Hip arthrograghy is a valuable procedure for visualization of the intrinsic obstructive factors impeding closed reduction and for critical assessment of quality of reduction in developmental dislocation of the hip. The authors have analyzed 25 cases of developmentally dislocated hips in 24 patients who have been followed up for more than 1 year postoperatively by roentgenographies and arthrographies. Among them 16 cases in 16 patients who had been treated by closed reduction according to acceptable quality of initial reduction were studied to estimate a value of arthrography and to evaluate an outcome of closed rediction performed on the base of an arthrographic finding. The following results were obtained. 1. The frequency of the common arthrographic observations were assessed. Medial dye columns identifying the depth of reduction were observed 25 cases(100%), configuration of osteocartilaginous structures in 24 cases(96.0%), limbus in 24 cases(96.0%), and ligamentum teres in 18cases(75.0%). 2. Good closed reduction classified according to Race and Herring on initial arthrography was associated with rapid improvement of acetabular angle and the CE angle and low incidence of avascular necrosis, compared with adequate or poor reduction. 3. In cases of initial good and adequate reductions, initial AP arthrograms showed some dye filling shadows owing to folding or redundancy of lax joint capsule of the dislocated hip after reduction just lateral to the limbus, of which finding decreased markedly on the second arthrograms. 4. The widths of medial dye column decreased with time during the first postoperative 7 weeks by an average of 0.5mm in cases with initial good quality of reduction, 3.5mm in adequate reductions and 0.5mm in poor reductions. 5. In cases with adequate closed reduction on initial arthrogram, but without substantial decrease in width of medial dye column on the second arthogram the outcome was poor. In those cases with decrease in width of medial dye column on the second arthrogram compared with initial arthogram, the shorter the period of immobilization in a plaster cast was, the worse eventual result was. 6. We think that hip arthography is a helpful procedure for visualization of obstacle obstructing closed reduction and for determination of treatment modality in developmental dislocation of the hip.
Acetabulum ; Arthrography ; Casts, Surgical ; Continental Population Groups ; Dislocations ; Hip ; Humans ; Immobilization ; Incidence ; Joint Capsule ; Necrosis ; Round Ligaments

No abstract available.
Nail-Patella Syndrome*

In 1910 Purtscher first presented his original report of "angiopathia retinae traumatica" before the German Congress of Ophthalmology in Heidelberg. Since then many varying fundus pictures have been described as "Purtscher's Disease" and many theories have been advanced as to the cause. In 1962 Marr and Marr provided an extensive review of the literature on traumatie retniopathy and pointed out that the cause of Purtscher's retinopathy was an abrupt rise of intravascular pressure in the vessel entering and leaving the orbit, and in most cases the mechanism of the injury was a sudden and violent compression of the chest. Recently we have experienced a case of bilateral Purtscher's traumatic retinal angiopathy leading to optic nerve atrophy and macular degeneraion. Our patient is a 36-year-old previously healthy Korean male. who had his left chest compressed by a truck when he was working in the country farm. Just after the accident he fall into an unconscious state for a short time. Two days after admission he was referred to our ophthalmologic department because of visual impairment. Funduscopic examination revealed Purtscher's retinopathy in both eyes. His chest X-ray examination showed several fractured ribs anterolaterally. Within several days after the accident the whitish retinal exudates and hemorrhages gradually disappeared in the left ocular fundus, but in the right fundus the retinal edema, situated at posterior pole, persisted for about 7 months duration. During this period optic nerve atrophy developed ill the right fundus. As soon as the retinal edema subsided, retinal degeneration of the macular area appeared in the right fundus. Five months after the accident temporal optic nerve atrophy appeared and the patient complained of marked visual impairment in the left eye. We could not find any similar cases in the literature, that is, after the retinopathy and impaired vision recovered, later, the vision was markedly impaired again due to secondary optic nerve atrophy and development of macular Degeneration. In a survey of literature we want to say that the pathogenesis of Purtscher's traumatic retinal angiopathy is due mainly to the result of a sudden and severe increased intravascular pressure. particularly in the upper portion of body. Following points influenced our thought. 1. The ocular fundus changes similar with Purtscher's retinopathy could be seen in hydrostatic pressure syndrome and compression cyanosis syndrome. 2. Purtscher's retinopathy could developed in minor chest compression which is not strong enough to fracture ribs or other banes. 3. Usually Purtscher's retinopathy is developed in both eyes. If unilateral development occurs, it is almost on the right eye. If bilaterally the right eye is more severe than the left. This is postulated due to the shorter venous path to the rijsht eye. In addition, the prognosis of Purtscher's retinopathy seems to be good but poor result such as in our case and other previously reported cases are also possible.
Adult ; Atrophy ; Cyanosis ; Exudates and Transudates ; Hemorrhage ; Humans ; Hydrostatic Pressure ; Macular Degeneration ; Male ; Motor Vehicles ; Ophthalmology ; Optic Nerve ; Orbit ; Papilledema ; Prognosis ; Retina ; Retinal Degeneration ; Retinaldehyde* ; Ribs ; Thorax ; Unconsciousness ; Vision Disorders

Ankle fractures in children often involve the physis. They are of particular importance because partial or entire growth arrest can occur and result in significant complications. We followed thirty-four ankle fracture involving distal physis of tibia and fibula for more than 1 year and analyzed them using the modified Salter-Harris classification, the Dias-Tachdjian classification and the type of fracture (closed or open), Complications occurred in eight cases (23.5%) – two of twenty-six closed fractures (7.7%) and six of eight open fractures (75%). The complications were more significant in open fractures. Angular deformity (5 cases), limb-length discrepancy (4 cases), incongruity of the joint surface (2 cases), fibular overgrowth (2 cases) and synostosis (1 case) occurred alond or combined. In three cases of them we performed surgical management (bone bridge resection or/and supramalleolar corrective osteotomy) and had satisfactory results. This study suggests that the incidence of complications is difficult to anticipate, but is correlated with severity of initial injuries of growth plate and soft tissue, and is much higher in open fracture. After physeal injury, children should be followed until skeletal maturity and the severe deformities can be prevented by early detection and correction of growth plate disturbance.
Ankle Fractures ; Ankle ; Child ; Classification ; Congenital Abnormalities ; Fibula ; Fractures, Closed ; Fractures, Open ; Growth Plate ; Humans ; Incidence ; Joints ; Synostosis ; Tibia

Purpose: This study aims to evaluate the quality of and trends in artificial intelligence (AI) chatbot responses to questions related to age-related macular degeneration (AMD) and to analyze the frequency of incorrect key information. Methods: Three chatbots, ChatGPT 3.5, ChatGPT 4.0, and Gemini, were used in this study. Nine questions were formulated covering general information about: 1) AMD, 2) AMD treatment options, 3) effects and side effects of intraocular injections. Each question was queried three times with each of the three chatbots using two different accounts. Responses to items 1–3 were rated as poor/acceptable/good, and the frequency of incorrect key information was noted. Results: Overall, the majority of the queries received acceptable or good responses. Poor-quality responses were noted in 16.7% of ChatGPT 3.5 responses. Incorrect key information was present in 6.5% of all responses. Conclusions While AI chatbots generally provided acceptable responses to questions regarding AMD, some responses contained incorrect key information, suggesting the need for caution when accessing medical information through AI chatbots.

Purpose: To evaluate and report the short-term anatomical effects of switching from bevacizumab to the ranibizumab biosimilar CKD-701 in patients undergoing treatment for neovascular age-related macular degeneration (AMD). Methods: A retrospective medical record analysis was conducted on patients receiving bevacizumab therapy for neovascular AMD who were subsequently switched to CKD-701. The changes in central macular thickness and frequency of intraretinal/subretinal fluid before and after a single CKD-701 injection were compared with those before and after a single bevacizumab injection. Results: A total of 20 eyes was included in the study. Following bevacizumab injection, the mean central macular thickness decreased by 14.9 ± 57.6 µm, with intraretinal and subretinal fluid observed in 75.0%/55.0% before injection and 60.0%/55.5% after injection, respectively. Following CKD-701 injection, the mean central macular thickness decreased by 34.9 ± 57.4 µm, with intraretinal and subretinal fluid observed in 75.0%/56.0% before injection and 45.0%/40.0% after injection, respectively. There were no significant differences between the two groups in terms of changes in central macular thickness (p = 0.204), frequency of intraretinal fluid (p = 1.000), and subretinal fluid (p = 0.748) observed before injection or in frequency of intraretinal fluid (p = 0.527) and subretinal fluid (p = 0.527) after injection. Conclusions The short-term anatomical outcomes following CKD-701 injection in neovascular age-related macular degeneration showed no significant difference compared to the short-term outcomes following bevacizumab injection previously administered.

Purpose: To evaluate the proportion of bevacizumab and the reason for its usage in wet age-related macular degeneration (AMD). Methods: Retrospective analysis of medical records was performed for 1,541 patients who received ranibizumab, aflibercept, or bevacizumab injection to treat wet AMD. The proportion of bevacizumab among the entire set of injections was identified. The reason for selecting bevacizumab was additionally identified. Results: During the study period, a total of 2,929 anti-vascular endothelial growth factor (anti-VEGF) injections were performed; 2,236 (76.3%) were ranibizumab or aflibercept injections and 693 (23.7%) were bevacizumab injections. The most common reason for bevacizumab usage was ‘having a 0.1 or worse best-corrected visual acuity or being unable to assure reimbursement due to the development of extensive scarring or geographic atrophy’ (297 bevacizumab injections, 42.9%). The second most common reason was ‘the inability to assure reimbursement such as extrafoveal choroidal neovascularization (CNV) or early CNV without definite fluid in the foveal region’ (201 bevacizumab injections, 29.0%). Conclusions Bevacizumab was used in 23.7% of the anti-VEGF injections to treat wet AMD. When analyzing patients’ treatment burden and financial impact, the results of the present study may provide useful information. Further multi-center studies are required to evaluate more precisely the usage of anti-VEGF drugs.

Purpose: To evaluate the proportion of bevacizumab and the reason for its usage in wet age-related macular degeneration (AMD). Methods: Retrospective analysis of medical records was performed for 1,541 patients who received ranibizumab, aflibercept, or bevacizumab injection to treat wet AMD. The proportion of bevacizumab among the entire set of injections was identified. The reason for selecting bevacizumab was additionally identified. Results: During the study period, a total of 2,929 anti-vascular endothelial growth factor (anti-VEGF) injections were performed; 2,236 (76.3%) were ranibizumab or aflibercept injections and 693 (23.7%) were bevacizumab injections. The most common reason for bevacizumab usage was ‘having a 0.1 or worse best-corrected visual acuity or being unable to assure reimbursement due to the development of extensive scarring or geographic atrophy’ (297 bevacizumab injections, 42.9%). The second most common reason was ‘the inability to assure reimbursement such as extrafoveal choroidal neovascularization (CNV) or early CNV without definite fluid in the foveal region’ (201 bevacizumab injections, 29.0%). Conclusions Bevacizumab was used in 23.7% of the anti-VEGF injections to treat wet AMD. When analyzing patients’ treatment burden and financial impact, the results of the present study may provide useful information. Further multi-center studies are required to evaluate more precisely the usage of anti-VEGF drugs.

Purpose: To evaluate 24-month outcomes of anti-vascular endothelial growth factor (VEGF) treatment in polypoidal choroidal vasculopathy (PCV). Methods: Retrospective review of medical records was performed for 34 patients (34 eyes) who were diagnosed with PCV. The best-corrected visual acuity (BCVA) was measured before the injection and at 6, 12, and 24 months after the first injection. The value measured before treatment was compared with those measured after treatment. Results: The patients received mean 6.5 ± 2.1 intravitreal anti-VEGF injections during the 24-month follow-up period. The logarithm of minimal angle of resolution (logMAR) BCVA before the injection and at 6, 12, and 24 months after the first injections were 0.57 ± 0.32, 0.43 ± 0.29, 0.46 ± 0.33, and 0.62 ± 0.39, respectively. The BCVA was significantly improved at 6 and 12 months (p = 0.001 and p = 0.037, respectively). However, there was no significant difference between BCVA before the injection and 24 months (p = 1.000) after the first injection. At the 24-month follow-up, stable (< 2 logMAR lines of change) or improved (≥ 2 logMAR lines of improvement) BCVA was noted in 13 (38.2%) and 10 eyes (29.4%), respectively. Conclusions Anti-VEGF therapy was beneficial in maintaining long-term visual acuity in PCV. However, significant improvement in visual acuity was not noted.

Purpose: To compare visual outcomes over 6 months between intravitreal anti-vascular endothelial growth factor (VEGF) therapy with or without pneumatic displacement in patients who were diagnosed with submacular hemorrhage secondary to polypoidal choroidal vasculopathy (PCV). Methods: This retrospective observational study included 12 eyes that underwent pneumatic displacement followed by anti-VEGF therapy (combined treatment group) and 17 eyes that underwent anti-VEGF monotherapy (anti-VEGF monotherapy group) for submacular hemorrhage secondary to PCV and were followed for at least 6 months. The best-corrected visual acuity (BCVA) was measured at diagnosis and at 1, 3, and 6 months. The BCVA at 6 months and degree of BCVA improvement during the 6 months of follow-up were compared between the 2 groups. Results: In the combined treatment group, the mean (± standard deviation) logarithm of minimal angle of resolution BCVA values at the defined periods were 1.40 ± 0.54, 1.08 ± 0.63, 0.83 ± 0.57, and 0.79 ± 0.64, respectively. In the anti-VEGF monotherapy group, the mean BCVAs were 1.48 ± 0.47, 1.31 ± 0.48, 1.13 ± 0.52, and 1.04 ± 0.67, respectively. BCVA was significantly improved in both the combined treatment group (p = 0.012) and the monotherapy group (p = 0.026). Neither the BCVA at 6 months nor the degree of improvement in the BCVA was different between the 2 treatment groups (p = 0.269 and p = 0.300, respectively). Conclusions No notable difference in efficacy was observed between intravitreal anti-VEGF therapy with or without pneumatic displacement in treating submacular hemorrhage secondary to PCV.