Capsular Distension Research Articles

MRI findings for unilateral sternoclavicular arthritis: differentiation between infectious arthritis and spondyloarthritis.

To analyze and identify magnetic resonance imaging (MRI) and clinical findings for the differentiation between infectious arthritis and spondyloarthritis in patients with unilateral sternoclavicular arthritis. We retrospectively collected and evaluated the magnetic resonance (MR) images of 21 patients diagnosed with unilateral sternoclavicular arthritis, including 12 with infection and nine with spondyloarthritis, between 2004 and 2017. Capsular distension, extracapsular fluid collection, periarticular muscle edema, the prevalence and distribution of bone marrow edema, and the prevalence and size of bone erosions were assessed on the MR images. Clinical data were also reviewed. Capsular distension was more prominent in patients with infectious arthritis than those with spondyloarthritis (p= 0.002); extracapsular fluid collection and periarticular muscle edema were also more common in infectious arthritis than spondyloarthritis (p< 0.001, respectively); moreover, bone erosions were larger in infectious arthritis than spondyloarthritis (p= 0.023). Other findings significantly associated with infectious arthritis included advanced age (p= 0.007), an elevated C-reactive protein (CRP) level (p= 0.001), and erythrocyte sedimentation rate (ESR) (p< 0.001). The prevalence and distribution of bone marrow edema and the prevalence of bone erosions on MRI, the white blood cell count, and sex showed no significant differences between the two groups. Capsular distension, extracapsular fluid collection, periarticular muscle edema, and the size of bone erosions on MRI, as well as the age, CRP level, and ESR of patients, could be helpful for differentiating infectious arthritis from spondyloarthritis involving the sternoclavicular joint.

Intra-articular distension without arthrography for adhesive capsulitis

Adhesive capsulitis is a clinical entity characterized by spontaneous onset of shoulder pain accompanied a loss of motion and a decrease of the joint volume capacity. The distension of the shoulder joint has proven to be an efficient percutaneous treatment, and various techniques have been proposed. The objective of the study is to determine the effectiveness and safety of the technique “repeated intra-articular distension without arthrography” combined with an intensive program of rehabilitation in patients with adhesive capsulitis. A prospective controlled study. Fifteen patients with adhesive capsulitis were included. Intervention consisted of three intra-articular distension with saline, xylocaine and corticosteroid, given at one-week intervals. The same technique was combined with an intensive program of rehabilitation associated. The evaluation parameters used were Hospital Anxiety and Depression Scale (HADS), Visual Analog Scale (VAS) pain score, a shoulder-specific disability measure by DASH score and range of active and passive motion (anterior elevation, lateral elevation and external rotation). Patients were evaluated before intra-articular distension. The outcome measures were assessed at 1, 2, 3, and 4 weeks after last capsular distension. Study population comprised fifteen patients with a mean age of 54.8 ± 8.6 underwent capsular distension. All patients reported significant improvement during the study in terms of the pain score, anterior elevation and lateral elevation after the first distension. External rotation, the DASH score and HADS improved after three capsular distension. One month after last capsular distension, this gain persisted in all functional parameters and in psychological profile. Results did not differ by etiology of capsulitis. No severe complications occurred as a result of the capsular distension. Our results show that three capsular distension and intensive program of physiotherapy have a beneficial effect. This combination has a useful role in the early management of adhesive capsulitis.

Traitement médical actuel de la capsule rétractile idiopathique et secondaire

Management of adhesive capsulitis of the shoulder depends on its severity, its stage, its physiopathology and its nature (idiopathic or secondary adhesive capsulitis). Today, there is no high level of evidence for its treatment's efficiency. During the first stage, called “freezing phase”, the main symptom is pain. The urgency is to relieve the pain and to prevent the shoulder from stiffness. The first treatment is painkiller with or without NSAID. If the patient is not enough relieved, we suggest intra-articular injection of corticosteroids which are efficient in reducing pain and gaining articular mobility in the short term. During stage two, called “frozen shoulder”, the objectives will be to improve articular mobility and to relieve pain. We suggest intra articular injection of corticosteroids in second line therapy, if there is no contraindication, when pain is intense and inflammatory. It showed to relieve pain and to improve mobility in the short term and to improve articular mobility in the mid term, in comparison to oral treatment, placebo and physical exercices. There is no place for oral corticosteroids, as it showed no superiority and they have many side effects, except in case of contra indication to intra-articular injections of corticosteroids. We still have to determinate if the earliness of diagnostic (thanks to the MRI) and the earliness of intra-articular injection could reduce the disease evolution. If the patient is not enough relieved and stiffness is important, we can propose capsular distension followed by intensive mobilization. At every stage, rehabilitation is very important in order to gain articular mobility. No study shows side effects of physical exercises. Several other treatments are under development and show promising results such as radio arterial embolization, intra-articular injection of hyaluronic acid, etc. These treatments could be really interesting in case of chronic stiff capsulitis as an alternative to surgery.

Effectiveness of Glenohumeral Joint Dilatation for Treatment of Frozen Shoulder: A Systematic Review and Meta-analysis of Randomized Controlled Trials

The objective was to explore the effectiveness of glenohumeral joint distension for the treatment of frozen shoulder. We searched electronic data sources including PubMed, Scopus, and Embase from the earliest records available to February 2017. Eleven randomized controlled trials including at least one pair of comparisons between capsular distension and a reference treatment were included, comprising 747 participants. Patients’ characteristics, details of reference treatments, aspects of capsular distension therapy, and outcome measurement were evaluated at three points in time: baseline, early following intervention, and at the trial’s end. The primary and secondary outcomes were the between-group standardized mean differences of changes in shoulder function and range of motion, respectively. Regarding the long-term primary outcome, the superiority of capsular distension to reference treatments was not identified. One secondary outcome (external rotation limitation) showed a probable early positive response to capsular distension when compared to intra-articular corticosteroid injection. Aspects of approaches, imaging guiding techniques and doses of distension were not found to modify treatment effectiveness. In conclusion, distension of the glenohumeral joint provides a similar long-term efficacy to all reference treatments. A single dose of a corticosteroid-contained regimen introduced through the ultrasound-guided posterior approach is a preferable practice of capsular distension for the management of frozen shoulder.

CSM 2017 Orthopaedic Section Platform Presentations (Abstracts OPL1–OPL64)

CSM 2017 Orthopaedic Section Platform Presentations (Abstracts OPL1–OPL64)

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.

An Anatomical Study on the Safe Placement of Orthopedic Hardware for Syndesmosis Fixation.

Articular cartilage and bony contact at the distal tibiofibular cartilage contact zone (TFCCZ) is variable. The appropriate placement of syndesmotic hardware would benefit from a more accurate characterization of the proximal extent of the TFCCZ allowing surgeons to place hardware that simultaneously improves biomechanical stability and decreases the risk of iatrogenic cartilage damage. In addition, Ilizarov wire fixation through the distal fibula and tibia can pass through the syndesmosis recess. Anatomically defining the proximal extent of this recess can help decrease the risk of inadvertent capsular penetration. This study anatomically defines the TFCCZ and syndesmosis recess establishing a safe and biomechanically advantageous distance from the plafond for orthopedic fixation. This study measured the height of the TFCCZ and the syndesmotic recess in 3158 anatomical and cadaveric specimens. A TFCCZ was present in 59% of the Robert J. Terry Anatomical Collection specimens. Maximal height of the TFCCZ averaged 5.7±1.7 mm (99% confidence interval [CI], 5.6-5.8 mm) for anatomical specimens and 5.6±1.6 mm (99% CI, 4.6-6.5 mm) for cadaveric dissections. The maximum TFCCZ height was 11.71 mm. Maximal height of the syndesmotic recess averaged 12.8±2.1 mm for anatomical specimens and 13.7±2.7 mm for cadaveric specimens. The "3 cm rule" appears to be appropriate for fine wire fixation accounting for capsular distension that can be associated with injuries but not applicable for syndesmotic fixation. There is a less than 0.1% chance of encountering the TFCCZ cartilage at 10.9 mm above the plafond and a less than 0.01% chance at 12 mm above the plafond. [Orthopedics. 2017; 40(2):e329-e333.].

Arthroscopic Revision Surgery for Failure of Open Latarjet Technique

To evaluate the efficacy in treating pain, limited range of motion, and continued instability of the Latarjet open technique via the use of arthroscopy. A retrospective review of patients who underwent arthroscopic capsule plication after failure of an open Latarjet technique was performed. Revision surgery was indicated in cases of recurrent instability and associated pain. Only patients with a glenoid defect <25% were considered. The Constant and Rowe scores were administered, whereas pain was assessed with a visual analog scale before the reoperation and at 24months after operation. Radiographs, computed tomography, and CT arthrography scans were performed. Twelve patients met the inclusion criteria. All patients had capsular distension and consequently were subjected to a capsuloplasty. Shoulder function, stability, and pain had all improved significantly at 24months after arthroscopic revision (P < .0001). In particular, the Constant score increased from 44.9 (standard deviation [SD] 7.10) to 89.3 (SD 12.6) points, the Rowe score improved from 49.5 (SD 10.1) to 80.9 (SD 10.9), whereas the visual analog scale pain score decreased from 6.75 (SD 1.17) to 1.38 (SD 1.06). Primary open Latarjet with a glenoid bone defect <25% that failed due to capsular redundancy is amenable to successful treatment with arthroscopic capsuloplasty. Arthroscopic approaches can offer a good solution for treating previously failed open Latarjet procedures. Level IV, therapeutic case series.

Kinésithérapie des capsulites rétractiles de l’épaule (incluant la post-capsulodistension)

Shoulder adhesive capsulitis is a common condition with favourable outcome but very long. Although full resolution of symptoms does not always occur, persistent symptoms are commonly mild with stiffness and/or minimal pain with possible persistent sequelae. Therapeutic interventions aim to reduce pain, which are important at the initial stage, and improve joint mobility thus shorten disability. There are no official guidelines for optimum therapeutic management. Conservative interventions including pain-killers, NSAIDs, corticosteroid infiltration and physical therapy are recommended at first. Shoulder capsular distension plus mobilisation is second line. Indications of arthroscopic capsular release or mobilisation under anesthesia are sparse. Physical therapy (techniques, duration and frequency of sessions, modality of management) need to be adapted to patient abilities and symptoms and must consider and treat the full shoulder complex dysfunction. Patient's involvement in rehabilitation and education to repeated home exercises is of paramount importance.

Kinetics of the Wrist in Scapholunate Advanced Collapse

Objective: Recent published experimental investigations have shown the relevance of the forearm muscles in providing dynamic stability to the scapholunate joint, in the wrists without osteoarthritis. Some chronic scapholunate advanced collapse (SLAC) wrists remain long time asymptomatic; the reason is unknown. How do forearm muscles influence on SLAC wrists? The kinetic behavior of an experimentally acute sectioned ligament compared with a SLAC wrist has not been determined. The hypothesis of this experimental biomechanical study was that there are no differences in SLAC and recent scapholunate instability wrists kinetics. Methods: The kinetic effects of isometric loading of 5 wrist motor tendons (abductor pollicis longus [APL], extensor carpi radialis longus [ECRL], extensor carpi ulnaris [ECU], flexor carpi ulnaris [FCU], and flexor carpi radialis [FCR]) on 12 fresh normal cadaver arms in which scapholunate ligament was sectioned and in 5 wrists with a SLAC pattern of carpal osteoarthritis were analyzed. A custom-designed testing apparatus was used to hold the forearm and wrist vertical in neutral position. A 6 degree-of-freedom electromagnetic motion tracking device with sensors attached to the scaphoid, triquetrum, capitate, and radius was used to monitor spatial changes in carpal bones alignment. The rotation sustained by the scaphoid in both experimentally acute sectioned scapholunate ligament and chronic SLAC groups were measured and statistically compared. Results: When all tendons were simultaneously loaded, no statistical differences were observed between the 2 groups: The proximal carpal row, as opposed to the normal wrist, tended to pronate in both situations. Under individual muscle loading, the kinetic carpal behavior of both groups was also the same, with no statistical differences between them: The ECU is the only muscle that provokes scaphoid pronation; all other muscles induce its supination. Isometric ECU contraction causes significant radioscaphoid subluxation, with the scaphoid rotating into substantial pronation (average 4.50°; confidence interval [CI], −1.33° to −1.67°) and extension (0.69°; CI, −0.72° to 2.69°). None of the other muscles exhibited such an obvious destabilizing effect. The experimental kinetic behavior of the chronic SLAC wrist is similar to the one with a recent scapholunate dissociation without carpal collapse associated. In both groups (1) the direction of the scaphoid displacement is the same (flexion, pronation and radial deviation), although the magnitude of the scaphoid displacement is greater in the SLAC wrists group, and (2) the ECU muscle load destabilizes the scapholunate joint, although SL joint destabilization is greater in the SLAC wrist group. Conclusions: These findings suggest that, in SLAC wrists, the capsular distension associated to a chronic malfunction of the carpus plays a significant role in the magnitude of the carpal bones displacement under load, and that in patients with scapholunate instability, both with and without carpal collapse associated, ECU muscle contraction should always be avoided.

Multi-modal imaging of adhesive capsulitis of the shoulder.

Adhesive capsulitis of the shoulder is a clinical condition characterized by progressive limitation of active and passive mobility of the glenohumeral joint, generally associated with high levels of pain. Although the diagnosis of adhesive capsulitis is based mainly on clinical examination, different imaging modalities including arthrography, ultrasound, magnetic resonance, and magnetic resonance arthrography may help to confirm the diagnosis, detecting a number of findings such as capsular and coracohumeral ligament thickening, poor capsular distension, extracapsular contrast leakage, and synovial hypertrophy and scar tissue formation at the rotator interval. Ultrasound can also be used to guide intra- and periarticular procedures for treating patients with adhesive capsulitis.Key Points• Diagnosis of adhesive capsulitis is mainly based on clinical findings.• Imaging may be used to exclude articular or rotator cuff pathology.• Thickening of coracohumeral and inferior glenohumeral ligaments are common findings.• Rotator interval fat pad obliteration has 100 % specificity for adhesive capsulitis.• Ultrasound can be used to guide intra- and periarticular treatments.

Correlations between MRI findings and outcome of capsular distension in adhesive capsulitis of the shoulder.

[Purpose] The aim of this study was to investigate the association between magnetic resonance imaging (MRI) findings in patients with adhesive shoulder capsulitis and the therapeutic effect of capsular distension. [Subjects and Methods] We retrospectively reviewed the medical records of 57 patients who underwent capsular distension therapy after a diagnosis of adhesive capsulitis with clinical and MRI scans. Axillary joint capsular thickness by MRI was graded as I (≤3.6 mm), II (3.7–4.2 mm), and III (≥4.3 mm). Subcoracoid fat obliteration of the rotator interval was graded subjectively as absent, partial, and complete. [Results] Capsular thickness and fat replacement were correlated with passive range of motion (PROM) and pain score on a visual analog scale (VAS) by analysis of variance with a Bonferroni correction before treatment and by analysis of covariance with a Bonferroni correction after treatment. Visual analog scale (VAS) for patients with all grades decreased significantly after treatment and passive range of motion (PROM) for patients with all grades improved. No difference was detected between grades. [Conclusion] Although MRI is useful to evaluate adhesive capsulitis, MRI findings of shoulder did not predict the prognosis after capsular distension treatment.

Case of tuberculosis acromioclavicular joint presenting as lytic lesion in lateral end clavicle: rare case report

Background: Rise in the incidence of tuberculosis (TB) seen in recent years. Skeletal TB accounts for less than 10% of all cases of TB. Most of these cases are in the spine and hip. The acromio-clavicular (AC) joint is a very uncommon site of skeletal TB. Case report: A 30 year old female developed pain in her right shoulder after sustaining trivial trauma. She was treated conservatively for six weeks, but patient complaints of increase in the intensity of pain with restricted movements. Radiographs repeated after six weeks showed a lytic lesion in the lateral end of clavicle with differential diagnosis of a solitary bone cyst or metastatic lesion. FNAC of the swelling done and MRI right shoulder advised. Histo-pathological report revealed evidence consistent with TB. The patient started on a multidrug anti-tubercular therapy (ATT) regimen with diagnosis of tuberculosis lateral end clavicle. MRI report after two weeks showed synovial hypertrophy and capsular distension with mild joint effusion in right AC joint. The diagnosis changed to tuberculosis of AC joint with continuation of the same treatment. Conclusion: The rarity of the occurrence of TB at unusual sites, and the ability of tuberculosis to mimic other diseases, combined with a lack of awareness by the treating orthopaedist often leads to diagnostic delays. A high index of suspicion should be maintained in cases of swellings around the shoulder, even if they lack systemic features of tuberculosis.rn

Effects of Ultrasound-guided intra-articular ketorolac injection with capsular distension

Frozen shoulder is a painful condition with gradual onset and loss of range of motion in the glenohumeral joint. To investigate the efficacy of ultrasound(US)-guided intra-articular (IA) ketorolac injection with capsular distension compared with steroid injection alone in patients with frozen shoulder by assessing pain relief, functional improvements, and range of motion at 1,3 and 6 months after the last injections. Between January 2009 and December 2012, 121 patient were treated with US-guided IA steroid injection or IA ketorolac injection with capsular distension for frozen shoulder. Patients (n= 57) of US-guided IA steroid injection group were administered with a mixture of 0.5% lidocaine (4 ml) plus triamcinolone (40 mg/ml; 1 ml) and patients (n= 64) of US-guided IA ketorolac injection with capsular distension group were administered by using 0.5% lidocaine (19 mL) plus ketorolac (30 mg/ml; 1 mL) for capsular distension. Outcome measurement was assessed by Shoulder Pain and Disability Index (SPADI), Verbal Numeric pain Scale (VNS) and passive range of motion (ROM) before injections and at 1, 3 and 6 months after the last injections. We regarded the outcomes as a success if patients obtained significant pain relief (as measured by > 50% improvement in the VNS score and 20 point improvement in the SPASI) at 1, 3 and 6 months after the last injections. SPADI, VNS and passive ROM were improved 1, 3 and 6 months after the last injections in both groups. The statistical differences were not observed in SPADI, VNS between groups (p< 0.05). Successful treatment rate were not significantly different between the groups as well as in 1, 3 and 6 month outcomes. However, greater improvement was found in a matter of range of motion in patients receiving IA ketorolac injection with capsular distension than participants receiving US-guided IA steroid injection alone. Significant differences in improvement at 3 and 6 months were observed for shoulder passive abduction and external rotation (p< 0.05). IA ketorolac injection with capsular distension was shown to be a treatment method as effective as the steroid injection alone in pain relief and functional improvement in patient with frozen shoulder and more improvement in passive abduction and external rotation than steroid injection alone at 3 and 6 months.

Anterior chamber depth and refractive change in late postoperative capsular bag distension syndrome: a retrospective analysis.

PurposeTo assess the characteristic findings and effects of laser capsulotomy in patients with late postoperative capsular bag distension syndrome (CBDS).MethodsTwenty patients diagnosed with late postoperative CBDS between July 2010 and August 2013 were retrospectively reviewed. Before and 1 week after capsulotomy, changes in the anterior chamber depth (ACD) were assessed using ultrasound biomicroscopy. Changes in the refractive status and uncorrected visual acuity (UCVA) were also measured 1 week and 1 month after capsulotomy. For patients who received bilateral cataract surgery, preoperative ACD and axial length measured by IOLMaster were compared between the two eyes.ResultsTwenty-two eyes from 20 patients who had undergone laser capsulotomy showed a mean UCVA improvement of 0.27 ± 0.24 logMAR (range, 0.00–0.90). ACD was increased by an average of +0.04 mm (95% confidence interval, +0.01 to +0.06 mm, p = 0.034), equivalent to predicted refractive change of +0.10 D. The discrepancy between actual (+1.33 D) and predicted refractive change after capsulotomy suggests that refractive change may not be generated from IOL displacement in late postoperative CBDS. Preoperative ACD was deeper in the eye with late postoperative CBDS in all bilaterally pseudophakic patients (mean, 3.68 mm vs. 3.44 mm in the fellow eye, p = 0.068).ConclusionsLate postoperative CBDS showed refractive changes that were resolved successfully after laser capsulotomy. The convex lens effects of opalescent material in the distended capsular bag may play a major role in myopic shift. A larger preoperative ACD is possibly associated with the development of late postoperative CBDS.

Posterior capsule opacification, capsular bag distension syndrome, and anterior capsular phimosis: A retrospective cohort study

ObjectiveTo determine the incidence and the risk factors involved in the development of the three main postoperative capsular complications: posterior capsule opacification (PCO), capsular bag distension syndrome (CBDS), and anterior capsular phimosis syndrome (ACP). Subjects, materials and methodsA retrospective cohort study was conducted on 801 patients submitted to cataract surgery in the ophthalmology unit of Hospital del Henares (Madrid) from March 2, 2009 to February 28, 2010. Computerized clinical charts were reviewed during July 2012. PCO was studied using the Kaplan–Meier method (log rank test). ResultsA total of 167 patients developed PCO. No association could be demonstrated between PCO and age, sex, diabetes mellitus, phaco technique, IOL model, tamsulosin intake, glaucoma, and age-related macular degeneration. Three patients developed CBDS, all of them have received a Akreos Adapt AO® (Bausch & Lomb). Two of them were young men who had received surgery for posterior subcapsular cataracts. Three patients developed ACP, 2 of whom had received a MicroSlim® IOL (PhysIOL). ConclusionsNo association was found between PCO and any of the studied variables. Male gender, young age, subcapsular cataract and large non-angulated lens such as Akreos Adapt AO® could be associated with CBDS. ACP could be more frequent when microincision IOLs (like MicroSlim®) are implanted.

Ultra-Late Onset Capsular Bag Distension Syndrome: Risk Factors and Characteristics on Scheimpflug Imaging

Background: To provide insights into the characteristic of ultra-late onset capsular bag distension syndrome (CBDS) after phacoemulsification. Design: An interventional, retrospective case series at a tertiary care institute. Participants: 5 Post-cataract surgery patients who presented with the retrolenticular fluid collection. Methods: This is an interventional, retrospective case series of 5 cases who presented with clinical signs of ultralate CBDS>7 years after uneventful phacoemulsification with in-the-bag posterior chamber intraocular lens implantation at a tertiary care institute. Scheimpflug imaging was used in all cases in addition to slit lamp biomicroscopic examination to assess and diagnose the condition. Neodymium:Yttrium Aluminium Garnet (Nd:YAG) posterior capsulotomy was performed in all to treat the condition. Main outcome measure: Results: All 5 patients presented with a milky fluid collection within the distended capsular bag without raised intraocular pressure or a shallow anterior chamber. Scheimpflug imaging confirmed the diagnosis in all cases and all eyes revealed a hyper-reflective space between the intraocular lens optic and the posterior capsule. Nd:YAG posterior capsulotomy was performed in all patients, with resolution of fluid and improvement of visual acuity. Conclusion: Our case series showed that Scheimpflug imaging is a useful modality to diagnose ultra-late onset CBDS and to differentiate this condition from intraocular lens opacification and posterior capsule opacification (PCO). Nd:YAG posterior capsulotomy proved to be successful treatment for ultra-late CBDS with no significant change in biometric or refractive parameters. Keywords: Ultra-late capsular bag distension syndrome;

Optical coherence tomography for an in-vivo study of posterior-capsule-opacification types and their influence on the total-pulse energy required for Nd:YAG capsulotomy: a case series.

BackgroundPosterior capsule opacification (PCO) is the most common post-operative complication associated with cataract surgery and is mostly treated with Nd:YAG laser capsulotomy. Here, we demonstrate the use of high-resolution spectral-domain optical coherence tomography (OCT) as a technique for PCO analysis. Additionally, we evaluate the influence of PCO types and the distance between the intraocular lens (IOL) and the posterior capsule (PC), i.e., the IOL/PC distance, on the total-pulse energy required for the Nd:YAG laser posterior capsulotomy.Methods47 eyes with PCO scheduled for the Nd:YAG procedure were examined and divided into four categories: fibrosis, pearl, mixed type and late-postoperative capsular bag distension syndrome. Using custom-made computer software for OCT image analysis, the IOL/PC distances in two dimensions were measured. The IOL/PC distances were compared with those of a control group of 15 eyes without PCO. The influence of the different PCO types and the IOL/PC distance on the total-pulse energy required for the Nd:YAG procedure was analyzed.ResultsThe total-pulse energy required for a laser capsulotomy differs significantly between PCO types (p = 0.005, Kruskal-Wallis test). The highest energy was required for the fibrosis PCO type, followed by mixed, pearl and late-postoperative capsular bag distension syndrome. The IOL/PC distance also significantly influenced the total-pulse energy required for laser capsulotomy (p = 0.028, linear regression). Lower total-pulse energy was expected for a larger IOL/PC distance.ConclusionsOur study indicates that the PCO types and the IOL/PC distance influence the total-pulse energy required for Nd:YAG capsulotomy. The presented OCT method has the potential to become an additional tool for PCO characterization. Our results are important for a better understanding of the photodisruptive mechanisms in Nd:YAG capsulotomy.

Opacificación de la cápsula posterior, síndrome de distensión capsular y síndrome de fimosis de la cápsula anterior: estudio de cohortes retrospectivo

ObjectiveTo determine the incidence and the risk factors involved in the development of the three main postoperative capsular complications: posterior capsule opacification (PCO), capsular bag distension syndrome (CBDS), and anterior capsular phimosis syndrome (ACP). Subjects, material and methodsA retrospective cohort study was conducted on 801 patients submitted to cataract surgery in the ophthalmology unit of Hospital del Henares (Madrid) from March 2, 2009 to February 28, 2010. Computerized clinical charts were reviewed during July 2012. PCO was studied using the Kaplan-Meier method (log rank test). ResultsA total of 167 patients developed PCO. No association could be demonstrated between PCO and age, sex, diabetes mellitus, phaco technique, IOL model, tamsulosin intake, glaucoma, and age-related macular degeneration. Three patients developed CBDS, all of them have received and Akreos Adapt AO® (Bausch & Lomb). Two of them were young men who had received surgery for posterior subcapsular cataracts. Three patients developed ACP, 2 of whom had received a MicroSlim® IOL (PhysIOL). ConclusionsNo association was found between PCO and any of the studied variables. Male gender, young age, subcapsular cataract and large non-angulated lens such as Akreos Adapt AO® could be associated with CBDS. ACP could be more frequent when microincision IOLs (like MicroSlim®) are implanted.

Management of the frozen shoulder

Management of the frozen shoulder Suzanne Margaretha van de Laar, Peer van der Zwaal Department of Orthopaedic Surgery and Trauma, Medical Center Haaglanden, The Hague, the Netherlands Abstract: Frozen shoulder is a very common condition with a prevalence of 2%&ndash;5% in the general population. Decrease in joint volume as a result of fibrosis and hyperplasia of the joint capsule leads to painful and restricted glenohumeral motion. Frozen shoulder is a self-limiting disease with a chronic character, and is mostly treated in a primary care setting. In this review, we set out to address the current evidence-based literature on management of this disabling disease using a PubMed search. Many non-surgical and surgical therapeutic options are described, including supervised neglect, intra-articular corticosteroid injections, physical therapy, manipulation under anesthesia, capsular distension, and arthroscopic capsular release. In the literature, the long-term outcome shows a significant decrease in pain and improvement of shoulder function for all treatment modalities without clear evidence of superiority of one over the other. This possibly indicates that a self-limiting character is the most important factor in the course of the disease. Management of frozen shoulder is primarily conservative. Supervised neglect is combined with analgesia and stretching exercises as the pain subsides. In the early painful phase, intra-articular corticosteroid injections are recommended for pain relief. When the patient has persistent pain and glenohumeral stiffness after adequate conservative treatment, invasive options can be considered, like arthroscopic capsular release, manipulation under anesthesia, or capsular distension. Keywords: frozen shoulder, adhesive capsulitis, treatment, pathophysiology