AimsTo study the risk factors associated with blindness after treatment of acute primary angle closure (APAC), and to identify the critical time window to decrease rate of blindness.MethodsIn this multicentre retrospective case series, 1030 consecutive subjects (1164 eyes) with APAC in China were recruited. The rates of blindness were analysed up to 3 months after treatment of APAC. A logistic regression was used to identify the risk factors associated with blindness, including age, gender, distance to hospital, rural or urban settings, treatment method, education level, time from symptom to treatment (TST, hours) and presenting intraocular pressure (IOP). The critical time window associated with a blindness rate of ≤1% was calculated based on a cubic function by fitting TST to the rate of blindness at each time point.ResultsThe rate of blindness after APAC was 12.54% after treatment. In multivariate regression, education level, TST and presenting IOP were risk factors for blindness (p=0.022, 0.004 and 0.001, respectively). The critical time window associated with a blindness rate of ≤1% was 4.6 hours.Conclusions and relevanceEducation level, TST and presenting IOP were risk factors for blindness after APAC. Timely medical treatment is key in reducing blindness after APAC.
This IRB-exempt study utilized unembalmed female human cadavers. Sacrohysteropexy was performed on 6 cadavers, by affixing polypropylene mesh posteriorly on the uterus/ vagina and anchoring it to the anterior longitudinal ligament overlying the S1 sacral vertebrae. A 9/16 to 3/4-inch diameter metal washer was placed above the midline uterine fundus and attached to a 6 inch long, 8/32 diameter bolt that was threaded through a small opening created at the uterine fundus, down the cervical canal, and out the vagina. The vaginal end of the bolt was fastened to a waxed surgical filament oriented parallel to the table and over a fixed pulley at the table's end. Successive weights of 0.5 to 4.0 kg (in 0.5 kg intervals) were added to provide increasing loads on the uterine fundus, and the distances traversed by the fundus were recorded. The same process was repeated after completion of a total hysterectomy (with vaginal cuff closure) and subsequent sacrocolpopexy with posterior mesh placement. Data were analyzed using ANOVA for within group comparisons. The mean distances traversed for each weight for the two procedures were compared using Student's t tests (Sigma Plot version 13.0), with P 0.05 considered statistically significant. RESULTS: The mean age of the cadavers was 75.3 years. Average BMI was 26.6 kg/m2. All specimens were white. Average distances (AE standard deviation) in cm pulled with 0.5, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, and 4.0 kg of traction against the uterine fundus after sacrohysteropexy were 0.7 (AE 0.3), 1.2 (AE 0.5), 1.7 (AE 0.5), 2.2 (AE 0.5), 2.6 (AE 0.6), 2.6 (AE 0.6), 2.9 (AE 0.8), and 3.0 (AE 0.7), respectively. After hysterectomy with sacrocolpopexy, these distances (cm) were 0.7 (AE 0.3), 1.0 (AE 0.4), 1.7 (AE 0.4), 1.8 (AE 0.4), 2.0 (AE 0.4), 2.5 (AE 0.4), 2.7 (AE 0.9), and 3.0 (AE 0.6), respectively. Figure 1 illustrates the distances traversed by the apex for these two procedures. There were no statistical differences in the distances moved between sacrohysteropexy and total hysterectomy/sacrocolpopexy. CONCLUSION: In this study, using each cadaver as its own control, there was no difference in the ability of the uterine fundus (after sacrohysteropexy) compared to the vaginal cuff (after sacrocolpopexy) to resist downward traction of successive weights up to 4 kg, as measured by the apical distance traveled. This suggests that functional support provided by these two procedures may be similar. Further studies are needed to correlate these findings with patient satisfaction, which may vary despite similar anatomic results.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.