Lumbar Herniated Degenerated Disc: Simple Discectomy or Fusion?

Background Data: Low back pain is estimated to occur in 84% of individuals at some point of their life. Lumbar disc degeneration is one of the most common finding in the work up of low back pain. Mechanical, nutritional, and genetic factors may play a role in the pathogenesis of disc degeneration. The etiology of back pain in degenerated disc is a complex process, and appears to be a combination of mechanical deformation and the release of inflammatory mediators. Being a recently highlighted illness, still there is a great controversy concerning the surgical treatment of degenerated lumbar disc hernia. Study Design: Prospective comparative clinical case study. Purpose: To compare the clinical outcome of patients presented with single degenerated lumbar disc hernia treated with fusion to those treated only with simple discectomy. Patients and Methods: Two groups of patients were recruited for this study included 20 patients each. Group A; patients treated with fusion and instrumental fixation. Group B; patients treated with simple discectomy. Both groups were homogeneous in terms of clinical presentation and imaging data. The VAS was used to evaluate leg and back pain, while ODI was used to evaluate the functional status both pre and post operatively. Results: Preoperatively, all patients suffered back pain, where 16 had moderate and 4 had severe pain in group A, and 14 had moderate and 6 had severe pain in group B. The ODI showed that, 16 and 17 patients had moderate disability in group A and B respectively. According to VAS, 12 patients had moderate and 8 had severe sciatica in group A, and 15 patients had moderate and 5 had severe sciatica in group B. With follow-up, back pain improved according to VAS, where 14 patients had no pain, 3 had mild and 3 had moderate pain in group A, and 18 (90%) patients had severe pain in group B. the ODI showed that 17 (85%) patients had minimal disability and 18 (90%) patients had moderate disability in group A and B respectively. According to VAS, 18 (90%) patients were pain free while 2 had mild sciatica in group A, and 17 patients became pain free in group B, however, 4 patients re-experienced moderate and 2 complained of severe pain due to recurrent disc. Conclusion: Despite the controversies regarding its ideal management, the results of discectomy and fusion stand better when compared with simple discectomy. However the disease needs more study to understand its pathogenesis. (2012ESJ034

Infectious Keratitis: The Great Enemy

Infectious keratitis tops the list of diseases leading to visual impairment and corneal blindness. Corneal opacities, predominantly caused by infectious keratitis, are the fourth leading cause of blindness globally. In the developed countries, infectious keratitis is usually associated with contact lens wear, but in developing countries, it is commonly caused by trauma during agricultural work. The common causative organisms are bacteria, fungus, Acanthamoeba, and virus. Severe cases can progress rapidly and cause visual impairment or blindness that requires corneal transplantation, evisceration, or enucleation. The precise clinical diagnosis, accurate diagnostic tools, and timely appropriate management are important to reduce the morbidity associated with infectious keratitis. Despite the advancement of diagnostic tools and antimicrobial drugs, outcomes remain poor secondary to corneal melting, scarring, or perforation. Eye care strategies should focus on corneal ulcer prevention. This review addresses the epidemiology, diagnostic approach, clinical manifestations, risk factors, investigations, treatments, and the update of major clinical trials about common pathogens of infectious keratitis

Keratoconus Treatment Toolbox: An Update

Keratoconus is a bilateral, asymmetric, progressive disease of the cornea which can lead to visual impairment and blindness as irregular astigmatism increases and corneal scar occurs. Currently, many methods are available for a treatment of keratoconus. The treatment can help enhance visual rehabilitation and prevent progression in keratoconus patients. The treatment options included non-surgical and surgical managements. This review offers a summary of the current and emerging treatment options for keratoconus- eyeglasses, contact lens, corneal collagen cross-linking (CXL), CXL Plus, intrastromal corneal ring segment (ICRS), Corneal Allogenic Intrastromal Ring Segments (CAIRS), Penetrating Keratoplasty (PK), Deep Anterior Lamellar Keratoplasty (DALK), Bowman layer transplantation (BL transplantation) and gene therapy

Corneal Microlayer Optical Tomography Review

Anterior segment ultra-high resolution OCT (UHR-OCT) uses a resolution of 1–4 μm to provide non-invasive imaging of the tear film and cornea. This new high definition imaging technology increases our understanding of normal structure and pathological changes in the cornea, and resolution has continued to improve over time. UHR-OCT is useful in the treatment of disease such as dry eye, subclinical keratoconus, keratoconus, and ocular surface pathology. It also aids clinicians in fitting contact lenses and screening tissue for corneal transplantation. In this review, we summarize applications of imaging the normal and pathologic ocular surface and cornea. Novel developments, such as the new-generation micro-OCT, Anterior segment OCT angiography and artificial intelligence have the potential to continue to increase our knowledge

Assessment of chandelier-assisted scleral buckling surgery

Context Recently, there has been a shift towards the use of pars plana vitrectomy (PPV) as the first choice for rhegmatogenous retinal detachment (RRD) repair. Combining the excellent view of PPV using the noncontact viewing system and the 25 G chandelier endoillumination system in scleral buckling may make the procedure more convenient than the typical procedure using indirect ophthalmoscope. Aim The aim of the present study was to assess the safety and efficacy of the 25 G chandelier endoillumination system in scleral buckling surgery in primary RRD. Design The present study was designed as a prospective interventional case series. Setting This study was conducted as a private practice. Materials and methods The study included 20 eyes with recent RRD operated by scleral buckling using the chandelier endoillumination and noncontact viewing system of PPV. Statistical analysis was performed. Results In total, 20 eyes with recent primary RRD were operated using 25 G chandelier endoillumination-assisted scleral buckling. At first postoperative day, 18 eyes (90%) had totally attached retina and the remaining two eyes (10%) had minimal subretinal fluid, which was completely absorbed within 1 week. At 1 month, one eye had recurrent retinal detachment due to lower proliferative vitreoretinopathy, which was treated with PPV. The remaining 18 eyes had attached retina by 1, 3, and 6 months postoperatively. Best corrected visual acuity improved from 0.001-0.4 preoperatively to 0.02-0.8 3 months and to 0.05-0.8 6 months postoperatively. The crystalline lens remained clear at 6 months postoperatively for all 18 eyes (excluding an aphakic eye and a vitrectomized eye). Conclusion Using 25 G chandelier endoillumination, surgical microscope, and wide-angle noncontact viewing system of PPV in scleral buckling surgery is easier and more convenient than the original buckling procedure using an indirect ophthalmoscope

Comparison between 1-week and 1-month results of intravitreal ranibizumab in diabetic macular edema

Purpose The aim of the present study was to compare the results of intravitreal ranibizumab in diabetic macular edema (DME) at 1-week and 1-month duration. Patients and methods The study included 34 eyes of 20 type II diabetic patients with DME fulfilling one or more of the following criteria: spongiform edema with central macular thickness (CMT) more than 350 μm; single or multiple cysts; or the area of sensory retinal detachment affecting the foveal center regardless of the CMT. The included eyes were subjected preoperatively to full ophthalmic examination, fluorescein angiography, and macular optical coherence tomography (OCT) using 512 by 128 cube macular scan protocol of Cirrus HD spectral domain OCT version 6. Intravitreal injection of 0.5 mg ranibizumab was administered. Follow-up, regarding the best-corrected visual acuity (BCVA) and the CMT, was scheduled at 1 week and 1 month. Results The mean log MAR BCVA at baseline was 0.7 ± 0.4. One week after injection the mean of log Mar BCVA improved to be 0.6 ± 0.4. One month after injection the mean log Mar BCVA improved to be 0.5 ± 0.4. The difference between BCVA of the included eyes at baseline and that at 1 week after injection was statistically significant (P = 0.012). However, the difference between the BCVA of the included eyes at 1 week and that at 1 month after injection was not statistically significant (P = 0.361). The mean of CMT at baseline was 367.4 ± 107.6 μm, which decreased at 1 week to 325 ± 86.1 μm and at 1 month to 321 ± 96.8 μm. The difference between the CMT of the included eyes at baseline and that at 1 week after injection was statistically significant (P = 0.025). However, the difference between the CMT of the included eyes at 1 week and that at 1 month after injection was not statistically significant (P = 0.816). Conclusion Intravitreal injection of ranibizumab for DME showed significant improvement at 1 week and 1 month after injection as regards the BCVA and the CMT. However, there was no statistically significant difference in these two parameters between 1 week and 1 month after injection

In situ visualization of tears on contact lens using ultra high resolution optical coherence tomography

To demonstrate the capability of directly visualizing the tear film on contact lenses using optical coherence tomography (OCT). Six eyes of three healthy subjects wearing PureVision and ACUVUE Advance soft and Boston RGP hard contact lenses were imaged with a custom built, high speed, ultra-high resolution spectral domain optical coherence tomograph. Refresh Liquigel was used to demonstrate the effect of artificial tears on the tear film. Ultra high resolution images of the pre- and post-lens films were directly visualized when each lens was inserted onto the eye. After the instillation of artificial tears during lens wear, the tear film was thicker. The post-lens tear film underneath the lens edge was clearly shown. Interactions between the lens edges and the ocular surface were obtained for each of the lens types and base curves. With a contrast enhancement agent, tear menisci on the contact lenses around the upper and lower eyelids were highlighted. With hard contact lenses, the tear film was visualized clearly and changed after a blink when the lens was pulled up by the lid. Ultra-high resolution OCT is a potentially promising technique for imaging tears around contact lenses. This successful demonstration of in situ post-lens tear film imaging suggests that OCT could open a new era in studying tear dynamics during contact lens wear. The novel method may lead to new ways of evaluating contact lens fitting

Cataract surgery after pars plana vitrectomy

To review recent studies and advances and their possible implications in the care of patients undergoing cataract surgery after pars plana vitrectomy. Optical biometry has shown to be superior to ultrasound biometry in vitrectomized eyes but still not achieving as good results as it does in nonvitrectomized eyes. Blue light-filter intraocular lenses, with their possible advantage of macular protection, have shown no operative or functional disadvantages in vitrectomized eyes, and thus their routine use can be justified. However, presbyopia-correcting intraocular lenses, at least at their current stage of development, generally, are still not accepted for vitrectomized eyes. Combining cataract surgery with intravitreal injections of bevacizumab or triamcinolone acetonide in patients with macular edema and cataract is advisable to avoid exacerbation of the condition and improve visual outcome. Despite the recent advances, incidences of posterior capsular opacification and retinal detachment are still considerable. Understanding ocular anatomical alterations imposed by the previous pars plana vitrectomy surgery and the underlying vitreoretinal disease will allow the surgeon to address the special challenges. Despite that, recent advances in techniques and instrumentation have improved the surgical safety and outcomes, reported complications rates are still relatively high