Descemet's Membrane Dehiscence Resulting From Misdirected Viscoelastic During Anterior Chamber Reformation.

We report a case of Descemet's membrane detachment after inadvertent intrastromal injection of hyaluronic acid. Surgical removal was attempted with minimal but slow improvement. Near-complete resolution occurred with subsequent conservative management within 6 weeks.

The comprehensive anatomical spinal osteotomy classification.

BACKGROUND: Global sagittal malalignment is significantly correlated with health-related quality-of-life scores in the setting of spinal deformity. In order to address rigid deformity patterns, the use of spinal osteotomies has seen a substantial increase. Unfortunately, variations of established techniques and hybrid combinations of osteotomies have made comparisons of outcomes difficult. OBJECTIVE: To propose a classification system of anatomically-based spinal osteotomies and provide a common language among spine specialists. METHODS: The proposed classification system is based on 6 anatomic grades of resection (1 through 6) corresponding to the extent of bone resection and increasing degree of destabilizing potential. In addition, a surgical approach modifier is added (posterior approach or combined anterior and posterior approaches). Reliability of the classification system was evaluated by an analysis of 16 clinical cases, rated 2 times by 8 different readers, and calculation of Fleiss kappa coefficients. RESULTS: Intraobserver reliability was classified as 'almost perfect'; Fleiss kappa coefficient averaged 0.96 (range, 0.92-1.0) for resection type and 0.90 (0.71-1.0) for the approach modifier. Results from the interobserver reliability for the classification were 0.96 for resection type and 0.88 for the approach modifier. CONCLUSION: This proposed anatomically based classification system provides a consistent description of the various osteotomies performed in spinal deformity correction surgery. The reliability study confirmed that the classification is simple and consistent. Further development of its use will provide a common frame for osteotomy assessment and permit comparative analysis of different treatments.

The effect of shoulder immobilization on driving performance.

BACKGROUND: The purpose of this study was to evaluate the effect of sling immobilization on driving performance with use of a driving simulator. METHODS: This is a prospective trial with a cohort of 21 healthy volunteers comparing their driving ability with and without sling immobilization on their dominant (driving) extremity. Multiple variables, including number of collisions, off-road excursions, and centerline crossings, were measured with a validated driving simulator. Trials were separated by 2 weeks to control for "adaptations" to the simulator. Statistical significance was found in collisions between sling and no-sling tests. RESULTS: The total number of collisions for trial 1 (no sling) was 36 (mean, 1.7 ± 1.2) compared with 73 (3.7 ± 1.6) (P < .01) for trial 2 (sling immobilization). Approximately 70% of participants with upper extremity immobilization were involved in ≥3 collisions; approximately 70% of no-sling participants were involved in ≤2 collisions. There was no statistically significant difference between groups with respect to overall vehicle road position and control. CONCLUSION: Sling immobilization of the dominant driving arm results in a decrease in driving performance and safety with respect to the number of collisions in a simulated driving circuit (P < .01). There were no significant differences in driving parameters that are indicative of overall vehicle position and control. The decrease in driving performance with respect to the number of collisions is likely to be related to the effect the immobilized arm has on effectively performing evasive maneuvers during hazardous driving conditions.

The comprehensive anatomical spinal osteotomy classification.

BACKGROUND: Global sagittal malalignment is significantly correlated with health-related quality-of-life scores in the setting of spinal deformity. In order to address rigid deformity patterns, the use of spinal osteotomies has seen a substantial increase. Unfortunately, variations of established techniques and hybrid combinations of osteotomies have made comparisons of outcomes difficult. OBJECTIVE: To propose a classification system of anatomically-based spinal osteotomies and provide a common language among spine specialists. METHODS: The proposed classification system is based on 6 anatomic grades of resection (1 through 6) corresponding to the extent of bone resection and increasing degree of destabilizing potential. In addition, a surgical approach modifier is added (posterior approach or combined anterior and posterior approaches). Reliability of the classification system was evaluated by an analysis of 16 clinical cases, rated 2 times by 8 different readers, and calculation of Fleiss kappa coefficients. RESULTS: Intraobserver reliability was classified as "almost perfect"; Fleiss kappa coefficient averaged 0.96 (range, 0.92-1.0) for resection type and 0.90 (0.71-1.0) for the approach modifier. Results from the interobserver reliability for the classification were 0.96 for resection type and 0.88 for the approach modifier. CONCLUSION: This proposed anatomically based classification system provides a consistent description of the various osteotomies performed in spinal deformity correction surgery. The reliability study confirmed that the classification is simple and consistent. Further development of its use will provide a common frame for osteotomy assessment and permit comparative analysis of different treatments.

Impact of unilateral corrective tethering on the histology of the growth plate in an established porcine model for thoracic scoliosis.

STUDY DESIGN: Histological growth plate analysis. OBJECTIVE.: To evaluate the histological effects on vertebral growth plates following corrective mechanical tethering in the porcine scoliosis model. SUMMARY OF BACKGROUND DATA: Theoretically, growth modulation allows progressive vertebral correction in the setting of scoliosis (Hueter-Volkmann principle). METHODS: This IACUC-approved study divided 9 immature Yorkshire pigs into 2 groups: deforming tether release (TR, n = 4) group and anterior corrective (AC, n = 5) tether group. Once 50° coronal Cobb was demonstrated, TR had release of the deforming tether, whereas AC had release of the deforming tether and additional placement of a corrective tether. After 20 weeks of observation, pigs were killed, spines were removed, and apical samples were prepared for histological study. Growth plate analysis included the following histological parameters: proliferative zone height, hypertrophic zone height, and cell heights within the hypertrophic zone. Student t test was used to evaluate differences within and between groups. RESULTS: No significant differences were found within the release group on the concave versus convex side in terms of proliferative zone height, hypertrophic zone height, and cell heights in the hypertrophic zone. In the anterior correction group, the proliferative zone height was significantly smaller on the concave side than on the convex side (P < 0.01); no significant differences were found in AC on the concave versus convex side in terms of hypertrophic zone height and cell heights in the hypertrophic zone. No significant differences were found in any parameters between TR and AC on either the concave or the convex side. CONCLUSION: No significant decrease in any of the measured parameters was observed in the anterior correction group compared with the tether release group. These histological findings are consistent with preservation of growth potential.

Activation of the epidermal growth factor receptor by hydrogels in artificial tears.

Most formulations of artificial tears include high-molecular weight hydrophilic polymers (hydrogels) that are usually thought to serve to enhance viscosity and to act as demulcents. A few reports have indicated that application of some of the polymers accelerates healing of wounds in epithelia. Since activation of the epidermal growth factor (EGF) receptor is critical for spontaneous corneal epithelial wound healing, we tested commonly used hydrogels for their ability to activate the EGF receptor and enhance closure of wounds. Five structurally unrelated hydrogels used in artificial tears were found to activate the EGF receptor. Importantly, two of the hydrogels enhanced wound healing in an organ culture model. We propose that the efficacy of hydrogels in treating dry eye may be related to their ability to activate the EGF receptor, and that hydrogels are inexpensive, safe agents to promote healing of wounds in the cornea and possibly in other tissues.

Hepatocyte growth factor induces epithelial cell motility through transactivation of the epidermal growth factor receptor.

Hepatocyte growth factor (HGF) is a potent inducer of motility in epithelial cells. Since we have previously found that activation of the epidermal growth factor receptor (EGFR) is an absolute prerequisite for induction of motility of corneal epithelial cells after wounding, we investigated whether induction of motility in response to HGF is also dependent on activation of the EGFR. We now report that HGF induces transactivation of the EGFR in an immortalized line of corneal epithelial cells, in human skin keratinocytes, and in Madin-Darby canine kidney cells. EGFR activation is unconditionally required for induction of motility in corneal epithelial cells, and for induction of a fully motile phenotype in Madin-Darby canine kidney cells. Activation of the EGFR occurs through amphiregulin and heparin-binding epidermal growth factor-like growth factor. Early after HGF stimulation, blocking EGFR activation does not inhibit extracellular-signal regulated kinase 1/2 (ERK1/2) activation by HGF, but the converse is seen after approximately 1 h, indicating the existence of EGFR-dependent and -independent routes of ERK1/2 activation. In summary, HGF induces transactivation of the EGFR in epithelial cells, and this is a prerequisite for induction of full motility.