Capsular Contraction Research Articles

Enhancing Facelift With Simultaneous Submalar Implant Augmentation.

The midface is particularly prone to the senescent changes of soft tissue ptosis and volume loss, which in individuals with aging or low adiposity can manifest as submalar hollowing. Facelift alone in those with submalar hollowing inadequately addresses the volume loss and may result in a gaunt appearance postoperatively. Submalar implant augmentation is a powerful tool for permanent midface volume restoration for a more youthful and natural contour, as opposed to soft tissue fillers that diminish over time. When performed together, submalar augmentation and facelift synergistically enhance facial rejuvenation results. Determine the long-term safety and efficacy of submalar implant augmentation as an adjunct to facelift. Retrospective review evaluating results and complications in all consecutive patients who had submalar implant augmentation with SMAS-plication facelift in a single surgeon private practice setting from January 1, 1991, to December 31, 2017. Forty-eight patients underwent submalar augmentation with simultaneous facelift with an overall satisfaction rate of 95.7%. Complications included 2.1%transient infraorbital hypoesthesia, 1.1% prolonged swelling, and 1.1% capsular contraction that required a minor adjustment under local anesthesia. No infection, implant migration, or extrusion or facial nerve injury occurred. Submalar implant augmentation is a safe and effective means of enhancing facelift results through midface volume restoration, subperiosteal release, and improved soft tissue suspension in a more favorable vector. Submalar implant augmentation performed simultaneously with facelift may be an attractive alternative to repeated soft tissue filler or fat injections for patients with submalar hollowing who are interested in facial rejuvenation surgery.

Incidence of diplopia after division and reattachment of the inferior oblique muscle during orbital fracture repair

BackgroundWide surgical access to the orbital floor and medial wall is often impaired by the course of the inferior oblique muscle. There is no current consensus on the optimal surgical approach for exposure, and techniques involving inferior oblique division are generally shunned for concern of possible complications. ObjectiveTo determine the safety and outcomes of inferior oblique division and reattachment for surgical access to the orbital floor and medial wall during orbital fracture repair. MethodsRetrospective, single-center, review of 85 patients that underwent orbital floor, medial wall or combined fracture repair with division and reattachment of the inferior oblique near its origin. Measured characteristics include surgical approach, type of surgery, time to surgery, pre- and post-operative diplopia, enophthalmos, and complications. ResultsForty-five patients (52.9%) with no pre-operative diplopia were followed up for a mean of six months. Of these, six patients (13.3%) developed post-operative binocular diplopia that resolved in all patients on an average of three months (range 2–6 months). No patients developed torsional diplopia. One patient developed a hematoma two years later attributable to capsular contraction around the implant. ConclusionDivision and reattachment of the inferior oblique muscle is a safe method that allows for panoramic surgical visualization of the inferior and medial orbit.

Operacija sive mrene pri bolnikih s sladkorno boleznijo

Ophthalmic complications of diabetes are one of the leading causes of visual loss and blindness in the working population worldwide. Globally, an estimated 422 million adults were living with diabetes in 2014. According to the World Health Organisation, this number will rise to an estimated 592 million by 2035. Cataract is a clouding of the eye lens. Surgery is indicated when cataract causes significant visual impairment. Several clinical studies have shown that cataract development occurs more frequently and at an earlier age in diabetic compared to nondiabetic patients. Cataract surgery is the most frequent ophthalmic surgical procedure and has an excellent outcome. However, diabetic patients may have more complications and a poor visual outcome. They are prone to ocular surface disease, intraoperative complications, corneal oedema in the early postoperative period and an increased incidence of cystoid macular oedema in patients with retinopathy. Anterior capsular contraction is also more frequent. A good prognosis is expected in patients with good systemic and ophthalmological preoperative, operative and postoperative management.

Surface Areas of Textured Breast Implants: Implications for the Biofilm Theory of Capsule Formation.

Increased surface area of mammary implants is suggested as a causative agent for the development of biofilms, which may lead to capsular contraction. The aim of this study was to quantify the surface areas of round implants of different textures and examine how these data can be interpreted with regard to clinical observation. Surface areas of textured round breast implants were calculated from previously reported confocal scanning microscopic assessment, and dimensions sourced from 3 breast implant manufacturers (McGhan, Mentor, and Silimed). Statistical comparisons were made between manufacturers for different implant volumes, profiles, and texturing. There was a difference in surface area between manufacturers for all implant profiles and between manufacturers for equivalent volume implants (F (3, 253) = 2,828.87; P < 0.001). Silimed polyurethane implants (mean area = 6.12 × 106 mm2) was the highest. Natrelle (mean area = 1.2 × 106 mm2) was the next highest, followed by Siltex (mean area = 4.8 × 105 mm2). Mentor smooth implants (mean area = 4 × 104 mm2) had the lowest mean surface area. There were no differences in surface area between the different profiles for Siltex, Silimed polyurethane, and Mentor smooth implants of the same volume. The increased surface area produced by texturing, although different between manufacturers, seems to provide protection against capsular contraction. Correlation with clinical data indicates that the surface area alone cannot account for these differences. Smooth implants, which have the smallest surface area have the highest incidence of capsular contraction. These data are at odds with the biofilm theory of capsular contraction.

Precision pulse capsulotomy in phacoemulsification: Clinical experience in Indian eyes.

Purpose:To evaluate the surgical outcome of precision pulse capsulotomy (PPC) in phacoemulsification surgery.Methods:One hundred twenty-three eyes of 99 consecutive patients who underwent phacoemulsification with PPC through a 2.8 mm clear corneal incision were prospectively studied at a tertiary care centre. The size, shape of capsulotomy and intraoperative capsulotomy, and surgery-related complications were noted. Visual outcome, IOL stability, and signs of capsular opacification/contraction were evaluated at 3 and 6 months.Results:The mean age of patients was 49.5 ± 7.77 years. Complete, circular capsulotomy averaging 5.5 mm diameter was achieved in 117 of 123 eyes. In seven eyes, we experienced complications like capsulorhexis tear (n = 6) and inadvertent iris capture (n = 1). Probe malfunction occurred in six cases. Stable intracapsular intraocular lens (IOLs) fixation and centration was achieved in all eyes. None of the eyes had any significant posterior capsular opacification or capsular contraction at 3 and 6 months. In one eye anterior capsular opacification at the capsulotomy edge was noted at 6 months.Conclusion:PPC is a useful device for achieving a perfectly round capsulorrhexis. However, it has a learning curve and chances of skip areas in capsulorhexis, capsular tag, and its extension should be kept in mind. Special care should be taken in initial cases and while operating on eyes with poorly dilating pupil and mature cataracts.

Complex morphological assessment of anterior capsule of the lens in patients with capsular contraction syndrome (a clinical case study)

To perform complex morphological assessment of ALC in patients with ACCS. The study involved complex analysis of ALC that was removed due to ACCS in the pseudophakic eye in the setting of diabetes mellitus and past vitreoretinal surgery. The following examination methods were used: light-optical microscopy of ALC samples in the form of polychrome-colored semifine sections using optical microscope Leica DM-2500 (Germany), scanning microscopy of ALC surface with EVO LS10 (Carl Zeiss, Germany) microscope, analysis of chemical element composition and its variation of the ALC sample with energy-dispersive spectrometer Oxford X-Max50 (Oxford, UK). Light-optical microscopy showed altered state and plication of ALC induced by proliferation from inner surface of the fibrocellular tissue, which gradually thickens (up to 360 µm) towards center and causes reduction of anterior capsulotomy opening. Scanning electron microscopy revealed presence of tissue with uneven micro-relief and a porous three-dimensional structure uncharacteristic for capsule on the surface of ALC. Thickness of the fibrous deposition significantly exceeded the thickness of ALC. Evaluation of elemental composition of the fibrocellular tissue showed elevated concentration of sulfur and phosphorus, which indicates high activity of the regenerative process. In the observed case, the regenerative process was of substitute nature because an attempt to restore the lens was accompanied by formation of connective tissue structurally different from original. Complex assessment of an isolated ALC sample allowed revelation of the chain of pathological processes accompanying the development of ACCS.

Do corticosteroid injections compromise rotator cuff tendon healing after arthroscopic repair?

BackgroundRotator cuff tears are associated with capsular contraction and stiffness that should be restored before surgical repair. Corticosteroid injections (CSIs) are frequently used as conservative treatments before surgical repair. This study aimed to determine the influence of preoperative and postoperative CSIs on clinical and anatomic outcomes after rotator cuff repair.MethodsThe authors analyzed the records of 257 patients who had arthroscopic rotator cuff repair, of whom 212 were evaluated at 3.1 ± 1.0 years (median, 2.9 years; range, 1.4-7.1 years) by clinical (Constant score) and ultrasound (Sugaya classification) examinations. Univariable and multivariable regressions were performed to determine associations between outcomes and administration of preoperative and postoperative CSIs, patient characteristics, and tendon characteristics.ResultsThe Constant scores improved from 56.4 ± 15.1 to 80.8 ± 12.5. Multivariable regression confirmed that postoperative scores were associated with postoperative CSIs (P < .001), preoperative scores (P < .001), gender (P < .001), and fatty infiltration (P < .005). Retears (Sugaya types IV-V) were observed in 27 shoulders (13%). Multivariable regression clarified that retear rates were associated only with postoperative CSIs (P = .007) and stage 3 fatty infiltration (P = .001). Adjusting for confounders, an additional postoperative CSI would decrease scores by 4.7 points and double retear risks.DiscussionPreoperative CSIs had no influence on clinical scores and retear rates, whereas postoperative CSIs were associated with lower scores and more retears. Although we can infer that preoperative CSIs do not affect outcomes, we cannot determine whether postoperative CSIs compromised outcomes or were administered in patients who had already poor outcomes. Our findings may resolve controversies about the administration of preoperative CSIs.

LB.03.06] ATTENUATION OF SPLANCHNIC AUTOTRANSFUSION FOLLOWING NON-INVASIVE ULTRASOUND RENAL DENERVATION

Objective: In the Valsalva manoeuvre, autotransfusion in Phase IIi arises from sympathetically mediated capsular contraction of intra-abdominal organs including the kidneys. We hypothesised that following successful renal nerve ablation this response would be attenuated and could serve as a marker of procedural success. Design and method: 23 patients (mean age 59.4 ± 10.5 years; BMI 30.2; anti-hypertensive medication 4.2; 65% males and 35% females) with resistant HTN (On 3 or more anti-hypertensive drugs including a diuretic) were enrolled in the double-blind, sham controlled KONA Wave IV study. They were randomised either to bilateral RDN using therapeutic levels of ultrasound energy (n = 12, 75% male, mean age 57.2 ± 10.3 years) or the sham procedure using bilateral application of diagnostic levels of ultrasound energy (n = 11, 55% male, mean age 61.9 ± 10.6 years). Within group changes in autonomic parameters, office blood pressure (OBP) and ambulatory BP (ABP) were compared between baseline and 6 months in a double blind manner. Results: There was significant OBP reduction in both treatment (16.1 ± 27.3 mmHg, p < 0.05) and sham groups (27.9 ± 15.0 mmHg, p < 0.01). In the treatment group, heart rate (HR) was significantly reduced following RDN both at rest (4.3 ± 6.6 bpm, p < 0.05) and in response to postural changes. During phase IIi Valsalva, RDN resulted in substantial and significant reduction in MAP (21.8 ± 25.2 mmHg, p < 0.05) with no significant changes in the sham group.Conclusions: BP reduction per se is not necessarily a marker of renal nerve ablation. Reduction in splanchnic auto-transfusion following RDN has not been previously demonstrated and denotes attenuation of (renal) sympathetic efferent activity and could serve as a marker of procedural success. Sham therapy results in clinically meaningful BP reduction that has implications for future trial design.

Characterization of the Capsule Surrounding Smooth and Textured Tissue Expanders and Correlation with Contracture.

Background:Capsular contracture is a common complication after breast augmentation surgery. This study pathologically evaluated the soft-tissue response to surface modifications in both smooth and textured tissue expander prostheses.Methods:Smooth tissue expanders and textured tissue expanders in 5 cases each were used for breast reconstruction after mastectomy. Histological samples were harvested from the capsules when the tissue expanders were replaced by silicone implants. Collagen orientation and cellular responses were assessed histologically. Capsular contracture was evaluated using the Baker classification 6 months and 2 years after the removal of the tissue expander.Results:The capsules surrounding the smooth tissue expanders tended to produce more contracture than those surrounding the textured tissue expanders. The collagen architecture of the capsules of the smooth tissue expanders showed random orientation with fragmentation. Conversely, the capsules of the textured tissue expanders showed parallel orientation with collagen bundles of almost normal structure. Significantly more fibrils of elastin and myofibroblasts were found in the capsules surrounding the smooth tissue than in those surrounding the textured ones.Conclusions:The collagen fibers surrounding the smooth tissue expanders could be cracked during expansion, which may lead to scarring and contracture. Conversely, the collagen orientation surrounding the textured tissue expanders was excellent. Moreover, the increase in elastic fibers and myofibroblasts in the capsules surrounding the smooth tissue expanders may be associated with in vivo contraction patterns. Therefore, the surface type of tissue expanders affects capsular contraction after replacement with definitive implants.

Preliminary report on the application of femtosecond laser-assisted anterior capsulotomy in intumescent white cataract surgery

Objective: To assess the effect of femtosecond laser-assisted anterior capsulotomy in intumescent white cataract surgery. Methods: Retrospective case series study. One hundred and fifty cataract patients (150 eyes) from June 2014 to June 2015 in Wuhan Aier ophthalmology hospital were enrolled in this study. They were divided into three groups: 50 intumescent white cataract patients (50 eyes) in the study group were performed femtosecond laser-assisted capsulotomy (LenSx system) operation selectively. Fifty intumescent white cataract patients (50 eyes) underwent normal manual continuous circular capsulorhexis as the control group 1. Fifty other types cataract patients (50 eyes) underwent femtosecond laser-assisted capsulotomy as the control group 2. To observe the complications such as radial tear in anterior capsule, posterior capsule rupture and vitreous prolapse occurred during operations in each group respectively. The microscopic images of the free anterior capsule after dyeing were observed in the studygroup and the control group 2. Using the German company Oculus Pentacam three-dimensional anterior eye segment system to collect the Scheimplug images of each group at 1, 3, 6 months and 1 year after operation. The data were analyzed by SPSS19.0 software package. Complications during operations in all groups were compared with Fisher exact test. The eccentricity and tilt of IOL in each group were analyzed by single factor analysis of variance. The SNK-q test was used to compare the different follow-up time groups. Results: One hundred and fifty patients aged from 50 to 86 years old, including 72 male cases and 78 female cases. In study group, radial tear in anterior capsule occurred in 2 eyes (4%), adherent tongue-like capsule adhesion was found in 6 eyes (12%), incomplete capsulotomy button happened in 2 eyes (4%), and posterior capsule rupture and vitreous prolapse occurred in 1 eye (2%). In the control group 1, radial tear in anterior capsule occurred in 8 eyes (16%) and posterior capsule rupture and vitreous prolapse occurred in 3 eyes (6%). The cases number of radial tear in anterior capsule and posterior capsule rupture and vitreous prolapse in the study group was obviously lower than the control group 1. The difference was statistically significant (P<0.05). In the control group 2, all 50 eyes were successfully completed. The implantation was uneventful and the IOL was centered. And posterior capsular rupture and vitreous prolapse did not occur. The difference was statistically significant between the study group and the control group 2 (P<0.05). After 1 year follow-up, the study group and the control group 2 showed no significant IOL tilt and eccentricity. The eccentricity and tilt of IOL in horizontal and vertical direction in control group 1 were significantly higher than those in the study group (F was 2.31, 1.10, 2.78 and 2.90 respectively) and control group 2 (F was 2.50, 2.32, 2.56 and 2.18respectively). The difference was statistically significant (P<0.05). Conclusions: Femtosecond laser-assisted anterior capsulotomy is accurate circle and center to avoid IOL eccentricity and tilt caused by capsular bag contraction asymmetrically after implantation, so as to ensure the long-term stability of the visual quality postoperatively. (Chin J Ophthalmol, 2017, 53: 281-287).

Benefits and barriers of accommodating intraocular lenses.

Presbyopia and cataract development are changes that ubiquitously affect the aging population. Considerable effort has been made in the development of intraocular lenses (IOLs) that allow correction of presbyopia postoperatively. The purpose of this review is to examine the benefits and barriers of accommodating IOLs, with a focus on emerging technologies. True accommodation of an IOL involves a dynamic increase in dioptric power to affect a shift from distance to intermediate or near focus. The Crystalens (Crystalens Bausch and Lomb, Inc., Rochester, NY, USA) was the first IOL labeled by the FDA as an accommodating IOL. Further studies have suggested that the Crystalens and several other single optic presbyopia-correcting IOLs may be providing improved intermediate or near vision predominantly through pseudoaccommodative mechanisms, in addition to small changes in axial translation. In light of these findings, a more objective demonstration of accommodation is now required for an IOL to have an accommodative label. Newer technology accommodating IOLs in development have embraced design strategies using dual optics, shape-changing optics, and IOLs with dynamic changes in refractive index. Prevention and treatment algorithms for capsular contraction syndromes unique to Crystalens and Trulign IOL designs will be discussed. Accommodating IOLs that are in current use are constrained by their low and varied amplitude of accommodation. Such limitations may be circumvented in the future by accommodative design strategies that rely more on shape-related changes in the surfaces of the IOLs or in dynamic changes in refractive index than by forward translation alone.

Combined YAG-laser capsulotomy in pseudophakic patients with anterior capsular contraction syndrome

to develop a safe technique of combined laser anterior capsulotomy (LAC) in patients with ACCS. The study included 19 patients (20 eyes) with ACCS. The suggested LAC technique involved two differently directed YAG-laser cuts that could be regarded as a combination of radial anterior capsulotomy and anterior peripheral linear capsulotomy. With the cuts located perpendicularly to each other, the distal end of each radial cut was connected to the middle of each longitudinal cut. The suggested technique allows an increase in the anterior capsulorhexis diameter up to more than twice the pre-laser size. The difference between the average pre- and post-laser capsulorhexis diameters was statistically significant (р<0.0001). Neither case developed an unpredictable anterior capsule tear. The safety of the new technique is ensured by preliminary longitudinal cuts that create a barrier against unpredictable radial tears in the capsular bag during radial capsulotomy.

Capsulotomia YAG laser: indicações, riscos e cuidados.

Posterior lens capsule opacification (PCO) is the most common complication after cataract surgery. Its treatment comprises Nd:YAG laser capsulotomy, which is also indicated in cases of capsular contraction syndrome, capsular bag distension syndrome, and negative dysphotopsia. Although it is a safe procedure, many complications occur when it is applied to patients with PCO. These complications include marks or fissures on the intraocular lens (IOL), increased intraocular pressure, displacement of the IOL, uveitis, cystoid macular edema, retinal detachment, macular hole, retinal hemorrhage, and endophthalmitis. Meticulous cortical cleaning, the IOL inside the capsular bag, continuous curvilinear capsulorhexis (which overlaps the optical edge of the 360° IOL), and changes in IOL designs and materials have all helped to decrease the rate of complications associated with PCO treatment. Antiglaucomatous eye drops and topical corticosteroids have also been used to prevent and treat complications associated with the use of Nd:YAG laser.

Clinical presentation and management of anterior capsular contraction

Purpose: Aim of this study is to analyze clinical presentation and predisposing risk factors of anterior capsular contraction following phacoemulsification and to assess challenges encountered in management. Methods: This is retrospective study of anterior capsular contractions of capsulorhexis following phacoemulsification. All patients were analyzed for clinical presentation by detail history and slit lamp examination. YAG laser capsulotomy or surgical excision of phimosis was done and various challenges encountered in management were detailed. Results: Total 20 patients (23 eyes), age between 26 years 72 years,, with 13 male and female 7 were analyzed retrospectively. The predisposing risk factors noted were Uveitis (7 patients), myopia (3 patients), pseudo exfoliation (2 patients), diabetes (3 patients), trauma (1 patient), both diabetes and uveitis (1patient), Status post phacovitrectomy (1 patient) and no accompaniments in (2 patients). We managed 18 patients (21 eyes) by observation in (3 eyes), YAG laser in (7 eyes), simple surgical excisions in (8 eyes), excision with vitrector (1 eye), aspiration of milky fluid behind IOL from bag (1 eye) and phimosed dislocated bag removal from anterior chamber and intraocular lens (IOL) exchange with (SF) scleral fixated IOL (1eye). Conclusions: Anterior capsular contraction is more common with patients with various risk factors and has varied clinical presentations. Simple procedures like YAG and surgical excision will help patients to restore vision.

Capsular Contracture In Silicone Breast Implants: Insights From Rat Models.

Breast augmentation with silicone implants is one of the most common procedures performed by plastic surgeons around the world. Capsular contracture is a frequent complication in breast augmentation and reconstructive surgery, that requires invasive intervention. The inflammatory response to implanted mammary prostheses appears to be directly associated to capsular contracture. This review discusses the evidences from rat models studies, on the role of inflammation and fibrosis in capsular contraction and its relation to silicone breast implants surface.

The Impact of Breast Implant Location on the Risk of Capsular Contraction.

Although many theories exist, the etiology of capsular contraction (CC) development is still not known. Anatomic location has been suggested as a possible risk factor, but rates of CC development vary between studies, often with conflicting results. This study examines the risk developing CC with subglandular compared to submuscular placement of the breast implant. A total of 1,283 studies were identified from December 2003 to December 2013 by PUBMED and MEDLINE searches and a manual search strategy. Two levels of screening resulted in 10 studies suitable for meta-analysis, providing data on a total of 17,520 breast implants. All statistical calculations were performed with Review Manager (RevMan) version 5.2.7. Random-effect (RE) pooled relative risk (RR) and confidence intervals (CI) were calculated for capsular contraction. The risk of developing capsular contraction with subglandular implants was more than 2-fold increased compared to submuscular implants (RE RR 2.18; 95% CI 1.41-3.35; P = 0.0005). The trend was not examined with regards to subfascial placement compared to submuscular or subglandular because more studies are needed to determine this. This analysis demonstrated a more than 2-fold increase in the risk of capsular contraction with subglandular compared to submuscular breast implant location. Risk.

Clinicopathologic Correlation of Lens Epithelial Metaplasia and Late Intraocular Lens Dislocation After Repair of Retinal Detachment

In-the-bag intraocular lens dislocation is an uncommon but serious complication of cataract surgery in patients with previous repair of retinal detachment. The causative mechanism is currently unknown. We report histologic findings from a retrospective case series from 1993 to 2010 and suggest a possible mechanism to explain this association. Clinical characteristics of 8 patients presenting with in-the-bag intraocular lens dislocation after repair of retinal detachment were evaluated. Explanted capsular bags from 3 of these patients were compared with pathologic changes of crystalline lenses associated with retinal detachment. Histologic examination of the explanted capsular bags revealed a paucicellular membrane that covered the concertina-like folded surface of the lens capsule. The lens capsule was devoid of epithelial cell nuclei and showed excessive thickening with the presence of spindle-shaped cells, such as fibroblasts. Collagen fibers were noted in the extracellular matrix. Previous studies of crystalline lens pathologic findings associated with retinal detachment have shown changes in the epithelium with migration and subsequent metaplasia of epithelial cells, resulting in excessive thickening of the anterior capsule with a layer of fibrous tissue. In this retrospective series, similar histologic findings were seen, suggesting that zonular dehiscence and lens dislocation may result from progressive capsular contraction secondary to retinal detachment-induced lens epithelial metaplasia.

A stepwise approach for the management of capsular contraction syndrome in hinge-based accommodative intraocular lenses.

PurposeThe aims of this study are to define the various stages of capsular contraction syndrome (CCS) and its effect on refractive error with hinge-based accommodating intraocular lenses (IOLs) and to describe a systematic approach for the management of the different stages of CCS.MethodsHinge-based accommodative IOLs function via flexible hinges that vault the optic forward during accommodation. However, it is the flexibility of the IOL that makes it prone to deformation in the event of CCS. The signs of CCS are identified and described as posterior capsular striae, fibrotic bands across the anterior or posterior capsule, and capsule opacification. Various degrees of CCS may affect hinge-based accommodating IOLs in a spectrum from subtle changes in IOL appearance to significant increases in refractive error and loss of uncorrected visual acuity. The signs of CCS and its effect on IOL position and the resulting changes in refractive error are matched to appropriate treatment plans.ResultsA surgeon can avoid CCS and manage the condition if familiar with the early signs of CCS. If CCS is identified, yttrium–aluminum–garnet laser capsulotomy should be considered. If moderate CCS occurs, it may be effectively treated with insertion of a capsular tension ring. If CCS is allowed to progress to advanced stages, an IOL exchange may be necessary.ConclusionSurgeons should be familiar with the stages of CCS and subsequent interventions. The steps outlined in this article help to guide surgeons in the prevention and management of CCS with hinge-based accommodative IOLs in order to provide improved refractive outcomes for patients.

Shoulder function after breast reconstruction with the latissimus dorsi flap: A prospective cohort study – Combining DASH score and objective evaluation

ObjectivesThe latissimus dorsi (LD) flap is well-known in breast reconstruction especially in previously-irradiated patients, in order to have a low capsular contraction rate whenever an implant is associated. The aim of this study is to closely evaluate the effect of LD flap harvesting on shoulder function as well as specific movements related to the LD, both objectively and subjectively. Materials and methodsWe retrospectively collected data on 86 patients who underwent pedicled LD muscle flap for breast reconstruction at the European Institute of Oncology between September 1995 until March 2011. ResultsThe majority of patients showed a joint recovery superior to 80% in all joint movements examined. Disabilities of the Arm, Shoulder and Hand questionnaire revealed minimal disability similar to normal range and furthermore it appears to decrease in all sports and in particular in those who practice with LD involvement. ConclusionFocusing this data, a growing, “disability-free” percentage changes depending on whether or not the patients have practiced sport could be appreciate.

Quality of information for women seeking breast augmentation in the Internet

Background Recently published data show that many women interested in breast augmentation (BA) actively search the Internet for information. The Internet is currently the main source of information on this topic.Objectives Little is known about the quality of available information on the Internet concerning BA. The goal was to evaluate this in a systematic manner using a validated and reproducible tool.Methods Women (n = 96) unrelated to medicine were asked which keywords they would use to search the Internet if they were interested in BA. Five keywords were used. Qualitative and quantitative assessment was performed with the modified Ensuring Quality Information for Patients (EQIP) tool. A total of 2500 websites containing information on BA were identified using Google, Bing, Yahoo, Ask, and AOL.Results Out of 623 eligible websites, only 153 (25%) addressed more than 20 EQIP items. Scores were higher for encyclopaedias and academic websites compared to hospital and practitioner websites. The median EQIP score was only 15 (IQR = 12–20), and quantitative postoperative morbidity and mortality risk estimates were available in only 38% and 25% of the websites, respectively. Major complications (e.g. capsular contraction, implant safety) were mentioned in only 156 (25%) of the websites.Conclusions This is the first assessment of online patient information on BA using the EQIP tool. This analysis demonstrated several shortcomings in the quality of information provided to BA candidates. There is an immediate need for better informative and educational websites regarding BA procedures that are compatible with international quality standards for plastic surgery.