OBJECTIVE

This study compared the choroidal vascularity indices (CVI) among eyes with neovascular, nonneovascular age-related macular degeneration (AMD) and healthy controls.

Spectral-domain optical coherence tomography (OCT) with enhanced depth imaging (EDI) from 52 eyes of 33 subjects were analyzed and designated into 3 groups: control, non-neovascular AMD, and neovascular AMD. Using Image J software, a 1.5 mm subfoveal choroidal area was segmented and binarized to measure total and luminal choroidal areas. The CVI was calculated as the ratio of luminal to total choroidal area. Correlation studies were done to assess relationship of CVI with best-corrected visual acuity (BCVA) and disease severity.

The overall median CVI was 0.66 (IQR = 0.62 – 0.69), with overall median total choroidal area of 696,707.60 (IQR = 530,776.80 – 806,348.00), overall median luminal choroidal area of 442,884.60 (IQR = 351,612.80 – 549,540.30), and an overall median choroidal thickness of 237.10 (IQR = 178.43 – 270.25). The overall median LogMAR BCVA was 0.30 (IQR = 0.10 – 0.54). Statistical comparisons showed no significant differences in the median CVI, median total choroidal area, median luminal choroidal area, and median choroidal thickness among the three groups (p > 0.05). However, median BCVA was significantly different among the groups (χ2=35.98, p=0.001). Specifically, those with non-neovascular AMD and neovascular AMD had significantly worse visual acuity compared to the control group (p < 0.05).

The study found that CVI, as measured by binarization of EDI-OCT images, was not significantly different among AMD and control groups. BCVA, however, was significantly affected by AMD. These findings suggest that while CVI may not vary with AMD severity, BCVA remains a crucial diagnostic factor. Further research is needed to explore the relationship between choroidal vascularity and AMD using advanced imaging techniques.

Background: Arthroscopic anterior cruciate ligament (ACL) reconstruction is gaining popularity. Different kinds of anesthetic techniques are used; however, regional nerve block (RNB) such as femoral nerve block is considered the most popular choice. The purpose of this study was to compare the effectiveness of long-acting local anesthesia infiltration (LAI) versus RNB used to control pain and reduce opioid consumption in patients undergoing arthroscopic ACL reconstruction. Methods: We conducted a meta-analysis using a comprehensive literature search of Google Scholar, PubMed, Medline, and Cochrane Library. All randomized trials comparing the use of infiltration anesthesia versus RNB in patients undergoing arthroscopic ACL reconstruction were included. Methodological quality, risk of bias, and grade of the eligible studies were assessed by 3 independent reviewers. The risk of bias was analyzed using contour-enhanced funnel plots. Results: The search yielded 671 records. Eight studies were included in the systematic review. The study focused on the assessment of immediate, 24-hour, and 48-hour postoperative pain scores and total opioid consumption. There was no significant difference between the use of LAI and RNB with regard to the immediate (p = 0.962), 24-hour (p = 0.156), and 48-hour postoperative pain scores (p = 0.216). The results suggested that LAI could lead to a similar level of opioid consumption as RNB (p = 0.304). However, there was considerable heterogeneity in the opioid consumption outcome due to the different anesthetic techniques used in the included studies. Conclusions Regarding postoperative pain control, LAI showed similar clinical effects when compared to the conventional RNB, while maintaining a similar level of opioid consumption postoperatively, decreasing the risk of any adverse effects of morphine.In summary, LAI offers a simpler method of achieving pain relief without the motor weakness associated with RNB. It also allows surgeons to perform ACL reconstruction in institutions without specialized anesthesia for RNB.

Background: Arthroscopic anterior cruciate ligament (ACL) reconstruction is gaining popularity. Different kinds of anesthetic techniques are used; however, regional nerve block (RNB) such as femoral nerve block is considered the most popular choice. The purpose of this study was to compare the effectiveness of long-acting local anesthesia infiltration (LAI) versus RNB used to control pain and reduce opioid consumption in patients undergoing arthroscopic ACL reconstruction. Methods: We conducted a meta-analysis using a comprehensive literature search of Google Scholar, PubMed, Medline, and Cochrane Library. All randomized trials comparing the use of infiltration anesthesia versus RNB in patients undergoing arthroscopic ACL reconstruction were included. Methodological quality, risk of bias, and grade of the eligible studies were assessed by 3 independent reviewers. The risk of bias was analyzed using contour-enhanced funnel plots. Results: The search yielded 671 records. Eight studies were included in the systematic review. The study focused on the assessment of immediate, 24-hour, and 48-hour postoperative pain scores and total opioid consumption. There was no significant difference between the use of LAI and RNB with regard to the immediate (p = 0.962), 24-hour (p = 0.156), and 48-hour postoperative pain scores (p = 0.216). The results suggested that LAI could lead to a similar level of opioid consumption as RNB (p = 0.304). However, there was considerable heterogeneity in the opioid consumption outcome due to the different anesthetic techniques used in the included studies. Conclusions Regarding postoperative pain control, LAI showed similar clinical effects when compared to the conventional RNB, while maintaining a similar level of opioid consumption postoperatively, decreasing the risk of any adverse effects of morphine.In summary, LAI offers a simpler method of achieving pain relief without the motor weakness associated with RNB. It also allows surgeons to perform ACL reconstruction in institutions without specialized anesthesia for RNB.

Background: Arthroscopic anterior cruciate ligament (ACL) reconstruction is gaining popularity. Different kinds of anesthetic techniques are used; however, regional nerve block (RNB) such as femoral nerve block is considered the most popular choice. The purpose of this study was to compare the effectiveness of long-acting local anesthesia infiltration (LAI) versus RNB used to control pain and reduce opioid consumption in patients undergoing arthroscopic ACL reconstruction. Methods: We conducted a meta-analysis using a comprehensive literature search of Google Scholar, PubMed, Medline, and Cochrane Library. All randomized trials comparing the use of infiltration anesthesia versus RNB in patients undergoing arthroscopic ACL reconstruction were included. Methodological quality, risk of bias, and grade of the eligible studies were assessed by 3 independent reviewers. The risk of bias was analyzed using contour-enhanced funnel plots. Results: The search yielded 671 records. Eight studies were included in the systematic review. The study focused on the assessment of immediate, 24-hour, and 48-hour postoperative pain scores and total opioid consumption. There was no significant difference between the use of LAI and RNB with regard to the immediate (p = 0.962), 24-hour (p = 0.156), and 48-hour postoperative pain scores (p = 0.216). The results suggested that LAI could lead to a similar level of opioid consumption as RNB (p = 0.304). However, there was considerable heterogeneity in the opioid consumption outcome due to the different anesthetic techniques used in the included studies. Conclusions Regarding postoperative pain control, LAI showed similar clinical effects when compared to the conventional RNB, while maintaining a similar level of opioid consumption postoperatively, decreasing the risk of any adverse effects of morphine.In summary, LAI offers a simpler method of achieving pain relief without the motor weakness associated with RNB. It also allows surgeons to perform ACL reconstruction in institutions without specialized anesthesia for RNB.

Background: Arthroscopic anterior cruciate ligament (ACL) reconstruction is gaining popularity. Different kinds of anesthetic techniques are used; however, regional nerve block (RNB) such as femoral nerve block is considered the most popular choice. The purpose of this study was to compare the effectiveness of long-acting local anesthesia infiltration (LAI) versus RNB used to control pain and reduce opioid consumption in patients undergoing arthroscopic ACL reconstruction. Methods: We conducted a meta-analysis using a comprehensive literature search of Google Scholar, PubMed, Medline, and Cochrane Library. All randomized trials comparing the use of infiltration anesthesia versus RNB in patients undergoing arthroscopic ACL reconstruction were included. Methodological quality, risk of bias, and grade of the eligible studies were assessed by 3 independent reviewers. The risk of bias was analyzed using contour-enhanced funnel plots. Results: The search yielded 671 records. Eight studies were included in the systematic review. The study focused on the assessment of immediate, 24-hour, and 48-hour postoperative pain scores and total opioid consumption. There was no significant difference between the use of LAI and RNB with regard to the immediate (p = 0.962), 24-hour (p = 0.156), and 48-hour postoperative pain scores (p = 0.216). The results suggested that LAI could lead to a similar level of opioid consumption as RNB (p = 0.304). However, there was considerable heterogeneity in the opioid consumption outcome due to the different anesthetic techniques used in the included studies. Conclusions Regarding postoperative pain control, LAI showed similar clinical effects when compared to the conventional RNB, while maintaining a similar level of opioid consumption postoperatively, decreasing the risk of any adverse effects of morphine.In summary, LAI offers a simpler method of achieving pain relief without the motor weakness associated with RNB. It also allows surgeons to perform ACL reconstruction in institutions without specialized anesthesia for RNB.

Background: Avascular necrosis (AVN) of the femoral head results from intraosseous pathology causing functional impairment. Early diagnosis allows conservative treatment like core decompression, delaying total hip arthroplasty. Objective: This meta-analysis aims to summarize platelet-rich plasma's (PRP) impact as an adjunct to core decompression (CD) on treatment outcomes and femoral head preservation in hip AVN. Methods: The study conducted a comprehensive literature search using PubMed, Cochrane Library, Science Direct, Google Scholar and Med Line, including randomized controlled trials (RCTs) and previous meta-analyses from various databases. Using a random effects model, it compared PRP+CD with bone grafting to CD with bone grafting alone in AVN patients, evaluating function, pain scores, disease progression and the need for hip surgery. Results: The meta-analysis examined 1041 records and included three studies. The primary outcomes were function and pain scores using Harris Hip Scoring (HHS) and Visual Analog Scale (VAS). Postoperative HHS scores at final follow-up favored the PRP+CD group significantly over CD alone. Postoperative VAS scores showed a trend towards higher scores in the CD alone group. The PRP+CD group demonstrated higher survival from disease progression compared to CD alone. Overall, the study suggests that PRP+CD led to better functional outcomes and disease progression outcomes than CD alone in AVN of the hip. Conclusion The PRP+CD treatment group showed significant benefits in AVN patients compared to CD alone, including higher HHS scores, improved disease progression survival and reduced need for hip surgery. Although PRP+CD resulted in decreased VAS scores, the difference was not statistically significant.
Osteonecrosis ; Femur Head ; Platelet-Rich Plasma ; Randomized Controlled Trial