Investigating the long-term outcomes and efficacy of surgical intervention in patients with adolescent idiopathic scoliosis and Cobb angles ranging between 40 and 50 degrees.

PURPOSE: Patients with adolescent idiopathic scoliosis (AIS) are either managed with non-operative strategies or surgery depending on the severity of lateral curvature and impact on quality of life. However, supportive evidence for the appropriate treatment approach is lacking in AIS patients with Cobb angles between 40 and 50 degrees. Therefore, we investigated differences in long-term patient-centered outcomes in AIS patients with Cobb angles between 40 and 50 degrees who received either operative or non-operative management. METHODS: A total of 919 patients aged 10-21 years old with adolescent idiopathic scoliosis and 40-50 degree Cobb angles were identified from the HARMS Study Group (HSG) registry and dichotomized based on operative or non-operative management. Baseline and 2 year follow-up SRS-22 scores from these patients were analyzed for significant differences between the total score values, domain values, and the magnitude of score change over time using multiple comparisons analyses. Multivariable regressions adjusting for age, body mass index, location of spinal deformity, and management strategy were also performed. RESULTS: Operative versus non-operative strategy was significantly, independently associated with differences in SRS-22 total and domain scores over time (effect likelihood ratio test, p < 0.03 for all regressions). Operatively managed patients had significantly greater improvement in SRS-22 total and domain scores over the follow-up duration compared to non-operatively managed patients (p < 0.02 for all comparisons). CONCLUSIONS: This preliminary analysis suggests that operatively managed patients may have had better long-term outcomes than non-operatively managed patients within this AIS subpopulation. These findings support the need for further prospective investigation to determine the optimal management strategy to improve evidence-based, patient-reported outcomes for AIS patients with Cobb angles between 40 and 50 degrees. LEVEL OF EVIDENCE: Level III.

Autologous Micrografts Containing Nanovesicles, Exosomes, and Follicle Stem Cells in Androgenetic Alopecia: In Vitro and In Vivo Analysis Through a Multicentric, Observational, Evaluator-Blinded Study.

BACKGROUND: The use of micrografts (MCGs) containing human follicle mesenchymal stem cells (HF-MSCs) is a hair loss (HL) treatment that needs to be standardized as seems to have promising effects on hair regrowth (HR-G) also thanks to the presence of extracellular vesicles (EVs). OBJECTIVES: The study aims to report both the in vivo results, obtained in patients affected by androgenic alopecia (AGA) treated using MCGs, and in vitro analysis characterizing the EVs. METHODS: A multicentric, retrospective, observational, evaluator-blinded study was conducted. Eighty-three AGA patients were initially enrolled [52 suffering from male pattern hair loss (MPHL) at stages I-III vertex by the Norwood-Hamilton scale and 31 suffering from female PHL (FPHL) at stages I-II by the Ludwig scale]. Sixty patients (20 females and 40 males) were treated and analyzed after exclusion and inclusion criteria assessment. The in vivo HR-G was evaluated through photography, physician's, and patient's global assessment scales, in addition to standardized photo-trichograms, during a follow-up for 1 year, while the in vitro analysis was performed through a quantitative, morphological, and dimensional characterization of the EVs population using transmission electron microscopy (TEM) and fluorescent microscopy. RESULTS: A hair density (HD) increase of 28 ± 4 hairs/cm2 at T4 after 12 months in the targeted area (TA) of FPHL, compared with the baseline, was observed using computerized trichograms with a statistically significant difference (SSD) in hair regrowth (HR-G) (p = 0.0429). Regarding MPHL, an HD increase of 30 ± 5 hairs/cm2 at T4 after 12 months in the TA was observed with an SSD in HR-G (p = 0.0012). The presence of EVs and their interaction with the surrounding cellular population were demonstrated. CONCLUSIONS: MCGs containing HF-MSCs and exosomes may fill in as a safe and viable alternative treatment against HL in mild and moderate degrees of AGA both in MPHL and in FPHL. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

A Review of the Tear Film Biomarkers Used to Diagnose Sjogren's Syndrome.

This literature review looks at Sjogren's Syndrome (SS), a chronic autoimmune disorder affecting exocrine glands, particularly the lacrimal and salivary glands. SS manifests as ocular and oral dryness, with severe complications like visual dysfunction and corneal perforation, as well as systemic implications, such as interstitial lung disease and lymphoma. This review explores the use of tear film biomarkers to diagnose SS, emphasizing the significance of their identification in aiding clinical diagnosis and differentiation from other diseases. This study identified and analyzed 15 papers, encompassing 1142 patients and employing various tear sample collection methods. Tear biomarkers were categorized by function and explored in-depth. Categories include (1) antimicrobials, antivirals, and antifungals; (2) components of immune regulation; (3) components that regulate metabolic processes; and (4) inflammatory markers. Noteworthy findings include the potential diagnostic values of tear lysozyme, lactoferrin, dinucleoside polyphosphates, cathepsin, defensin, antibodies, epidermal fatty acid-binding protein, HLA-DR, ADAM10, aquaporin 5, and various miRNAs and mRNAs. Overall, our understanding of SS tear film composition is enhanced, providing valuable insights into the pathogenesis of SS and offering a foundation for future diagnostic and therapeutic advancements in autoimmune conditions affecting the ocular surface.

Socioeconomic Status and Time to Treatment in Patients With Traumatic Rotator Cuff Tears.

INTRODUCTION: Socioeconomic status (SES) affects access to care for traumatic rotator cuff (RTC) tears. Delayed time to treatment (TTT) of traumatic RTC tears results in worse functional outcomes. We investigated disparities in TTT and hypothesized that individuals from areas of low SES would have longer time to surgical repair. METHODS: Patients who underwent repair of a traumatic RTC tear were retrospectively reviewed. Median household income and Social Deprivation Index were used as a proxy for SES. The primary outcome was TTT. Patients were further stratified by preoperative forward flexion and number of tendons torn. RESULTS: A total of 221 patients met inclusion criteria. No significant difference in TTT was observed between income classes (P = 0.222) or Social Deprivation Index quartiles (P = 0.785). Further stratification by preoperative forward flexion and number of tendons torn also yielded no significant difference in TTT. DISCUSSION: Contrary to delays in orthopaedic care documented in literature, our study yielded no difference in TTT between varying levels of SES, even when stratified by the severity of injury. Thus, we reject our original hypothesis. Based on our findings, mechanisms in place at our institution may have mitigated some of these health disparities within our community.

Modified peri-areolar mastopexy and fat grafting in complex breast ptosis: A randomized open-label controlled trial.

BACKGROUND: Complex breast ptosis may be caused by moderate to severe degrees of skin and glandular sagging associated with breast and nipple-areola complex (NAC) asymmetries and deformities. The use of traditional peri-areolar mastopexy (t-PM) with or without implants is limited only to mild or moderate breast ptosis. OBJECTIVES: This study aimed to report the safety and efficacy of the modified peri-areolar mastopexy (m-PM) characterized by a vertical shift of the classical pattern with implants and fat grafting (FG) in complex breast ptosis and to evaluate the influence of breast and NAC asymmetries, breast, and chest deformities on aesthetics outcomes. METHODS: An open-label randomized controlled trial was performed. Forty women (study group - SG) affected by breast ptosis (moderate and severe), asymmetries, and deformities were treated with m-PM, implants, and FG, and their outcomes were compared with those in a control group (CG) (n = 35) treated with t-PM and implants. Aesthetic outcomes were evaluated using the patient's satisfaction grade, physician's assessment score, and visual Analog Scale (VAS). RESULTS: Overall, 75% (n = 30) of SG patients reported excellent results in terms of breast lift, shape, volume, NAC position, and scar quality after 12 months, whereas the CG reported the same outcomes in 60% (n = 21) of the cases. SG patients showed a vertical NAC shift and a satisfaction degree higher than that in the CG (p < 0.001 vs. CG). CONCLUSIONS: The m-PM with implants and FG was found to be safe and effective in this trial.

AI-enhanced "Two-thirds Guidelines" for Lipolifting: Addressing Multiple Hallmarks of Facial Aging.

Background: Facial aging involves complex changes such as volume loss, ligament weakening, and skin quality alterations. The "two-thirds guidelines" emerge as a novel strategy to combat these aging signs, drawing from an extensive analysis of 2800 facial fat grafting procedures conducted over two decades. Methods: Guided by facial lipolifting data, including patient age, fat type (microfat and nanofat), and injection depth, this study devises a systematic framework for multilayer fat rejuvenation and ligament restoration. The two-thirds guidelines advocate injecting two-thirds of the patient's age for microfat and one-third for nanofat, with specific injection codes for lower, middle, and upper facial regions. Results: A prospective study involving 400 patients confirms the efficacy of the two-thirds guidelines. However, applicability may vary for patients outside SD ranges, particularly concerning facial proportions and body mass index. Patients within the golden ratio range (1.4-1.9) report high satisfaction rates and a 50% fat graft uptake, with minimal complications. For patients outside this range, an artificial intelligence (AI) program was implemented. Conclusions: The two-thirds guidelines offer a comprehensive approach to facial rejuvenation, addressing volume loss, ligament weakening, and skin quality. They are applicable in early aging stages, promising enduring and natural outcomes while mitigating effects of weight fluctuations. These guidelines provide a safe, replicable, and adaptable approach to facial fat grafting, either standalone or in combination with facelift techniques, with minimized overfilling risks. A dataset obtained from 2800 patients serves as the foundation for developing an AI program tailored to aid doctors in diagnosing and treating similar cases.

Mental Health Disorders and Surgical Outcomes in Patients With Bone and Soft Tissue Sarcoma.

BACKGROUND: We conducted a study to investigate the relationship between a mental health diagnosis (MHD) and postoperative outcomes in orthopedic patients with bone and soft tissue sarcoma. We hypothesized that patients with sarcoma with a preoperative MHD would have worse outcomes and more postoperative complications. MATERIALS AND METHODS: A retrospective review was performed of 356 patients who underwent surgical treatment for bone or soft tissue sarcoma. Patients were divided into two groups: those with a diagnosis of depression, anxiety, bipolar disorder, and/or schizophrenia and those with no previous MHD. Statistical analysis was performed using independent t, Mann-Whitney U, and chi-square tests. RESULTS: Statistical analysis demonstrated significant differences between the MHD group and the control group in three outcomes: length of stay, 90-day readmission rate, and incidence of surgical site infections. Subgroup analysis of the MHD group yielded significantly higher 90-day readmission rates for patients who were diagnosed during sarcoma treatment. CONCLUSION: Patients with sarcoma and an MHD had a longer postoperative hospital stay, an increased 90-day readmission rate, and a greater risk of surgical site infection. Given the rising prevalence of mental health disorders nationwide, orthopedic surgeons should be aware of differences in postoperative outcomes between patients with sarcoma with and without mental illness. [Orthopedics. 20XX;4X(X):XXX-XXX.].

Differences in Risk Factors for Rotator Cuff Tears in Young Versus Old Individuals.

Background The etiology of rotator cuff tears is thought to be multifactorial with current literature that varies with regard to identifiable risk factors. The purpose of this retrospective review was to identify risk factors for full-thickness rotator cuff tears and determine whether they differ in young versus older individuals. Methods To determine the presence or absence of a rotator cuff tear, 1,561 patients with a shoulder MRI were reviewed. If a tear was present, it was further classified into a partial or full-thickness tear. Demographic variables and clinical data were collected and analyzed with a two-sided Student's t-test or Wilcoxon rank sum test for continuous variables and a Chi-square test or Fisher's exact test for categorical variables. Age and BMI were dichotomized using receiver operator curves. Results Charlson Comorbidity Index, age, BMI, sex, race, and work status were all factors that variably affected a patient's risk of experiencing a rotator cuff tear, with different factors carrying more influence on outcomes within those who are older versus those who are younger. Gender and race were found to differ as risk factors between young and older individuals. Conclusion We were able to identify risk factors overall associated with increased odds of sustaining a full-thickness rotator cuff tear. Our analyses also showed differences in the effect of gender and race as risk factors between young and older patients with rotator cuff tears. This finding may aid clinicians in counseling patients on more specific risks for their given age.

Accuracy of Clinical Suspicion for Rotator Cuff Tears by Orthopedic Surgeons When MRI Was Ordered on Initial Visits: Should Physical Therapy Be Mandated by Insurance Before MRI?

INTRODUCTION: Insurance companies often mandate six weeks of physical therapy (PT) prior to approving MRIs for patients with atraumatic rotator cuff (RTC) tears. While this is designed to limit unnecessary imaging orders, it can increase healthcare costs and delay diagnosis and surgery. This study investigated the incidence of full- and partial-thickness tears when an MRI was ordered at the time of initial consultation for shoulder pain by an orthopedic provider. METHODS: A retrospective review of patients who had an MRI ordered upon initial orthopedic consultation for chronic shoulder pain was conducted. The primary outcome measured was the presence of RTC tears as determined by the MRI report. The cost of six weeks of PT versus the cost of immediate MRI in these patients was collected from our institution's financial database. ANOVA, independent T-test, and chi-square test were used to analyze the differences between groups. RESULTS: A total of 365 patients were included. There were no significant differences in demographics between patients with full, partial, or no tears, with the exception that patients with full-thickness tears were older. Specifically, 43.0% had a full-thickness tear, 24.7% had a partial-thickness tear, and 32.2% had no tear on MRI. A total of 56.1% of the full-thickness tears proceeded to surgery. The cost of an upper extremity MRI without contrast averages $2,268, while two sessions of PT per week for six weeks totals $2,328. DISCUSSION: Over 67% of MRI orders yielded a positive finding of an RTC tear and remained at 67.2% in the absence of a history of conservative treatment, validating a specialist's clinical suspicion for an RTC tear and indication for MRI. Pre-MRI PT to satisfy insurance requirements may therefore delay intervention and increase healthcare costs when an orthopedic provider believes an MRI is warranted for clinical decision-making.

Programmed Death Ligand 1 (PD-L1) Expression in Lymphomas: State of the Art.

The interaction of programmed death-1 (PD-1) on T lymphocytes with its ligands Programmed Death Ligand 1 (PD-L1) and Programmed Death Ligand 2 (PD-L2) on tumor cells and/or tumor-associated macrophages results in inhibitory signals to the T-cell receptor pathway, consequently causing tumor immune escape. PD-L1/PD-L2 are currently used as predictive tissue biomarkers in clinical practice. Virtually PD-L1 levels expressed by tumor cells are associated with a good response to immune checkpoint blockade therapies targeting the PD-1/PD-L1 axis. These therapies restore T-cell antitumor immune response by releasing T-lymphocytes from the inhibitory effects of tumor cells. Immune checkpoint therapies have completely changed the management of patients with solid cancers. This therapeutic strategy is less used in hematological malignancies, although good results have been achieved in some settings, such as refractory/relapsed classic Hodgkin lymphoma and primary mediastinal large B-cell lymphoma. Variable results have been obtained in diffuse large B-cell lymphoma and T-cell lymphomas. Immunohistochemistry represents the main technique for assessing PD-L1 expression on tumor cells. This review aims to describe the current knowledge of PD-L1 expression in various types of lymphomas, focusing on the principal mechanisms underlying PD-L1 overexpression, its prognostic significance and practical issues concerning the evaluation of PD-L1 immunohistochemical results in lymphomas.

Educational and Clinical Outcome Measures in an Integrated Hand Service.

Background: We recently sought to integrate our orthopaedic and plastic hand surgeons with the goal of improving education, patient care, and providing seamless, continuous coverage for our trauma center. Our hypothesis was that integration could serve both the orthopaedic and plastic surgery training programs well and provide more consistent care for the trauma patients. Materials and Methods: Program director approval was granted for blinded analysis of case logs from plastic and orthopaedic surgery programs from 2012 through 2019. Data on mean and total number of hand cases were analyzed and compared for both specialties. Institutional Review Board approval was granted for a retrospective review of patient outcomes. Results: For both orthopaedic and plastics resident trainees, the mean number of hand cases increased during this study period suggesting that the integration had a favorable impact on both programs. The mean number of hand cases for orthopaedic residents rose from 163 to 246. The mean number of hand cases for plastic surgery residents rose from 218 to 295. Patient outcomes as reflected in length of stay and time to consultation also improved. Conclusion: To improve hand surgical training and patient care, an integrated orthoplastics approach to hand surgery was implemented at our institution. Plastic surgery trainees are completing more hand surgery cases in an integrated model (p < 0.001), including fracture care (p < 0.047). Orthopaedic surgery trainees have doubled the percentage of integumentary and microsurgery cases in the integrated model (p < 0.001). The educational and clinical changes affected in an integrated model have changed the paradigm for educating future hand surgeons at our institution.

Chronic myeloproliferative neoplasms with concomitant CALR mutation and BCR::ABL1 translocation: diagnostic and therapeutic implications of a rare hybrid disease.

Myeloproliferative neoplasms (MPNs) are subdivided into Philadelphia (Ph) chromosome-positive chronic myeloid leukemia (CML) and Ph-negative MPNs. BCR::ABL1 translocation is essential for the development and diagnosis of CML; on the other hand, the majority of Ph-negative MPNs are characterized by generally mutually exclusive mutations of Janus kinase 2 (JAK2), calreticulin (CALR), or thrombopoietin receptor/myeloproliferative leukemia (MPL). CALR mutations have been described essentially in JAK2 and MPL wild-type essential thrombocythemia and primary myelofibrosis. Rarely coexisting CALR and MPL mutations have been found in Ph-negative MPNs. BCR::ABL1 translocation and JAK2 mutations were initially considered mutually exclusive genomic events, but a discrete number of cases with the combination of these genetic alterations have been reported. The presence of BCR::ABL1 translocation with a coexisting CALR mutation is even more uncommon. Herein, starting from a routinely diagnosed case of CALR-mutated primary myelofibrosis subsequently acquiring BCR::ABL1 translocation, we performed a comprehensive review of the literature, discussing the clinicopathologic and molecular features, as well as the outcome and treatment of cases with BCR::ABL1 and CALR co-occurrence.

Comparing Rates of Radiographic Baseplate Loosening Between Cement and Cementless INFINITY Total Ankle Prostheses.

INTRODUCTION: Total ankle replacement is indicated for end-stage ankle osteoarthritis. Periprosthetic radiolucency, from separation between the bone and implant, is suggested to be indicative of potential prosthesis failure risk. Anchoring implants with cement may mitigate this. This study aimed to compare rates of periprosthetic radiolucency between patients with cement-affixed and cementless implants. METHODS: A retrospective analysis was performed on 28 patients who underwent total ankle replacement with the INFINITY Total Ankle System (Wright Medical, Memphis, Tennessee) implant between January 2016 and May 2022. Anteroposterior, mortise, and lateral ankle X-rays were reviewed by 2 independent reviewers for tibiotalar angle, talar tilt, and periprosthetic radiolucency. The Wilcoxon rank-sum test and chi-square test were performed. RESULTS: The incidence of periprosthetic radiolucency at the most recent follow-up did not significantly differ between cement and cementless groups (57.1% in both groups, P = 1.0). Follow-up tibiotalar and talar tilt angles were not significantly different (P > .51 for all comparisons). CONCLUSIONS: Patients with cemented implants had a similar incidence of periprosthetic radiolucency compared with patients with cementless prostheses. Understanding of long-term clinical outcomes will help inform optimal operative approaches for ankle prostheses. LEVELS OF EVIDENCE: Therapeutic, Level III, Retrospective cohort study.

Mechanical Purification of Lipofilling: The Relationship Between Cell Yield, Cell Growth, and Fat Volume Maintenance.

BACKGROUND: The mechanical manipulations of fat tissue represented from centrifugation, filtration, washing, and fragmentation were considered the most effective strategies aiming to obtain purified lipofilling with different impacts both in terms of adipose-derived stem cells amount contained in stromal vascular fraction, and fat volume maintenance. OBJECTIVES: The present work aimed to report results in fat volume maintenance obtained by lipofilling purification based on the combined use of washing and filtration, in a clinical study, and to deeply investigate the adipose-derived stem cells yield and growth capacity of the different stromal vascular fraction extraction techniques with an in vitro approach. METHODS: A preliminary prospective, case-control study was conducted. 20 patients affected by face and breast soft tissue defects were treated with lipofilling and divided into two groups: n = 10 patients (study group) were treated with lipofilling obtained by washing and filtration procedures, while n = 10 (control group) were treated with lipofilling obtained by centrifugation according to the Coleman technique. 6 months after the lipofilling, the volume maintenance percentage was analyzed by clinical picture and magnetic resonance imaging comparisons. Additionally, extracted stromal vascular fraction cells were also in vitro analyzed in terms of adipose-derived stem cell yield and growth capacity. RESULTS: A 69% ± 5.0% maintenance of fat volume after 6 months was observed in the study group, compared with 44% ± 5.5% in the control group. Moreover, the cellular yield of the control group resulted in 267,000 ± 94,107 adipose-derived stem cells/mL, while the study group resulted in 528,895 ± 115,853 adipose-derived stem cells /mL, with a p-value = 0.1805. Interestingly, the study group showed a fold increase in cell growth of 6758 ± 0.7122, while the control group resulted in 3888 ± 0.3078, with a p < 0.05 (p = 0.0122). CONCLUSIONS: The comparison of both groups indicated that washing and filtration were a better efficient system in lipofilling preparation, compared to centrifugation, both in terms of volume maintenance and adipose-derived stem cell growth ability. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

Medicare Reimbursement in Hand and Upper Extremity Procedures: A 20-Year Analysis.

PURPOSE: Concern exists that Medicare physician fees for procedures have decreased over the past 20 years. The Centers for Medicare & Medicaid Services (CMS) is set to re-evaluate these physician fees in the near future for concern that these procedures are overvalued. Our study sought to analyze trends in Medicare reimbursement rates from 2000 to 2019 for the top 20 most billed hand and upper extremity surgical procedures at our institution. METHODS: The financial database of a single academic tertiary care center was queried to identify the Current Procedural Terminology codes most frequently utilized in orthopedic hand and upper extremity procedures in 2019. The Physician Fee Schedule Look-Up Tool from the CMS was queried for annual physician fee data. Monetary data were adjusted for inflation using the consumer price index of Urban Research Series (CPI-U-RS) and expressed in 2019 constant US dollars (USD). The average annual and total percent change in reimbursement were calculated via linear regression for all procedures (P < .05). RESULTS: Accounting for inflation, the total average physician reimbursement decreased by 20.9% from 2000 to 2019, with 12 of 20 codes decreasing by more than 20%. The greatest decrease pertained to arthrodesis of the wrist at 33.9%. Upon linear regression, all procedures were found to decrease annually, with arthrodesis of the wrist decreasing by an average of 2.3% annually over this period. CONCLUSIONS: Over the past 2 decades, physician reimbursement for hand and upper extremity procedures has significantly decreased.

Mental health disorders and pain modulation in orthopedic shoulder patients.

Background: Various studies have examined the relationship between preoperative mental health diagnoses (MHDs) and postoperative outcomes in orthopedic shoulder patients. However, few investigations delve into the relationship between a preoperative MHD and postoperative opioid pain control regimens in patients who have undergone rotator cuff repair (RCR), total shoulder arthroplasty (TSA), and reverse TSA (rTSA). We hypothesize that orthopedic shoulder patients with a preoperative MHD will be prescribed more opioids (ie, request more refills) postoperatively than those without a MHD. Methods: An institutional review board-approved retrospective chart review was performed on 438 patients, 18 years or older, who underwent RCR, TSA, or rTSA. Patients were divided into two groups: those diagnosed with depression, anxiety, bipolar disorder, and/or schizophrenia (n = 193), and those with no previous MHD (n = 245). Statistical outcomes were analyzed with the independent t-test, Mann-Whitney U test, one-way Analysis of Variance, and Kruskal-Wallis test. Results: Univariate analysis demonstrated significant differences between the MHD group and non-MHD group in average 90-day postoperative opioid scripts (2.10 vs. 1.55, respectively, P < .001) and median 90-day postoperative morphine milligram equivalents (MMEs) prescribed (225 MME vs. 185.25 MME, respectively, P < .001). Among patients who were opioid naive 90 days preoperatively, significant differences were found in MMEs prescribed between the MHD and non-MHD group (225 MME vs. 150 MME, respectively, P < .001). Further analysis of opioid naive patients with specifically depression compared to patients with an alternate or no MHD diagnosis yielded significant differences in scripts (1.78 vs. 1.33, respectively, P = .031) and MMEs prescribed (225 MME vs. 150 MME, respectively, P < .001). Conclusion: This study found that RCR, TSA, or rTSA patients with a preoperative MHD were prescribed significantly more postoperative MMEs and more opioid scripts (ie, requested more refills) than those without MHD. This is despite preoperative education on postoperative pain expectations and limiting opioid use. Our findings support our hypothesis and emphasize the clinical importance of recognizing mental health disease while navigating postoperative pain control expectations. Given the rising prevalence of mental health disorders nationwide, considering the effect of these comorbidities on postoperative pain in RCR, TSA, and rTSA patients will be essential to enhance preoperative and postoperative counseling and management by orthopedic surgeons. We further recommend a multidisciplinary approach to help manage pain in these patients.

Hemi-Ultrathin Descemet Stripping Automated Endothelial Keratoplasty (Hemi-UT-DSAEK) Using Pediatric Donor Corneas: A Case Series.

OBJECTIVE: We sought to evaluate the clinical outcomes of hemi-UT-DSAEK grafts from the pediatric donor corneas of patients affected by Fuchs Endothelial Corneal Dystrophy (FECD). METHODS: A prospective, interventional case series was conducted at the Ophthalmology Department of Venice Civil Hospital and the Veneto Eye Bank Foundation (Venice, Italy). Six eyes of six patients affected by FECD received large-diameter, semicircular hemi-UT-DSAEK grafts obtained from three pediatric donor corneas using the standard pull-through method. Endothelial cell density (ECD), central corneal thickness (CCT), best-corrected visual acuity (BCVA) and intraoperative and postoperative complications were recorded at different time intervals up to 12 months. RESULTS: The average donor age was 64.6 ± 8.6 years, and the pre-operative ECD was 3266 ± 225 cells/mm2. At 12 months postoperatively, the average ECD was 1376 ± 509 cells/mm2 with a mean decrease of 56.8 ± 19.1% from the preoperative donor count. At 12 months, four out of six eyes had significantly improved and reached a BCVA of ≥20/25 (Snellen equivalent). The mean CCT significantly decreased from 788 ± 138 µm before surgery to 576 ± 30 µm at 12 months postoperatively (p < 0.01). CONCLUSIONS: Hemi-UT-DSAEK grafts using pediatric donor corneas are surgically feasible and can provide similar clinical outcomes compared to conventional UT-DSAEK. Transplanting pediatric donor tissues with high ECD into two patients could potentially increase the donor tissue pool to treat endothelial disease.

Artificial Intelligence-Assisted Processing of Anterior Segment OCT Images in the Diagnosis of Vitreoretinal Lymphoma.

Anterior segment optical coherence tomography (AS-OCT) allows the explore not only the anterior chamber but also the front part of the vitreous cavity. Our cross-sectional single-centre study investigated whether AS-OCT can distinguish between vitreous involvement due to vitreoretinal lymphoma (VRL) and vitritis in uveitis. We studied AS-OCT images from 28 patients (11 with biopsy-proven VRL and 17 with differential diagnosis uveitis) using publicly available radiomics software written in MATLAB. Patients were divided into two balanced groups: training and testing. Overall, 3260/3705 (88%) AS-OCT images met our defined quality criteria, making them eligible for analysis. We studied five different sets of grey-level samplings (16, 32, 64, 128, and 256 levels), finding that 128 grey levels performed the best. We selected the five most effective radiomic features ranked by the ability to predict the class (VRL or uveitis). We built a classification model using the xgboost python function; through our model, 87% of eyes were correctly diagnosed as VRL or uveitis, regardless of exam technique or lens status. Areas under the receiver operating characteristic curves (AUC) in the 128 grey-level model were 0.95 [CI 0.94, 0.96] and 0.84 for training and testing datasets, respectively. This preliminary retrospective study highlights how AS-OCT can support ophthalmologists when there is clinical suspicion of VRL.