ObjectiveTo evaluate the efficacy and security of intravitreous injection with triamcinolone acetonide (TA) for macular edema.MethodsA total of 41 eyes in 37 patients with macular edema who measured up were collected, including 21 eyes of 21 cases in retinal vein occlusion (RVO) group, 17 eyes of 13 cases in diabetic retinopathy (DR) group, and 3 eyes of 3 cases in the other-causes group. Before the treatment, the average visual acuity was 0.07, 0.06, and 0.08 in the 3 groups respectively, and the mean thickness of macular fovea detected by optic coherence tomography (OCT) was (974±394) and (873±213) in RVO and DR group, respectively. Intravitreous injection with 0.1 ml TA (40 mg/ml) was performed on each patient. The average follow-up duration was 8 months after the treatment. The visual acuity, intraocular pressure (IOP), changes of lens and ocular fundus, and retinal thichness at macular area before and after the treatment was observed and compared.ResultsAll eyes except one had improved visual acuity. The mean visual acuity improved to 0.25, 0.20, and 0.35 in the 3 groups respectively 6 months after the treatment. Alleviated or reducing macular edema was found in all of the patients. The average retinal thickness at macular fovea was (173±41) and (204±76) in RVO and DR group respectively 1 month after the treatment, which had statistical significance compared with that before the treatment (t =8.323, 6.842; P＜0.01). The intraocular pressure was ＞21 mm Hg (1 mm Hg = 0.133 kPa) in 6 eyes (14.6%), which mostly happened 1 week to 2 months after the injection, and was controlled to normal level after partially treated with βreceptor retarder. The cataract developed in 1 eye, and another patient with macular edema after vitrectomy due to diabetes had macular hole 2 months after the injection. There were 2 eyes underwent intravitreous injection with 0.1 ml TA 4-5 months after the first treatment due to the recurrence of macular edema in RVO and DR group respectively.ConclusionsIntravitreous injection with TA is a promising therapeutic method for macular edema that fails to respond to conventional treatment. Transient elevation of ocular pressure is the most common side effect. Further study is needed to assess the long-term efficacy and safety. (Chin J Ocul Fundus Dis, 2005,21:209-212)
Purpose To explore the role of scanning laser tomography in the assessment of macular hole surgery. Methods Fifteen eyes of 14 patients with macular holes underwent scanning of their affected macular area using the Heidelberg retina tomograph (HRT). The significance of topographic changes postoperatively were determined in eleven eyes which received vitrectomy surgery. The scan field was set at 15°of the retina and the depth was set to 1.5 mm or 2.0 mm. All the measurements were taken for 3 times and the average value of the 3 measurements was used. Results The average hole area was (0.499±0.34) mm 2 and the maximal depth of the hole was (0.284±0.11) mm. Topographic difference analysis of the eleven eyes showed a significant reduction in the height of the retina after vitrectomy. The maximal depth of the hole was (0.063±0.04) mm postoperatively. Conclusion Scanning laser tomography provides an objective evaluation of the anatomic outcome of the macular hole surgery. (Chin J Ocul Fundus Dis, 2002, 18: 125-127)
Objective To explore the practicability and safety of ultrasonic bone curette in the laminoplasty of spinal canal after resection of intraspinal tumors. Methods The clinical data of 17 patients with thoracolumbar intraspinal tumors treated with ultrasonic bone curette after resection of intraspinal tumors between December 2015 and April 2017 were retrospectively analyzed. All patients were male, aged 42-73 years with an average of 57.4 years. The disease duration was 2-47 months with an average of 21.1 months. Among them, there were 4 cases of thoracic intrathoracic tumors (T10 in 1, T12 in 3) and 13 cases of lumbar intrathoracic tumors (L1 in 5, L2 in 4, L3 in 2, and L4 in 2). Postoperative pathological diagnosis showed that 8 cases were schwannoma, 4 cases were meningioma, 2 cases were neurofibroma, 2 cases were dermoid cyst, and 1 case was ependymoma. Spinal nerve function was evaluated preoperatively according to Frankel classification criteria, with 2 cases of grade B, 7 cases of grade C, and 8 cases of grade D. During the operation, the time of single segmental vertebral canal posterior wall incision, the overall operation time, intraoperative blood loss, intraoperative dural injury, and cerebrospinal fluid leakage, spinal cord and nerve root injury were recorded. At 3-6 months after operation, the tumor and bone healing were observed according to MRI and CT three-dimensional reconstruction, and the spinal nerve function was evaluated by Frankel classification. Results The time of ultrasonic osteotomy for the posterior wall of a single segmental vertebral canal was 3.4-5.7 minutes, with an average of 4.1 minutes. The overall operation time was 135-182 minutes, with an average of 157.3 minutes. The intraoperative blood loss was 300-500 mL, with an average of 342.6 mL. There was no accidental dural injury, and cerebrospinal fluid leakage, nerve root injury, or spinal cord injury. The incision healed by first intention after operation. All the 17 patients were followed up 9-18 months, with an average of 12.7 months. MRI examination showed no tumor recurrence, and CT three-dimensional reconstruction showed good bone healing in all patients. During the follow-up, there was no loosening or rupture of the internal fixator and there was no re-compression of the spinal cord. At last follow-up, according to Frankel classification, there were 1 case as grade B, 5 cases as grade C, 7 cases as grade D, and 4 cases as grade E. Conclusion The application of ultrasonic bone curette in laminoplasty of spinal canal after resection of intraspinal tumors can preserve the integrity of the bone ligament structure of posterior column, maintain the volume of vertebral canal, and has high safety, practicability, and good postoperative effectiveness.
Objective To compare the effectiveness of O-arm navigation and ultrasound volume navigation (UVN) in guiding screw placement during minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery. Methods Sixty patients who underwent MIS-TLIF surgery for lumbar disc herniation between June 2022 and June 2023 and met the selection criteria were included in the study. They were randomly assigned to group A (screw placement guided by UVN during MIS-TLIF) or group B (screw placement guided by O-arm navigation during MIS-TLIF), with 30 cases in each group. There was no significant difference in baseline data, including gender, age, body mass index, and surgical segment, between the two groups (P>0.05). Intraoperative data, including average single screw placement time, total radiation dose, and average single screw effective radiation dose, were recorded and calculated. Postoperatively, X-ray film and CT scans were performed at 10 days to evaluate screw placement accuracy and assess facet joint violation. Pearson correlation and Spearman correlation analyses were used to observe the relationship between the studied parameters (average single screw placement time and screw placement accuracy grading) and BMI. Results The average single screw placement time in group B was significantly shorter than that in group A, and the total radiation dose of single segment and multi-segment and the average single screw effective radiation dose in group B were significantly higher than those in group A (P<0.05). There was no significant difference in the total radiation dose between single segment and multiple segments in group B (P>0.05), while the total radiation dose of multiple segments was significantly higher than that of single segment in group A (P<0.05). No significant difference was found in the accuracy of screw implantation between the two groups (P>0.05). In both groups, the grade 1 and grade 2 screws broke through the outer wall of the pedicle, and no screw broke through the inner wall of the pedicle. There was no significant difference in the rate of facet joint violation between the two groups (P>0.05). In group A, both the average single screw placement time and screw placement accuracy grading were positively correlated with BMI (r=0.677, P<0.001; r=0.222, P=0.012), while in group B, neither of them was correlated with BMI (r=0.224, P=0.233; r=0.034, P=0.697). Conclusion UVN-guided screw placement in MIS-TLIF surgery demonstrates comparable efficiency, visualization, and accuracy to O-arm navigation, while significantly reducing radiation exposure. However, it may be influenced by factors such as obesity, which poses certain limitations.
Abnormal uterine bleeding with ovulatory dysfunction (AUB-O) is a common reproductive endocrine disease with complex and variable clinical manifestations. This disease has a long course and large individual differences. Difficulties in diagnosis and treatment and nonstandardized management are common in primary hospitals. In order to improve the diagnosis and treatment efficiency of AUB-O in primary hospitals, the gynecological endocrinologists in western China proposed this primary diagnosis and treatment norms and referral recommendations for gynecological outpatient clinics in primary hospitals, including the key points of diagnosis, hemostasis and cycle adjustment strategies, adjuvant treatment, and the principle of two-way referral. In particular, individualized treatment recommendations were proposed for young adolescents and menopausal transition patients. This recommendations are expected to serve as an important reference for AUB-O diagnosis, treatment and two-way referral of primary hospitals in western China.