A quality of life assessment of military recruits after refractive surgery

AIM: To evaluate the quality of life of recruits after refractive surgery. METHODS: Population-based, cross-sectional study. Using the Quality of Life Impact of Refractive Correction (QIRC) questionnaire, the quality of life in 615 recruits underwent refractive surgery was evaluated. The overall score and each question score of QIRC were compared between subgroups of different strength of preoperative refractive error, postoperative interval, type of surgical procedure and postoperative recovery. RESULTS: The mean overall QIRC score of recruits underwent refractive surgery was 49.15±7.89. Significant difference was found for strength of preoperative refractive error (F=4.16, P<0.05), with the low myopia group (50.67±7.59) had significantly better scores than those with high myopia (47.57±7.52, F=4.16, P<0.05). Recruits after a postoperative interval no more than 6mo (49.18±7.86) scored equally to those of more than 6mo (49.18±8.03). Recruits underwent surface ablation surgery scored lowest (46.68±6.09), but showed no significant difference when compared with all underwent refractive surgery (t=1.99, P>0.05). Scores of recruits underwent mechanical microkeratome laser in situ keratomileusis (MK-LASIK), Sub-Bowman’s keratomileusis (SBK), femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK), femtosecond lenticule extraction (ReLEx flex) or small-incision lenticule extraction (ReLEx SMILE) procedure showed no significant difference too. Recruits had adverse complaints postoperatively (45.85±6.66) scored lower when compared with all underwent refractive surgery (t=5.28, P<0.01). CONCLUSION: The quality of life of recruits after refractive surgery was good except those with postoperative complications. Preoperative low myopia recruits had better quality of life than medium and high myopia ones.

Pyloroplasty for Refractory Gastroparesis

Gastroparesis is a chronic gastric motility disorder in which the pathophysiology mimics a post-vagotomy state. Pyloroplasty is beginning to emerge as a successful drainage procedure for refractory gastroparesis. Here we report our experience using pyloroplasty in the surgical management of diabetic and nondiabetic gastroparesis. A retrospective study was performed of 46 patients undergoing pyloroplasty for refractory gastroparesis from January 2010 through December 2013. Gastric emptying scintigraphy and the Gastroparesis Cardinal Symptom Index were assessed pre-and postoperatively. Laparoscopic pyloroplasty was performed in 42 patients, open pyloroplasty in three, and one patient was converted from laparoscopic to open pyloroplasty. Studies were repeated during the six to 12 month postoperative interval. The postoperative gastric emptying scintigraphy improved in 90 per cent of patients and normalized in 60 per cent. Postoperative T½ was significantly reduced ( P = 0.001) as was four-hour retention ( P < 0.001). The Gastroparesis Cardinal Symptom Index showed statistically significant reduction in symptom severity for all nine categories ( P < 0.0005) as well as total symptom score ( P < 0.005). No patients developed dumping syndrome. Pyloroplasty is a highly effective therapy for refractory gastroparesis, offering significant reduction in symptom severity, improvement in quality of life, and acceleration of gastric emptying.

Long Term Followup of Photorefractive Keratectomy with Adjuvant Use of Mitomycin C

Purpose.To study the long term refractive and visual outcomes of photorefractive keratectomy (PRK) with intraoperative application of mitomycin C (MMC).Methods.This study included 37 eyes who received myopic PRK; after photoablation, a sponge soaked in 0.02% MMC solution was applied in all corneas for 2 minutes. Efficacy, safety, predictability, and stability of PRK MMC were evaluated. Endothelial cell density was evaluated at the last postoperative interval.Results.Mean preoperative spherical equivalent (SEQ) was−6.03±1.87 D (diopters) and reduced to−0.09±0.53 D at the last postoperative examination. Mean followup was44.73±18.24months. All the eyes were in the ±1.00 D of attempted versus achieved SEQ at the one-year follow-up interval. Furthermore, 95% of the eyes did not lose lines or gained 1 to 2 lines of CDVA, while 5% lost 1 line. At the third postoperative month, 89% of the eyes either were clear or had trace haze, while 4 eyes had mild haze; by the 12-month postoperative interval, none of the eyes demonstrated haze. Mean endothelial cell density (ECD) at the last postoperative interval was2658±153 cells/mm2.Conclusions.PRK, with intraoperative use of MMC, demonstrates stable refractive and visual outcomes up to 44 months after surgery.

A new technique for reduction of atlantoaxial subluxation using a simple tool during posterior segmental screw fixation

Object The authors introduce a simple technique and tool to facilitate reduction of atlantoaxial subluxation during posterior segmental screw fixation. Methods Two types of reduction tool have been designed: T-type and L-type. A T-shaped levering tool was used when a pedicle or pars screw was used for C-2, and an L-shaped tool was used when a laminar screw was used for C-2. Twenty-two patients who underwent atlantoaxial segmental screw fixation and fusion for the treatment of anteroposterior instability or subluxation, using either of these new types of reduction tool, were enrolled. Demographic, clinical, and surgical data, which had been prospectively collected in a database, were analyzed. The atlantodens interval was measured on lateral radiographs, and the space available for the spinal cord was measured on CT scans. Results The authors could attain reduction of the atlantoaxial subluxation without difficulty using either type of tool. The preoperative atlantodens interval ranged from −16.9 to 10.9 mm in a neutral position, and the postoperative interval ranged from −2.8 to 3.0 mm, with negative values due to extension-type or mixed-type instability. The mean space available for the spinal cord significantly increased, from 9.5 mm preoperatively to 15.4 mm postoperatively (p < 0.001). Conclusions This technique allowed for controlled manipulation and reduction of the atlantoaxial subluxation without difficulty.

Acute Skier's Thumb Repaired With a Proximal Phalanx Suture Anchor

The purpose of this study was to determine the functional outcome of a surgical technique for the repair of injuries of the ulnar collateral ligament of the thumb. A 14-point questionnaire was developed to determine functional outcome after surgical repair of acute ulnar collateral ligament rupture. Early ulnar collateral ligament repair was performed on 58 patients with grade III sprains (complete rupture) of the ligament using a new technique that employs a suture anchor for fixation. Forty-five patients were interviewed at a minimum postoperative interval of 12 months and were included in this study. Forty-four patients (98%) believed they had a stable repair, were satisfied with their surgery, and would have it again if necessary. Forty-four patients (98%) were not hindered in their day-to-day activities and had a functional range of motion. Mild discomfort was felt by eight of our patients (17%), but only three patients (7%) had pain with activities. The average time to return to skiing was 1.7 days. The use of a suture anchor provided a strong and stable repair if the surgery was performed early.

Long-term efficacy of microvascular decompression in trigeminal neuralgia

✓ Forty patients were followed for an average period of 8½ years after 44 consecutive suboccipital craniotomies for trigeminal neuralgia. Among these patients, 36 had microvascular decompression (MVD) of the nerve, four had repeat trigeminal rhizotomy after MVD was not successful in controlling their pain, and four had primary trigeminal rhizotomies. Of the 36 patients undergoing MVD, 17 (47%) experienced recurrent postoperative neuralgic pain: in 11 (31%) pain recurrence was major, and in six (17%) it was minor. Among the eight patients undergoing rhizotomy, four (50%) had major pain recurrences and one (13%) had a minor recurrence, for a 63% total recurrence rate. There was a strong statistical relationship between an operative finding of arterial cross-compression of the nerve and long-term complete pain relief. Patients with other compressive pathology (related to veins or bone structures) did not on the average fare as well. Despite this, there appeared to be no point in time in the postoperative interval when the patient could be considered “cured.” Major recurrences averaged 3.5% annually, and minor recurrences averaged 1.5% annually. The implications of these findings for the treatment of trigeminal neuralgia and the current understanding of the mechanism of MVD for this disorder are discussed.