To test the hypothesis that blunt trauma shockwave propagation may cause macular and peripheral retinal lesions, regardless of the presence of vitreous. The study was prompted by the observation of ...macular hole after an inadvertent BB shot in a previously vitrectomized eye.
The computational model was generated from generic eye geometry. Numeric simulations were performed with explicit finite element code. Simple constitutive modeling for soft tissues was used, and model parameters were calibrated on available experimental data by means of a reverse-engineering approach. Pressure, strain, and strain rates were calculated in vitreous- and aqueous-filled eyes. The paired t-test was used for statistical analysis with a 0.05 significance level.
Pressure at the retinal surface ranged between -1 and +1.8 MPa at the macula. Vitreous-filled eyes showed significantly lower pressures at the macula during the compression phase (P < 0.0001) and at the vitreous base during the rebound phase (P = 0.04). Multiaxial strain reached 20% and 25% at the macula and vitreous base, whereas the strain rate reached 40,000 and 50,000 seconds(-1), respectively. Both strain and strain rates at the macula, vitreous base, and equator reached lower values in the vitreous- compared with the aqueous-filled eyes (P < 0.001). Calculated pressures, strain, and strain rate levels were several orders of magnitude higher than the retina tensile strength and load-carrying capability reported in the literature.
Vitreous traction may not be responsible for blunt trauma-associated retinal lesions and can actually damp shockwaves significantly. Negative pressures associated with multiaxial strain and high strain rates can tear and detach the retina. Differential retinal elasticity may explain the higher tendency toward tearing the macula and vitreous base.
To evaluate the long-term visual prognosis and intraocular pressure (IOP) control following direct and indirect cycloplexy for the surgical treatment of traumatic cyclodialysis clefts.
Retrospective ...consecutive case series of 17 eyes of 17 patients. All eyes showing signs of ocular hypotony were treated with either cleft cyclocryotherapy and/or direct surgical cycloplexy. Cycloplexy was performed by directly suturing the ciliary body to the scleral spur under a double-lamellar limbal-based scleral flap. The main outcome measures were IOP, best-corrected visual acuity (BCVA), and the occurrence of postoperative complications.
The cyclodialysis clefts were post-traumatic in all the 17 eyes and extended for 2.1 ± 1.6 clock-hours (range, 0.5-6 clock-hours). The mean follow-up time was 43.7 ± 24.6 months (range, 12-110 months). Preoperatively, the mean IOP was 6.9 ± 4.0 mm Hg (range, 2-14 mm Hg). Postoperatively, painful reversible IOP spikes of up to 70 mm Hg developed in 13 eyes. The final mean postoperative IOP was 12.2 ± 4.1 mm Hg with no cases of secondary glaucoma. Preoperatively, BCVA was 6/12 or better in 4 eyes (24%), which rose to 12 eyes (71%) at final follow-up. Of the 12 patients who underwent direct cycloplexy, 75% achieved a final BCVA of 6/12 or better. There were no serious complications related to direct cycloplexy, including suprachoroidal haemorrhage or endophthalmitis.
Successful cyclodialysis cleft repair can lead to a good long-term visual prognosis and stable IOP control, even in cases with a protracted history of ocular hypotony.
Percutaneous treatments for spinal injury are underused by neuroradiologists and spine surgeons, mainly owing to a lack of data on indications.
To assess the safety and efficacy of vertebral body ...stenting (VBS) for post-traumatic A3.2 and A2 fractures (Magerl classification) and determine the factors that influence the improvements.
We retrospectively reviewed patients who underwent VBS to treat a single traumatic thoracolumbar fracture from 2010 to 2019. Kyphosis, loss of vertebral body height (VBH), and clinical and functional outcomes (including the Visual Analog Scale pain score and Oswestry Disability Index) were assessed. We examined the overall effects of VBH in all patients by constructing a linear statistical model and evaluated whether the efficacy was dependent on the characteristics of the patients or fractures.
We included 63 patients comprising 44 A3.2 and 19 A2 fractures. No patient had worsening neurological symptoms or wound infection. The average rates of change were 67.1% (95% CI 59.1% to 75%) for kyphosis and 88.5% (95% CI 85.6% to 91.3%) for VBH (both p<0.0001). After 1 year, the VBS treatment was more effective for kyphosis in younger patients and at the L1 level, and for VBH in younger patients and cases of Magerl A3.2 fracture.
This large reported series on VBS validates this surgical treatment. All patients had improved kyphosis and restored VBH. We recommend using VBS rather than open surgery for A3.2 and A2 fractures at the thoracolumbar junction and in young patients.
To report the first case of inadvertent cyclodialysis cleft and hypotony requiring surgical repair following ab-interno trabeculotomy (AIT) using the Trabectome device, and the postoperative clinical ...results following direct suture cyclopexy.
A 55-year-old man with hypotonous maculopathy secondary to cyclodialysis cleft inadvertently created 3 years earlier during AIT using the Trabectome device was referred for repair. Direct suture cyclopexy was performed and topical homatropine and dexamethasone drops were prescribed postoperatively.
Gonioscopic examination revealed complete cleft closure on postoperative day 1 confirmed by anterior segment optical coherence tomography. At 11 weeks postoperatively, visual acuity had improved from 20/400 to 20/40, with resolution of preoperative macular folds on fundoscopic examination. At 9 months postoperatively, visual acuity had further improved to 20/20 with intraocular pressure stable at 9 mm Hg maintained on travoprost and brimonidine.
Inadvertent cyclodialysis cleft from a malpositioned AIT and resultant hypotony is rare and in this case was successfully treated by direct suture cyclopexy.
To investigate factors that may influence successful correction of hypotony in a consecutive series of patients with cyclodialysis clefts repaired surgically over a 10-year period.
Retrospective ...interventional case series.
Interventional case series of consecutive patients with cyclodialysis clefts and hypotony treated surgically after failure of conservative treatment.
Eighteen patients (18 eyes) of mean (SD) age 48.3 (15.8) years at the time of surgery were included (16 male, 2 female). All were diagnosed using gonioscopy, usually assisted with intracameral viscoelastic injection. Imaging used in three cases was not found to be sufficiently precise to plan surgical intervention, without prior gonioscopic cleft visualisation. The intraocular pressure (IOP) was restored in nine cases (50%) after one procedure with a postoperative IOP (mean ± SD) of 13.6 ± 4.5 mm Hg (6/11 who had cyclopexy as a first procedure and 3/6 who had cryopexy). 2-3 procedures were required in the remaining nine patients. There was a trend towards the use of cyclopexy for larger clefts and cryopexy for smaller clefts (NS). We observed a trend for a lower likelihood of successful closure of larger clefts after one intervention. Two eyes that had cyclopexy required later IOP-lowering surgery to achieve IOP control.
Most clefts were closed with one procedure. A trend towards larger cleft size as a preoperative risk factor for failure to achieve closure with one procedure was observed. In this series, imaging was not found to be sufficiently precise to replace viscoelastic-assisted gonioscopy in the diagnosis and evaluation of cyclodialysis clefts.
To analyze the clinical characteristics of intervertebral disc tissue injury and herniation into the vertebral body in thoracolumbar fracture on fracture healing, vertebral bone defect volume and ...intervertebral space height.
From April 2016 to April 2020, a total of 140 patients with thoracolumbar single vertebral fracture combined with upper intervertebral disc injury treated with pedicle screw rod system reduction and internal fixation in our hospital. There were 83 males and 57 females, aged from 19 to 58 years old, with an average age of (39.33±10.26) years old. All patients were followed up regularly 6 months, 12 months and 18 months after surgery. The patients with injured intervertebral disc tissue not herniated into the fractured vertebral body were the control group, and the patients with injured intervertebral disc and herniated into the fractured vertebral body were the observation group. By detecting the thoracolumbar AP and lateral X-ray films, CT and MRI of the thoracolumbar segment at different
Purpose
To assess the surgical and functional outcome of internal direct cyclopexy as therapy of complicated traumatic cyclodialysis.
Methods
The single‐centre interventional case‐series study ...included eyes with traumatic cyclodialysis who had consecutively been treated. Internal cyclopexy was performed using double‐armed sutures introduced into the eye through the pars plana opposite to the cyclodialysis cleft and which were laid parallel to limbus. Additional procedures included cataract surgery, and pars plana vitrectomy. The cyclodialysis was documented upon ultrasound biomicroscopy and gonioscopy.
Results
The study included 44 patients (44 eyes). The cyclodialysis extended over 4.8 ± 3.2 clock hours of scleral spur circumference (range 1–12 hr, median 4 hr), involving >180° of the scleral spur circumference in 16 eyes (37%) and 360° in 3 eyes (7%). Besides cyclodialysis, additional trauma‐related complications included hyphema, iridodialysis, lens dislocation, cataract, vitreous haemorrhage, retinal detachment, suprachoroidal haemorrhage and endophthalmitis. The surgery performed on average at 64 days after the trauma included a mean number of 4.6 ± 1.9 sutures (range: 2–9), with 1.2 sutures per 30° width of cyclodialysis. Mean follow‐up was 32 ± 8 weeks (range: 6–51 weeks). Closure of the cyclodialysis was achieved in all 44 eyes, and intraocular pressure (IOP) increased from 8.0 ± 3.4 mmHg (range: 3 21 mmHg) to 14.4 ± 4.0 mmHg (range: 11–21 mmHg). Mean visual acuity (VA) improved from 2.3 ± 1.1 logMAR (range: 0.22–4.0) to 1.2 ± 0.8 logMAR (range 0.3–4.0 logMAR).
Conclusion
In conclusion, internal direct cyclopexy is a novel and relatively little invasive surgery technique for the repair of traumatic cyclodialysis.
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