Aim: To identify whether the location of refractory patella tendinopathy (PT) has an effect on treatment modality (radial extracorporeal shock wave therapy (rESWT) or arthroscopic debridement). Methods: Between 2012 and 2014, 40 patients with PT underwent a magnetic resonance imaging (MRI) scan. This confirmed the diagnosis as either involving the tendon itself (group A, 20) or with retropatella fat pad extension (group B, 20). All patients underwent rESWT. If there was no improvement patients proceeded with surgery in the form of arthroscopic debridement (by senior authors CW and AG). Outcomes were assessed before and after treatment using the Victorian Institute of Sports Assessment-Patella (VISA-P) score. Results: There were 18 males and 2 females in group A and 15 males and 5 females in group B. The mean age was 41.4 years in group A (23-59) and 34.7 in group B (19-52). Seventeen of 20 in group A reported good or excellent outcomes and did not require surgical intervention (remaining three improved after second course of ESWT). All patients in group B failed to improve with rESWT, resulting in arthroscopic debridement and reported good or excellent outcomes. After 6 months, group A mean VISA-P score increased from 50.2 to 65.0 (p ¼ 0.01) and group B from 39.6 to 78.4 (p ¼ <0.001). Conclusion: An MRI should be performed to determine the precise location of tendinosis in patients with refractory PT who fail standard conservative management. If the MRI scan shows intratendon changes only, ESWT should be performed and those with extension into the fat pad should proceed to arthroscopic debridement without rESWT.
We describe two cases of optic neuropathy related to sinus disease. Sinusitis is an uncommon cause of the same. Nonetheless, it demands an accurate diagnosis with prompt, appropriate management which in some cases must be surgical. The cases described highlight the potential for much variability in outcome.
Introduction To report the posterior corneal changes after Bowman Layer Transplant for keratoconus in a tertiary hospital in the UK. Methods 5 eyes of 5 patients receiving Bowman Layer Transplant for advanced keratoconus in Royal Gwent Hospital (Newport, UK) were included. Pre and postoperative posterior corneal astigmatism, posterior Kmean, and back surface elevation were analysed. Results No significant changes were seen in the posterior corneal astigmatism, posterior Kmean, or back surface elevation between the pre- and postoperative period. Conclusion This results would support the idea that the corneal changes seen after Bowman Layer Transplant are mainly in the anterior corneal surface.
Purpose:
To assess the effectiveness and safety of viscocanalostomy (VC) and phaco-viscocanalostomy (PV) surgeries in eyes with a five-year follow-up.
Methods:
Retrospective review of patients who underwent VC and PV between January 2010 and December 2012 in the Stanley Eye Unit Abergele, UK. Patients were included for the analysis if they had a full 5-year follow-up or required redo surgery in the 5-year period. Success was defined as an intraocular pressure (IOP) of <21 mmHg. The subanalysis included IOP <16 mmHg, IOP reduction >20%, and IOP reduction >30%, the complication rate, and the drop in the use of glaucoma medications post-surgery.
Results:
A total of 370 eyes from 303 patients were included for the analysis. The mean preoperative IOP was 23 mmHg ± 5.3 mmHg with an average of 3.0 ± 0.1 medications. By year 5, this was reduced to 14.3 mmHg ± 6.5 mmHg with a mean of 1.0+/- 0.9 medications; 47.8% of the eyes had an IOP of <21 mmHg by year 5 without medication with a total of 92.6% of the eyes reaching this target with medication. The main complication in this group was the perforation of the Trabeculo Descemet’s Window (TDW) but this was not associated with a poorer outcome.
Conclusion:
This large data set of eyes undergoing VC surgery demonstrates the effectiveness and safety of this technique over 5 years.
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