Results of Phacoemulsification with Malyugin Ring in Comparison with Manual Iris Stretching with Hooks in Eyes with Narrow Pupil

Purpose. To evaluate the results of phacoemulsification in eyes with a narrow pupil dilated with Malyugin Ring, in comparison with manual pupillary stretching with hooks. setting. Department of Ophthalmology, Medical University of Lodz, Poland. Materials and Methods. The examined group (group 1) consisted of 23 eyes of 23 patients whose pupil was dilated using Malyugin Ring. The reference group (group 2) consisted of 17 eyes of 17 patients whose pupil was dilated manually by stretching with hooks. All patients underwent uneventful standard phacoemulsification. Patients were examined preoperatively, 1 day, and 1 month after the surgery. Best-corrected visual acuity (BCVA), intraocular pressure, anterior and posterior segment of the eye, and corneal endothelial cell density were evaluated. Statistical analysis was done using nonparametric tests. Results. Mean preoperative BCVA in group 1 was 0.31±0.27 and in group 2 it was 0.26±0.26 (p&gt;0.05). In both groups there was a significant improvement in BCVA after the surgery (p&lt;0.05). Mean postoperative BCVA in group 1 was 0.75±0.30 and in group 2 it was 0.56±0.56 (p&lt;0.05). Mean corneal endothelial cell loss measured 30 days postoperatively amounted to 9.35±11% in group 1 and 13.77±8.0% in group 2 (p&lt;0.05). No serious complications were found. Conclusions. In eyes with narrow pupil, the use of Malyugin Ring makes the surgery easier and allows for better functional results and smaller corneal endothelial cell loss in comparison with manual pupillary stretching with 2 hooks. </jats:sec

Prognosis for Peripheral Nerve Injuries after Hip Joint Arthroplasty

Background. Peripheral nerve damage is a rare complication of hip replacement surgery that severely impairs the therapeutic outcome. The aim of the present study was to determine the time needed for nerve recovery and re­storation of activity following iatrogenic damage during a primary or revision hip arthroplasty from an anterolateral approach and its relationship with the severity of damage. Materials and methods. A prospectively collected database of 1107 patients treated with primary arthroplasty and 303 patients following revision arthroplasty (mean age 63 years, range 53 to 72 years) was analysed. This included 15 cases of palsy of the peroneal branch of the sciatic nerve and 7 of the femoral nerve. The mean follow-up was 3.6 years (minimum two years). Results. The following risk factors were identified: dysplastic osteoarthritis, limb elongation, revision arthroplasty, female sex and post-traumatic osteoarthritis. All five patients demonstrating light palsy (Lovett score 3-5), and 9 out of the 17 with severe palsy (Lovett score 0-2) achieved full recovery. Of all patients, 63.6% regained nerve function after 4 weeks to 24 months (mean 17 months), with nine demonstrating complete recovery and five partial. Also, 66.6% patients regained femoral nerve function and 61.5%, sciatic nerve function. Conclusion. 1. The femoral nerve and the peroneal branch of the sciatic nerve demonstrate a similar pattern of functional recovery following damage. 2. All patients recovered from light palsy, and almost 2/3 of cases of severe palsy demonstrated partial or complete recovery. 3. Female sex is a significant risk factor. </jats:p

Heterotopic Ossification: A Challenging Complication of Total Hip Arthroplasty: Risk Factors, Diagnosis, Prophylaxis, and Treatment

Background. This review is intended to summarize the risk factors, classification, diagnosis, and treatment of heterotopic ossification (HO) of previously published studies. Results. Heterotopic ossification is a common complication of total hip arthroplasty. Its prevalence is not the same in all of the patient groups. Frequency of HO varies from 15 to 90%. Hip ankylosis, male gender, and previous history of HO are said to be risk factors with a significant level. Diagnosis is based on a single AP radiograph: the Brooker classification that divides HO into four grades is the most commonly used. The confirmation test that can be used is a bone scan. A great amount of bone metabolic turnover markers have been tested, but none of them seems to be relevant in case of prevention or diagnosis of HO. The most effective prophylactic treatment is radiotherapy or administration of nonsteroidal anti-inflammatory drugs. Over the years a lot of different RT protocols have been tested. Nowadays the most often used regimen is 7 Gy given postoperatively in a single dose. The most commonly prescribed drug in prophylaxis of HO is indomethacin. Also, the efficacy of ibuprofen and diclofenac was proven. Recently researchers focused on selective COX-2 inhibitors. They appear to be as effective as nonselective NSAIDs having less side effects. The one and only treatment of HO is a revision arthroplasty.</jats:p