Diagnostic accuracy of somatosensory evoked potential monitoring during scoliosis fusion

The goal of this review was to ascertain the diagnostic accuracy of intraoperative somatosensory evoked potential (SSEP) changes to predict perioperative neurological outcome in patients undergoing spinal deformity surgery to correct adolescent idiopathic scoliosis (AIS). The authors searched PubMed/MEDLINE and World Science databases to retrieve reports and/or experiments from January 1950 through January 2014 for studies on SSEP use during AIS surgery. All motor and sensory deficits were noted in the neurological examination administered after the procedure which was used to determine the effectiveness of SSEP as an intraoperative monitoring technique. Fifteen studies identified a total of 4763 procedures on idiopathic patients. The observed incidence of neurological deficits was 1.11% (53/4763) of the sample population. Of the patients with new postoperative neurological deficits 75.5% (40/53) showed significant SSEP changes, and 24.5% (13/53) did not show significant change. Pooled analysis using the bivariate model showed SSEP change with pooled sensitivity (average 84%, 95% confidence interval 59-95%) and specificity (average 98%, 95% confidence interval 97-99%). The diagnostic odds ratio of a patient who had a new neurological deficit with SSEP changes was a diagnostic odds ratio of 340 (95% confidence interval 125-926). Overall, detection of SSEP changes had excellent discriminant ability with an area under the curve of 0.99. Our meta-analysis covering 4763 operations on idiopathic patients showed that it is a highly sensitive and specific test and that iatrogenic spinal cord injury resulting in new neurological deficits was 340 times more likely to have changes in SSEP compared to those without any new deficits

Value of intraoperative neurophysiological monitoring to reduce neurological complications in patients undergoing anterior cervical spine procedures for cervical spondylotic myelopathy

The primary aim of this study was to conduct a systematic review of reports of patients with cervical spondylotic myelopathy and to assess the value of intraoperative monitoring (IOM), including somatosensory evoked potentials, transcranial motor evoked potentials and electromyography, in anterior cervical procedures. A search was conducted to collect a small database of relevant papers using key words describing disorders and procedures of interest. The database was then shortlisted using selection criteria and data was extracted to identify complications as a result of anterior cervical procedures for cervical spondylotic myelopathy and outcome analysis on a continuous scale. In the 22 studies that matched the screening criteria, only two involved the use of IOM. The average sample size was 173 patients. In procedures done without IOM a mean change in Japanese Orthopaedic Association score of 3.94 points and Nurick score by 1.20 points (both less severe post-operatively) was observed. Within our sub-group analysis, worsening myelopathy and/or quadriplegia was seen in 2.71% of patients for studies without IOM and 0.91% of patients for studies with IOM. Variations persist in the existing literature in the evaluation of complications associated with anterior cervical spinal procedures. Based on the review of published studies, sufficient evidence does not exist to make recommendations regarding the use of different IOM modalities to reduce neurological complications during anterior cervical procedures. However, future studies with objective measures of neurological deficits using a specific IOM modality may establish it as an effective and reliable indicator of injury during such surgeries

New minimally invasive, deep sclerotomy ab interno surgical procedure for glaucoma, six years of follow-up

Purpose: The goal of this study is to show the efficacy and safety of an innovative surgical procedure regarding the treatment of openangle and juvenile glaucoma known as sclerothalamotomy ab interno (STT ab interno). Patients and Methods: Between February and July 2002 surgery was performed in 58 eyes of 58 consecutive patients, of which 53 were diagnosed with open-angle and 5 with juvenile glaucoma. The procedure was performed with the assistance of a custom-made high-frequency dissection probe (19 gauge with a tip of 0.3 X 1 mm), which applies a bipolar current of 500 kHz frequency. The probe penetrates approximately 1mm into the nasal sclera (ab interno) and through the trabecular meshwork and Schlemm’s canal, thus forming a deep sclerotomy or "thalami" of 0.3mm height and 0.6mm width. Results: The average baseline intraocular pressure (IOP) was 25.6±2.3mm Hg (range: 18--48mm Hg) for the open-angle glaucoma group and 39.6±2.3mm Hg (range: 34--46mm Hg) for the juvenile glaucoma group. All patients had a minimum follow-up of 72 months. The mean IOP for the stated period was 14.7±1.8mm Hg for the open-angle glaucoma group and 13.2±1.3mm Hg for the juvenile group. The IOP after surgery was statistically significantly lower than the baseline IOP at all measured intervals (P&lt;0.001). After 72 months only 11 eyes accounted for a 20.8% continuous antiglaucoma therapy. With regard to the procedure no serious complication was documented. Conclusions: Sclerothalamotomy ab interno is a minimally invasive, safe, and efficient surgical technique for lowering the IOP in openangle and juvenile glaucoma.</p

Comparison of the effects of dorzolamide/timolol and latanoprost/timolol fixed combinations upon intraocular pressure and progression of visual field damage in primary open-angle glaucoma

Objective: To report the long-term effect of the dorzolamide/timolol (DTFC) and latanoprost/timolol (LTFC) fixed combinations on intraocular pressure (IOP) and visual field defects over time in naïve primary open-angle glaucoma (POAG) patients. Study design and methods: Prospective, 4-year, open-label, interventional study. Setting: high-volume outpatient clinic. Patients: 178 patients were assigned to receive medical treatment with either DTFC or LTFC. Intervention: over 4 years, tri-monthly IOP and yearly visual field assessment (Octopus 101, Program G2). outcomes: effect of treatment on IOP, visual field indices mean defect (MD), and visual field indices variance loss (VL) over time. Results: DTFC and LTFC significantly (p &lt; or = 0.001) reduced mean IOP over time (from 22.6 +/- 3.0 to 13.8 +/- 1.9 mmHg and from 22.3 +/- 4.0 to 14.7 +/- 1.9 mmHg, respectively). In all, 56 patients (70.9%) and 14 (17.9%) showed a significant MD improvement in the DTFC- and LTFC-treated groups, respectively, p = 0.0001. DTFC progressively and significantly decreased mean VL (from 30.21 +/- 23.88 to 8.11 +/- 8.50 dB). Mean sensitivity slopes during follow-up were 1.14 dB/year and -0.34 dB/year for DTFC and LTFC treatment groups, respectively; p = 0.028. Conclusion: Both treatments significantly reduced IOP as compared with baseline. Additionally, treatment with dorzolamide/timolol fixed combination seem to be effective in preventing glaucomatous visual field progression. This study has some limitations that should be noted, among them its open-label design.</p

User friendliness of a wearable visual behavior monitor for cataract and refractive surgery

A prospective feasibility study was conducted to determine whether a new wearable device, the Visual Behavior Monitor (VBM), was easy to use and did not present any difficulties with the daily activities of patients. Patients for cataract surgery and refractive lens exchange were randomly selected and screened for inclusion in the study. A total of 129 patients were included in the study as part of a multicenter study. All measurements were performed before surgery. Upon inclusion, patients were trained to wear the device, instructed to wear it for a minimum of 36 h, and were scheduled to return in one week. The VBM measures the distance at which patients' visual activities are performed, the level of illumination, and head translational and rotational movements along the three axes. On the follow-up visit, patients completed a questionnaire about their experience in wearing the device. All patients underwent standard diagnostic testing, with their cataract grade determined by the Lens Opacities Classification System (LOCS) classification. Results indicate that 87% of patients felt comfortable using the wearable device while 8% of patients responded as not feeling comfortable (5% of patients did not respond to the question). In addition, 91% of patients found it easy to attach the wearable to the magnetic clip while 4% of patients did not find it easy, and 5% of patients did not respond. Overall, patients found the device easy to use, with most reporting that the device was not intrusive

Cataract surgery performed by high frequency LDV Z8 Femtosecond laser: safety, efficacy, and its physical properties

Background: The aim of our study was to investigate the safety and efficacy of the LDV Z8 femtosecond laser in cataract surgery compared to the conventional procedure. Methods: This prospective study was performed at the Swiss Eye Research Foundation, Eye Clinic ORASIS, Reinach, Switzerland. The study included 130 eyes from 130 patients: 68 treated with femtosecond laser-assisted cataract surgery (FLACS) using the FEMTO LDV Z8 and 62 treated with conventional phacoemulsification. Capsulotomy and lens fragmentation in the laser group were performed with the FEMTO LDV Z8 femtosecond laser system, which employs a new, low-energy, high repetition rate laser process for cataract surgery. In the conventional group, the capsulotomy was performed by a cystotome, and lens fragmentation was achieved by the stop-and-chop. Results: Ease of phacoemulsification (on a 4-point scale), the completeness of capsulotomy (on a 10-point scale), effective phacoemulsification time (seconds), uncorrected distance visual acuity (UCVA), best spectacle-corrected distance visual acuity (BSCVA), spherical equivalent (SE), and safety of the procedure were evaluated. The total follow-up time was three months. Conclusions: FLACS with the FEMTO LDV Z8 system was characterized by complete and reproducible capsulotomy and highly effective lens fragmentation. Postoperative visual outcomes were excellent, and the safety of the procedure was optimal

First experience with the new high-frequency femtosecond laser system (LDV Z8) for cataract surgery

The purpose of this work is to report our experience using the new Z8 laser system for femtosecond laser-assisted cataract surgery (FLACS) and to provide a sample of the performance and safety results using this new technology

Multimodal intraoperative monitoring: towards a routine use in surgical treatment of severe spinal disorders

Editorialinfo:eu-repo/semantics/publishe

Long-term Results of a Novel Minimally Invasive High-frequency Deep Sclerotomy Ab Interno Surgical Procedure for Glaucoma

High-frequency deep sclerotomy (HFDS) glaucoma surgery is a new ab interno procedure to lower the intraocular pressure in open-angleglaucoma. Using high-frequency energy, six small pockets are formed which significantly reduce the outflow resistance for aqueous humour. This article presents the impressive results of a long-term study about the HFDS glaucoma procedure and demonstrates its efficacy andsafety. The operation technique and the devices used for a successful HFDS glaucoma intervention are described step by step