Thickness of the choroid, ciliary body and retina according to optical coherence tomography in patients after Femto LASIK

Background. In the available literature, there are isolated publications devoted to the topic of the possible effect of laser correction by the Femto LASIK method on the myopic eye choroid. In this connection, in our opinion, the relevance of continuing research in this direction remains.The aim of this study was to examine the volume of the retina in the macular zone, the thickness of the choroid and the ciliary body using optical coherence tomography on myopic eyes after femtosecond-assisted laser in situ keratomileusis in the short term.Material and methods. 30 patients (30 right eyes) aged 20 to 35 years, suffering from mild and moderate myopia, but without pathological changes in the retina according to OCT, made up the study group. All patients underwent myopia correction using the Femto LASIK method. Before the operation, after 4 hours and the next day, they underwent the examination of the retinal volume in the macular zone, the choroidal and the ciliary body thickness using OCTResults. The analysis of the obtained results of the studied parameters showed that the ciliary body thickness and the retinal volume in the macular zone did not undergo statistically signifi cant changes and remained within the preoperative values (p > 0.05). We observed a tendency to an increase in the thickness of the choroid 4 hours after the operation, but the carried out statistical analysis did not confi rm the reliability of its changes (p > 0.05). On the next day, the choroidal thickness indices practically recovered to the preoperative level (p > 0.05).Conclusion. A study of the retinal volume in the macular zone, the thickness of the choroid and ciliary body using OCT in myopic eyes in the short term after Femto LASIK showed the absence of statistically signifi cant changes in the studied parameters, which indirectly indicates the safety of this method of laser correction for the posterior segment of the eye.

Influence of pars plana vitrectomy on ocular surface using noninvasive Keratograph 5M

AIM: To evaluate the influence of pars plana vitrectomy (PPV) on ocular surface using Keratograph 5M. METHODS: Totally 30 consecutive patients (30 eyes) undergoing primary 23-gauge PPV were recruited in the study. Ocular Surface Disease Index (OSDI) questionnaire was performed. Ocular surface parameters, including tear meniscus height (TMH), noninvasive tear break up time (NITBUT) and bulbar redness score were obtained preoperatively, in 1, 2, 4, 8 and 12wk postoperatively by Keratograph 5M. Correlations between all the clinical parameters were analyzed further. RESULTS: The percentages of both photophobia and gritty within 4wk after PPV were significantly higher than pre-operation, while they decreased to the preoperative levels in both 8wk and 12wk postoperatively. The percentage of sore eyes in the first week postoperatively was significantly higher than pre-operation, but there were no significant differences between the percentages of pre-operation and 2, 4, 8, and 12wk postoperatively. OSDI score increased significantly within 4wk postoperatively, but it returned to the preoperative level in 8 and 12wk. TMH increased with 2wk postoperatively, but there were no significant differences compared with preoperation. Both NITBUT-first and NITBUT-average shortened significantly within 8 weeks postoperatively, but they gradually improved to the preoperative levels in 12wk. Bulbar redness score was significantly higher than the preoperative level within 4wk postoperatively, but it returned to the preoperative level in 8wk. NITBUT-first and NITBUT-average had a significant positive correlation at each visit. TMH had a significant positive correlation with NITBUT-average in the first week postoperatively. CONCLUSION: Keratograph 5M can provide a reliable noninvasive method to assess the influence of PPV on the ocular surface. PPV may cause various changes in both symptoms and signs of ocular surface damages at the early stage, while all these changes will return to preoperative levels gradually in 12wk postoperatively.

The role of folded fibular flap in patients’ reconstruction of mandibular defects: a retrospective clinical study

This study has analyzed 41 patients with mandibular ameloblastoma who underwent a partial mandibulectomy and reconstruction by folding the free fibular flap. In the preoperative and postoperative (6 months and 24 months after surgery), the Quality of Life (QOL) of these patients was assessed by using the University of Washington Quality of Life Questionnaire (UW-QOL) and the medical outcome study short form-36 (SF-36) questionnaires. SPSS 20.0 statistical software was used to conduct statistical analysis on the base data of the two groups of patients. Independent sample t test was conducted for sf-36 and UW-QOL scores at two time points in each group. The SF-36 survey showed that body pain (54.54 ± 8.10), general health (55.27 ± 7.54), and health changes (58.29 ± 9.60) decreased significantly at 6 months after surgery, but the mean score at 24 months after surgery all exceeded the preoperational level. At 24 months after the surgery, the vitality (80.41 ± 3.74), social function (81.61 ± 4.07), emotional role (82.39 ± 4.07), psychological health (81.66 ± 4.37) and total score (704.00 ± 31.53) all returned to the preoperative level, which was statistically significant compared with 6 months after surgery. However, there was no significant difference compared with the preoperative level. The UW-QOL survey showed that chewing (56.68 ± 7.23), speech (54.54 ± 7.7) and taste (62.29 ± 10.15) have significantly changed at 6 months after the surgery, and the difference was statistically significant at 24 months after surgery. Saliva generation decreased slightly (80.76 ± 3.35) at 6 months after surgery, but quickly returned to the preoperative level (81.59 ± 4.06). The total score of the patients almost recovered to the preoperative level at 24 months after surgery. The folded the fibular flap can not only repair the defects of soft tissue and bone tissue, but also restore the height of the alveolar ridge to, avoid the imbalance of crown and root ratio after implantation and reduce the occurrence of peri-implant inflammation, so that a true functional reconstruction can be realized.

Our Experience in Applying the National Polymer Microshunt in Refractory Glaucoma Surgery

Purpose. To analyze the outcomes of the national polymer microshunt implantation in refractory glaucoma surgery and to show its efficacy and safety. Patients and methods. We analyzed the results of treatment of 90 patients (90 eyes) with refractory glaucoma. All patients were divided into two groups: main group and comparison group. The patients in the main group (44 eyes) were implanted with the national polymer microshunt (Reper-NN). The patients in the comparison group (46 eyes) were implanted with Ex-PRESS. Control criteria in the postoperative period included visometry, tonometry by Maklakov, computed perimetry. The examinations were performed preoperatively, at discharge, in a month, in six months and later postoperatively.Results. When implanting the national polymer microshunt we reached the significant decrease in the intraocular pressure in the postoperative period in comparison with the preoperative level. The implantation outcomes of the national polymer microshunt and Ex-PRESS were comparable in efficacy and safety. The easy implantation and special construction of the national polymer microshunt provided with the sufficient efficacy and safety in refractory glaucoma surgery and allowed recommending its further application in the clinical practice.Conclusion. The use of Reper-NN microshunt is effective and safe method of treating refractory glaucoma. The implantation of this shunt may be the method of choice both in primary and secondary refractory glaucoma surgery. The least price of Reper-NN microshunt in comparison with the foreign analogue allows this surgery to be more available for patients with refractory glaucoma.

Comparative analysis of intraocular pressure dynamics after phacoemulsification with intraocular lens implantation in eyes with primary glaucoma

PURPOSE. To conduct a comparative analysis of changes in intraocular pressure (IOP) after cataract phacoemulsification with implantation of intraocular lens (IOL) in comorbidity with primary open-angle (POAG) and primary closed-angle glaucoma (PACG).METHODS. The study analyzed the dynamics of IOP changes after cataract phacoemulsification in 65 patients (89 eyes) with comorbid PACG and 46 patients (58 eyes) with comorbid POAG, aged 50 to 92 years. Thirty-five (53.85%) patients with POAG had history of glaucoma surgery, and 12 (20.69%) patients with PACG had been treated with laser iridectomy. The disease was in the initial stage in 14.6% of POAG patients and 5.15% of PACG patients; moderate stage — in 55.05% and 47.19%, respectively; advanced stage — in 30.34% and 24.14%. Intraocular pressure in POAG was compensated in 84.5% and subcompensated in 15.5% of patients; in PACG it was compensated in 77.6%, subcompensated in 12.6%, and uncompensated in 10.4% of patients. Compensation of IOP was achieved either by previous surgeries, or application of local antihypertensive medications. Patients with subcompensated and elevated IOP received the maximum possible amount of hypotensive medications. The follow-up period ranged from 1 month to 2 years.RESULTS. Patients were divided into three groups according to postoperative IOP levels: the first group with IOP equal to preoperative level, the second group — with IOP below the initial level, and the third group with IOP above the initial level. The IOP levels were consistent with preoperative values at all follow-up periods in most of study patients, and after 2 years their portion exceeded 70%, while in POAG it was somewhat higher than in PACG (77.42% against 71.43%). The IOP below the preoperative level was observed in eyes with initial and moderate open-angle and closed-angle glaucoma, with the amount decreasing with longer follow-up (from 63.16% at 3 months to 16.13% after 2 years in POAG, and from 62.74% to 19.04% in PACG). In the early postoperative period, number of POAG and PACG patients in this group was comparable, but after 8 months it included more PACG patients. Elevation of IOP in both forms of glaucoma was most often observed in faradvanced stage in the early post-op period after phacoemulsification, subsequently their number decreased and by two years it decreased by almost twice (6.45% vs. 11.84% in POAG and 9.53% vs. 15.69% in PACG). During the entire follow-up period, the number of patients with ophthalmic hypertension in PACG was 30% higher than in POAG.CONCLUSION. The study showed that in most cases phacoemulsification has a stabilizing effect in patients with cataracts in combination with glaucoma. The hypotensive effect of the operation was observed in initial and advanced stages of glaucoma, when the drainage system of the eye was still preserved, and in the long term it was observed in a larger percentage of cases in angle-closure glaucoma compared to open-angle glaucoma. An increase in intraocular pressure relative to the preoperative level was observed in advanced glaucoma throughout the entire follow-up period, and the number of patients with angleclosure glaucoma was one-third higher than the number of patients with open-angle glaucoma. The obtained ambiguous results of intraocular pressure measurements after phacoemulsification of cataract with implantation of IOL in combination with various forms of glaucoma dictate the need for further study of this problem.

Multiple hippocampal transections for mesial temporal lobe epilepsy

Background: The purpose of this study was to evaluate the effectiveness of multiple hippocampal transections (MHT) in the treatment of drug-resistant mesial temporal lobe epilepsy. Methods: Six patients underwent MHT at Burdenko Neurosurgery Center in 2018. The age of the patients varied from 18 to 43 years. All patients suffered from refractory epilepsy caused by focal lesions of the mesial temporal complex or temporal pole in dominant side. Postoperative pathology revealed neuronal-glial tumors in two patients, focal cortical dysplasia (FCD) of the temporal pole – in two patients, cavernous angioma – in one patient, and encephalocele of the preuncal area – in one patient. Results: All patients underwent surgery satisfactorily. There were no postoperative complications except for homonymous superior quadrantanopia. This kind of visual field loss was noted in four cases out of six. During the follow-up period five patients out of six had Engel Class I outcome (83.3%). In one case, seizures developed after 1 month in a patient with FCD in the uncus (Engel IVA). After surgery, three out of six patients developed significant nominative aphasia. Two patients relative to the preoperative level demonstrated improvement in delayed verbal memory after MHT. Two patients showed a decrease level in delayed verbal memory. In preoperative period, visual memory was below the normal in one patient. Delayed visual memory in two cases impaired compared to the preoperative level. Conclusion: MHT can be considered as an effective method of drug-resistant mesial temporal lobe epilepsy caused by tumors of the medial temporal complex. At the same time, MHT makes it possible to preserve memory in patients with structurally preserved hippocampus. However, MHT do not guarantee the preservation of memory after surgery.

Aggravation of Reflux Finding Score (RFS) after thyroidectomy

Laryngopharyngeal reflux (LPR) has been suggested as a possible cause of post-thyroidectomy syndrome. However, the pathophysiology and relationship between thyroidectomy and LPR have not been well investigated. We aimed to evaluate the correlation between thyroidectomy and LPR by assessing changes in LPR-related symptoms and laryngoscopic findings before and after thyroidectomy. Ninety-five patients who underwent thyroidectomy with or without central neck dissection were included. The reflux finding score (RFS) and reflux symptom index (RSI) were investigated one day before surgery and two, four, six, and twelve months after surgery. The RFS scores increased significantly after thyroidectomy and decreased to the preoperative level 12 months after surgery. The RSI scores increased after surgery and decreased gradually by 12 months postoperatively, although it was not statistically significant. The RSI and RFS scores improved with the administration of proton pump inhibitors. In conclusion, LPR-related laryngoscopic findings were exacerbated after uncomplicated thyroidectomy. Further studies using pH-monitoring and esophageal manometry are required to investigate the possible deterioration of LPR itself and the UES pressure after thyroidectomy.

Cell-Free Biomimetic Osteochondral Scaffold for the Treatment of Knee Lesions: Clinical and Imaging Results at 10-Year Follow-up

Background: Cell-free devices have been introduced to restore osteochondral defects, avoiding the limitations of cell-based procedures. Among these, an osteochondral scaffold made of type I collagen and hydroxyapatite has been investigated with promising results up to medium-term follow-up. However, the clinical and imaging results over time still need to be documented. Purpose: To evaluate the clinical outcome and tissue maturation at long-term follow-up after the implantation of the osteochondral scaffold. Study Design: Case series; Level of evidence, 4. Methods: A total of 24 patients (7 women, 17 men; age, 36 ± 9.5 years) underwent surgical implantation of the osteochondral scaffold and were prospectively evaluated before surgery, at 2-, 5-, and 10-year follow-up. The mean defect size was 2.9 ± 1.4 cm2. Patients were evaluated using the International Knee Documentation Committee (IKDC) subjective and objective scores, and the activity level was documented with the Tegner score. Magnetic resonance imaging (MRI) evaluation involved the use of the magnetic resonance observation of cartilage repair tissue score combined with 5 more variables focused on the bone layer. Results: A statistically significant improvement of all clinical scores was documented from the baseline to the final evaluation. The IKDC subjective score improved from the preoperative level to 2 years (41 ± 13.2 and 77.1 ± 14.6, respectively) ( P < .0005), with stable results up to 10 years (77.4 ± 19.4). The IKDC objective score changed from 52% of normal and nearly normal knees before the treatment to 84% at 10 years ( P < .0005). Tegner sports activity at the final evaluation (3.8 ± 1.7) was higher compared with the preoperative level (1.6 ± 1.1; P < .05), but it remained significantly lower compared with the preinjury level (5.5 ± 2.6; P < .05). Treatment failed in 1 patient. Persisting graft alterations were observed on MRI scans, although without correlating with the clinical outcome. Conclusion: The regenerative potential of this scaffold is limited, as demonstrated by the signal alterations persisting over time on MRI scans. On the other hand, the clinical improvement was significant and stable over time both in terms of subjective and objective outcomes, including activity level, with overall good results.

Tibial lengthening in achondroplasia patients aged 6–9 years as the first stage of growth correction

Background Height increase and improvement of body proportions for achondroplasia patients normally require two or more stages of reconstructive treatment to be followed by rehabilitation between lengthening periods, and growth correction can take a significant part of life in the cohort of patients. What is the best age to start growth correction is an important question. The purpose of this paper was to present an argument for arranging the first stage of growth correction in achondroplasia patients aged 6–9 years based on the structural and functional muscle evaluation of tibiae to be lengthened. Material and methods Achondroplasia patients aged 6–9 years (n = 30) were examined preoperatively, during distraction, fixation and at 1.5 to 2 years of frame removal. Tibial lengthening was produced monofocally and bifocally. Contractile force of the dorsal and plantar flexion muscles of the foot was measured with dynamometer. Ultrasonography of tibial muscles was performed with HITACHI ultrasound imaging device (Japan). Results Achondroplasia patients aged 6–9 year who underwent tibial lengthening of at least 50% of the initial length developed neuropathy in 2.6 % of cases and soft tissue inflammation in 5.6 % of cases. Characteristic muscle striation of m. tibialis anterior and m. extensor digitorum longus appeared to restore at 1.5 to 2 years of tibial lengthening with clear contouring of the intermuscular septa and retained contractile force of the muscles. The contractile force restored to 96.15 % of preoperative level in the anterior tibial muscles, and to 101.92 % in the posterior muscles. Conclusion The comprehensive clinical, ultrasonographic and dynamometric evaluation of tibial muscles presented a good argument for tibial lengthening in achondroplasia patients aged 6–9 years. Regained muscle striation and spare capacity of m. tibialis anterior and extensor digitorum longus, the restored force of the anterior tibial muscles to 96.15 % of the preoperative level suggested the possibility for the next stage of growth correction.