Purpose Investigating the efficacy of intravitreal injection of erythropoietin (EPO) in managing indirect traumatic optic neuropathy (ITON) of different durations. Methods A case series that included two groups of ITON patients: recent ITON group (<3 months trauma duration; 7 eyes) and old duration ITON group (3–36 months; 7 eyes). Diagnostic computerized tomography (CT) and baseline flash visual evoked response (VER) were performed at the presentation time. At the initial visit and each follow-up, all patients had undergone assessment of best-corrected visual acuity (BCVA), pupil reaction, and anterior and posterior segments. VER was repeated 1 and 3 months after injection. All patients received an intravitreal injection of 2000 IU EPO in 0.2 ml of commercially available sterile EPREX 4000 solution, Jansen Cilag, Zug, Switzerland. Five patients had received a second injection 3 months later. Results Significant improvement was found in BCVA, VER amplitude, and latency (P < 0.0001, 0.0154, and 0.0291, respectively). Initial values of BCVA, VER amplitude, and latency correlated significantly to the final values. Differences between recent and old trauma groups were insignificant in the three parameters. In patients who received second injection, further clinical but statistically insignificant improvement was noted in BCVA in 60% of patients, VER amplitude in 50% of patients, and in VER latency in 100% of patients. No complications were recorded. Conclusion Intravitreal injection of EPO may be effective and safe in treatment of recent and old indirect traumatic optic neuropathy.

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Background Recurrent disc herniation is the most common cause of reoperation after the primary disc surgery, The management of recurrent disc herniation remains somewhat controversial. Surgical treatment for recurrent disk herniation can be broadly categorized as revision discectomy alone or revision discectomy and fusion or percutaneous endoscopic interlaminar discectomy. Aim of the work to evaluate and compare the therapeutic effect between different modalities of treatment of the recurrent lumbar disc protrusion (RLDP) through 3 groups: (1) First group treated by conventional discectomy. (2) Second group treated by discectomy and lumbar fusion either by PLF, PLIF or TLIF. (3) Third group treated by percutaneous endoscopic interlaminar discectomy. Patients and methods It is a prospective cohort study performed between January 2012 and April 2017 on 150 patients complained of recurrent lumbar disc herniation. They were surgically treated at the Department of Neurosurgery, Ain Shams University Hospitals. All patients are evaluated clinically by VAS, JOA and Oswestry disability index (ODI) through follow up period of 2 years (one month, 6 months, 1 yr, 2 yrs). They were divided into 3 groups (I&II and III) each group was a fifty patients Results the mean overall recovery rate is 89%, comparison between the three groups showed significant improvement of the endoscopic group and fixation group than simple discectomy group in term of VAS LBP, leg pain , JOA and ODI. Intraoperative blood loss, length of operation and hospital stay were significant less in endoscopic group than fixation and simple discectomy group CONCLUSION Recurrent lumbar disc prolapse management is a controversial issue, there are different surgical modalities (either by open discectomy, discectomy and fixation or Percutaneous interlaminar lumbar discectomy PEILD) although those surgical modalities are successful the PEILD is the optional choice that offers less tissue trauma, rapid recovery, less cost effect and early return to work