. 293-298
Author(s):  
Sophie Pope-Jones ◽  
William Dickson
Keyword(s):  
Treatment Options ◽  
Outpatient Management ◽  
Remote Assessment ◽  
Accepted Practice ◽  
Definition Of ◽  
High Level ◽  
Improve Cost ◽  
Selection Of Patients

More than 90% of burns can be managed as outpatients by non-specialists e.g. emergency departments, minor injury units and general practice. Outpatient management in supportive home environments aims to reduce unnecessary admissions and improve cost effectiveness without compromising quality of care. This chapter discusses the definition of minor burns, assessment and selection of patients for outpatient management, treatment options, complications, when to admit and typical follow up arrangements. However, since research into burn injuries has largely focused on burns requiring inpatient resuscitation, high level evidence on which to base robust recommendations is limited. This chapter, therefore, summarizes the authors’ practice, widely accepted practice and existing evidence for consideration and does not constitute dogmatic recommendations.

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