Background: Many studies have reported that minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) provides satisfactory treatment comparable to other fusion methods. However, in the case of MI-TLIF, there are concerns about the long-term outcome compared to conventional bilateral PLIF due to the small amount of disc removal and the lack of autogenous bone graft. Long-term follow-up studies are still lacking as most of the previous reports have follow-up periods of up to 5 years. Methods: Thirty patients who underwent MI-TLIF were followed up for > 10 years (mean, 11.1 years). Interbody fusion rates were determined using a modified Bridwell grading system.Adjacent segment disease (ASD) was defined as radiological adjacent segment degeneration (R-ASDeg) as seen on plain X-rays; reoperated adjacent segment disease referred to the subsequent need for revision surgery. Clinical outcomes after surgery were assessed based on back and leg pain as well as the Oswestry disability index (ODI). Results: The overall radiological fusion rate, at the 1-, 5-, and 10-year follow-up was 77.1%, 91.4%, and 94.3%, respectively. The incidence of R-ASDeg 1, 5, and 10 years after surgery was 6.7%, 16.7%, and 43.3% at the proximal adjacent segment and 4.8%, 14.3%, and 28.6% at the distal adjacent segment, respectively. R-ASDeg at either the proximal or distal segment was determined in 50.0% of the patients 10 years postoperatively. All clinical parameters improved significantly during follow-up, although the ODI and the visual analog scale (VAS) for leg pain at the 10-year follow-up were significantly worse in the R-ASDeg group than in the other patients (P = 0.009, P = 0.040). Conclusion MI-TLIF improved both clinical and radiological outcomes, and the improvements were maintained for up to 10 years after surgery. However, R-ASDeg developed in up to 50% of the patients within 10 years, and both leg pain on the VAS and the ODI were worse in patients with R-ASDeg.

Objective: To investigate the correlation between bone mineral density (BMD) and duration of injury in individuals with spinal cord injury (SCI). Methods: Patients with SCI who visited the outpatient department between January 2009 and January 2019 were enrolled. Patients’ most recent dual energy X-ray absorptiometry images were reviewed. According to the 2007 International Society for Clinical Densitometry guidelines, vertebrae with a local structural change were excluded when deriving spine BMD. If one or no vertebra is suitable for evaluation, spine BMD was judged as “improper for assessment”. Correlation analysis was performed between duration from injury and BMD Z-scores of the hip and spine. Results: Among 83 individuals with SCI, the spines of 44 were judged as improper for assessment. The correlation analysis showed a significant negative relationship between the duration from injury and femur neck BMD (r=-0.40, p<0.01) and total proximal femur BMD (r=-0.39, p<0.01). However, no significant correlation was found between the duration from injury and spine BMD Z-score. Conclusion The duration of SCI correlated with hip BMD, but not with spine BMD. Further, more than half of the individuals with SCI could not undergo spinal assessment due to local structural changes. Therefore, spine BMD measurement is not an appropriate method for predicting future fracture risk in those with SCI.

PURPOSE: To report a case of ab interno trabeculotomy with Trabectome(R) (NeoMedix Corp., CA, USA) conducted on a refractory primary open angle glaucoma (POAG) patient. CASE SUMMARY: Trabectome(R) has microelectrocautery with simultaneous infusion and aspiration of debris and ablates a segment of trabecular meshwork and the inner wall of Schlemm's canal. The patient, a 54-year-old man had uncontrolled intraocular pressure (IOP) with topical anti-glaucoma medications after trabeculectomy and Ahmed valve implantation for POAG. For the patient, ab interno trabeculotomy with Trabectome(R) was performed. There were no other postoperative complications except for microhyphema immediately after surgery. The IOP was controlled between 14 to 24 mm Hg up to 3 months postoperatively with topical anti-glaucoma medications (Cosopt(R), Alphagan-P(R), Lumigan(R)). CONCLUSIONS: Ab interno trabeculotomy with Trabectome(R) appears to offer a newer method of lowering IOP in POAG than conventional trabeculectomy and glaucoma drainage device surgery.
Drainage ; Glaucoma ; Glaucoma, Open-Angle ; Humans ; Intraocular Pressure ; Middle Aged ; Postoperative Complications ; Trabecular Meshwork ; Trabeculectomy

PURPOSE: To compare conventional laser peripheral iridotomy (LPI) and LPI combined with laser peripheral iridoplasty in eyes with primary angle closure suspect (PACS) by assessment of anterior chamber dimensional changes using a Pentacam. METHODS: Forty-eight eyes of 24 subjects with bilateral PACS were recruited consecutively. Each eye was randomly allocated to treatment with conventional LPI, argon LPI only, or LPI plus iridoplasty, which consisted of simultaneous argon LPI and peripheral iridoplasty. Anterior chamber measurements were performed on each eye using a Pentacam, both before and after treatment. Mean anterior chamber depth (ACD), anterior chamber volume (ACV), and anterior chamber angle were measured, and topographic ACD analysis was performed. Results were compared between the two treatment groups. RESULTS: After treatment with either conventional LPI or LPI plus iridoplasty, the mean ACD and ACV increased significantly. Topographic ACD analysis revealed that the mid-to-peripheral ACD increase was significantly greater in the LPI plus iridoplasty group than in eyes treated with conventional LPI. Intraocular pressure changes and post-LPI complications did not differ between the groups. CONCLUSIONS: Compared with conventional LPI, our study showed that LPI plus iridoplasty improved the mid-to-peripheral ACD increase. This procedure may have a role as an adjunct for reducing angle closure by simultaneously eliminating pupillary and non-pupillary block components.
Adult ; Aged ; Anterior Chamber/*pathology/surgery ; Diagnostic Techniques, Ophthalmological/*instrumentation ; Equipment Design ; Female ; Follow-Up Studies ; Glaucoma, Angle-Closure/pathology/physiopathology/*surgery ; Gonioscopy ; Humans ; Intraocular Pressure ; Iridectomy/*methods ; Iris/pathology/*surgery ; Laser Therapy/*methods ; Lasers, Solid-State ; Male ; Middle Aged ; Prospective Studies ; Tonometry, Ocular

PURPOSE: To report two cases of trabeculectomy with biodegradable collagen material conducted on two post-vitrectomy patients. CASE SUMMARY: The first patient was a 43-year-old woman with uncontrolled increased intraocular pressure (IOP) after pars plana vitrectomy with scleral buckling for diabetic retinopathy and vitreous hemorrhage. Another patient, a 28-year-old woman with aphakia, also had uncontrolled increased IOP after pars plana vitrectomy with encircling scleral buckling for retinal detachment. For both of these patients, we performed trabeculectomy using mitomycin C and recently developed biodegradable collagen matrix. In the first case, the IOP was increased three months after the surgery, for which needling was done. After needling, the IOP was well controlled in the range of 16 to 19 mmHg up to eight months postoperatively with stilling anti-glaucomatous eyedrops (Cosopt(R), Xalatan(R)). In the second case, IOPwas increased one week after the surgery, but it was well controlled between 14 to 21 mmHg up to nine months postoperatively with anti-glaucomatous eye drops (Combigan(R)). CONCLUSIONS: Biodegradable collagen matrix can possibly reduce the surgical failure of trabeculectomy and it is especially suitable for high risk patients when combined with anti-metabolic agents like MMC.
Adult ; Aphakia ; Collagen ; Diabetic Retinopathy ; Female ; Humans ; Intraocular Pressure ; Mitomycin ; Ophthalmic Solutions ; Retinal Detachment ; Scleral Buckling ; Trabeculectomy ; Vitrectomy ; Vitreous Hemorrhage ; Wound Healing

PURPOSE: Recently, biodegradable collagen matrix has been used as a possible substitute for anti-metabolite in trabeculectomy in order to control the responsiveness of the wound healing process. This paper reports a case of encapsulation of the biodegradable collagen matrix after trabeculectomy. CASE SUMMARY: We conducted a fornix-based trabeculectomy on a 58-year-old man with medically uncontrollable steroid-induced glaucoma. We implanted biodegradable collagen matrix onto the sclera flap beneath the conjunctiva. Immediately after the surgery, we observed a localized bleb with high elevation. In the three months of follow-up, the bleb became encapsulated, and an increase in intraocular pressure was noted. During the wound revision, encapsulated material surrounded by thick fibrous membrane was found and removed from the subconjunctival space, followed by biopsy. Biopsy results demonstrated that amorphous collagenous material was surrounded by spindle and inflammatory cells. CONCLUSIONS: It is important to note that the fibrous encapsulation of collagen material is a possible complication of biodegradable collagen matrix-augmented trabeculectomy.
Biopsy ; Blister ; Collagen ; Conjunctiva ; Follow-Up Studies ; Glaucoma ; Glycosaminoglycans ; Humans ; Intraocular Pressure ; Membranes ; Middle Aged ; Sclera ; Trabeculectomy ; Wound Healing

This prospective observational case series study included 6 eyes of 6 consecutive glaucomatous patients. Each patient underwent trabeculectomy with mitomycin C, and received a 1.25 mg of subconjunctival bevacizumab injection at completion of the trabeculectomy. Study eyes included two with neovascular glaucoma, three with uveitic glaucoma, and one with secondary glaucoma following vitrectomy. All eyes had undergone failed glaucoma laser/surgical treatment or an intraocular surgical procedure. Intraocular pressure (IOP) at the following postoperative visits: preoperative, 1 week, 1 month, 2 months, 3 months, and 6 months, was measured. We also evaluated postoperative bleb findings and complications. IOP measured at each visit was 37.5+/-14.4 mmHg, 6.2+/-3.4 mmHg, 8.3+/-7.2 mmHg, 12.0+/-4.4 mmHg, 10.8+/-3.1 mmHg, and 12.2+/-3.3 mmHg, respectively, for each visit. All eyes had functioning blebs with normal IOP at postoperative 6 months with no additional IOP-lowering medication.
Adult ; Aged ; Angiogenesis Inhibitors/*administration & dosage ; Antibodies, Monoclonal/*administration & dosage ; Conjunctiva ; Female ; Glaucoma/*drug therapy/etiology/*surgery ; Glaucoma, Neovascular/drug therapy/surgery ; Humans ; Injections, Intraocular ; Male ; Middle Aged ; Prospective Studies ; Trabeculectomy/*methods ; Uveitis/complications ; Vascular Endothelial Growth Factor A/*antagonists & inhibitors ; Vitrectomy/adverse effects

PURPOSE: To investigate the visual field (VF) and retinal nerve fiber layer (RNFL) status of the fellow eyes in patients with unilateral retinal vein occlusion (RVO). METHODS: Fifty patients with unilateral RVO and 35 normal control subjects wereconsecutively recruited. Humphrey VF parameters and RNFL status using scanning laser polarimetry with variable corneal compensation (GDx-VCC) were compared between the fellow eyes of the patients with unilateral RVO and control eyes. We also assessed the risk factors for the development of glaucomatous damage in the fellow eyes of unilateral RVO patients. RESULTS: Twelve fellow eyes out of 50 patients with unilateral RVO showed glaucomatous VF and RNFL changes assessed by GDx-VCC. VF indices and RNFL thickness parameters in the study group were significantly lower than those in the control group (p<0.05). Increased age and vertical cup-to-disc ratio were significantly associated with severity of VF and RNFL damage in the fellow eye of unilateral RVO patients (p<0.05). CONCLUSIONS: The fellow eyes in patients with unilateral RVO showed significantly worse VF indices and lower RNFL thickness than normal control eyes. The glaucomatous change should be carefully monitored in the fellow eyes of unilateral RVO patients.
Compensation and Redress ; Eye ; Glaucoma ; Humans ; Nerve Fibers ; Retinal Vein ; Retinal Vein Occlusion ; Retinaldehyde ; Risk Factors ; Scanning Laser Polarimetry ; Visual Fields

PURPOSE: To compare high-sensitivity C-reactive protein (hsCRP) levels and lipid profiles between Korean normal tension glaucoma (NTG) patients and healthy controls. METHODS: This cross-sectional study included 38 Korean patients with NTG and 38 age- and sex-matched healthy control subjects. We excluded the patients with cardiovascular risk factors and other systemic diseases that might affect CRP levels and lipid profiles. Each patient underwent a Humphrey visual field examination and blood sampling for hsCRP and lipid profile analyses. Subsequently, the NTG patients were classified into two groups based on their untreated intraocular pressure (IOP) level: low NTG (LNTG) with IOP< or =13 mmHg (13 subjects) and high NTG (HNTG) with relatively high IOP (>13 and < or =21 mmHg, 25 subjects). The hsCRP levels and lipid profiles were compared between NTG patients and healthy controls, and between LNTG, HNTG, and healthy controls. RESULTS: There were no significant differences in hsCRP and lipid profiles between either the NTG patients and healthy controls, or between the LNTG, HNTG, and controls (p>0.05) after exclusion of Korean patients with cardiovascular risk factors. There was no significant association between hsCRP and visual field indices (p>0.05). CONCLUSIONS: High-sensitivity C-reactive protein-related vascular inflammatory conditions may not be directly associated with the development of NTG, regardless of the untreated IOP level.
Adolescent ; Adult ; Aged ; *Asian Continental Ancestry Group ; C-Reactive Protein/*metabolism ; Cross-Sectional Studies ; Female ; Humans ; Lipids/*blood ; Low Tension Glaucoma/*blood ; Male ; Middle Aged ; Young Adult

PURPOSE: To report a case of optic neuropathy from vitamin B12 deficiency associated with chronic alcoholism and malnutrition. CASE SUMMARY: A 51-year-old man with a complaint of declining visual acuity in both eyes without pain was found to have a temporal optic disc pallor in the left eye. The patient had a history of chronic alcoholism and malnutrition for the previous 7 months. Visual field examination showed central scotoma in both eyes. The vitamin B12 level was undetectable by a blood biochemistry test. Blood dyscrasia such as anemia or thrombocytopenia was not found. The vitamin B12 level became normal after intramuscular cobalamin injections, and visual acuity and visual field tests recovered after 3 months. CONCLUSIONS: Optic neuropathy from vitamin B12 deficiency can be solely present without other systemic manifestations in a patient with chronic alcoholism and malnutrition. Prompt diagnosis by thorough history taking and vitamin B12 supplementation can reverse the disease.
Alcoholism ; Anemia ; Biochemistry ; Eye ; Humans ; Malnutrition ; Middle Aged ; Optic Nerve Diseases ; Pallor ; Scotoma ; Thrombocytopenia ; Visual Acuity ; Visual Field Tests ; Visual Fields ; Vitamin B 12 ; Vitamin B 12 Deficiency ; Vitamins