Objective To investigate the effectiveness of arthroscopic medial retinaculum plication (MRP) for acute patellar dislocation (APD) in adolescents. Methods Between March 2007 and June 2011, 24 adolescent patients suffering from APD were treated by arthroscopic MRP. There were 14 males and 10 females, aged 8-18 years (mean, 12.7 years). The location was the left knee in 16 cases and the right knee in 8 cases. Injury was caused by sports in 19 cases, by traffic accident in 4 cases, and by heavy bruising in 1 case. The duration from injury to operation was 3 to 21 days with an average of 7.8 days. The results of floating patella test and dislocation apprehension test were both positive. MRI examination showed the arthroedema in all cases; associated injuries included medial retinaculum injury in 20 cases, medial patellar injury in 8 cases, and meniscus tear in 5 cases. Results All incisions healed by first intention without complication of infection or neurovascular injury. All the patients were followed up 12-36 months (mean, 14.6 months). Only 2 patients suffered from patellar re-dislocation at 4 months and 6 months after operation respectively. The knee joint activity returned to normal at 12 months. The Lysholm, Kujala, and International Knee Documentation Committee (IKDC) scores at 3 and 12 months after operation were significantly higher than those before operation (P lt; 0.05), and the scores at 12 months were significantly higher than those at 3 months (P lt; 0.05). Conclusion Treatment of APD with arthroscopic MRP has the advantages of minor trauma and good knee functional improvement. The technique can decrease incidence of patellar re-dislocation in adolescent.
Objective To explore the effectiveness of arthroscopic medial retinaculum pl ication (MRP) for recurrent patellar dislocation in adolescents. Methods Between March 2000 and October 2007, 30 adolescent patients with recurrent patellar dislocation underwent arthroscopic MRP, and 28 of them (12 left knees and 16 right knees) completed thefinal follow-up and were enrolled. There were 5 males and 23 females with an average age of 14.7 years (range, 12-19 years). The dislocation duration was 4 to 39 months with an average of 18.8 months. All patients experienced 2-4 episodes of dislocation. Before operation, all the patients showed positive apprehension test; the degree of lateral patellar translation was (2.9 ± 0.7)° and there was no hardness termination in lateral translation. The International Knee Documentation Committee (IKDC), Lysholm, Kujala, and Tegner scores were 47.7 ± 3.7, 52.6 ± 4.9, 66.7 ± 5.9, and 3.1 ± 1.3, respectively. All patients underwent arthroscopic MRP procedure. Results All incisions healed by first intention without compl ication. All the patients were followed up 2-7 years (4.8 years on average). During the follow-up, more and more patients showed positive apprehension test, and at 24 months of follow-up, 12 patients showed positive apprehension test; less and less patients had hardness termination in lateral translation, only 3 patients at 24 months of follow-up; the degree of lateral patellar translation increased, (2.3 ± 1.1)° at 24 months of follow-up. There were significant differences in positive apprehension test and hardness termination between preoperation and 24 months of follow-up (P lt; 0.05). Moreover, 6 patients suffered from redislocation, and 23 patients experienced patella instabil ity. The IKDC, Lysholm, Kujala, and Tegner scores at 24 months of follow-up were 62.5 ± 6.2, 70.7 ± 5.1, 76.6 ± 4.8, and 3.9 ± 0.7, respectively, showing significant differences when compared with preoperative scores (P lt; 0.05). CT examination showed that the congruence angle, lateral patellar angle, and patellar tilt angle were recovered to normal level after operation immediately, however, the final patellar position at 24 months of follow-up was not significantly betterthan that before surgery (P gt; 0.05). There was significant difference in the lateral patellar displacement between preoperation and 24 months of follow-up (P lt; 0.05). Conclusion Arthroscopic MRP is not rel iable for maintaining the corrected position of the patella for recurrent patellar dislocation in adolescents, though functional improvements are significant.
Objective To investigate the procedure and effectiveness of medial patellofemoral l igament (MPFL) reconstruction for the treatment of recurrent patellar dislocation. Methods Between June 2005 and September 2007, 29 patients with recurrent patellar dislocation underwent MPFL reconstruction with allograft semitendinosus or allograft anterior tibial is tendon. There were 6 males and 23 females with an average age of 20.3 years (range, 13-45 years). The patients sufferedfrom 2-10 times patellar dislocation preoperatively. The average time between last dislocation and surgery was 43.9 months (range, 1-144 months). CT scan was performed to measure the tibial tuberosity-trochlear groove distance (TT-TG). The femoral tunnel was made at the origin of MPFL insertion, just inferior to the medial epicondyle. The double L-shape patellar tunnels were made on the medial rim of patella with 4.5 mm in diameter. The loop side of the graft was fixed with a bioabsorbable interference screw in the femoral tunnel both ends of the graft. For the TT-TG was more than 20 mm, a modified Elmsl ie-Trillat osteotomy was performed to correct the distal al ignment of patella. The arthroscopic examination was also performed for loosebody and lateral retinacular release. Results Twenty-seven patients were followed up 45.5 months on average (range, 40-67 months). No recurrent dislocation or subdislocation occurred. All the patients showed negative apprehension test at 0° and 30° flexions of knee. The range of motion of knee restored normal 1 year after operation. The Kujala score was improved from 72.03 ± 17.38 preoperatively to 94.10 ± 7.59 postoperatively, and Lysholm score was improved from 72.65 ± 14.70 to 95.44 ± 6.25, both showing significant differences (P lt; 0.05). The Tegner score was decreased from 5.25 ± 1.83 preoperatively to 4.33 ± 1.00 postoperatively, showing no significant difference (t=1.302, P=0.213). In patients whose TT-TG was more than 20 mm, TTTG was decreased from (23.38 ± 3.70) mm to (16.88 ± 5.92) mm at last follow-up, showing significant difference (t=2.822,P=0.026). Conclusion The technique of MPFL reconstruction is an effective surgical procedure for the treatment of recurrent patellar dislocation, which can improve the patella stabil ity and knee function.
Objective To evaluate the effects of vitrectomy with internal limiting membrane (ILM) peeling on epiretinal membrane and visual acuity of rhegmatogenous retinal detachment (RRD) with severe proliferative vitreoretinopathy (PVR). Methods Sixty-two patients with RRD and PVR (C3 - D2) were enrolled in this study. The patients were divided into two groups: 30 patients in group A had undergone conventional vitrectomy; 32 patients in group B had undergone vitrectomy and ILM peeling. All patients had been tamponaded by silicone oil after the operation. The logarithm of minimal angle of resolution (logMAR) visual acuity in group A and B before the operation were 1.47±0.38 and 1.44±0.33 respectively, the difference between two groups was not statistically significant (F=0.089，P=0.766). The followup period was 9-12 months. The silicone oil was removed three months after the operation. LogMAR visual acuity, ocular fundus, and optical coherence tomography had been followed up. Results Epimacular membrane formation was found in seven eyes (23.3%) in group A, but none in group B, the difference was significant (χ2＝8.42, P＝0.004). The logMAR visual acuity increased significantly both in group A (0.70±0.22) and B (0.57±0.17) at the last visit (t=16.881, 17.887; P=0.000). The logMAR visual acuity in group B was better than that in group A (t=2.497, P=0.015), the difference of vision improvement was not significant between those two groups (F=2.084, P＝0.153). Conclusions Vitrectomy with ILM peeling can significantly inhibit the epimacular membrane formation and improve the visual acuity in eyes with RRD and severe PVR.
Objective To compare the macular imaging and measurements of patients with idiopathic epiretinal membranes (ERM) by stratus optical coherence tomography (OCT) and two different types of spectral-domain OCT. Methods Forty-six consecutive patients (46 eyes) diagnosed as idiopathic ERM in the period of August 2008 to October 2008 were enrolled in this study. The patients included 11 males and 35 females, with a mean age of (61.04plusmn;10.13) years. Twenty-one age- and sex- matched normal subjects (21 eyes) were enrolled in this study as control group. All the subjects underwent stratus OCT, cirrus OCT and 3D OCT-1000 examinations. The macular area was divided into three concentric circles which including central region with 1 mm diameter, inner area with ＞1 mm but le;3 mm diameter, and outer ring area with ＞3 mm but le;6 mm diameter. The inner area and outer ring area were divided into superior, nasal, inferior and temporal quadrants by two radioactive rays. The characteristics of OCT images and the quantitative measurements were compared among these three machines. The macular thickness of ERM group and control group was also compared. And the correlation of visual acuity and the macular thickness in idiopathic ERM patients was evaluated. Results The increased macular retinal thickness, disorder structure of inner retina, uneven surface and proliferative inner and outer plexiform layer were observed in ERM group by stratus and spectral-domain OCT. But the minor pathological changes on inner retina structure and internal surface proliferation could be observed more clearly by spectral-domain OCT than those by stratus OCT.The macular thicknesses of all the subjects measured by Cirrus OCT and 3D OCT-1000 were thicker than those measured by Stratus OCT (t=7.445-11.253,P=0.000). The correlations of measurements between three OCTs were good (r＞0.9). The flatted or disappeared fovea of ERM patient group was observed by all three OCTs. The macular thicknesses on different subfields of patients in ERM group were thicker than those in control group, especially in the 1-3 mm inner ring (t=2.477-10.139,P＜0.05). Moderate negative correlations were shown on the macular thickness and visual acuity in ERM group (r=-0.216-0.517). Conclusions Spectral domain OCT yields better visualization of the intraretinal layers than time domain OCT. The images in spectral domain OCT are more clear and fine compared to stratus OCT. Stratus OCT correlates with spectral domain OCT, but they are different, and cannot be replaced by each other.
Objective To investigate the protective effect of blocking the signal path of p38 mitogen activated protein kinase on blood retinal barrier (BRB) and retinal ganglion cells (RGC) in early diabetic rats.Methods A total of 60 Wistar rats were divided into the control and diabetes group, with 30 rats in each group. Diabetes was induced in rats in diabetes group by peritoneal injection of streptozotocin (STZ);the plasma glucose level of ＞16.7 mmol/L indicated that the diabetes model was set up successfully.The rats in the control group underwent peritoneal injection of equivalent sodium citrate solution. IgG leakage method was used to measure the damage of BRB function and vascular leakage. The expression and localization of caspase-3 and vascular endothelial growth factor (VEGF) in retina of diabetic rats were examined by immunohistochemistry analyses.Two weeks after the establishment of the diabtes model, the rats in diabtes group underwent intravitreal injection with SB203580, a p38 inhibitor;six weeks after the injection, the expression of caspase-3 and VEGF was detected, and the number of apoptosis RGC was counted via immunofluorescence technique.Results In the contral group, IgG staining located in the blood vessels with little leakage; while the IgG leakage was much more obvious in the diabetes group eight weeks after the establishment of the model. Six weeks after intravitreal injection with SB203580, the leakage decreased in diabtes rats. The results of semiquantitative analysis and fluorescence immunohistochemistry showed that compared with the results in diabetes rats 8 weeks after intravitreal injection (2.9 times much more than that in the control group), the fluorescence expression of VEGF decreased in diabetes rats six weeks after intravitreal injection (1.8 times much more than that in the control group).The apoptisis RGC number in rats 6 weeks after intravitreal injection of SB203580 was much less than that in rats without intravitreal injection (t＝5.731, Plt;0.01). Conclusions SB203580 can alleviate the disruption of BRB and apoptosis of RGC in early diabetes rats, which suggests that p38 MAPK pathways appear to be directly involved in the pathogenesis of early diabetic retinopathy.
Objective To quantitatively assess the damage of blood-retinal barrier (BRB) in rats with diabetic retinopathy using dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI). Methods Forty 3-week-old Sprague-Dawley (SD) rats were randomly divided into experiment and control group. The rats in experiment group underwent intraperitoneal injection of streptozotocin. The rats with blood glucose over 16.65 mmol/L and ldquo;+++rdquo; of urine glucose were considered as diabetes and were further divided into four subgroups according to the course of diabetes mellitus (2, 4, 6, and 8 months).The rats in control group underwent intraperitoneal injection with the same volume of buffer and were divided into four subgroups (with 5 rats in each subgroup) according to the coordinate age of rats in experimental group.All of the eyeballs were scanned by DCE MRI and enucleation was performed after intraperitoneal injection with pentobarbitone.The data were analyzed by SPSS 12.0 statistical software.Results All the rats in experiment group became diabetic models. There was no obvious BRB permeability in control group and in 2- and 4-months experiment group.The average BRB permeability rate in 6 and 8 month experiment groups were (0.1399plusmn;0.0065) and (0.1816plusmn;0.2756) mm3/min respectively (Z=-2.121, Plt;0.05). Retinal edema and cellular disorganization appeared at 4 months and became more severe when diabetes course extended.Conclusions DCE MRI can measure the BRB permeability rate accurately and assess the extent of BRB damage quantitatively in rats with diabetic retinopathy.
The debate on the cell of origin of human retinoblastoma lasted for more than one century. In the recent issue of ldquo;cellrdquo;, David Cobrinikprime;s group shows that L/M cone precursors are the most likely answer as they have an intrinsic circuitry, including murine double minute 2 (MDM2), Nmyc, the nuclear receptors retinoid X receptor and thyroxine receptor 2, making them extremely sensitive to transformation following retinoblastoma gene inactivation.
Objective To investigate the histological changes of the internal limiting membrane (ILM) in pathological myopic eyes, and the relationships between those changes and the formation of macular hole.Methods The clinical data of 34 patients （34 eyes）with pathological myopia and macular hole, who had undergone vitrectomy were retrospectively analyzed. All the patients had a diopter over -6.00 D, their ocular axial length ranged from 26.00 to 33.12 mm with an average of 27.74 mm. There were 5 eyes without retinal detachment （macular hole group）while the other 29 eyes all had posterior retinal detachment（RD group）. A standard threeport pars plana vitrectomy was performed in all eyes. The existence of Weiss ring was considered as the sign of posterior vitreous detachment. The epiretinal membranes from 34 eyes and ILM specimens from 19 eyes were stained by hematoxylineosin (HE) and acetate uranyl acetatelead citrate, and then investigated under optical microscope and transmission electron microscope. Results The Weiss ring was observed in 5 eyes during the surgery, multilayer of vitreous tissue resides on the retinal surface in 24 eyes. The results of optical microscope showed that the epiretinal membranes were composed of vitreous collagen, astrocytes and extracellular matrixes. The results from transmission electron microscope showed a sandwich structure (ILMvitreous collagencells) in 5 eyes, and ILM damage, surface traction and astrocytes migration in 1 eye. Conclusions Splitting of posterior surface of vitreous and surface structure change of ILM are the major mechanisms for the formation and progression of macular holes, and even retinal detachment in high myopic eyes.
Objective To investigate the relationship among central retinal vein occlusion (CRVO), major systemic diseases, ocular local diseases and related risk factors in Chinese population. Methods Seventeen-six patients with CRVO diagnosed by fundus fluorescein angiography (FFA) without any medical treatment were in CRVO group. Another 76 patients without CRVO or any vascular diseases of ocular fundus were in the control group who were matched with the ones in CRVO group to a one-to-one partnership according to the age and gender. The 2 groups were subdivided into le;45 years old (25 patients, 32.9%) and gt;45 years old (51 patients, 67.1%) subgroups according to the age, and 2 ischemia and non-ischema subgroups according to the results of FFA, respectively. The blood lipid, blood pressure, and fasting blood glucose were measured. The systematic diseases, ocular local diseases and the related risk factors were statistically analyzed and compared. Results The incidence of hypertension and hyperlipemia in CRVO group were significantly higher than that in the control group (Plt;0.001,P=0.001). There was no significant difference of cardiovascular diseases, cerebrovascular diseases, open-angle glaucoma, and smoking and drinking between the two groups(Pgt;0.05). In le;45 years old subgroups, there was no significant difference of each examination target between CRVO and control group(Pgt;0.05). In ischemia subgroups, except for the hypertension and hyperlipemia, the incidence of diabetes mellitus was obviously higher in CRVO group than that in the control group (hyperlipidemia:P=0.031; diabetes mellitus:P=0.024; diabetes mellitus: Plt;0.001). Conclusion Hypertension and hyperlipidemia are the systematic factors in Chinese population with occurrence of CRVO. In addition, diabetes mellitus is associated with ischemic CRVO. Timely diagnosis and treatment of the systematic diseases is important to the prevention and treatment for CRVO. (Chin J Ocul Fundus Dis, 2007, 23:159-162)