The safety, efficacy and cost-effectiveness of intraoperative cell-salvage in metastatic spine tumour surgery, The Spine Journal (2017), http://dx.doi.org

Purpose: To evaluate the role of cycloplegic agents in diagnosis and management of accommodative spasms. Methods: Prospective cohort study included patients with recent onset ocular strain. All patients underwent comprehensive eye examination and objective refraction. Then patients were randomized to receive either atropine or cyclopentolate for cycloplegia. And objective refraction was recorded again. Patients were randomly assigned to one of the two treatments i.e.full cycloplegic correction or 0.001% atropine and reviewed at 1-, 2- and 3-month follow-ups. Results: Total 52 patients, mean age16.1±4.7 were evaluated. 33 patients (63.5%) received atropine and 19 (36.5%) received cyclopentolate. There was significant difference between precycloplegic and post cycloplegic refraction however, the difference between cyclopentolate and atropine was not significant. None of the patients, whether treated with glasses or low dose atropine experienced any ocular strain till the end of study. Conclusion: Both cyclopentolate and atropine are equally effective in achieving adequate cycloplegia in patients with accommodative spasm. Plus corrective wear or low dose atropine are equally effective in relieving the symptoms of patients. Keywords: Cycloplegic agents, Post-cycloplegic refraction, Accommodative spasm

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Aim: To survey eye-care professionals in Pakistan, including optometrists, ophthalmologists, and residents from either, on their knowledge, opinions, and clinical practice patterns. We also looked to see if their myopia-related practice habits were in accordance with current standards of care and guidelines. Methods: An online survey was created and shared with eyecare providers from all provinces in Pakistan. The responses were collected over a span of 8 weeks. Results: 173 professionals took part in the survey and 146 were able to complete the survey (based on their response to specific questions). Most common method of refraction was cycloplegic refraction, and most tended to under-correct myopia. Only 1/4th of clinicians were measuring axial length and 21% never performed binocular testing and checked lag of accommodation in myopes. Most common method of myopic fundus examination was dilated fundus biomicroscopy and criteria for peripheral fundus examination was myopia greater than 6 diopters. Almost half have not attended a course/ workshop on myopia (control) in past 6 months and 1/4th tended to rarely read a myopia related journal article. Progression of more than 1 diopter a year was criteria for initiation of control strategies for most clinicians and 0.01% atropine was the preferred initial concentration and almost half of them believed the control strategies to be moderately effective. Conclusion: A substantial proportion of eyecare providers do not appear to be aware of current concepts and do not incorporate recent guidelines into their practices regarding myopia management. Keywords: Practice patterns, Eye care providers, Myopia

Background: Extensile interventions to provide anterior spinal column support in metastatic spinal cord compression (MSCC) surgery incur added morbidity in this surgically frail group of patients. We present our preliminary results of posterior spinal decompression and stabilization coupled with vertebral body cemented stents for anterior column support in MSCC. Methods: Fourteen patients underwent posterior spinal decompression and pedicle screw construct along with vertebral body stenting (VBS) technique for reconstruction and augmentation of the vertebral body. The primary in all except one was solid organ malignancy and 10 patients (71%) were treatment naïve. The mean revised Tokuhashi score was 10.7 ± 2.7 and the mean spinal instability neoplastic score was 9.6 ± 1.9. All vertebral body lesions were purely lytic and were associated with a cortical defect in the posterior wall. Results: A mean 5.3 ± 2.7 ml low-viscosity polymethyl methacrylate bone cement was injected within the stent at each compression level. No cement extrusion posteriorly was noted in any case from intraoperative fluoroscopy or postoperative radiographs. Five patients died at a mean 6.8 months (range 1–15 months), while the remaining patients have a mean survival of 18 months. Neither further revision surgical intervention nor any neurological deterioration was noted in any patient, who all continued to be ambulatory. The mean postoperative Core Outcome Measures Index score for 11 patients was 4.03 (standard deviation 3.11, 95% confidence interval (1.93–6.12). Conclusion: In lytic vertebral body lesions with posterior wall erosions, cemented VBS technique adds to the surgical armamentarium in MSCC surgery showing promising early results without added complications.