arash maleki

Acromion, lateral projection of scapular spine, fracture is an uncommon injury which is often diagnosed late. Though, usually managed conservatively, the indications for surgery in these fractures are very specific. We are reporting on a 56-year-old active woman with an isolated displaced base of acromion fracture by tension- band wire fixation which resulted into uneventful union, and obtained good shoulder Constant Score and UCLA shoulder score . (( Acromion, lateral projection of scapular spine, fracture is an uncommon injury which is often diagnosed late. Though, usually managed conservatively, the indications for surgery in these fractures are very specific. We are reporting on a 56-year-old active woman with an isolated displaced base of acromion fracture by tension- band wire fixation which resulted into uneventful union, and obtained good shoulder Constant Score and UCLA shoulder score Acromion, lateral projection of scapular spine, fracture is an uncommon injury which is often diagnosed late. Though, usually managed conservatively, the indications for surgery in these fractures are very specific. We are reporting on a 56-year-old active woman with an isolated displaced base of acromion fracture by tension- band wire fixation which resulted into uneventful union, and obtained good shoulder Constant Score and UCLA shoulder score . . ))

To report a case of carboplatin-induced bilateral optic neuropathy in a patient with metastatic squamous cell carcinoma of the tongue.

Case Report: 

A 65-year-old man with a history of squamous cell carcinoma of the tongue with metastasis to the right axillary lymph node treated with carboplatin and paclitaxel was evaluated for decreased visual acuity in both eyes. Visual acuity was 20/70 in the right eye and no light perception in the left eye. On dilated fundus examination, optic disc edema was present in both eyes with more severity in the left eye, flame shape hemorrhages around the optic nerve head in both eyes and cotton wool spots around the left optic nerve head. Brain and orbital MRI demonstrated enhancement of the bilateral optic nerve sheaths. He was diagnosed with bilateral carboplatin-induced optic neuropathy.

Our findings in this case justify monitoring of patients during their course of intravenous carboplatin therapy.

Background and The tibial shaft fracture is the most common long bone fracture in children. This type of fracture has a high capacity for deformity correction, a process known as remodeling. In many circumstances, casting is the choice of treatment.

This study aims to investigate the rate of tibial fracture remodeling after 6 months of non-rigid fixation.

This research was a retrospective study conducted from March 2017 to March 2018. The study population included 74 children with tibial shaft fracture, treated with a long leg plaster under general anesthesia. Patients were evaluated by obtaining anteroposterior (AP) and lateral view x-rays in the first week, second week, 2 months, and 6 months after casting.

Seventy-four individuals were admitted with a diagnosis of tibial shaft fracture. A total number of 39 patients (52%)-13 girls and 26 boys- were treated with the long-leg casting under general anesthesia. The patients’ average age was 7.94±2.69 years (2-14 years). In the second week, four cases were excluded. Remodeling in the fracture site was significant in AP radiography at the end of the second month (P=0.044). Six-month follow-up showed that the remodeling in AP was significant (P=0.017) while in lateral was partially significant (P=0.05).

Due to the presence of the growth plate and a dense periosteum, remodeling of the tibial shaft fracture is extremely likely, and the remaining deformity is corrected over time by casting, and no surgical intervention is required. Level of evidence: IV

Nord Stream 2 is a pipeline built to transmit gas from Russia to Germany through the Baltic Sea. Between December 2019 to  May 2021, the United States government sanctioned offshore units and related natural and legal persons by implementing the national defense authorization act for the fiscal year 2020, which as a result, closed an 11-billion-dollar project. What comes to mind in this connection is the possibility of a contradiction between this action and the previous commitments of this government. In this article, using the descriptive-analytical method and the use of library resources, it has been proven that the implementation of the National Defense Authorization Act for the fiscal year 2020 with the obligations of the United States of America to the United Nations Charter due to the lack of a logical relationship and public agreement and trade is not inconsistent due to the previous announcement and temporary nature, but it violates the resolution 41/128 of the United Nations General Assembly, which, in view of the lack of legal obligation, despite the repeated violation of international law through unilateral sanctions, in this particular case, it cannot be The imposition of sanctions against the Nord Stream 2 pipeline claimed the international responsibility of the United States government. However, the negative effects of this action on the international legal order cannot be denied.

Clubfoot is a multifactorial disease with the prevalence of one in 1000 live births. The presentations of clubfoot are forefoot adductus, hindfoot varus, cavus, and equinus. Ponseti method is an efficient nonoperative clubfoot treatment containing manipulation, serial casting, and Achilles tendon tenotomy if necessary. Our prospective observational study assessed the outcome and probability of recurrence in the treated clubfoot with the Ponseti method.

This prospective observational study was performed in Akhtar Hospital in Tehran, Iran. 27 patients with 38 feet of idiopathic clubfoot in our study were treated with the Ponseti method. The patients were assessed before and after treatment and demographic characteristics, Dimeglio scores, number of recurrenes, and need for tenotomy were recorded.

All patients (38 feet) successfully achieved complete deformity correction, but 13 feet had a relapse. The mean age of cases with relapse was more than cases without relapse. Cases with a higher initial Dimeglio score had a higher recurrence rate after Ponseti method treatment. Eight feet (five patients) out of 38 feet did not use Denis Browne (DB) splint as our protocol; all of them had a relapse. On the other hand, only 5 of 30 feet (16.7%) that used splint had recurrence.

The treatment should be started as soon as possible because it is more effective at a younger age. Severe cases at the initial visit had more recurrence rate. Besides, the recurrence rate in cases that used DB orthosis improperly, irregularly, and incorrectly was higher than others.

To study whether rituximab and bortezomib combination therapy is more effective than rituximab monotherapy in the treatment of nonparaneoplastic autoimmune retinopathy (npAIR).

Retrospective case series involving six patients with npAIR, taking either rituximab and bortezomib combination therapy (three cases) or rituximab monotherapy (one case and two historical patients).

Patients on both treatment regimens showed stability in most of the visual function parameters during the one year of follow-up. Combination therapy resulted in improvement of scotopic combined rod and cone a-wave and b-wave amplitudes in all eyes where they were available (four eyes); however, rituximab monotherapy resulted in only two eyes with stable scotopic combined rod and cone a-wave and b-wave amplitudes, while four eyes showed a decrease in both a- and b-wave amplitudes. The average improvement in b-wave amplitude (50.7% ± 29.4% [range, 25–90%]) was higher than the average improvement in awave amplitude (35.7% ± 9.74 [range, 25–63%]). No severe adverse effects were reported.

Rituximab and bortezomib combination therapy may not be more effective than rituximab monotherapy in npAIR patients for most of the visual function parameters; however, this combination therapy may be more effective in improving scotopic combined rod and cone a- and b-wave amplitudes. This may indicate the higher efficacy of combination therapy when there is involvement of the inner retina.

Studies have proved that in addition to the inlet and outlet views, the intraoperative lateral sacral viewis required to ensure the correct entry point, reduce operating time, and lower radiation exposure. Considering thecomplex anatomy of the sacrum, we showed a safe corridor for sacroiliac joint (SIJ) screw insertion that was accessibleusing only inlet and outlet fluoroscopic views. From 2013 to 2020, we enrolled 215 patients who underwent percutaneous SIJ screw insertion. Ourexperience in SIJ screw insertion is presented using only two views (inlet and outlet). We reported on the radiationexposure time, operating time, rate of screw malposition, neurologic injury, and revision surgery. The screw malposition rate was 5.5%, including 11 foraminal perforations and one perforated anterior sacralcortex. Paresthesia after the surgery was observed in six patients (2.8%). No revision surgery or screw removal wasperformed. The radiation exposure and operation time for each screw were 21 ± 4.5 s and 13.5 min, respectively. The most anterior and the lowest part of the S1 vertebra can be easily found using intraoperative inletand outlet views. It is a safe corridor for SIJ screw insertion with low radiation time, neurologic injury, and revision rates.Level of evidence: IV

Between 1998 to 2000, the autonomous province of Kosovo faced an armed conflict between the Kosovo liberation army and Serbian belligerents. Due to the issuance of the declaration of independence of Kosovo in 2008, an investigation took place regarding the behaviors of Kosovo liberation army members by the parliamentary assembly of the Council of Europe resulted in confirmed violent and humiliating behaviors by members of this group. In 2014, The European Union and the government of Kosovo reached an agreement on establishing a special tribunal regarding charges within the investigation report, and subsequently, the Kosovo specialist department & specialist prosecutor's office were established. From the perspective of historical evolution, International criminal tribunals divide into four generations, and the specialist branches of Kosovo is below international criminal tribunals. The importance of the position of global criminal justice in the process of international peace and security requires that this new and little-known court as an agent of global criminal justice be evaluated formally and substantively from the point of view of its structure, competences and judicial procedure, in order to strengthen its strengths and Let's consider the correction of weak points. What we obtained by studying relevant documents and practical precedent of the specialist branches of Kosovo are the failure to provide a precise definition of the crime of forced disappearance of persons and the slow activity of the specialist branches as weak points. At the same time, it should be mentioned the necessity of judges' skill in criminal law as a criterion for tenure and great accuracy and attention to related details in drafting the judgment as strengths.

To evaluate the B‑scan ultrasound findings in unilateral posterior scleritis.

This was a retrospective observational case series at a tertiary uveitis clinic. The study population included patients who had been diagnosed with milder forms of unilateral posterior scleritis since 2010 and had B‑scan ultrasonography of that eye. The healthy eye of each patient was considered the control eye for that patient.

The average age of patients was 50.2 ± 17.8 (range, 18–67). Posterior scleritis was idiopathic in 6 (66.7%) patients and associated with rheumatoid arthritis in two and HLA‑B27 ankylosing spondylitis in one patient. The thickness of the thickest area in the diseased eye was 2.08 ± 0.49 (range, 1.35–3.2) and the control eye was 1.53 ± 0.38 (range, 1.03–2.3). The difference between the symptomatic and control eye was statistically significantly different (P = 0.02). 1.7 mm was the cut‑off‑point on the receiver operating characteristics curve with the highest combined sensitivity and specificity of 87.5% and 88.9%, respectively. Comparing the thickness of the thickest section of the symptomatic eye of one patient with the same section in the other eye of the same patient, there was a difference of 20% or more in sclero‑choroidal complex.

In this study, the sclero‑choroidal complex thickness higher than 1.7 mm has the highest combined sensitivity and specificity. Comparing the thickest section of the symptomatic eye of one patient with the same section in the other eye can be diagnostic.

Gathering reliable evidence is one of the significant challenges in international criminal trials. The main reasons for this challenge include location differences regarding court and crime scenes and measures taken by states to prevent neutral institutes reach for the evidence. In this circumstance, using new technologies may be a solution to solve this challenge. The gunshot detection system is among new technologies that could be useful. The mechanism of this technology works based on identification, recording, and immediate transfer of the information regarding using a firearm to a designated bureau, having civilian and military usage. Since many international crimes happen based on guns, recording and instant transferring related information could help the further trial. This article discusses the feasibility of using the gunshot detection system regarding the statute and the rules of procedure in five currently active international criminal tribunals. The International Criminal Court can use this technology more than other courts due to paragraph 3 of Article 69 of the Rome Statute and the features of permanence and universality.

To show whether subcutaneous repository corticotropin injection (RCI, Acthar® Gel, a repository corticotropin injection, can be an effective potential therapeutic agent for noninfectious retinal vasculitis.

Patients with active retinal vasculitis were followed with serial ultra-widefield fluorescein angiograms and treated with 80 units of subcutaneous repository corticotropin injection twice weekly.

Primary outcome of ≥50% improvement in response level (RL) for retinal vasculitis and percent improvement in retinal vasculitis severity scoring (RVSS) by more than one quartile (≥25%) at week 12 was met in 15 and 16 of the 30 total eyes, respectively, including 1 eye with severe retinal vasculitis in each group. Complete resolution of retinal vasculitis was seen in seven eyes with a mean time of 17.1 weeks. Intraocular pressure elevation requiring therapy and cataract progression were noted in two and three eyes, respectively. One patient stopped medication due to side effects (injection site reaction).

Repository corticotropin injection was well-tolerated overall. Repository corticotropin injection may be an effective therapeutic agent in the treatment of noninfectious retinal vasculitis.

Human rights are a set of fundamental rights and freedoms that are granted to human beings without any discrimination and simply because they are human beings. Governments are generally responsible for guaranteeing and enforcing these rights. Governments can facilitate the implementation of this responsibility by taking precautionary measures. One of these preventive measures is universal human rights education. People can claim their fundamental rights and prevent them from being violated by relying on awareness. Peace, in addition to being a strategic situation, is also recognized as a human right and has developed within the framework of the activities of the UN General Assembly and the Human Rights Commission. Therefore, in addition to the absence of war, peace is an expression of a situation with constructive, fair and democratic necessities. Meanwhile, Afghanistan is one of the developing countries. The UN Human Rights Council's global reports show the Afghan government's progress in guaranteeing and enforcing human rights. There is no doubt that the implementation of public human rights education plans and programs will be effective in developing this progress. Given the Afghan government's exposure to a number of challenges, such as armed conflict, terrorism, drug production and transit, and the like, it is worth considering assessing the benefits of human rights education in achieving and maintaining peace in Afghanistan. In this study, while examining the form and substance of the human rights education process, suggestions are provided for the development of public human rights education in Afghanistan according to the specific situation of the country.

To report the efficacy of topical interferon alpha 2b in the treatment of refractory diabetic macular edema.

In this retrospective interventional case series, five eyes of three individuals with diabetic macular edema resistant to multiple intravitreal injections of anti-vascular endothelial growth factor drugs and macular photocoagulation were included.

All studied eyes had undergone multiple intravitreal injections including bevacizumab, combination of bevacizumab and triamcinolone and aflibercept, and macular laser photocoagulation before being included in this study. Two intravitreal ranibizumab injections had also been performed in both eyes of one patient. Two eyes had undergone pars plana vitrectomy, one for diabetic macular edema and the other for rhegmatogenous retinal detachment. After a discussion regarding the experimental topical interferon alpha 2b treatment, all patients agreed to start interferon alpha 2b drops four times a day. One month after the treatment, optical coherence tomography demonstrated a significant improvement in macular structure and thickness which was stable or improved at the three-month follow-up visit. Visual acuity in all eyes was stable or improved throughout the three-month follow-up period. Conjunctival injection and follicular conjunctivitis were the side effects of topical interferon alpha 2b and were treated with lubrication and steroids.

This case series demonstrated the potential efficacy of interferon alpha 2b in the treatment of refractory diabetic macular edema. It might be an option in patients with contraindications for intravitreal injections.

To determine the efficacy and safety of infliximab therapy in patients with HLA B-27-associated ocular inflammation resistant or intolerant to conventional immunomodulatory therapy.

This was a retrospective observational case series. All cases were uveitic patients with positive HLA-B27, confirmed through HLA testing, resistant or intolerant to conventional immunomodulatory therapy. The primary outcome of the study was to identify the efficacy of infliximab determined by the control of inflammation, duration of remission, and the ability to reduce conventional immunomodulatory therapy. The secondary outcome was an improvement of two or more lines of best-corrected visual acuity (BCVA) on the Snellen visual acuity chart.

Twenty-four patients (38 eyes) were included in the study. All patients were followed for 24 months. Twenty-one (87.5%) patients completed 24 months of follow-up. Sixteen (66.7%) patients had active uveitis at the beginning of therapy. One patient out of these active patients had active inflammation at the end of follow-up period. Thirteen (87.5%) out of sixteen active patients were in steroid-free remission. The mean duration of treatment to induce remission was 16.5 months (range 6–24 months). Corticosteroid was stopped in 19 (90.5%) patients by the end of the study. At the end of the study, in patients who achieved remission, 14 (58.3%) patients were in remission on infliximab therapy and 6 (25%) patients were in remission off infliximab therapy. Of the 38 eyes, 8 (21.05%) showed improvement in BCVA (three eyes had successful cataract extraction with intraocular lens implantation during infliximab therapy with no subsequent inflammation), while 26 eyes (68.4%) had stable BCVA over the 24-month study period. The side effects included allergic reaction, fatigue, cellulitis, headache, restlessness, elevation of liver enzymes, and anemia. Two patients (n = 24, 8.3%) experienced severe adverse effects and the treatment was stopped prematurely in these two patients.

Infliximab might induce and maintain the steroid-free remission in HLAB27- associated ocular inflammation in patients resistant or intolerant to conventional immunomodulatory therapy.

Amniotic band syndrome (ABS) is a rare congenital anomaly may affecting any region of the fetus. Here, we reported a case of ABS involving the upper limbs resulted in amputation, syndactyly and lymphedema of several fingers. One of the the amputated finger reimplanted on to the upper back of the fetus between two scapular bone. The finger-like mass had no osseous tissue.

Ulnar shaft fracture with DRUJ injury in children is rare. This pattern of injury does not adapt to the account for Monteggia or Galeazzi fractures-dislocation. We present the case of patient with ulnar shaft fracture and DRUJ dislocation in 10 years old man and discussed about mechanisms and treatment of this injury.

Study design: A retrospective radiographic review was undertaken in patients treated for AIS.
To determine the most important preoperative factors that affect on postoperative junctional kyphosis complication.
sagittal spine profilewere measured on the standing radiographs before, after and in the last follow-up visit of the operated patients for AIS. The following parameters were measured on lateral views including: lumbar lordosis, thoracic kyphosis, the sagittal offset distance of C7 to a vertical line from postero-superior edge S1 (Sagittal Vertical Axis-SVA) and T9 sagittal offset angle.
One hundred twenty patients with mean of 42 months follow-up(24-112 months) were included in the study. Mean values of the parameters before corrective surgery were: lumbar lordosis 45° ± 13.6°, thoracic kyphosis 28°±18.4°, SVA 35 ± 27.2mm and T9 offset angle, 7.8°± 5.1°. Mean values at last follow-up were: lumbar lordosis 49 ± 9.8°, thoracic kyphosis 35 ± 16.4°, SVA 39 ± 24mm and T9 offset angle, 8.6°± 5.8° . There were 10 upper junctional kyphosis (8.4%).T test statistics revealed significant correction of lumbar lordosis and thoracic kyphosis after fusion in all patients (P Normal sagittal balance of spine is essential for the optimum function of the intervertebral disks and preventing sagittal postoperative complication like proximal junctional kyphosis. More attention to preoperative sagittal parameters of the spine like T9 offset may be important to prevent such complications.

To determine the most important preoperative factors that affect postoperative coronal parameters of scoliotic curves.
All Adolescent Idiopathic Scoliosis (AIS) patients included in the study were classified according to Lenke and King Classification. The fusion levels were selected according to the rigidity of the existing curves (correction less than 50%), tilt of T1 and shoulders, sagittal angle of the curves and with considering stable and neutral end vertebra. The radiographic coronal parameters: shoulders tilt angle, iliolumbar angle and coronal balance were measured in all patients before, after, and in the last follow- up visit.
One hundred twenty patients after mean of 25 months follow-up (18-40 months) were included in the study. Before operation, abnormal coronal balance (more than 2 cm shift) was noticed in 46 patents (38%) and in the last visit, was noted in 22 patients (18%). Multivariate regression analysis revealed a significant predictive value of the preoperative coronal balance on the last visit coronal balance (P value=0.01).
Preoperative coronal balance is very important to make a balanced spine after surgery. Other parameters like Lenke classification or main thoracic overcorrection did not affect postoperative coronal decompensation.

Dislocation of the first carpometacarpal (CMC) is a rare occurrence. Treatment of this dislocation varies from closed reduction and casting to ligament repair. Neglected dislocation or incomplete reduction of the 1st CMC cause chronic instability and painful arthritis, muscle imbalance and decreased grip force. In our study 6 patients is evaluated that were visited in less than 24 hours from their injury. All were primarily reduced and except one patient later injured ligament were repaired. All patient after 6 months had normal range of motion without pain and they had not any complaint. Stability at the 1st CMC joint is dependent on static and dynamic forces. However, dislocation of the 1st CMC occur rare, but important function of the thumb specially in gripping and grasping makes it a significant problem. Injured ligament should repair for increased stability of 1st CMC joint, because neglected dislocation or incomplete reduction cause chronic instability and painful arthritis.

Rural tourism is one of activities which in recent decades in developed countries and in recent years in developing countries, including Iran, have been attentioned. Predominantly rural tourism considered as a tool for socio-economic development of rural areas, but certainly the impact of different dimensions, is not easy to predict and manage. Therefore, knowledge about the effects of tourism in rural areas is very important. The aim of this study is to investigate the effects of tourism on economic, social and environmental aspects of rural areas in NatelkenafSofla in Noor Township. Method of this study is analytical using field surveys and questionnaires to collect information. After completing the questionnaire in groups of tourists, residents and the village, for data analysis spss and excel softwares was used. Results show that in the study area, both positive and negative aspects of rural tourism have arrived. Tourism development in the study area, although associated with desirable consequences, especially in the economic aspects, but with profound impact on the social, cultural, environmental fields and key components of sustainable tourism, means the consent and support of the host community, tourists satisfaction and sources and attractions of tourism, show destructive and unsustainable process of tourism development.

Tibial torsion is a term used to describe the physiologic twist of the distal relative to the proximal articular axis of the tibial bone in the transverse plane around its longitudinal axis. This study focuses on a method of tibial torsion measurement with computerized tomography cuts. Sixty four volunteers aged over 16 years old had CT imaging of proximal and distal tibia in a teaching hospital in Tehran-Iran. The images were evaluated for leg rotation by four physicians using two different techniques in two different occasions، one month apart. In the first technique the middle of tibia and middle of fibula were used as reference points and in the second method the perpendicular axis to the line connecting the distal fibular notches on CT scans was used. The values were analyzed، and the intra and inter observer agreements for tibia torsions were assessed. The inter-observer agreement in tibial torsion was. 861 and. 863 in the first and second methods respectively. The intra-observer reliability in both measurements techniques were. 868. The two techniques also had excellent agreement in tibial torsion measurements. The second technique has high reliability and reproductivity in assessing tibial rotation in fibula deformity.

Kienbock disease resulting from avascular necrosis of lunate bone leads to pain and disability in young active patients. Radial shortening is one of the treatment methods in this disease. In this study we evaluated the mid-term results of treatment of Kienbock using radial shortening. In a retrospective study 9 males and 6 females with Kienbock disease with average age of 28.6±9.37 years who had undergone radial shortening were examined in a teaching hospital in Tehran-Iran. There were 2 patients in stage II 5 in IIIa and 8 in step IIIb of Lichman’s class. In a mean follow-up of 5±2.44 years these 15 cases were evaluated for wrist motion and gap strength and also with quick-DASH score. The radiograph Stahl index and carpal height ratio were also assessed. Pain and range of motion improved and grip strength was favorable in 13 patients. Quick-DASH score was 8.5±.84 in patients with stage II 12.72±5.09 in stage IIIa and 27.57±18.87 in stage IIIb. Stahl index and carpal height ratio were the same in patients with stage II but significantly decreased in other patients. Kienbock disease progressed in 2 cases. Radial shortening can relief clinical symptoms even in stage III and IIIb of Kienback diseases although the disease X-ray show radiographic worsening.

The role of increased posterior tibial slope in rupture of the anterior cruciate ligament (ACL) is controversial. The purpose of current study was to determine the effect of posterior slope on the ACL injury.

In a case control study 61 consecutive cases with ACL injury who were candidates for reconstruction were compared with 61 persons with normal knees who were matched for age and sex over a 2-year period at a teaching hospital in Tehran Iran. The posterior tibial slope angles were measured on true lateral radiographs on all the cases. The measurement variations were analyzed between the two groups.

The mean posterior tibial slope was 9.4±1.8 degrees in controls and 12.3±4.4 in patients with ruptured ACL (p

The anterior cruciate ligament is the primary structure that controls anterior displacement in the unloaded knee. Anterior cruciate ligament reconstruction may return normal functions of the knee. The aim of the present study was to compare three different femoral fixation techniques in anterior cruciate ligament reconstruction. In a clinical trial study 120 patients that were candidates for ACL reconstraution were randomly divided into 3 groups of 40 individuals. The femoral fixations were by the three methods of "Aperfix" "Rigidfix" or "Endobutton". The cases were re-examined 12 months after surgery and evaluated by Lysholm score as well as with KT-1000 machine. The results were compered together for the three above methods. The Lysholm score showed improvement from pre-operative values in all three techniques: From 63.21±18.59 to 90.64±9.47 in "Endobutton" group from 65.72±18.74 to 96.22±5.35 in "Aperfix" and from 69.21±17.45 to 90.64±9.47 in the "Rigifix" group. There were 6 failures in "Endobutton" 4 in "Rigidfix" and one in "Aperfix" group. The anterior displacement tibia was 3.96±1.58 millimeters in "Endobutton" 4.28±1.48 in "Rigidfix" and 4.03±1.79 millimeters in "Aperfix" group. There was no significant difference in the operating time in the 3 groups. Regarding the instant stability of the graft the "Aperfix" method seemed stranger. Further investigations with larger number of cases and longer duration of follow up are recommended.

The vitreoretinal interface is involved in a wide range of vitreoretinal disorders and separation of the posterior vitreous face from the retinal surface is an essential part of vitrectomy surgeries. A diverse range of enzymatic and non-enzymatic agents are being studied as an adjunct before or during vitrectomy to facilitate the induction of posterior vitreous detachment. There is a significant body of knowledge in the literature about different vitreolytic agents under investigation for a variety of pathologies involving the vitreoretinal interface which will be summarized in this review.