Clinical Analysis of Dry Eye Syndrome According to Anterior Displacement of the Marx Line

Purpose: To evaluate the clinical characteristics of patients with dry eye syndrome according to anterior displacement of the Marx line.Methods: This retrospective study involved 127 eyes in 127 patients with dry eye, who were divided into three groups: group 1, aqueous-deficient, including Sjögren syndrome; group 2, meibomian gland dysfunction (MGD) dry eye; and group 3, other tear layer instability. A detailed assessment was conducted, involving the Ocular Surface Disease Index, corneal fluorescein staining (score: 0-15), conjunctival Lissamine green staining (score: 0-12), measurement of tear breakup time, and Schirmer’s test.Results: The proportion of patients with MGD was highest in the group with anterior displacement of the Marx line (p < 0.05). The correlation between anterior dislocation of the Marx line and Schirmer’s test, an objective indicator of dry eye syndrome, was significantly weaker when there was anterior displacement of the Marx line.Conclusions: Anterior dislocation of the Marx line was more common in patients with MGD. The Marx line is a useful marker for diagnosing MGD.

Abnormalities of foot and ankle alignment in individuals with chronic ankle instability: a systematic review

Background To prevent recurrent ankle sprain, it is important to clarify the pathology of chronic ankle instability (CAI). An association has been reported between CAI and abnormalities of foot posture and ankle alignment. There is no consensus on the types of these abnormalities that occur in individuals with CAI. The objective of this systematic review is to clarify the relevance of abnormality of foot posture and ankle alignment for CAI. Methods A systematic computerized literature search was performed of the PubMed, CINAHL, SPORTDiscus, Web of Science, and the Cochrane Register of Clinical Trials databases. The selected studies either compared CAI patients with a control group or CAI ankles with contralateral healthy ankles and specifically reported foot posture and alignment of the ankle in the outcomes. They were written in English and published prior to June 2021. The methodological quality of the included studies was evaluated using a 16-question index. Data were extracted independently by two reviewers, and the certainty of evidence was assessed using GRADE approach. Results Sixteen studies including 872 patients of high to low methodological quality were included. These showed there was significant anterior displacement and internal rotation of the talus in CAI ankles (low evidence), but there was no consensus on fibular alignment or foot posture. Conclusions This review showed there was significant anterior displacement and internal rotation of the talus in CAI ankles but found no consensus on the characteristics of fibular and foot alignment. Further investigations are required to clarify the characteristic foot and ankle malalignment in CAI to facilitate the development of efficient interventions.

THE ROLE OF MAGNETIC RESONANCE RESEARCH IN THE TREATMENT OF DYSFUNCTION OF THE TEMPOROMANDIBULAR JOINT

The main criterion for diagnosis of dysfunctional conditions of the temporomandibular joint is the visualization of the intra-articular cartilaginous disc. The method of diagnosis, that the most perfectly determines the disorders in the temporomandibular joint, particular the displacement of the menisci, is magnetic resonance imaging. So, the aim of the work was to determine the amplitude of anterior displacements of the menisci in patients suffering from dysfunction of the temporomandibular joint using magnetic resonance imaging. In 20 patients, who underwent magnetic resonance imaging, different amplitudes of the anterior displacements of the meniscus were determined. Patients were divided into groups. The first group included 6 patients who were diagnosed by MRI the anterior displacement of the disc to the center of the articular head. The second group included 4 patients who had anterior displacement of the disc to the center of the articular head by 2/3 of its own length. Ten patients of the third group had a displacement of the meniscus to the center of the articular head by 1/2 of its own length. For the future treatment of TMJ dysfunction, the distance of the pathological displacement of the meniscus determines the degree of occlusion. All patients were prescribed a Michigan-splint occlusal splint in combination with a sling-like head cap at night. The results of the selected treatment were interpreted after 3-6 months. A series of magnetic resonance imaging has described the articular fissures of the temporomandibular joint, articular discs (their shape in frontal projection and on parasagittal sections), posterior ligaments, and lateral pterygoid muscles. Each of the joints was carefully examined in the case when the mouth is closed and open. During the MRI description, the shape of the joint heads and their possible pathological changes were determined. In the position of the closed or open mouth, the positions of each of the discs and their poles relatively to the articular head in centimeters were compared, and the movement of the menisci was described. The sizes of disks of the closed and open mouth were defined. The study protocol also reported the shape and amplitude of the movements of the articular heads. Treatment was planned according to the selected protocol. For the first group of patients diagnosed with anterior meniscus dislocation, treatment was planned by separating the occlusion to the relatively physiological rest of the mandible (2 - 4 mm). The patients of the second group, in which anterior displacements of the disc relatively to the articular head by 2/3, were treated with detachment of the occlusion to contact with the cutting edge of the teeth of the upper and lower jaws. For the third patients’ group with diagnosed anterior displacement of the meniscus by 1/2, treatment was performed with a separation of the bite on 2 - 4 mm above the contact with the cutting edges of the front teeth. The main criterion for recovery is the complete disappearance of symptoms of dysfunction, even without the use of a splint. At the first stage of treatment the task was the following: reconstruction of a myotatic reflex by means of the medical and diagnostic occlusal splint "Michigan-splint" completed with the main slingshot cap. Patients were monitored monthly. The main problems were the following: after a week of using the structure the patients complained of increased salivation, muscle pain and burning, headache, which disappeared after approximately 3 weeks. The main cause of such phenomena is the physiological rearrangement of the muscular reflex, which involves a certain tension in the muscles and irritation of the nerve endings in the muscles due to changes in the usual occlusion. During planned examination, the patients demonstrated supercontacts followed by cap correction. In 3 or 6 months of using the Michigan-splint occlusal splint, patients noted a significant improvement and they didn’t have any complaints. The main criterion for recovery is the complete disappearance of symptoms of dysfunction, even without the use of a splint. Therefore, the next stage of treatment depended on the anatomical and functional changes of TMJ and consolidation of therapeutic effect was been necessary. Therefore, the use of magnetic resonance imaging of the temporomandibular joint to determine the amplitude of the displacements of the discs, ensures the effectiveness of the selected treatment. Prospects for further research include improvement of the MRI protocol and its correlation with definite symptoms, the distance of the vertical separation of occlusal surfaces, and the introduction of the protocol into practical health care.

Changes in plantar load distribution in legally blind subjects

We investigated the impact of visual impairment on balance control. We measured the center of pressure (COP) between the two feet and plantar surface pressures on each foot in 18 normal-sighted participants and compared their data with measures from 18 legally blind participants, either acquired or congenital. Pressures were measured in open- and closed-eye conditions using a baropodometric resistive plate. In the eyes-open condition, there were no differences between the sighted and legally blind groups in COP displacement. However, participants with visual loss had significantly increased pressures in two metatarsal regions (M1 and M2 zones) of the plantar surface in both viewing conditions (p < 0.05). The differences in pressure measures between the normally sighted and legally blind groups could be attributed mainly to the subgroup of subjects with acquired impairment. Our findings suggest that subjects with visual impairment present increased metatarsal pressures (i.e. forefoot), not yet associated to anterior displacement of COP or impaired balance control.

Clinical outcome after lumbar spinal fusion surgery in degenerative spondylolisthesis: a 3-year follow-up

Introduction Lumbar spinal fusion surgery is a widely accepted surgical treatment in degenerative causes of lumbar spondylolisthesis. The benefit of reduction of anterior displacement and restoration of sagittal parameters is still controversially debated. Purpose of the underlying publication was to analyze the influence of radiographic sagittal parameters of the spine in aspects of changes in postoperative clinical outcome. Materials and methods By prospective analysis, we included patients with low-grade degenerative lumbar spondylolisthesis (Meyerding grades I and II) with mono- or bisegmental fusion surgery with a minimum follow-up data of 3 years. For clinical outcome measures, COMI, ODI and EQ-5D were used. Spinopelvic parameters (sacral inclination, pelvic tilt, sacral slope and pelvic incidence, lumbar lordosis and lumbar index as well as anterior displacement and sagittal rotation) were measured on plain radiographs. Results We could observe a significant benefit in clinical outcome after lumbar fusion surgery in low-grade spondylolisthesis in our mid-term follow-up data including 32 patients. By surgical reduction, we could see significant restoration of anterior displacement and sagittal rotation. Interestingly, a significant correlation between restoration of both sagittal rotation and sacral inclination and clinical outcome score was observed in the 3-year follow-up. Conclusion In low-grade spondylolisthesis, spinal fusion surgery is a well-established surgical procedure; however, the impact of sagittal parameters and reduction of anterior displacement remains controversial. Within our findings, restoration of sagittal parameters showed significant correlation to improvement in clinical outcome in our mid-term follow-up data.

Measurement of Force Required for Anterior Displacement of Intraocular Lenses and Its Defining Parameters

Intraocular stability during or after cataract and glaucoma filtration surgeries and vitreous surgery with a gas/silicone oil tamponade might differ among intraocular lenses (IOLs). We used six different one-piece IOL models and measured the force that displaced the IOLs from the vitreous cavity to anterior chamber as a measure of stability against the pressure gradient between the anterior and posterior IOL surfaces. We measured IOL hardness, haptics junction area, and posterior IOL bulge to identify what determines the IOL displacement force. The KOWA YP2.2 IOL (1.231 mN) required significantly greater force than the HOYA XY1 (0.416 mN, p = 0.0004), HOYA 255 (0.409 mN, p = 0.0003), Alcon SN60WF (0.507 mN, p = 0.0010), and Nidek NS60YG (0.778 mN, p = 0.0186) IOLs; J&J ZCB00V IOL (1.029 mN) required greater force than the HOYA XY1 (p = 0.0032) and HOYA 255 (p = 0.0029) IOLs; the Nidek NS60YG IOL required greater force than the HOYA 255 (p = 0.0468) IOL. The haptics junction area was correlated positively with the IOL displacement force (r = 0.8536, p = 0.0306); the correlations of the other parameters were non-significant. After adjusting for any confounding effects, the haptics junction area was correlated significantly with the IOL displacement force (p = 0.0394); the IOL hardness (p = 0.0573) and posterior IOL bulge (p = 0.0938) were not. The forces that displace IOLs anteriorly differed among one-piece soft-acrylic IOLs, and the optics/haptics junction area was the major force determinant.

A INFLUÊNCIA DA TÉCNICA DE POSTUROTERAPIA NEUROSSENSORIAL NO EQUILÍBRIO DO IDOSO

The aim of the present study was to evaluate the effectiveness of manual technique of NeuroSensory Posturotherapy (PNS) applied indirectly to vestibulocochlear nerve in the balance regulation of elderly. Across-sectional study, including 53 elderly, with average age 73.5±7.0 years old, evaluated preand postthe application of the PNS on the Cyber-Sabots stabilometric platform, withopened eyes (OE) and closed eyes (CE).For the analysis of the variables obtained pre and posttechniquewith OE and CE,the Wilcoxon test was used. The results showed that after applying the PNS with OE and also CE there was a decrease ofposterior-anterior displacement (p<0.0001) and energy cost in the elderly (OE: p=0.004 and CE: p=0.020). It was concluded that there was a significant improvement in the static body balance of the elderly after applying the PNS, as OEas CE.