Thumb Function and Electromyography Result after Modified Camitz Tendon Transfer.

BACKGROUND: Various techniques of opponensplasty have been developed with the aim of restoring the thumb function. The modified Camitz opponensplasty is a simple technique done together with an open carpal tunnel release. It restores thumb palmar abduction soon after the procedure, during such time that the abductor pollicis brevis (APB) is still recovering. The aim of this study was to assess the recovery and level of activity of the abductor pollicis brevis and palmaris longus (PL) muscles during thumb opposition and abduction after performing the modified Camitz opponensplasty. METHODS: The records of 21 patients who underwent modified Camitz opponensplasty for severe carpal tunnel syndrome were reviewed. Thumb function was evaluated using the Van Wetter Apogee test, Kapandji index, tripod pinch strength, and power grip. Electromyography was utilized to evaluate APB recovery; ultrasonography was employed to evaluate PL activity. RESULTS: Twenty patients reached 80% of the abduction height of the contralateral hand; the Kapandji index was good in thirteen. Palmaris longus activity was evaluated together with the APB muscle recovery. There was significant improvement in the average grip strength and average tripod pinch strength. However, this did not correlate with the degree of neurologic and muscular recovery of the APB. We surmise that the palmaris longus augmented the abductor pollicis brevis muscle even in those with full muscle recovery. CONCLUSIONS: The modified Camitz opponensplasty is a practical option for patients suffering from severe carpal tunnel syndrome with diminished thumb function.

Deep anterior lamellar keratoplasty: challenges in histopathological examination.

BACKGROUND/AIMS: To characterise histopathological changes in corneal buttons associated with deep anterior lamellar keratoplasty (DALK). METHODS: This was a retrospective, clinical laboratory study. All recipient corneal buttons that underwent DALK in the West of Scotland and were submitted to the regional Ocular Pathology Laboratory (Glasgow, UK) between 2001 and 2010 were examined. Cases affected by artefacts secondary to DALK were highlighted. Keratoconus cases that underwent DALK were compared to those that underwent penetrating keratoplasty (PK). RESULTS: 225 DALK corneal buttons were examined. Of these, 61.8% were affected by artefacts or problems related to DALK. Overall, 58.2% of the affected buttons were affected by corneal emphysema related to intrastromal air injection (the 'big bubble' technique), 5.3% by epithelial oedema related to the hydrodelamination procedure, which mimicked bullous keratopathy secondary to endothelial cell deficiency, and 0.9% were lost specimens. We were not able to identify any conus, which is a characteristic histopathological feature of keratoconus, in 10 (7.4%) of the DALK-keratoconus cases as opposed to two (1.6%) of the PK-keratoconus cases (p=0.036). CONCLUSIONS: DALK poses new challenges for histopathological examination of corneal buttons. Awareness of DALK-related histopathological characteristics should be raised among ocular pathologists and ophthalmologists in view of the increasing popularity of this technique.