Angle Surgery Research Articles

One-year results of double site versus single site rigid probe viscotrabeculotomy in primary congenital glaucoma.

to compare single- site viscotrabeculotomy in one eye and double-site rigid probe viscotrabeculotomy in the other eye of the same patient with Primary congenital glaucoma to evaluate the effect of the extent of angle treatment on success rate in the study's locality. This prospective randomized study included 70 eyes of 35 children diagnosed with bilateral PCG who attended Mansoura Ophthalmic Center from June 2021 to July 2023. For each patient, one eye underwent single-site rigid probe viscotrabeculotomy (Group S: 35 eyes) and the fellow eye underwent double- site rigid probe viscotrabeculotomy (Group D: 35 eyes). At one-year follow up, complete success was defined as IOP >5 mmHg and ≤16 mmHg without any further IOP-lowering medications and qualified success when IOP ≤16 mmHg with using IOP-lowering medications. Failure was defined as IOP more than 16 mmHg despite the use of IOP-lowering medications, the need for other glaucoma surgery to control IOP or hypotony. Single-site rigid probe viscotrabeculotomy showed a one-year complete success rate of 88.57% and for double-site viscotrabeculotomy was 91.43% but the difference was not statistically significant (p-value 0.9). There were no major complications in both groups, hyphema was the most common complication and was self-limited. Single-site viscotrabeculotomy shows comparable results to double-site viscotrabeculotomy in PCG preserving more than half of the angle in the former for a second possible angle surgery in recurrent cases.

Primary Congenital and Childhood Glaucoma—A Complex Clinical Picture and Surgical Management

Childhood glaucoma encompasses a group of rare but severe ocular disorders characterized by increased intraocular pressure (IOP), posing significant risks to vision and quality of life. Primary congenital glaucoma has a prevalence of one in 10,000–68,000 people in Western countries. More worryingly, it is responsible for 5–18% of all childhood blindness cases. According to the Childhood Glaucoma Research Network (CGRN), this spectrum of disease is classified into primary glaucoma (primary congenital glaucoma and juvenile open-angle glaucoma) and secondary glaucomas (associated with non-acquired ocular anomalies, non-acquired systemic disease, acquired conditions, and glaucoma after cataract surgery). They present very specific ocular characteristics, such as buphthalmos or progressive myopic shift, corneal modifications such as Haab striae, corneal edema or increased corneal diameter, and also glaucoma findings including high intraocular pressure, specific visual fields abnormalities, and optic nerve damage such as increased cup-disc ratio, cup-disc ratio asymmetry of at least 0.2 and focal rim thinning. Surgical intervention remains the cornerstone of treatment, and initial surgical options include angle surgeries such as goniotomy and trabeculotomy, aimed at improving aqueous outflow. For refractory cases, trabeculectomy and glaucoma drainage devices (GDDs) serve as second-line therapies. Advanced cases may require cyclodestructive procedures, including transscleral cyclophotocoagulation, reserved for eyes with limited visual potential. All in all, with appropriate management, the prognosis of PCG may be quite favorable: stationary disease has been reported in 90.3% of cases after one year, with a median visual acuity in the better eye of 20/30. Immediate recognition of the specific signs and symptoms by caregivers, primary care providers, and ophthalmologists, followed by prompt diagnosis, comprehensive surgical planning, and involving the caregivers in the follow-up schedule remain critical for optimizing outcomes in childhood glaucoma management.

Two-year randomized controlled trial of circumferential versus segmental ab externo angle surgery in patients with primary open angle glaucoma.

To compare the surgical outcomes of visco-circumferential-suture-trabeculotomy (VCST) and rigid probe segmental viscotrabeculotomy (VT) in primary open-angle glaucoma (POAG). A prospective randomized controlled study. Patients presenting with POAG and operated upon in Mansoura Ophthalmic Center in Mansoura, Egypt between February 2017 and September 2021 were enrolled. Study eyes were randomized to either VCST or VT and follow up extended for 24 months. Success was defined as an intra ocular pressure (IOP)≤18 mmHg with a 40% reduction from baseline. Complications were noted. The study enrolled 166 (82 in the circumferential group) eyes of 107 patients. There were no statistically significant differences between both groups in any demographic or preoperative clinical characteristics. The IOP trend demonstrated marked initial reduction (from 32.3±2.4 and 31.8±2.6 mmHg preoperatively in VCST and VT groups respectively) followed by a slow gradual rise over subsequent follow-up settling at lower IOP values in the circumferential (12.4±1.2 mmHg) than in the segmental group (15.5±0.9 mmHg) (p<0.001), both settling at significantly lower levels than preoperative values. The survival curve demonstrates complete success rates at 12, 15, 18, and 24 months were 98.8%, 96.4%, 95.1%, and 85.4% in the circumferential group and 98.8%, 92.9%, 91.7%, 79.8% in the segmental group respectively. Minimal self-limiting hyphema was universal in all study eyes. Angle procedures -segmental and circumferential- are effective in lowering the IOP for at least 2 years in eyes with POAG, with circumferential angle surgery providing a greater reduction of IOP and requiring fewer subsequent glaucoma procedures.

The Intraosseous Subarcuate Loop of Anterior Inferior Cerebellar Artery: Anatomic Management Guide, Single-Center MRI Study, and Scoping Review

BACKGROUND AND OBJECTIVES: The intraosseous subarcuate loop (SL) is a unique variant of the anterior inferior cerebellar artery (AICA), where a loop of the artery is trapped in the petrous bone's subarcuate fossa (SF). Recognizing this variant is crucial for planning cerebellopontine angle (CPA) surgeries; however, data regarding its frequency and management vary in the published literature. A cohort from a single center was studied using MRI to assess its prevalence, and the findings were compared with the existing literature. In addition, an intraoperative guide for mobilizing the intraosseous AICA's SL was provided through a detailed step-by-step cadaveric dissection. METHODS: Two hundred fifty-eight patients who had undergone MRI scans of the CPA (516 sides) were retrospectively reviewed. MRIs displaying vascular loops visible in the axial view were analyzed using multiplanar reconstruction, and the intraosseous loop frequency was evaluated. A scoping review was undertaken to provide an overview of previously published data on its prevalence. One embalmed and latex-injected specimen with intraosseous AICA's SL was dissected through a retrosigmoid approach, and 1 surgical case was detailed, describing the procedure to release it. RESULTS: Intraosseous AICA's SL mobilization involves the identification of its entry and exit points within the petrous bone, dural incision to expose the SF, SF drilling, subarcuate artery division, and detaching the vascular loop. Preservation of a dural cuff is crucial to prevent vascular injury. We analyzed 258 brain MRIs (mean age 55 years, 42% male). The intraosseous AICA's SL was present in 4 of 516 evaluated CPAs (0.8%). The prevalence of the vascular anomaly in the reviewed literature using different radiological modalities ranged from 0.2% to 1.6%. CONCLUSION: The intraosseous AICA's SL is an uncommon anatomic variation detectable by MRI, posing an added risk in CPA surgery. Identifying and properly mobilizing it is crucial for safe vascular preservation.

Treatment patterns of childhood glaucoma in the United States: Analysis of IRIS® Registry (Intelligent Research in Sight)

PurposeTo investigate treatment patterns of childhood glaucoma in the United States. DesignRetrospective clinical cohort study SubjectsPatients under 18 years of age with a diagnosis code for glaucoma between January 1, 2013, and December 31, 2020, in the IRIS® Registry (Intelligent Research in Sight). MethodsPatient demographic information and clinical characteristics were extracted. A Cox regression model was used to determine predictors of undergoing incisional glaucoma surgery. Main Outcome MeasuresThe primary outcomes were the percentage of childhood glaucoma eyes that underwent glaucoma-related procedures and those receiving intraocular pressure (IOP)-lowering medications. Our secondary outcomes were hazard ratios (HRs) of demographic and clinical factors for undergoing incisional surgeries. ResultsA total of 5017 eyes of 3069 patients were included in this study. Based on billing codes, 208 eyes (4.1%) had primary congenital glaucoma (PCG), 1911 eyes (38.1%) had juvenile open-angle glaucoma (JOAG), 999 eyes (19.9%) had glaucoma following cataract surgery (GFCS), and 1646 (32.8%) had secondary glaucoma other than GFCS. Out of 5017 eyes with childhood glaucoma, 808 eyes (16.1%) underwent glaucoma-related procedures, and 4698 eyes (93.6%) received antiglaucoma medications. Angle surgery was the most common first-recorded procedure for PCG, and tube shunt surgery for GFCS and secondary glaucoma. Laser trabeculoplasty was mainly performed for JOAG by non-glaucoma subspecialists. Factors associated with higher likelihood of incisional surgeries were PCG (vs. JOAG, HR 5.40, 95% confidence interval [CI] 1.55–18.84, p = 0.008), increase in IOP (HR 1.06 per mmHg, CI 1.05–1.08, p<0.001), and index date at age < one year (vs. ages 11–15 years, HR 6.08, CI 1.51 – 24.44, p = 0.011). Being cared for by a non-glaucoma subspecialist was associated with a lower likelihood of undergoing incisional surgery (HR: 0.32 (95%CI: 0.23 – 0.44, p<0.001). ConclusionsWe found that 1 in 6 childhood glaucoma eyes underwent glaucoma-related procedures, and nearly all received antiglaucoma medications. The choice of first-recorded procedure differed across age and diagnosis. Type of glaucoma, baseline IOP, age, and type of treating subspecialist were predictors for undergoing incisional glaucoma surgery.

Short-Term Outcomes of High-Density Porous Polyethylene Orthoses for Chin and Gonial Angle Augmentation.

This retrospective observational study evaluated 100 patients over 18years. Data on age, sex, aesthetic complaints, surgery types, and postoperative complications were collected and analyzed using the two-proportion z-test and descriptive statistics in RStudio 4.3.3. All patients with neuropraxia underwent neurosensory evaluation. The average age was 35.92years for males and 33.71years for females, with a male predominance (76%). Aesthetic complaints were prevalent in 72% of patients (p < 0.01). Chin surgery was performed on 56% of patients, jaw angle surgery on 17%, and both on 39%. Complications included one case of suture dehiscence, three wound infections, and four transient cases of paresthesia, all resolving within 30days. Overall, patient satisfaction with outcomes was high. High-density porous polyethylene implants proved effective and safe in enhancing facial aesthetics and correcting mandibular deformities. Further research should focus on long-term outcomes to consolidate these findings. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Distribution of Port-Wine Birthmarks and Glaucoma Outcomes in Sturge-Weber Syndrome

PurposeTo identify which features of Sturge-Weber Syndrome (SWS) were most associated with glaucoma onset, severity, and treatment failure at a tertiary care center. DesignRetrospective cross-sectional study. SubjectsChildren who had SWS with and without glaucoma. MethodsElectronic health records were reviewed for all children with SWS presenting between 2014-2020. Examination and imaging findings from dermatology, neurology, and ophthalmology were collected. Logistic regression was used to identify factors associated with glaucoma-related outcomes. Main Outcome MeasuresPrimary outcomes included glaucoma development, progression to surgery, and treatment failure. Failure was defined as having a final intraocular pressure >21 mmHg, devastating complication, or ≤20/200 vision. ResultsTwenty-three of 44 SWS patients (52.3%) developed glaucoma, and 6 of 23 patients (26.1%) had both eyes affected. Sixteen of 29 eyes (55.2%) required surgery, and 29.6% overall met our failure criteria (mean follow-up: 5.1±4.3 years). Glaucoma diagnosis was associated with bilateral port wine birthmarks (PWB; OR 5.9; 95% CI 1.3-43.2), PWB with any lower eyelid involvement (OR 9.7, 95% CI 2.6-44.5), and choroidal hemangiomas (OR 3.8, 95% CI 1.1-13.8), but was not associated with upper eyelid or leptomeningeal angiomas, seizures, prior hemispherectomy or pulsed-dye laser. Eyes that progressed to surgery were more likely to have PWB affecting the lower eyelid (OR 33.7, 95% CI 4.5-728.0). No clinical or demographic factors were associated with treatment failure. In most cases, angle surgery failed (72.7%) but was a temporizing measure before subconjunctival filtering surgery. ConclusionsLower eyelid and choroidal angiomas were associated with glaucoma diagnosis, suggesting a spatial relationship with SWS findings. However, leptomeningeal angiomas were not associated possibly because these are further from the eye.

In Vivo Assessment of the Pediatric Trabecular Meshwork, Schlemm Canal, and Iridocorneal Angle Using Overhead-Mounted Optical Coherence Tomography

PurposeTo describe the in vivo morphologic characteristics of the trabecular meshwork (TM), Schlemm canal (SC), and iridocorneal angle in pediatric patients with normal eyes, glaucoma and cataract. DesignProspective cohort study Study population70 eyes (41 children) were enrolled. 28 normal eyes, 19 eyes with glaucoma, and 26 eyes with cataract (15 pre-, 11 post-lensectomy). Average age was 2.8±3.0 years at imaging. MethodsPediatric patients undergoing clinically indicated examination under anesthesia underwent overhead-mounted optical coherence tomography (OCT) imaging of the outflow pathway. Images were then evaluated for abnormalities in the outflow pathway. Main outcome measurePresence of thickened TM, SC patency, any iridocorneal angle malformation, and episcleral vessel patency in normal eyes vs. all other eyes. ResultsThickened TM tissue was found in no normal eyes, 47.4% of eyes with glaucoma, and 53.8% of eyes with cataracts. A patent SC was demonstrated in all normal eyes, 32% with glaucoma, and 65.4% with cataracts. Iridocorneal angle abnormality was identified in no normal eyes, 94.7% with glaucoma, and 69.2% with cataracts. Prevalence of iridocorneal angle abnormality was similar in cataract eyes pre- and post-lensectomy. All but one eye with glaucoma secondary to anterior segment dysgenesis had patent episcleral vessels. Intraocular pressure (IOP) at imaging was lower in eyes with than without a patent SC (13.9±3.8mmHg vs. 28.2±11.7mmHg, p<0.001). IOP was lower in eyes with normal iridocorneal angles compared to those with angle malformation (13.9±3.2mmHg vs. 22.6±12.1mmHg, p<0.001). There was no significant difference in IOP between eyes with normal TM thickness compared to those with thickened TM (17.4±8.2mmHg vs.17.4±9.5mmHg, p = 0.943). ConclusionEyes of children with glaucoma demonstrated thickened TM, decreased patency of SC, and abnormalities of the iridocorneal angle on OCT imaging, compared to normal controls. These abnormal findings also appear in many pediatric eyes with cataracts, even prior to lensectomy. Future study is warranted to evaluate the role these structural differences may play in the development of glaucoma following cataract surgery and the significant variation in how individual glaucoma eyes respond to angle surgery.

Visual and surgical outcomes of childhood glaucoma following cataract surgery

PurposeTo evaluate frequency of surgery and post-treatment outcomes in glaucoma following cataract surgery (GFCS). MethodsThe medical records of patients with GFCS were reviewed retrospectively. Lensectomy and glaucoma surgery details and final examination findings were collected. Inclusion criteria included history of lensectomy at <1 year of age, diagnosis of glaucoma, and at least 1 year of follow-up. ResultsOf 169 eyes of 127 GFCS patients (66 male, 58 bilateral cases), 88 eyes (52%) of 73 (57%) patients underwent glaucoma surgery (median, 3.5 years of age at first glaucoma surgery; median of two glaucoma surgeries). At final follow-up (mean, 13.6 ± 7.0 years), eyes requiring glaucoma surgery had worse visual acuity (P = 0.01) and greater cup:disk ratio (P < 0.01). GFCS patients with history of bilateral congenital cataracts had better visual acuity in affected eyes than those with history of unilateral congenital cataract (P < 0.01). Angle surgery (n = 56), Baerveldt devices (n = 38), Ahmed valves (n = 19), and cycloablation (n = 21) showed 1-year survival rates between 64% and 75%. Baerveldt implants showed the highest 5- and 10-year survival rates, at 65% and 43%, respectively. ConclusionsMore than 50% of eyes with GFCS in our study cohort required at least one glaucoma surgery. Glaucoma surgery and history of unilateral cataract were associated with worse visual acuity outcomes.

Hard and Soft Tissue Facial Landmarks for Mandibular Angle Reduction: A Clinical Study.

Square faces, which are influenced by genetic factors and structural features, are considered undesirable among the Asian population. Surgical interventions, such as mandibular angle reduction, aim to alter these characteristics, though complications may arise. We aimed to investigate the morphology of the mandibular angle and masseter muscle thickness using computed tomography (CT) and to analyze hard and soft tissue correlations to enhance surgical outcomes for patients with square faces. This retrospective clinical study included 100 Taiwanese patients aged 18-50 years. CT was used to analyze key clinical parameters, including bilateral mandibular width, mandibular divergence angle, ramus height, distance from the mandibular angle to the inferior alveolar nerve (IAN), and the thickness of the masseter muscle. Significant correlations were noted between the patients' physical height and weight, mandibular width, ramus height, masseter thickness, and distance from the angle to the IAN. Males exhibited a significantly longer and thicker ramus height (66.48 ± 4.28 mm), greater masseter thickness (15.46 ± 2.35 mm), and greater safety range for mandibular angle reduction surgery (18.35 ± 3.19 mm) (p < 0.00008). Significant correlations were observed among all parameters, except between mandibular width and gonial angle and the distance from the angle to the IAN and between mandibular divergence and masseter muscle thickness (p > 0.1). Our study highlighted the complex interplay among factors that contribute to square facial morphology. Careful preoperative assessments and customized surgical planning are essential for addressing this multifaceted clinical challenge.

Clinical, Anatomical, and Histological Features of the Rhomboid Lip and Considerations for Surgery Using a Retrosigmoid Approach: A Retrospective Study

The rhomboid lip is a neural tissue encountered during cerebellopontine angle surgery, with differing shape and extent among individuals. This study aimed to investigate the variation of rhomboid lips during posterior fossa surgery. In this retrospective study, we examined posterior cranial fossa surgeries performed using a retrosigmoid approach. Rhomboid lips were classified according to thickness, extent, and appearance, with some subjected to histological analysis. T2-weighted magnetic resonance imaging (MRI) of rhomboid lips was conducted. Among 304 surgeries, rhomboid lips were observed in 75 patients who underwent schwannoma or meningioma resection, facial spasm-related neurovascular decompression, and other surgeries (37, 2, 32, and 4 patients, respectively). Rhomboid lips were categorized based on apparent thickness: thin membranous type, resembling an arachnoid membrane, and thick parenchymal type. Rhomboid lip extension was classified by position relative to the choroid plexus: non-extension, lateral extension, and jugular foramen (41, 22, and 12 patients, respectively). Veins were observed on the rhomboid lip surface in 37 cases. The rhomboid lip was visible in only one case (parenchymal jugular foramen type) on MRI. Histologically, the rhomboid lip comprised an ependymal cell layer, a glial layer, and connecting tissue. The glial layer thickness determined the rhomboid lip thickness, which was greater in the parenchymal type than in the membrane type. In 42 patients, the rhomboid lip was dissected, with no complications observed. Morphological classification of the rhomboid lip and understanding of its anatomical details contribute to safe surgical field development for neurosurgeons.

Single-Center Experience in Microsurgical Resection of Acoustic Neurinomas and the Benefit of Microscope-Based Augmented Reality.

Background and Objectives: Microsurgical resection with intraoperative neuromonitoring is the gold standard for acoustic neurinomas (ANs) which are classified as T3 or T4 tumors according to the Hannover Classification. Microscope-based augmented reality (AR) can be beneficial in cerebellopontine angle and lateral skull base surgery, since these are small areas packed with anatomical structures and the use of this technology enables automatic 3D building of a model without the need for a surgeon to mentally perform this task of transferring 2D images seen on the microscope into imaginary 3D images, which then reduces the possibility of error and provides better orientation in the operative field. Materials and Methods: All patients who underwent surgery for resection of ANs in our department were included in this study. Clinical outcomes in terms of postoperative neurological deficits and complications were evaluated, as well as neuroradiological outcomes for tumor remnants and recurrence. Results: A total of 43 consecutive patients (25 female, median age 60.5 ± 16 years) who underwent resection of ANs via retrosigmoid osteoclastic craniotomy with the use of intraoperative neuromonitoring (22 right-sided, 14 giant tumors, 10 cystic, 7 with hydrocephalus) by a single surgeon were included in this study, with a median follow up of 41.2 ± 32.2 months. A total of 18 patients underwent subtotal resection, 1 patient partial resection and 24 patients gross total resection. A total of 27 patients underwent resection in sitting position and the rest in semi-sitting position. Out of 37 patients who had no facial nerve deficit prior to surgery, 19 patients were intact following surgery, 7 patients had House Brackmann (HB) Grade II paresis, 3 patients HB III, 7 patients HB IV and 1 patient HB V. Wound healing deficit with cerebrospinal fluid (CSF) leak occurred in 8 patients (18.6%). Operative time was 317.3 ± 99 min. One patient which had recurrence and one further patient with partial resection underwent radiotherapy following surgery. A total of 16 patients (37.2%) underwent resection using fiducial-based navigation and microscope-based AR, all in sitting position. Segmented objects of interest in AR were the sigmoid and transverse sinus, tumor outline, cranial nerves (CN) VII, VIII and V, petrous vein, cochlea and semicircular canals and brain stem. Operative time and clinical outcome did not differ between the AR and the non-AR group. However, use of AR improved orientation in the operative field for craniotomy planning and microsurgical resection by identification of important neurovascular structures. Conclusions: The single-center experience of resection of ANs showed a high rate of gross total (GTR) and subtotal resection (STR) with low recurrence. Use of AR improves intraoperative orientation and facilitates craniotomy planning and AN resection through early improved identification of important anatomical relations to structures of the inner auditory canal, venous sinuses, petrous vein, brain stem and the course of cranial nerves.

Outcome of illuminated microcatheter-assisted circumferential trabeculotomy following failed angle surgery in PAX6 aniridic glaucoma: a case report and literature review

BackgroundAniridia is a rare eye disorder with a high incidence of glaucoma, and surgical intervention is often needed to control the intraocular pressure (IOP). Here, we reported a case of illuminated microcatheter-assisted circumferential trabeculotomy (MAT) performed on an aniridic glaucoma patient following a previous failed angle surgery. The surgical procedures for aniridic glaucoma were also reviewed.Case presentationA 21-year-old man, diagnosed with aniridic glaucoma, came to our hospital consulting for the poor control of left eye’s IOP despite receiving goniotomy surgery 3 years ago. The IOP was 26 mmHg with maximum topical antiglaucoma eyedrops. The central cornea was opaque and the majority of iris was absent. The gonioscopy and ultrasound biomicroscopy (UBM) demonstrated that 360° anterior chamber angle was closed. The whole exome sequencing of peripheral blood confirmed a 13.39 Mb copy number loss at chromosome 11p15.1p13, containing PAX6 and WT1 gene. The 360° MAT surgery was performed on his left eye. At 1-year follow-up, the IOP was 19mmHg with 2 kinds of topical antiglaucoma medications, and the postoperative UBM demonstrated the successful incision of the anterior chamber angle.ConclusionsThe case presented here exhibited a case of aniridic glaucoma treated by MAT surgery. The MAT surgery may be an effective option for IOP control in aniridic glaucoma patients following a previous failed angle surgery.

What Is the Correlation between Coronal Plane Alignment Measured on Pre- and Postoperative Weight-bearing Radiographs and Intraoperative Navigation When Stress Is Applied to the Knee?

This study examines the correlation between the weight-bearing (WB) long leg radiograph (LLR)-derived hip-knee-ankle angle (HKAA) and intraoperative supine computer-assisted surgery (CAS)-derived HKAA measurements at the beginning and end of total knee arthroplasty (TKA). The primary aim of the study was to determine if WB alignment could be mimicked or inferred based on intraoperative alignment findings. We conducted a prospective analysis from a cohort of 129 TKAs undergoing a CAS TKA at a single center by a single surgeon. The HKAA was recorded using the CAS navigation system immediately postregistration of navigation data and after implantation of the prosthesis. The intraoperative HKAA was recorded in both the supine "resting" position of the knee and also while the knee was manipulated in an effort to replicate the patient's WB alignment. These measurements were compared with the HKAA recorded on pre- and postoperative WB LLRs. There was a strong correlation between the preoperative WB LLR HKAA and the intraoperative preimplant CAS-derived stressed HKAA (R = 0.946). However, there was no correlation between the postoperative WB LLR HKAA and the postimplant insertion HKAA as measured intraoperatively via CAS for either a "resting" or "stressed" position of the operated knee (R = 0.165 and R = 0.041, respectively). Thus, the interpretation of intraoperative alignment data is potentially problematic. Despite technological advances in the development and utilization of computer navigation and robotics in arthroplasty to help obtain the optimal alignment, it would seem apparent from our study that this alignment does not correlate to upright stance postoperatively. Surgeons should apply caution to the strength of assumptions they place on intraoperative coronal plane alignment findings.

Factors and outcomes associated with corneal edema and Haabs striae in primary congenital glaucoma

PurposeTo identify specific factors and outcomes associated with corneal edema and Haabs striae in primary congenital glaucoma (PCG). MethodsThe medical records of patients with PCG from 2011 to 2023 with >3 months’ follow-up were reviewed retrospectively. Preoperative details and final outcomes were compared between eyes with and without corneal findings. The right eye of bilateral cases and the affected eye in unilateral cases were included. ResultsA total of 58 patients (104 eyes, 69% male) underwent initial angle surgery at an average age of 297 ± 368 (median, 134) days. Corneal edema and Haabs striae were present preoperatively in 72 (69%) eyes of 41 patients and 68 (65%) eyes of 39 patients, respectively. Patients with corneal edema presented at a younger age (P < 0.0001) and with shorter axial length (P = 0.01) than those without edema. Univariate analysis showed that corneal edema was associated with worse visual acuity at final follow-up (OR = 4.4; 95% CI, 1.2-25.3). Patients with Haabs striae were older than those without striae (P = 0.04). After angle surgery, corneal edema was present at 1 month in 71% (95% CI, 52-84), at 2 months in 26% (95% CI, 12-42), at 3 months in 16% (95% CI, 6-30), and at 1 year in 3% (95% CI, 0-13). Corneal opacification did not resolve in 4 eyes of 3 patients after >4 years of follow-up. ConclusionsIn our study cohort, corneal edema resolved in the majority of PCG cases within 2-3 months of initial angle surgery but was associated with younger age at presentation and worse visual acuity at final follow-up.

Transmastoid Approach to Repair Iatrogenic Cerebrospinal Fluid Otorhinorrhea After Cerebellopontine Angle Tumor Resection.

The precise treatment of iatrogenic cerebrospinal fluid (CSF) otorhinorrhea has been poorly studied. The purpose of the study was to investigate the clinical manifestation, surgical results, and management of CSF leak. Electronic medical record database of iatrogenic CSF leaks after erebellopontine angle(CPA) surgery from 2019 to 2022 was retrospectively analyzed. Three patients returned to the hospital with the complication of CSF leak. After failed attempts of conservative strategies or reverse surgical repair, adipose tissue was applied to the mastoid cracks repair. With the techniques described above, the CSF leaks were successfully settled. The identified patients were observed for at least 10 months. and there was no recurrence or other complications. Conservative treatment and initial surgical methods for occult postoperative CSF leaks are prone to delay effective results, particularly in patients with well-evaporated temporal bone. This complication can be minimized with transmastoid closure utilizing autologous fat.

Evaluation of subarcuate canal on CT images in the perspective of clinical basis.

The aim of our study to contribute to the field of morphometrics by including measurements of the SAC and SAF and their distances from surrounding structures, particularly for surgeons involved in retrosigmoid approach for internal acoustic meatus tumor surgery and cerebellopontine angle surgery. Although there is limited information in the literature regarding the role of the subarcuate fossa (SAF) and subarcuate canal (SAC), it has been suggested that the SAC may be a potential pathway for infection from the middle ear to the posterior cranial fossa, and cerebellar abscesses may have this origin. For the images of our study, computerized tomography images of 118 individuals (59 females and 59 males) between the ages of 18-65 who applied to Bayındır Health Group. The width of the cranial opening of the subarcuate canal was determined as 44 ± 0.54mm, width of the labyrinth opening of the subarcuate canal was determined as 60 ± 0.42mm, Length of the subarcuate canal was determined as 8.79 ± 2.31mm, width of the subarcuate canal was determined as 5.54 ± 1.75mm, and depth of subarcuate fossa was determined as 1.67 ± 0.69mm. The distance of the cranial opening of the subarcuate canal to the superior semicircular canal (SSC-SAC/C) was measured as 5.33 ± 1.81mm, The distance of the labyrinth opening of the subarcuate canal to the superior semicircular canal (SSC-SAC/L) was measured as 3.90 ± .98mm, length of the petrous part of the temporal bone medial to the anterior semicircular canal measured from the apex to the SSCD (PLM) was measured as 33.56 ± 0.42mm. No statistically significant differences were found between the right and left sides. The morphometric measurements obtained in this study can provide useful information for neurosurgeons, neurotologist and otolaryngologists involved in retrosigmoid approach for internal acoustic meatus tumor surgery and cerebellopontine angle surgery, and for patients undergoing cochlear implant planning with a retrofacial approach.

Postoperative Herpes Viral Infections in Neurosurgery - An Experience and Arguments for and against the Plausible Hypotheses.

The literature contains several reports of herpes recrudescence after neurosurgery. We analyze our experience by vindicating or refuting the existing plausible hypotheses. This is a retrospective review of all neurosurgical cases that developed postoperative herpes infection between January 2016 and June 2020. Six patients developed herpes infection after vestibular schwannoma (VS) surgery. Other neurosurgical cases did not develop herpes infection. There were five females and one male, with a mean age of 44.1 years. Four out of six patients developed delayed facial palsy (DFP) and did not improve after antiviral treatment. Postoperative herpes infections were 0.2% among all operated patients, 3.07% among all cerebellopontine (CP) angle surgeries, and 5.6% among VS surgeries. To date, none of the plausible hypotheses satisfactorily addresses all aspects of viral recrudescence. The etiology may be multi-factorial, and in all cases of unexplained clinical deterioration, herpes infection needs consideration in the differential diagnosis.

Results of Combined Phacoemulsification and Goniosynechialysis in the Management of Refractory Acute Angle Closure Glaucoma in Ratchaburi Hospital

Objective: To assess the effectiveness of combined phacoemulsification and goniosynechialysis (PE-GSL) of angle closure glaucoma in patients with uncontrolled intraocular pressure (IOP) and persistent peripheral anterior synechiae (PAS) initially presented with acute angle closure attack. Materials and Methods: The present study was a retrospective cohort study of medical records of Thai glaucoma patients comprising 19 eyes of 19 patients (13 females and 6 males) with acute angle closure attacks. All patients were performed with PE-GSL Results: There were statistically significant differences between preoperative and postoperative IOP, PAS, and the number of medications required for IOP control. Postoperative visual acuities were improved. At the final examination for each patient, IOP was 12.15±1.57 mmHg (range 10 to 16). The extent of recurrent PAS was 66.32±40.72° (range 0 to 90), and the number of antiglaucoma medications was 0 (range 0 to 2). IOP was less than 20 mmHg in 16 eyes (80%) without medications. Three eyes were controlled with medications. In the 16 eyes with successful PE-GSL, the mean time between the angle closure attack and surgery was 7.5±5.6 weeks. Conclusion: PE-GSL are effective in decreasing IOP, PAS, and medications, as well as improvement of visual acuity in eyes with uncontrolled IOP and persistent PAS in patients who initially presented with acute angle closure attacks. Keywords: Angle-closure glaucoma; Phacoemulsification; Goniosynechialysis; Cataract; IOP

Indocyanine green-assisted goniotomy in eyes with hazy cornea.

Corneal haze, due to edema or opacity, is a major contraindication for performing ab interno angle surgeries such as goniotomy in children with primary congenital glaucoma (PCG), despite otherwise favorable surgical outcomes expected in these patients. In this case series involving patients of PCG with moderate corneal haze, the authors describe a technique for performing goniotomy in cases with compromised visibility by using indocyanine green (ICG) to aid in the visualization of angle structures. The authors used 0.2% ICG intracamerally, which stained the anterior and posterior trabecular meshwork (TM) with different intensities, before proceeding with goniotomy. The junction between the two zones was discernible due to the contrast imparted by ICG staining, despite poor visibility, allowing the surgeon to incise the TM at the correct site. The possibility of performing goniotomy in such patients with the help of ICG can revolutionize our surgical approach to patients with PCG and corneal edema.