Purpose To describe ocular findings in patients with established obstructive sleep apnoea hypopnoea syndrome (OSAHS) using continuous positive airway pressure (CPAP). Methods One hundred and fifteen referrals investigated for OSAHS were included. Patients with OSAHS were compared with those with normal sleep study controls. Subgroup analysis for CPAP users and nonusers was also carried out. Results OSAHS patients (n ¼ 89) compared with the controls (n ¼ 26) had higher ocular irritation symptoms (Po0.001), abnormal tear break-up time (Po0.05) with increased upper (Po0.001) and lower (Po0.001) lid laxity. Floppy eyelid syndrome (FES) was noted in 31.5% (28/89) OSAHS patients vs 3.8% (1/26) controls (P ¼ 0.005). Open angle glaucoma prevalence in OSAHS patients (3/89, 3.4%) was similar to the controls (1/26, 3.8%) (P ¼ 0.92). Sixty-seven (75.3%) OSAHS patients were using CPAP (average duration: 19.6 ± 15.3 months). All CPAP users maintained a supine sleep posture to prevent mask edge leaks. A fifth of CPAP users (14/67) had experienced earlier episodes of conjunctivitis secondary to leaks. CPAP users had similar upper and lower lid laxity (P ¼ 0.746 and 0.633) to non-CPAP users, but a better tear film (P ¼ 0.029) and less ocular irritation (P ¼ 0.134). Conclusion OSAHS patients showed increased ocular irritation, abnormal tear film, lid laxity, and FES. The prevalence of glaucoma in our series was similar to normal population data of 2%, P ¼ 0.429, and may relate to use of CPAP in majority of the patients. More stable tear film in CPAP users was probably secondary to the supine sleep postures necessarily adopted with CPAP use.

Although growing rods have efficacy in the control of deformity within the growing spine, they also have adverse effects on the spine. Immature spines treated with a growing rod have high rates of unintended autofusion which can possibly lead to difficult and only moderate correction at the time of definitive fusion.

Level II.

Finite element modeling suggests that the pathomechanics at the proximal end of a scoliosis construct may be diminished by preserving the ISL/SSL complex and possibly completely eliminated with the use of rods with a diameter transition at the most proximal level.

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Object There are few data on treatment results for patients with idiopathic infantile scoliosis (IIS). Thus, the authors have performed a retrospective review of their experience with treating these patients, particularly as newer technologies, such as the vertical expandable prosthetic titanium rib (VEPTR), emerge. Methods This retrospective study was conducted to evaluate the methods of treatment used to manage IIS at a single institution. The authors reviewed 31 consecutive patients with a primary diagnosis of IIS. Patients were screened to ensure that there were no confounding congenital anomalies or comorbidities that may have contributed to the spinal deformity. The average age at the time of initial treatment was 25 months. Treatment modalities included bracing, serial body casting, and VEPTR. Pretreatment, posttreatment, and most recent Cobb angles were compared to assess the overall curve correction, and patient charts were reviewed for the occurrence of complications. Results Of the 31 patients, 17 were treated with a brace, 9 of whom had curve progression and went on to other forms of treatment. Of the 8 who did respond, there was an overall improvement of 51.2%. The 10 patients who received body casts, who had a mean preoperative Cobb angle of 50.4°, demonstrated an average correction of 59.0%, with only a few skin irritations reported. The 10 patients treated with VEPTR devices demonstrated a mean preoperative Cobb angle of 90.0°, and an average correction of 33.8% was attained. Three of the VEPTR-treated patients (33%) experienced minor problems. Conclusions The authors' results suggest that body casting has utility for appropriately selected patients; that is, those with smaller, flexible spinal curves. Bracing had limited utility, with high levels of progression and the need for secondary treatments. The VEPTR device appears to be a viable alternative for large-magnitude curves.

Our study finds axial rotation correction using APSs and a direct vertebral body derotation technique was significantly greater than that obtained with the HR construct.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.