scholarly journals Microcatheter–Assisted Circumferential Trabeculotomy in Primary Congenital Glaucoma: Long-Term Clinical Outcomes

2022 ◽  
Vol 11 (2) ◽  
pp. 414
Author(s):  
Luigi Fontana ◽  
Alberto Neri
Keyword(s):  
Clinical Outcomes ◽  
Primary Outcome ◽  
Glaucoma Surgery ◽  
Congenital Glaucoma ◽  
Primary Congenital Glaucoma ◽  
Age At Surgery ◽  
The Mean ◽  
One Year

Purpose: The purpose of this study was to report the long-term efficacy and clinical outcomes of microcatheter-assisted circumferential trabeculotomy (MCT) in children with primary congenital glaucoma (PCG). Methods: This is a single-center retrospective study including consecutive children with PCG who underwent MCT with > two years follow up. The primary outcome was surgical success, defined as intraocular pressure (IOP) ≤ 21 mmHg with (qualified) or without (complete) medications, measured at six months, one year, and then annually. Secondary outcomes were visual acuity (VA), refraction, axial length (AXL), complications, reinterventions, and number of medications. Results: Twelve eyes of ten patients were included. In eight children only one eye was affected. The mean ± standard deviation (SD) age at surgery was 6.3 ± 4.1 months. The mean postoperative follow-up was 66 ± 35 months. The mean IOP was 34.3 ± 9.6 mmHg preoperatively and 14.6 ± 2.3 mmHg postoperatively at the last visit (p < 0.001). Complete success was achieved at all time points in 10 out of 12 eyes, while 2 eyes had a qualified success. At three years of age, the mean VA of the operated eyes was 0.25 ± 0.12 logMAR, the mean spherical equivalent was −0.78 ± 1.43 diopters, and the mean AXL was 23.78 mm. Transient hyphema was the only complication observed. None of the children required additional glaucoma surgery. Conclusions: Circumferential trabeculotomy for PCG effectively lowers the IOP at more than two years after surgery. Following this procedure, the prognosis for the visual function is good, and the refractive error is low. Postoperative complications were not significant.

Long-Term Visual Outcomes in Children with Primary Congenital Glaucoma

2017 ◽  
Vol 27 (6) ◽  
pp. 705-710 ◽  
Author(s):  
Sanaa A. Yassin
Keyword(s):  
Visual Impairment ◽  
Visual Outcome ◽  
Glaucoma Surgery ◽  
Congenital Glaucoma ◽  
Primary Congenital Glaucoma ◽  
Visual Outcomes ◽  
Antiglaucoma Medication ◽  
Poor Visual Outcome ◽  
The Mean

Purpose To determine the long-term visual outcomes and risk factors for visual loss in children with primary congenital glaucoma (PCG) who underwent angle surgery over a 21-year period. Methods This was a retrospective study of patients who underwent trabeculotomy, trabeculectomy, or combined trabeculotomy-trabeculectomy for PCG. Visual acuity (VA), surgeries, and underlying cause of visual impairment were recorded and compared. Main outcome measures were final best-corrected good VA (20/20 to 20/50), moderate VA (<20/50 to 20/200), or poor VA (<20/200); age at surgery, sex, laterality, type of initial glaucoma surgery, and number of surgeries were recorded. Results Fifty-three eyes were eligible to be included in the study. The mean logMAR VA was 0.61 ± 0.57. A good VA was attained in 51%, moderate VA in 30%, and poor VA in 19%. The main cause of visual impairment with VA <20/50 was deprivation amblyopia (64%). There was no association between VA level and status of success (controlled with or without medications) (p = 0.202). The mean spherical equivalent of refraction was -4.47 ± 5.66; myopia was the predominant refractive error (74%) and astigmatism >2 D (40%). A statistically significant high myopic shift was more frequent in the visually impaired group. None of the studied factors was statistically associated with moderate to poor visual outcome (all p>0.05). Conclusions A favorable VA outcome was achieved. Topical antiglaucoma medication has an adjuvant role in maintaining the success rate of surgery without risking the visual outcome. Corneal opacification and anisometropia were the cause of amblyopia.

scholarly journals Subthalamic Nucleus Stimulation in Pediatric Isolated Dystonia: A 10-Year Follow-up

2020 ◽  
Vol 47 (3) ◽  
pp. 328-335
Author(s):  
Wenying Xu ◽  
Hongxia Li ◽  
Chencheng Zhang ◽  
Bomin Sun ◽  
Yiwen Wu ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Subthalamic Nucleus ◽  
Rating Scale ◽  
Motor Score ◽  
Age At Surgery ◽  
Short And Long Term ◽  
The Mean ◽  
Stn Dbs

ABSTRACT:Objective:To evaluate the short-term and long-term clinical effectiveness and safety of subthalamic nucleus deep brain stimulation (STN-DBS) for medically intractable pediatric isolated dystonia.Methods:Using a longitudinal retrospective design, we assessed the clinical outcomes of nine patients who underwent STN-DBS for treatment-refractory pediatric isolated dystonia one decade ago (mean age at surgery: 15.9 ± 4.5 years). The primary clinical outcome used was assessed by retrospective video analyses of patients’ dystonia symptoms using the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS). Clinical assessments were performed at baseline, 1-year follow-up (1-yr FU), and 10-year follow-up (10-yr FU). Adverse side effects, including surgery-related, device-related, and stimulation-related effects, were also documented.Results:After STN-DBS surgery, the mean improvement in the BFMDRS motor score was 77.1 ± 26.6% at 1-yr FU and 90.4 ± 10.4% at 10-yr FU. Similarly, the mean BFMDRS disability score was improved by 69.5 ± 13.6% at 1-yr FU and by 86.5 ± 13.9% at 10-yr FU. The clinical improvements gained at 10-yr FU were significantly larger than those observed at 1-yr FU. Negative correlations were found between the duration of disease to age at surgery ratio (DD/AS) and the improvements in the BFMDRS motor score and total score at 1-yr FU and 10-yr FU.Conclusion:To our knowledge, this study provides the first clinical evidence for the short- and long-term effectiveness and safety of STN-DBS for pediatric isolated dystonia. Additionally, putative evidence is provided that earlier STN-DBS intervention in patients with refractory pediatric isolated dystonia may improve short- and long-term clinical outcomes.

scholarly journals Axial Length Changes Following Surgical Intervention in Children With Primary Congenital Glaucoma

2021 ◽  
Vol 1 ◽  
Author(s):  
Hind A. Al Dalgan ◽  
Ibrahim A. Al Obaida ◽  
Adi M. Al Owaifeer ◽  
Khabir Ahmad ◽  
Rizwan Malik
Keyword(s):  
Axial Length ◽  
Substantial Reduction ◽  
Glaucoma Surgery ◽  
Mixed Effects ◽  
Congenital Glaucoma ◽  
Primary Congenital Glaucoma ◽  
Post Surgery ◽  
Length Changes ◽  
The Mean

BackgroundPrimary congenital glaucoma (PCG) is a challenging condition to diagnose, treat and effectively monitor. Serial assessment of intraocular pressure (IOP), optic disc cupping, refraction, and axial length (AxL) after surgery are useful to assess disease control. This study aimed to evaluate AxL changes in relation to IOP changes following glaucoma surgery in children with PCG.MethodsWe retrospectively studied AxL changes in children with PCG undergoing surgery. Eyes of children aged ≤ 4 years that did not have prior ocular surgery and that underwent at least one glaucoma surgery during the course of follow-up between June 2014 and July 2018, were included. The effect of change in IOP on change in AxL was estimated using linear mixed effects models.ResultsA total of 105 eyes (of 72 children) with PCG underwent glaucoma surgery representing 26.4% (105/397) eyes. The mean ± SD age of children at baseline was 3.53 ± 4.04 months. At baseline, the mean IOP and AxL were 26.63 ± 9.57 mmHg and 21.67 ± 1.82 mm, respectively. During the course of follow-up post-surgery, the IOP decreased by a mean of 7.25 ± 12.08 mmHg while the AxL increased by a mean of 0.70 ± 1.40 mm. A multivariable mixed effects linear regression revealed that change in AxL was significantly associated with change in IOP (p=0.030) and time since first surgery (p&lt;0.001). A substantial reduction in IOP (≥35 mmHg) was needed at 3 months post-surgery, for AxL to regress.ConclusionIn children with PCG who undergo glaucoma surgery, change in IOP significantly influences change in AxL. For AxL to regress, a substantial reduction in IOP is needed post-surgery.

scholarly journals Satisfactory long-term clinical outcomes after bone marrow stimulation of osteochondral lesions of the talus

2021 ◽  
Author(s):  
Quinten G. H. Rikken ◽  
Jari Dahmen ◽  
Sjoerd A. S. Stufkens ◽  
Gino M. M. J. Kerkhoffs
Keyword(s):  
Bone Marrow ◽  
Clinical Outcomes ◽  
Degenerative Changes ◽  
Osteochondral Lesions ◽  
Ankle Osteoarthritis ◽  
Bone Marrow Stimulation ◽  
Marrow Stimulation ◽  
The Mean

Abstract Purpose The purpose of the present study was to evaluate the clinical and radiological outcomes of arthroscopic bone marrow stimulation (BMS) for the treatment of osteochondral lesions of the talus (OLTs) at long-term follow-up. Methods A literature search was conducted from the earliest record until March 2021 to identify studies published using the PubMed, EMBASE (Ovid), and Cochrane Library databases. Clinical studies reporting on arthroscopic BMS for OLTs at a minimum of 8-year follow-up were included. The review was performed according to the PRISMA guidelines. Two authors independently conducted the article selection and conducted the quality assessment using the Methodological index for Non-randomized Studies (MINORS). The primary outcome was defined as clinical outcomes consisting of pain scores and patient-reported outcome measures. Secondary outcomes concerned the return to sport rate, reoperation rate, complication rate, and the rate of progression of degenerative changes within the tibiotalar joint as a measure of ankle osteoarthritis. Associated 95% confidence intervals (95% CI) were calculated based on the primary and secondary outcome measures. Results Six studies with a total of 323 ankles (310 patients) were included at a mean pooled follow-up of 13.0 (9.5–13.9) years. The mean MINORS score of the included studies was 7.7 out of 16 points (range 6–9), indicating a low to moderate quality. The mean postoperative pooled American Orthopaedic Foot and Ankle Society (AOFAS) score was 83.8 (95% CI 83.6–84.1). 78% (95% CI 69.5–86.8) participated in sports (at any level) at final follow-up. Return to preinjury level of sports was not reported. Reoperations were performed in 6.9% (95% CI 4.1–9.7) of ankles and complications related to the BMS procedure were observed in 2% (95% CI 0.4–3.0) of ankles. Progression of degenerative changes was observed in 28% (95% CI 22.3–33.2) of ankles. Conclusion Long-term clinical outcomes following arthroscopic BMS can be considered satisfactory even though one in three patients show progression of degenerative changes from a radiological perspective. These findings indicate that OLTs treated with BMS may be at risk of progressing towards end-stage ankle osteoarthritis over time in light of the incremental cartilage damage cascade. The findings of this study can aid clinicians and patients with the shared decision-making process when considering the long-term outcomes of BMS. Level of evidence Level IV.

Arthroscopic Versus Open Anterior Shoulder Stabilization: A Prospective Randomized Clinical Trial With 15-Year Follow-up With an Assessment of the Glenoid Being “On-Track” and “Off-Track” as a Predictor of Failure

2021 ◽  
pp. 036354652110182
Author(s):  
Craig R. Bottoni ◽  
John D. Johnson ◽  
Liang Zhou ◽  
Sarah G. Raybin ◽  
James S. Shaha ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Shoulder Instability ◽  
Anterior Shoulder Instability ◽  
Shoulder Stabilization ◽  
Mri Studies ◽  
Open Stabilization ◽  
The Mean ◽  
Recurrent Anterior Shoulder Instability

Background: Recent studies have demonstrated equivalent short-term results when comparing arthroscopic versus open anterior shoulder stabilization. However, none have evaluated the long-term clinical outcomes of patients after arthroscopic or open anterior shoulder stabilization, with inclusion of an assessment of preoperative glenoid tracking. Purpose: To compare long-term clinical outcomes of patients with recurrent anterior shoulder instability randomized to open and arthroscopic stabilization groups. Additionally, preoperative magnetic resonance imaging (MRI) studies were used to assess whether the shoulders were “on-track” or “off-track” to ascertain a prediction of increased failure risk. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A consecutive series of 64 patients with recurrent anterior shoulder instability were randomized to receive either arthroscopic or open stabilization by a single surgeon. Follow-up assessments were performed at minimum 15-year follow-up using established postoperative evaluations. Clinical failure was defined as any recurrent dislocation postoperatively or subjective instability. Preoperative MRI scans were obtained to calculate the glenoid track and designate shoulders as on-track or off-track. These results were then correlated with the patients’ clinical results at their latest follow-up. Results: Of 64 patients, 60 (28 arthroscopic and 32 open) were contacted or examined for follow-up (range, 15-17 years). The mean age at the time of surgery was 25 years (range, 19-42 years), while the mean age at the time of this assessment was 40 years (range, 34-57 years). The rates of arthroscopic and open long-term failure were 14.3% (4/28) and 12.5% (4/32), respectively. There were no differences in subjective shoulder outcome scores between the treatment groups. Of the 56 shoulders, with available MRI studies, 8 (14.3%) were determined to be off-track. Of these 8 shoulders, there were 2 surgical failures (25.0%; 1 treated arthroscopically, 1 treated open). In the on-track group, 6 of 48 had failed surgery (12.5%; 3 open, 3 arthroscopic [ P = .280]). Conclusion: Long-term clinical outcomes were comparable at 15 years postoperatively between the arthroscopic and open stabilization groups. The presence of an off-track lesion may be associated with a higher rate of recurrent instability in both cohorts at long-term follow-up; however, this study was underpowered to verify this situation.

scholarly journals One-Year Visual and Refractive Outcomes following LASIK for Myopia and Myopic Astigmatism with MEL 90 versus Schwind Amaris 750S Excimer Laser: A Comparative Study

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Sheetal Brar ◽  
Dishitha P. Rathod ◽  
C. R. Roopashree ◽  
Sri Ganesh
Keyword(s):  
Comparative Study ◽  
Clinical Outcomes ◽  
Excimer Laser ◽  
Infectious Keratitis ◽  
Safety And Efficacy ◽  
Refractive Outcomes ◽  
The Mean ◽  
One Year ◽  
Myopic Astigmatism

Purpose. To compare clinical outcomes following LASIK for myopia performed with MEL 90 vs. Schwind Amaris 750S excimer laser. Methods. Data were collected retrospectively for patients who underwent Femto-LASIK, using the MEL 90 and Schwind Amaris 750S excimer laser for correction of myopia and myopic astigmatism within the range of −1.00 to −10.00 D SE from January 2013 till June 2018. Outcomes were analysed at 12 months for safety, efficacy, enhancement rate, and long-term complications. Results. A total of 328 eyes of 328 patients were analysed. One hundred and sixty-three eyes were treated with Schwind Amaris and the remaining 165 eyes with the MEL 90 laser. Twelve months postoperatively, the mean UDVA, CDVA, residual SE, and cylinder in the Amaris group were −0.10 ± 0.09 logMAR, −0.14 ± 0.06 logMAR, −0.21 ± 0.22 D, −0.13 ± 0.18 D versus −0.05 ± 0.07 logMAR, −0.09 ± 0.08 logMAR, −0.23 ± 0.23 D, and −0.14 ± 0.21 D for the MEL 90 group ( p values >0.05). For the Amaris group, safety and efficacy indices were 1.12 and 1.02, whereas for the MEL 90 group, these indices were 1.08 and 1.00, respectively. No eye in either group had any postop flap-related complications, infectious keratitis, diffuse lamellar keratitis, or keratectasia. Two eyes in the Amaris and 4 eyes in MEL 90 group required enhancement for the progression of myopia. Conclusion. At 12 months, both Schwind Amaris 750S and MEL 90 lasers demonstrated comparable clinical outcomes for myopic LASIK in a single surgeon setting.

Long-term functional outcomes of different subtypes of primary congenital glaucoma

2019 ◽  
pp. bjophthalmol-2019-315131 ◽  
Author(s):  
Richard Sher Chaudhary ◽  
Amisha Gupta ◽  
Ajay Sharma ◽  
Shikha Gupta ◽  
Rayees Ahmad Sofi ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Congenital Glaucoma ◽  
Cumulative Probability ◽  
Primary Congenital Glaucoma ◽  
Visual Outcomes ◽  
Post Surgery ◽  
Kaplan Meier ◽  
Significant Difference

AimTo analyse long-term visual outcomes across different subtypes of primary congenital glaucoma (PCG).MethodsPatients with PCG with a minimum of 5-year follow-up post surgery were included in the study. Snellen visual acuity recordings taken at their last follow-up were analysed. We evaluated the results using Kaplan-Meier curves to predict the probability of maintaining good vision (as defined by a visual acuity of 6/18 or better) in our patients after 30-year follow-up. The results were also analysed to determine whether there were any differences in the long-term visual acuities with time between the neonatal and infantile PCG. We also analysed the reasons for poor visual outcomes.ResultsWe assessed a cohort of 140 patients with PCG (235 eyes) with an average follow-up of 127±62.8 months (range 60–400 months). Overall, the proportion of eyes with good visual acuity was 89 (37.9%), those with fair visual acuity between 6/60 and 6/18 was 41 (17.4%), and those with poor visual acuity (≤6/60) was 105 (44.7%). We found a significant difference (p=0.047) between neonatal and infantile patients with PCG whereby the neonatal cohort fared worse off in terms of visual morbidity. On Kaplan-Meier analysis, the cumulative probability of survival of a visual acuity of 6/18 or better was more among the infantile PCG in comparison to the neonatal PCG (p=0.039) eyes, and more among the bilateral than the unilateral affected eyes (p=0.029). Amblyopia was the most important cause for poor visual acuity as shown on a Cox proportional-hazards regression model .ConclusionsLong-term visual outcomes of infantile are better than neonatal PCG. Eyes with unilateral have worse visual outcomes compared with those with bilateral PCG because of the development of dense amblyopia.

Identifying Effectors of Outcomes in Patients with Large Umbilical Hernias

2016 ◽  
Vol 82 (7) ◽  
pp. 613-621 ◽  
Author(s):  
Steven A. Groene ◽  
Davis W. Heniford ◽  
Tanushree Prasad ◽  
Amy E. Lincourt ◽  
Vedra A. Augenstein
Keyword(s):  
Umbilical Hernia ◽  
Defect Size ◽  
Long Term Outcomes ◽  
Preoperative Pain ◽  
The Mean ◽  
The Difference ◽  
One Year

Quality of life (QOL) has become an important focus of hernia repair outcomes. This study aims to identify factors which lead to ideal outcomes (asymptomatic and without recurrence) in large umbilical hernias (defect size ≥9 cm2). Review of the prospective International Hernia Mesh Registry was performed. The Carolinas Comfort Scale was used to measure QOL at 1-, 6-, and 12-month follow-up. Demographics, operative details, complications, and QOL data were evaluated using standard statistical methods. Forty-four large umbilical hernia repairs were analyzed. Demographics included: average age 53.6 ± 12.0 and body mass index 34.9 ± 7.2 kg/m2. The mean defect size was 21.7 ± 16.9 cm2, and 72.7 per cent were performed laparoscopically. Complications included hematoma (2.3%), seroma (12.6%), and recurrence (9.1%). Follow-up and ideal outcomes were one month = 28.2 per cent, six months = 42.9 per cent, one year = 55.6 per cent. All patients who remained symptomatic at one and two years were significantly symptomatic before surgery. Symptomatic preoperative activity limitation was a significant predictor of nonideal outcomes at one year ( P = 0.02). Symptomatic preoperative pain was associated with nonideal outcomes at one year, though the difference was not statistically significant ( P = 0.06). Operative technique, mesh choice, and fixation technique did not impact recurrence or QOL. Repair of umbilical hernia with defects ≥9 cm2 had a surprising low rate of ideal outcomes (asymptomatic and no recurrence). All patients with nonideal long-term outcomes had preoperative pain and activity limitations. These data may suggest that umbilical hernia should be repaired when they are small and asymptomatic.

scholarly journals Long-term outcomes in Primary congenital glaucoma, aniridia and anterior segment dysgenesis

2022 ◽  
pp. 112067212110732
Author(s):  
Tejal Magan ◽  
Alexander Tanner ◽  
Julia Fajardo-Sanchez ◽  
Kin Sheng Lim ◽  
Saurabh Goyal ◽  
...  
Keyword(s):  
Anterior Segment ◽  
Congenital Glaucoma ◽  
Consecutive Series ◽  
Long Term Outcomes ◽  
Primary Congenital Glaucoma ◽  
Anterior Segment Dysgenesis ◽  
Long Term Follow Up ◽  
Advanced Glaucoma

Aim To determine the long-term outcomes of a cohort of complex patients with primary congenital glaucoma, aniridia and anterior segment dysgenesis. Methods Retrospective consecutive series between 1990–2021 in two UK tertiary centres: Guy's and St Thomas’ NHS Foundation Trust and King's College Hospital NHS Foundation Trust. We recorded the number and types of surgical and laser treatments along with preoperative and postoperative data, including intraocular pressures (IOP) and anti-glaucoma medications. Results A total of 41 eyes of 21 patients were included. Primary diagnoses were primary congenital glaucoma in 16 eyes (39.0%), aniridia in 14 eyes (34.2%), and anterior segment dysgenesis in 8 eyes (19.5%). Sixteen eyes (39.0%) had one or more glaucoma surgery or laser procedures for advanced glaucoma, and the long-term follow-up was 12.8 ± 3.6 years. There was a significant decrease in postoperative IOP (mmHg) at 3 months (16.5 ± 1.6; p = 0.0067), 6 months (18.7 ± 2.1; p = 0.0386), 12 months (18.6 ± 1.7; p = 0.0229), 3 years (14.7 ± 1.2; p = 0.0126), 5 years (15.5 ± 1.8; p = 0.0330) and 10 years (15.4 ± 2.3; p = 0.7780), compared to preoperatively (24.1 ± 2.6). Surgical success (complete and qualified) was 62.5%, 50.0%, 43.8%, 46.2%, 45.5% and 28.6% at 3 months, 6 months, 12 months, 3 years, 5 years and 10 years, respectively. There was no significant change in the number of anti-glaucoma drugs postoperatively ( p > 0.05). Four eyes (25.0%) had postoperative complications (hyphaema, hypotony) that resolved after conservative management. Conclusions Surgical management of these complex eyes with advanced glaucoma is challenging. Overall, the cohort had good surgical outcomes with a significant decrease in IOP by 36.1% after long-term follow-up.

scholarly journals Flexor Hallucis Longus Tendon Transfer for Reconstruction of Chronically Ruptured Achilles Tendons

2009 ◽  
Vol 17 (2) ◽  
pp. 194-198 ◽  
Author(s):  
Ravindra H Mahajan ◽  
Rakesh B Dalal
Keyword(s):  
Wound Healing ◽  
Tendon Transfer ◽  
Flexor Hallucis Longus ◽  
Related Complication ◽  
Hind Foot ◽  
The Mean ◽  
American Orthopaedic ◽  
One Year

Purpose. To report the mid-term results of flexor hallucis longus (FHL) tendon transfer for reconstruction of chronically ruptured Achilles tendons. Methods. 24 men and 12 women aged 56 to 78 (mean, 70) years underwent FHL tendon transfer for reconstruction of chronically ruptured Achilles tendons by a single surgeon. Ruptures were secondary to trauma (n=20), long-term steroid intake (n=12), or chronic renal failure (n=6). Two patients had bilateral ruptures. The mean interval from rupture to surgery was 15 (range, 12–24) weeks. Pre- and post-operative American Orthopaedic Foot and Ankle Society (AOFAS) hind foot scores were compared. Wound healing, push-off, and patient satisfaction were evaluated. Results. The mean follow-up period was one year. The mean AOFAS scores were 69 (range, 58–76) preoperatively and 88 (range, 79–94) postoperatively; the mean improvement was 19 (p<0.001). 28 patients had excellent and 8 had fair results. 33 patients graded their outcome as ‘very satisfactory’ and 3 as ‘satisfactory’. Five patients developed wound healing complications but only one needed debridement. There was no fixation-related complication or sural nerve injury. Conclusions. Transfer of the FHL for reconstruction of chronically ruptured Achilles tendons is effective, safe and easily performed in patients with low-to-moderate demands.

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