Journal of the West African College of Surgeons最新文献

{"title":"Clinical and Radiographic Outcomes Following Complex Spine Reconstruction in Neurofibromatosis with Severe Spinal Deformity.","authors":"Kwadwo Poku Yankey, Derrick Nyantakyi Owusu, Arthur Sackeyfio, Francis Addai, Irene Wulff, Liudmila Gross-Fenandez, Oheneba Boachie-Adjei","doi":"10.4103/jwas.jwas_43_25","DOIUrl":"10.4103/jwas.jwas_43_25","url":null,"abstract":"<p><strong>Introduction: </strong>Neurofibromatosis (NF) associated spine deformity is uncommon and can be debilitating to patients. Surgery for deformity correction is associated with improved neurological status and quality of life, however, the surgical correction of the spinal deformity can be challenging can be and associated with high complication rates. We present a series of NF patients with curves >100° or treated with a vertebral column resections (VCR).</p><p><strong>Hypothesis: </strong>Spine deformity correction surgery in NF patients with curves >100° or indicated for VCR have higher rates of postsurgical complications.</p><p><strong>Materials and methods: </strong>Twelve consecutive NF patients from a multi-centre study group who underwent complex spine reconstruction as a result of NF associated deformity (>100° or treated by VCR) were enrolled in the study. Analysis included demographic, clinical, pr-operative, intraoperative, and postoperative complications. scoliosis research society (SRS)-22 scores were used to compare pre-and 2-years postoperative functional outcomes.</p><p><strong>Results: </strong>Mean age and body mass index were 14 ± 2.9 and 19.8 ± 4.7 kg/m², respectively. Of the twelve patients enrolled, six patients had severe kyphoscoliosis, two patients presented with kyphosis, and four with scoliosis. Halo-gravity traction was used in 75% (9/12) of patients. Mean preoperative coronal and sagittal Cobb angles were 99.7 ± 22.5 and 99.1 ± 35.4, respectively. Seven patients had VCR and five had posterior column osteotomies. At 2-years postoperatively, mean coronal and sagittal Cobb angles were 44.9 ± 17.5 and 62.7 ± 21.7, respectively. Two patients with preoperative motor deficits improved at 1 year follow-up and 1 (8.3%) patient had new neurologic deficit postoperatively but recovered within a year follow-up. About 16.70% (2/12) had post-op pulmonary complications (atelectasis and pleural effusion) and 16.7% (2/12) patients required a revision surgery for implant related complications. There were no pseudarthrosis, visual complications (blindness) or deaths in the study cohort. health related quality of life measures, including SRS-22 scores demonstrated significant improvement at 2-years follow-up.</p><p><strong>Conclusion: </strong>Complex reconstruction resulted in significant curve improvement in both coronal and sagittal planes in NF-associated spine deformity. There were low of postsurgical complications. SRS outcomes improved in all patients after 2 year f/u.</p>","PeriodicalId":73993,"journal":{"name":"Journal of the West African College of Surgeons","volume":"16 3","pages":"337-342"},"PeriodicalIF":0.0,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13362879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148439252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Profile and Outcome of Surgical Management of Spinal Tumours in Abuja.","authors":"Yusuf Ayodeji Salman, Jabir Kassim Muhammad, Adebiyi Jamiu Ayodele, Teli Mukhtar Isa, Uthman Uthman","doi":"10.4103/jwas.jwas_87_25","DOIUrl":"10.4103/jwas.jwas_87_25","url":null,"abstract":"<p><strong>Background: </strong>Spinal tumours may originate from the native tissues of the spine, spinal cord, or secondary to metastatic spread. Their neurological manifestations are often similar, irrespective of origin. Surgical intervention may be curative in most benign tumours and palliative in metastatic spine tumours. Improvement in the surgical management of spine tumours has resulted in better patients' health-related quality of life. There have been only few reports on surgical management of spinal tumours in Nigeria.</p><p><strong>Objective: </strong>The study aimed to retrospectively evaluate the clinical aspects and short-term outcome of surgically managed patients with spine tumours in our institution over 3 years.</p><p><strong>Materials and methods: </strong>A retrospective review of patients treated surgically for spinal tumours at the Neurosurgery Department of National Hospital Abuja between June 2021 and November 2024.</p><p><strong>Results: </strong>Thirty-four patients with histologically proven spinal tumours who had surgeries were reviewed. There was a slight female preponderance with mean age of 51 years. Back pain and motor deficits were the most common presentation. Metastatic tumours from prostates and the breast were the commonest operated cases. The thoracic spine was most frequently affected (50%), followed by the cervical spine (20.6%). Gross total resection was achieved for all meningioma and schwannoma cases. Most metastatic tumours were debulked to decompress the spinal cord. Half of the patients improved, 30% remained same and 20% deteriorated as at last follow up.</p><p><strong>Conclusion: </strong>Surgical intervention results in significant improvement of pain and neurological deficit in most of the patients with spinal tumours. Metastatic spinal tumours were the most operated cases.</p>","PeriodicalId":73993,"journal":{"name":"Journal of the West African College of Surgeons","volume":"16 3","pages":"268-273"},"PeriodicalIF":0.0,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13362954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148439267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smartwatch Technology Retained Aesthetic Prosthesis (STRAP) Hand: A Functional and Aesthetic Innovation.","authors":"Arpit Sikri, Tarun Kalra, Vaishali Kalra, Jyotsana Sikri","doi":"10.4103/jwas.jwas_74_25","DOIUrl":"10.4103/jwas.jwas_74_25","url":null,"abstract":"<p><p>The hand performs essential functions such as grasping, touching, holding, and manipulating, while also contributing significantly to personal identity and psychological well-being. Partial hand loss compromises both aesthetics and function, often resulting in emotional distress. A well-designed prosthesis can restore the hand's length, preserve stump sensitivity with a thin interface, protect the residual limb, and offer pressure and positional feedback. While implant-based prostheses yield superior results, their high cost limits accessibility. For transmetacarpal and carpometacarpal amputations, cosmetic gloves remain the most common solution, despite lacking anatomical detail, and colour accuracy. Functional prosthetic fitting at this level is particularly challenging due to limited residual length, stump irregularities, grafted skin, contractures, and a lack of effective options. This case report presents the development of the <b>smartwatch technology retained aesthetic prosthesis (STRAP) Hand: A functional and aesthetic innovation</b>, an inventive solution for prosthetic rehabilitation following a proximal (transmetacarpal) hand amputation. The prosthesis was meticulously fabricated using room temperature vulcanising silicone with intrinsic staining to replicate natural skin tones. Engineered as a hollow, glove-like structure, the design significantly reduced weight and cost while achieving lifelike aesthetics through distinct dorsal and ventral colour matching. A three-part mould technique enabled efficient silicone packing and precise pigment application. In addition, novel sectional wax patterning and flasking protocols were employed to enhance fabrication accuracy. A key innovation of this prosthesis was the incorporation of a silicone smartwatch strap, providing superior retention, comfort, and discreet wearability. The STRAP hand demonstrated excellent fit and passive functionality, and the patient expressed high satisfaction in terms of aesthetics, social reintegration, and ease of performing daily tasks.</p>","PeriodicalId":73993,"journal":{"name":"Journal of the West African College of Surgeons","volume":"16 3","pages":"343-350"},"PeriodicalIF":0.0,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13362881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148439270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Evaluation of Composite Resin Bonded with Novel and Conventional Bonding Agents for Cost Effectiveness, Retention, and Secondary Caries: A Clinical Study.","authors":"Farkhaunda Ilyas, N Sneharaj, Priya Subramaniam, K Kiran","doi":"10.4103/jwas.jwas_115_25","DOIUrl":"https://doi.org/10.4103/jwas.jwas_115_25","url":null,"abstract":"<p><strong>Introduction: </strong>Restoring aesthetics in primary teeth presents a significant challenge for dentists due to factors such as thin enamel, unique pulpal anatomy, and the small size of these teeth. Discolouration, malformation, extensive caries, or damage from trauma in primary teeth often raise considerable concerns for both patients and their parents. Composite resin has become one of the most popular and reliable tooth-colour restorative materials, offering excellent aesthetic outcomes.</p><p><strong>Aim: </strong>To evaluate the cost effectiveness, retention, and secondary caries of universal adhesive Tetric N-Bond Vivapen and conventional adhesives followed by the composite restorations.</p><p><strong>Materials and methods: </strong>Two dental adhesive products was used: conventional adhesive and Tetric N-Bond universal Vivapen. The study included 30 children who required composite restoration and were divided into two groups. Group 1 was treated with conventional adhesive and Group 2 with Tetric N-bond. After treatment, the cost-effectiveness was assessed immediately, and children were followed-up after 12 months for the evaluation of retention and secondary caries.</p><p><strong>Results: </strong>The study showed that Tetric N-Bond Universal Vivapen is more cost-effective than conventional adhesive. Group 2 experienced significantly better outcomes for both retention of restoration (100% vs. 53.8%, <i>P</i> = 0.003) and incidence of secondary caries (100% vs. 15.4%, <i>P</i> < 0.001) over a 1-year period compared to Group 1.</p><p><strong>Conclusion: </strong>The study concludes that Tetric N-Bond Universal Vivapen is cost-effective, provides better retention, and reduces secondary caries compared to conventional adhesives, making it more durable for composite restorations in dental treatment.</p>","PeriodicalId":73993,"journal":{"name":"Journal of the West African College of Surgeons","volume":"16 4","pages":"453-459"},"PeriodicalIF":0.0,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pedicled Myocutaneous Trapezius Flap Reconstruction for Scalp and Back Defects: Our Experience of Management.","authors":"Jiten K Mishra, Valsalan Abhijith, Shamendra A Sahu, Jalaz J Rahmi","doi":"10.4103/jwas.jwas_96_25","DOIUrl":"https://doi.org/10.4103/jwas.jwas_96_25","url":null,"abstract":"<p><strong>Background: </strong>Posterior scalp defects are trivial defects to reconstruct due to the location, defect size, exposed calvaria/implants, and lack of local tissue. They are also pressure-bearing areas. These require optimal reconstruction for adequate postoperative functional outcomes with less complications.</p><p><strong>Materials and methods: </strong>Here, we collected data of our operated patients (four patients) involving posterior scalp and neck defects of varying etiologies like acne keloidalis nuchae, dermatofibrosarcoma, postoperative implant exposure, and trichilemmal carcinoma, all of which were managed using a pedicled lower trapezius myocutaneous flap. The details of the patient, procedure, and outcome were tabularised in the results section.</p><p><strong>Results: </strong>All patients underwent optimal coverage of defects with trapezius myocutaneous flap reconstruction. Three patients had uneventful recoveries, and one developed wound infection and dehiscence, which was effectively managed with negative pressure wound therapy and secondary suturing. No major flap-related complications or functional deficits in the trapezius muscle were noted. Patients remained asymptomatic and satisfied during follow-up periods of up to 2 years.</p><p><strong>Conclusion: </strong>Despite advancement of microsurgical techniques and ease of performing microsurgery, the lower trapezius myocutaneous flap has its merits as a suitable alternative to free tissue transfer for coverage of posterior scalp and neck defects.</p>","PeriodicalId":73993,"journal":{"name":"Journal of the West African College of Surgeons","volume":"16 4","pages":"397-402"},"PeriodicalIF":0.0,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation between Transrectal Doppler Sonography and Tumour Grade in Nigerian Men with Prostate Carcinoma.","authors":"Christopher Onyeka Otene, Chidi Kingsley Oranusi, Alexander Maduaburochukwu Ekwunife Nwofor, Chisolum Ogechukwu Okafor","doi":"10.4103/jwas.jwas_41_25","DOIUrl":"https://doi.org/10.4103/jwas.jwas_41_25","url":null,"abstract":"<p><strong>Background: </strong>Trans-rectal ultrasound (TRUS) Doppler assessment of the prostate can complement TRUS-guided biopsy of the prostate in the diagnosis of prostate cancer.</p><p><strong>Aim: </strong>This study aimed to correlate the trans-rectal Doppler sonography findings and tumour grade in Nigerian men with prostate carcinoma.</p><p><strong>Materials and methods: </strong>This was a prospective longitudinal study of men counselled for prostate biopsy after a written informed consent was obtained. Patients who met the inclusion criteria had six (sextant) core biopsy samples taken from the peripheral zone of the prostate. In addition, targeted biopsies from areas of increased vascularity on colour Doppler ultrasound outside the six core areas were also included in the study. Pathological results were correlated with the imaging data.</p><p><strong>Results: </strong>Sixty-nine patients met the inclusion criteria for the study. The mean age was 70.22 ± 8.91 years. The median Gleason grade was 8.0, indicative of a high-grade tumour among the patients. All 69 patients had prostatic adenocarcinoma on histological examination. Overall, 69.6% had high-grade tumours on TRUS Doppler sonography-guided biopsy, indicating a high percentage of high-grade tumours. There was a statistically significant correlation between the Doppler ultrasoundfindings and Gleason score (<i>r</i> = 0.837; <i>P</i> < 0.0001).</p><p><strong>Conclusion: </strong>Addition of colour Doppler scan to routine TRUS examination can help map out areas for targeted biopsies during prostate biopsies. Areas of increased vascularity correlated with high Gleason's grade and tumour grade.</p>","PeriodicalId":73993,"journal":{"name":"Journal of the West African College of Surgeons","volume":"16 4","pages":"433-437"},"PeriodicalIF":0.0,"publicationDate":"2026-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atraumatic Distal Radius and Ulna Fracture Following An Electrocution in a 14 Years Old Child: A Case Report.","authors":"Ravi Kumar, Srikanth Eppakayala, Adinarayana Kashap, Deepankar Satapathy, Sreedhar Sathu, Maheshwar Lakkireddy","doi":"10.4103/jwas.jwas_115_24","DOIUrl":"10.4103/jwas.jwas_115_24","url":null,"abstract":"<p><p>Fractures following a household electrical injury are uncommon, and it is even rarer to pick up fractures in patients who devoid a history of falls. The authors are presenting a case of a 14-year-old boy who had an electric shock at home and had continuous pain in his left wrist before presenting to us. He has sustained both distal radius and ulna uni-cortical break which were treated non-operatively. Household low-voltage electrical injuries resulting in fractures due to tetany are very uncommon. Having a uni-cortical break at both the distal radius and ulna with ventromedial displacement makes it unique, as it has never been reported. It is extremely important for the clinicians who are involved in electrical injury patient care to be suspicious about fractures associated with electrical injuries and should be looking at cues carefully for fractures even without a history of falls.</p>","PeriodicalId":73993,"journal":{"name":"Journal of the West African College of Surgeons","volume":"16 1","pages":"103-105"},"PeriodicalIF":0.0,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12959859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Address by the President to 65th Annual General Meeting of the WACS at Centre International de Conference de Bamako (CIDB), Mali, on 19 February 2025.","authors":"Emmanuel R Ezeome","doi":"10.4103/jwas.jwas_81_25","DOIUrl":"https://doi.org/10.4103/jwas.jwas_81_25","url":null,"abstract":"<p><p>Notwithstanding the challenges experienced in holding the 65th Conference of WACS in Bamako, Mali, we must express our gratitude to the LOC of Bamako 2025 for the wonderful work they did in organizing a peaceful and well conducted conference. The incapacitation of the WACS President-elect created a constitutional challenge in Bamako which the Council and AGM must resolve to have a president to lead the College after the conference. The 32nd EXCO of the College accomplished a lot of milestones within the two years of its existence. Clinical examination was extended to Enugu, a new examination centre was opened in Cameroun, fledging young examination centres in Banjul, Freetown and Liberia were sustained. College sources of funding were reengineered with increased contributions from non-examination sources while maintaining exam contribution. Examinations returned to profitability and overall, College finances were tremendously increased. The construction of WACS skills and simulation centre in Abuja and the Accra office of the College were initiated during this period. Renovation of real estate properties in Morris Street Lagos guaranteed increased inflow of funds. BOT membership in Ghana and Nigeria were formalized. College-wide training-of-trainers and curriculum review with emphasis on competency acquisition and assessment were implemented. Subspecialisation commenced fully in all the faculties as well as post fellowship training in Surgical Oncology. A renewed emphasis was placed on skills training with different curricular designed for basic laparoscopic, mid level and advanced level skills and simulation programs. In collaborations with Universities, in-residency PhD degree training was started. College research capacity was greatly increased with registration on Gov.org and grants applications to facilitate training in surgical sciences. It was indeed a two-year of intense activity and I express my gratitude to all the fellows who made all the achievement possible.</p>","PeriodicalId":73993,"journal":{"name":"Journal of the West African College of Surgeons","volume":"16 1","pages":"7-10"},"PeriodicalIF":0.0,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12959869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges and prospects of surgical simulation among final-year medical students in Enugu State, Nigeria.","authors":"Kelechi U Imediegwu, Chinenye C Odo, Chiamaka Q Onyebuchukwu, Kosisochukwu C Okeke, Somadila T Agulanna, Ikwuoma G Eleweke, Bassey Asuquo, Uku Thomas, Chiamaka Onwuasoigwe","doi":"10.4103/jwas.jwas_103_23","DOIUrl":"10.4103/jwas.jwas_103_23","url":null,"abstract":"<p><strong>Background: </strong>Simulation has rapidly become the go-to method for skill practice and training in surgical practice, to reduce the use of patients.</p><p><strong>Objectives: </strong>To determine the current state of simulations in surgical education among final-year medical students in Enugu state, Nigeria, ascertain the challenges, and proffer realistic solutions to the provision of simulations for surgical education among the students.</p><p><strong>Materials and methods: </strong>A cross-sectional survey of final-year medical students in two (2) medical schools in Enugu state, Nigeria. Data collection was done using a well-structured and validated online questionnaire distributed through online social media platforms (WhatsApp and Telegram). Descriptive and inferential data analysis was done with Statistical Package for the Social Sciences (SPSS) version 21. Chi-squares and Fischer's exact values were calculated. Significance was set at <i>P</i> < 0.05. Consent was obtained from all participants.</p><p><strong>Results: </strong>113 final-year medical students completed and submitted the questionnaires. The most commonly used virtual resource for simulation was Zoom lectures (39.8%), followed by recorded teachings (24.8%), and mannequin use (17.7%). The majority agreed that these resources caused less emotional (always = 31.0%; most times = 31.0%) and physical stress (always = 34.5%; most times = 41.6%) as well as aided better understanding of concepts (always = 22.1%; most times = 40.7%). More than half (62.8%) of respondents agreed that inadequate numbers of simulation devices was a very significant challenge, and 67.3% also recognised cost to be a very significant challenge. Among the suggested solutions, the majority agreed that curriculum restructuring was beneficial (67.3%; statistically significant with <i>P</i> = 0.05), increased funding (71.7%), training courses (48.7%) and increased awareness (62.8%) were still needed as solutions to the challenges.</p><p><strong>Conclusion: </strong>There is a need for larger-scale studies to determine the nationwide status of surgical simulation in medical schools. There is also a need to coordinate efforts towards establishing and incorporating simulator-based curricula in medical students' surgical training in Nigeria.</p>","PeriodicalId":73993,"journal":{"name":"Journal of the West African College of Surgeons","volume":"16 1","pages":"48-53"},"PeriodicalIF":0.0,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12959855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparison of Vitrectomy with and without Intravitreal Methotrexate for Advanced Proliferative Vitreoretinopathy.","authors":"Ogugua Ndubuisi Okonkwo, Adekunle Olubola Hassan, Toyin Akanbi, Arinze Anthony Onwuegbuna","doi":"10.4103/jwas.jwas_189_24","DOIUrl":"https://doi.org/10.4103/jwas.jwas_189_24","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To determine the anatomical visual outcomes and safety of intravitreal (IV) injection of self-compounded methotrexate (MTX) to treat proliferative vitreoretinopathy (PVR), since compounding pharmacies are limited or unavailable locally.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This was a retrospective comparative, interventional study. Data was obtained from case records and surgical logs. IV MTX compounded in the operating room into aliquots was injected into the vitreous cavity containing silicone oil of eyes after vitrectomy for rhegmatogenous retinal detachment (RRD) complicated with advanced PVR-labelled with methotrexate PVR (WMPVR). Weekly IV MTX at 500 µg/0.1 mL was administered in a fixed dosing regimen in Nigerian PVR patients. The anatomical and visual outcome in WMPVR was compared with two groups matched for age and sex: PVR in which MTX was not used, labelled without MTX PVR (WOMPVR), and retinal detachment without PVR, labelled no PVR (NPVR). The primary outcome was the percentage of retina attachment after a minimum of 6 months follow-up, and the secondary outcome was the change in Snellen best corrected visual acuity conversion to LogMAR. Documented observed complications assessed the safety of IV MTX. Data analysis was done using Statistical Package for the Social Sciences version 22. Means were used for measuring continuous variables and percentages for discrete variables. The three study groups and the two PVR groups were compared. Kruskal-Wallis and Mann-Whitney U were used to calculate the relationship between variables.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 90 RRD eyes were studied, 30 in each group. The number of detached quadrants, PVR grade, and macular involvement were similar in WMPVR and WOMPVR (&lt;i&gt;P&lt;/i&gt; &gt; 0.05, 95% CI), but NPVR had fewer detached quadrants (&lt;i&gt;P&lt;/i&gt; &lt; 0.05, 95% CI). Total IV MTX injections was 84, average 2.8 (range: 1-7). Anatomical reattachment was high, &gt;93% in the three groups (&lt;i&gt;P&lt;/i&gt; = 0.81). Preoperative LogMAR vision in WMPVR and WOMPVR was 2.14/0.60 (20/2520) and 1.93/0.72 (20/1600) (&lt;i&gt;P&lt;/i&gt; = 0.13), and 1.30/0.83 (20/400) for NPVR (&lt;i&gt;P&lt;/i&gt; = 0.00). Postoperative LogMAR vision was 1.58/0.83 (20/800) for WMPVR, 1.48/0.95 (20/630) (&lt;i&gt;P&lt;/i&gt; = 0.92) for WOMPVR, and 0.79/0.91 (20/125) (&lt;i&gt;P&lt;/i&gt; = 0.002) for NPVR. Subgroup analysis of silicone oil removed eyes in all three groups showed similar anatomical outcomes (&lt;i&gt;P&lt;/i&gt; = 0.797); postoperative vision was superior in the WOMPVR and NPVR groups compared to WMPVR (&lt;i&gt;P&lt;/i&gt; = 0.001). Intraocular pressure in WMPVR increased from preoperative 5 mm Hg to postoperative 13 mm Hg. The three eyes that had keratopathy resolved with copious lubrication. There was no endophthalmitis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Preliminary findings demonstrate the safety of self-compounded IV MTX in Nigerians. There was no significant visual improvement despite favourable anatomical outcomes. In this research, a non-PVR g","PeriodicalId":73993,"journal":{"name":"Journal of the West African College of Surgeons","volume":"16 4","pages":"408-417"},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}