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Surgical decompression is standard care in the treatment of degenerative spondylolisthesis in patients with symptomatic lumbar spinal stenosis, but there remains controversy over the benefits of adding fusion. The persistent lack of consensus on this matter and the availability of new data warrants a contemporary systematic review and meta-analysis of the literature.Multiple online databases were systematically searched up to October 2022 for randomized controlled trials (RCTs) and prospective studies comparing outcomes of decompression alone versus decompression with fusion for lumbar spinal stenosis in patients with degenerative spondylolisthesis. Primary outcome was the Oswestry Disability Index. Secondary outcomes included leg and back pain, surgical outcomes, and radiological outcomes. Pooled effect estimates were calculated and presented as mean differences (MD) with their 95% confidence intervals (CI) at two-year follow-up.Of the identified 2403 studies, eventually five RCTs and two prospective studies were included. Overall, most studies had a low or unclear risk of selection bias and most studies were focused on low grade degenerative spondylolisthesis. All patient-reported outcomes showed low statistical heterogeneity. Overall, there was high-quality evidence suggesting no difference in functionality at two years of follow-up (MD - 0.31, 95% CI - 3.81 to 3.19). Furthermore, there was high-quality evidence of no difference in leg pain (MD - 1.79, 95% CI - 5.08 to 1.50) or back pain (MD - 2.54, 95% CI - 6.76 to 1.67) between patients undergoing decompression vs. decompression with fusion. Pooled surgical outcomes showed less blood loss after decompression only, shorter length of hospital stay, and a similar reoperation rate compared to decompression with fusion.Based on the current literature, there is high-quality evidence of no difference in functionality after decompression alone compared to decompression with fusion in patients with degenerative lumbar spondylolisthesis at 2 years of follow-up. Further studies should focus on long-term comparative outcomes, health economic evaluations, and identifying those patients that may benefit more from decompression with fusion instead of decompression alone. This review was registered at Prospero (CRD42021291603).

Single-stage lateral lumbar interbody fusion is a safe and effective procedure that relies on indirect decompression and fusion to treat various lumbar pathologies. This technique, however, has an overall 9% rate of indirect decompression failure, which may require additional surgery to achieve adequate direct decompression. To address this concern, we modified this technique by adding a minimally invasive, direct tubular decompression in lateral position when indicated. No study has described the technical nuances of incorporating a microtubular decompression into the single-stage lateral lumbar interbody fusion workflow (SSLLIF+).To report on the procedural steps and clinical outcomes of the SSLLIF+.In this retrospective case series of prospectively collected data, we present the detailed surgical approach of the SSLLIF+ with a single-center case series over a 5-year period. Surgical and clinical outcomes are presented.A total of 7 patients underwent a SSLLIF+ with a total of 18 levels fused and 7 levels decompressed. The SSLLIF+ was successfully performed in all cases without the occurrence of intraoperative complications in this case series. There was 1 revision after 20 months of follow-up because of adjacent segment disease. There was no need for further direct decompression in a delayed fashion.SSLLIF with direct microtubular decompression in lateral position is a safe and effective procedure in patients where indirect decompression alone may not achieve the surgical goal. Adherence to minimally invasive spine surgery principles and thoughtful patient selection facilitate the successful management of these patients while demonstrating short hospital stay and low-risk of perioperative complications.

Purpose The purpose of this report was to describe the ocular findings in Myelodysplasia, Infection, Restriction of growth, Adrenal hypoplasia, Genital problems, and Enteropathy (MIRAGE) syndrome, a multisystem congenital disorder. Methods This was a case report and literature review. Results An infant with MIRAGE syndrome (combined immunodeficiency with recurrent infections, growth restriction, adrenal insufficiency, 46,XY karyotype with hypovirilization, dysphagia, gastroesophageal reflux disease, and dysautonomia) underwent ophthalmological evaluation because of persistent conjunctivitis during his 8-month admission in the neonatal intensive care unit. His parents noted absence of tears when crying since birth. Bilateral broad corneal epithelial defects were noted, and treatment was initiated with frequent lubricating ointment. At 9 months, his vision was estimated at 20/380 in both eyes using Teller Acuity Cards. There were persistent bilateral epithelial defects, confluent punctate epithelial erosions, low Schirmer strip wetting (right eye 3 mm and left eye 2 mm), and decreased corneal sensation. Brain magnetic resonance imaging images demonstrated hypoplastic lacrimal glands bilaterally. More aggressive lubrication and installation of punctal plugs in all 4 lids were successful at preventing further epithelial defects. Conclusions This case presents deficient lacrimation as a manifestation of MIRAGE syndrome and is the first to identify lacrimal gland hypoplasia and corneal anesthesia. Autonomic and neurologic dysfunction have been proposed to play a role in the pathophysiology of hypolacrimation in similar syndromes and likely contributed to the poor ocular surface in this case. Patients with MIRAGE should undergo ophthalmic assessment as soon as possible after birth because early intervention is essential to preventing irreversible corneal damage.

Purpose: To report high toric intraocular lens (IOL) implantation in a patient with previous radial keratotomy and significantly flat corneal powers. Methods: Case report. Results: A 64-year-old woman with previous bilateral 8-incision radial keratotomy was referred for cataract surgery. Corrected distance visual acuity was 20/70 in the right eye and counting fingers in the left eye (could not be refracted). The power of the flat meridian was below 30.00 diopters (D) bilaterally, so no IOL power predictions were reported by standard biometric devices. Calculations were run with the American Society of Cataract and Refractive Surgery (ASCRS) IOL Calculator for Eyes with Prior Radial Keratotomy using data from biometry, tomography, and topography. Toric cylinder and meridian were calculated with the ASCRS Barrett Toric Calculator. Given reasonable agreement in corneal cylinder and meridian between imaging modalities, toric IOLs (3.75 D IOL cylinder) were implanted. Postoperatively, spherical equivalent was −0.50 D in the right eye and plano in the left eye. Cylinder was reduced from 3.24 to 1.00 D in the right eye and from 4.13 to 1.00 D in the left eye. Conclusions: Toric IOLs offer an opportunity to reduce postoperative astigmatism in radial keratotomy cases with high cylinder, significantly flat corneal powers, and no classic bowtie pattern on topography. Pre-cataract refractions are useful in these cases after radial keratotomy, because corneal imaging modalities may underestimate astigmatism after radial keratotomy. [ Journal of Refractive Surgery Case Reports. 2022;2(4):e68–e71.]

Ophthalmologists experience high rates of work-related musculoskeletal (muscle and bone) disorders as a result of poor postures over long periods of time. This study seeks to assess the posture of eye care providers when using a standard slit lamp compared to the posture when using a slit lamp microscope with adjustable oculars. Studying the differences in postures while using different equipment may help identify poor postures that currently exist. Additionally, the findings of this study may help improve the design of future equipment which may reduce the risk of work-related musculoskeletal disorders. This is a prospective study of eye care providers at the Ivey Eye Institute, St. Joseph’s Hospital. The postures of eye care providers will be assessed while using the traditional slit lamp and the slit lamp with adjustable oculars.

Patients with nAMD undergoing anti-VEGF eye injections will be invited to take part in this study when their injection interval is being extended to 16 weeks. Data will be collected from the medical record from the time of first injection, the time at which the injection interval is extended to 16 weeks, and at timepoints 1 and 2 years later. Data to be collected includes: age, sex, anti-VEGF type, visual acuity, disease characteristics from OCT images, length of treatment and number of injections received, and final injection interval.

In this study, patients newly diagnosed with nAMD will be randomized into two groups. Half of the patients will watch a video with information about their disease and the other half will receive information from the ophthalmologist as usual without watching the video. The effectiveness of the video will be tested with a knowledge assessment form and patient information satisfaction questionnaire.

Objective Little is known about how low vision services by ophthalmologists are being provided. Here, we analyze the patterns of provision and utilization of vision rehabilitation services in Ontario, Canada. Design Retrospective population-based study between 2009 and 2015. Participants Ophthalmologists (n = 92) who billed for vision rehabilitation services through the Ontario Health Insurance Plan in Ontario and the patients (n = 8949) who received these services. Methods Billing data for low vision services (2009–2015) was received from Ontario Health Insurance Plan. Data were analyzed to describe patient demographics (age, sex, geographic distribution, number, and type of visits) and service provider information (geographic location, number of years providing services, and number of services per year). Results It is estimated that ≤ 5% of patients with low vision in Ontario accessed these vision rehabilitation services by ophthalmologists. The majority of these patients were females (61%) and > 60 years old (79%). While patient and provider geographic distributions overlapped in the areas with largest patient populations, many regions lacked services. The majority of patients (71%) made only one vision rehabilitation visit. Nine providers practiced low vision for 7 years, while 43 provided services for only 1 year. In 2015, the most common diagnostic service provided to low vision patients was Optical Coherence Tomography of the retina and the most common therapeutic service was intravitreal for wet age-related macular degeneration. Conclusion Although low vision services increased between 2009 and 2015, there were differences in ability to access care based on age, sex, and geographic location.