AIM： To assess the feasibility of radial optic neurotomy （RON） in central retinal vein occlusion （CRVO） treatment with a Meta-analysis.METHODS： Electronic databases were searched for comprehensive articles that ...AIM： To assess the feasibility of radial optic neurotomy （RON） in central retinal vein occlusion （CRVO） treatment with a Meta-analysis.METHODS： Electronic databases were searched for comprehensive articles that compared efficacy of RON with that of other treatments in CRVO. Study quality was assessed and risk ratio （RR） and 95% confidence interval （Cl） with fix or random-effects model were calculated according to the heterogeneity. RESULTS： A total of 200 eyes from 5 studies were included. The results indicated that no significant differences were found between groups with and without RON in improvement of visual acuity （VA） at 6mo follow- up （pooled RR 0.51, 95%CI 0.22 to 1.18, P=0.117） while improvement of VA showed significantly favourable in patients receiving RON treatment at 12mo follow-up （pooled RR 2.27, 95% CI 1.31 to 3.95, P=0.004）. For complications, RON treatment was more effective in reducing neovascular glaucoma （pooled RR 0.45, 95%CI 0.21 to 0.97, P=0.042） but was comparable in retinal detachment （pooled RR 2.41, 95%CI 0.51 to 11.39, P=0.267） and vitreous hemorrhage （pooled RR 0.91, 95%CI 0.33 to 2.46, P=0.847）. CONCLUSION： Compared with some certain treatment modalities, RON might offer better VA at 12mo and decrease the rate of neovascular glaucoma without changing the rate of retinal detachment and vitreous hemorrhage. Further studies are required considering the limitation of the research.展开更多
We studied the microselective neurotomy (MSN) and its advantages to alleviate disabling spasticity. The best indication for MSN is focal spasticity. We performed 298 MSN, 87 nerves on the upper limb, 211 nerves on the...We studied the microselective neurotomy (MSN) and its advantages to alleviate disabling spasticity. The best indication for MSN is focal spasticity. We performed 298 MSN, 87 nerves on the upper limb, 211 nerves on the lower limb) in 68 patients. The initial causes were: stroke, cranial trauma, postoperative complications and multiple sclerosis. MSN procedures were performed on the median nerve (n = 40) for wrist and finger flexion;musculo-cutaneus nerve (n = 38) for elbow flexion;ulnaris nerve (n = 9) for cubital deviation of the hand;gastrocnemius nerve (n = 98) and soleus nerve (n = 49) for equinus foot, tibial posterior nerve (n = 45) for varus foot, and fascicles (or bundles) of the flexor digitorum for “claw” toes (n = 19). The main preoperative test to identify the responsible nerve was a neuromuscular block with local anesthesia (lidocaine or bupivacaine) injected into the site of the nerve connecting the spastic muscle. During surgery, the identified nerve was exposed and its epineurium opened. Nerve bundles were teased apart into individual rootlets and a number of rootlets cut were previously planned, according to the spasticity. Follow-up was performed for up to 10 years, with a mean period of 29 months. Results demonstrated a reduction of limb spasticity of 2 to 3 points: modified Ashworth scale (MAS). Pain and clonus were also diminished in the affected limb. In some cases, voluntary movement was once again possible. MSN is a useful alternative in those cases of focal spasticity where physiotherapy and nerve block with botulinum toxin or phenol no longer produce satisfactory results.展开更多
基金Supported by National Science Foundation of Tianjin, China (No. 15JCQNJ11400)
文摘AIM： To assess the feasibility of radial optic neurotomy （RON） in central retinal vein occlusion （CRVO） treatment with a Meta-analysis.METHODS： Electronic databases were searched for comprehensive articles that compared efficacy of RON with that of other treatments in CRVO. Study quality was assessed and risk ratio （RR） and 95% confidence interval （Cl） with fix or random-effects model were calculated according to the heterogeneity. RESULTS： A total of 200 eyes from 5 studies were included. The results indicated that no significant differences were found between groups with and without RON in improvement of visual acuity （VA） at 6mo follow- up （pooled RR 0.51, 95%CI 0.22 to 1.18, P=0.117） while improvement of VA showed significantly favourable in patients receiving RON treatment at 12mo follow-up （pooled RR 2.27, 95% CI 1.31 to 3.95, P=0.004）. For complications, RON treatment was more effective in reducing neovascular glaucoma （pooled RR 0.45, 95%CI 0.21 to 0.97, P=0.042） but was comparable in retinal detachment （pooled RR 2.41, 95%CI 0.51 to 11.39, P=0.267） and vitreous hemorrhage （pooled RR 0.91, 95%CI 0.33 to 2.46, P=0.847）. CONCLUSION： Compared with some certain treatment modalities, RON might offer better VA at 12mo and decrease the rate of neovascular glaucoma without changing the rate of retinal detachment and vitreous hemorrhage. Further studies are required considering the limitation of the research.
文摘We studied the microselective neurotomy (MSN) and its advantages to alleviate disabling spasticity. The best indication for MSN is focal spasticity. We performed 298 MSN, 87 nerves on the upper limb, 211 nerves on the lower limb) in 68 patients. The initial causes were: stroke, cranial trauma, postoperative complications and multiple sclerosis. MSN procedures were performed on the median nerve (n = 40) for wrist and finger flexion;musculo-cutaneus nerve (n = 38) for elbow flexion;ulnaris nerve (n = 9) for cubital deviation of the hand;gastrocnemius nerve (n = 98) and soleus nerve (n = 49) for equinus foot, tibial posterior nerve (n = 45) for varus foot, and fascicles (or bundles) of the flexor digitorum for “claw” toes (n = 19). The main preoperative test to identify the responsible nerve was a neuromuscular block with local anesthesia (lidocaine or bupivacaine) injected into the site of the nerve connecting the spastic muscle. During surgery, the identified nerve was exposed and its epineurium opened. Nerve bundles were teased apart into individual rootlets and a number of rootlets cut were previously planned, according to the spasticity. Follow-up was performed for up to 10 years, with a mean period of 29 months. Results demonstrated a reduction of limb spasticity of 2 to 3 points: modified Ashworth scale (MAS). Pain and clonus were also diminished in the affected limb. In some cases, voluntary movement was once again possible. MSN is a useful alternative in those cases of focal spasticity where physiotherapy and nerve block with botulinum toxin or phenol no longer produce satisfactory results.
