Transepithelial Phototherapeutic Keratectomy Using a 213-nm Solid-State Laser System Followed by Corneal Collagen Cross-Linking with Riboflavin and UVA Irradiation

Purpose. To present a case of a keratoconic patient who underwent epithelial removal with transepithelial phototherapeutic keratectomy (t-PTK) using a 213-nm solid-state laser system followed by corneal collagen cross-linking (CXL) with riboflavin and ultraviolet-A (UVA) irradiation. Methods. Case report. Results. A twenty-four-year-old male with keratoconus underwent CXL treatment after epithelial removal with t-PTK using a solid-state laser system. No intra- or early postoperative complications were found. One month postoperatively, uncorrected visual acuity (UCVA) improved from 20/63 to 20/32 while best spectacle- corrected visual acuity (BSCVA) improved from 20/40 to 20/25. Corneal topography revealed a significant improvement which remained stable during the six-month followup period. Conclusions. Epithelial removal with t-PTK before CXL could improve patient's visual outcome

Tono-Pen XL tonometry during application of a suction ring in rabbits

<p>Abstract</p> <p>Background</p> <p>The purpose of this study is to evaluate the use of Tono-Pen XL in measuring IOP during the application of a suction ring in rabbit eyes with manometrically controlled IOP.</p> <p>Methods</p> <p>Tono-Pen XL was calibrated against direct manometry in 10 rabbit eyes. A suction ring was then applied in 4 rabbit eyes and the IOP was determined manometrically during suction ring application at 350 mmHg vacuum pressure. Finally, in 6 catheterized rabbit eyes the IOP was measured with Tono-Pen XL during suction ring application at suction vacuum from 350 to 650 mmHg, while keeping actual IOP stable at 30 mmHg and 60 mmHg.</p> <p>Results</p> <p>Linear regression analysis revealed that the Tono-pen XL was reliable for IOPs between 10 and 70 mmHg (R²= 0.9855). Direct manometry during suction ring application showed no statistically significant variation of Tono-Pen XL readings when the incanulation manometry intraocular pressure changed from 30 mmHg to 60 mmHg and no statistically significant correlation between suction vacuum and IOP measurements.</p> <p>Conclusion</p> <p>Tono-Pen XL measurements are unreliable during the application of a suction ring on living rabbit eyes even when the actual IOP is forced to be within the validated range of Tono-Pen XL measurements. This inaccuracy is probably related to altered corneal and scleral geometry and stress.</p

Clinical Study Long Term Followup of Photorefractive Keratectomy with Adjuvant Use of Mitomycin C

properly cited. Purpose. To study the long term refractive and visual outcomes of photorefractive keratectomy (PRK) with intraoperative application of mitomycin C (MMC). Methods. This study included 37 eyes who received myopic PRK; after photoablation, a sponge soaked in 0.02% MMC solution was applied in all corneas for 2 minutes. Efficacy, safety, predictability, and stability of PRK MMC were evaluated. Endothelial cell density was evaluated at the last postoperative interval. Results. Mean preoperative spherical equivalent (SEQ) was −6.03 ± 1.87 D (diopters) and reduced to −0.09 ± 0.53 D at the last postoperative examination. Mean followup was 44.73 ± 18.24 months. All the eyes were in the ±1.00 D of attempted versus achieved SEQ at the one-year follow-up interval. Furthermore, 95% of the eyes did not lose lines or gained 1 to 2 lines of CDVA, while 5% lost 1 line. At the third postoperative month, 89% of the eyes either were clear or had trace haze, while 4 eyes had mild haze; by the 12-month postoperative interval, none of the eyes demonstrated haze. Mean endothelial cell density (ECD) at the last postoperative interval was 2658 ± 153 cells/mm 2 . Conclusions. PRK, with intraoperative use of MMC, demonstrates stable refractive and visual outcomes up to 44 months after surgery

Estimating the repeatability of measurements of corneal topographic system in ophthalmology

Purpose. To describe a new software tool for the detailed presentation of corneal topography measurements variability by means of color coded maps. Methods. Software was developed in Visual Basic to analyze and process a series of 10 consecutive measurements obtained by a topographic system on calibration spheres and individuals with emmetropic low high and irregular astigmatic corneas Corneal surface was segmented into 1200 segments and the coefficient of variance of each segment’s keratometric dioptric power was used as the measure of variability. The results were presented graphically in color coded maps (Variability Maps). Two topographic systems the TechnoMed C-Scan and the TOMEY Topographic Modeling System (TMS-2Ν) were examined to demonstrate our method. Results. Graphic representation of coefficient of variance offered a detailed representation of examination variability both in calibration surfaces and human corneas. It was easy to recognize an increase in variability as the irregularity of examination surfaces increased. In individuals with high and irregular astigmatism a variability pattern correlated with the pattern of corneal topography, steeper corneal areas possessed higher variability values compared with flatter areas of the same cornea. Numerical data permitted direct comparisons and statistical analysis. Conclusions. We propose a method that permits a detailed evaluation of the variability of corneal topography measurements. The representation of the results both graphically and quantitatively improves interpretability and facilitates a spatial correlation of variability maps with original topography maps. Given the popularity of topography based custom refractive ablations of the cornea it is possible that variability maps may assist clinicians in the evaluation of corneal topography maps of patients with very irregular corneas before custom ablation procedures.Σκοπός. Ο προσδιορισμός της επαναληψιμότητας τοπογραφικών συστημάτων μέσω ενός λογισμικού που χρησιμοποιεί ανάλυση σημείο-προς σημείο των εξαχθέντων πρωτευόντων δεδομένων (Raw Data). Μέθοδοι. Ένας εξεταστής λαμβάνει 10 διαδοχικές τοπογραφικές μετρήσεις με δυο τοπογραφικά συστήματα το TechnoMed C Scan και το Tomey Topographic Modeling System (TMS-2N) σε σφαίρες βαθμονόμησης, σε εμμετροπικούς, μυωπικούς, αστιγματικούς και σε πολύ ανώμαλης επιφάνειας κερατοειδείς. Ο κερατοειδής χωρίζεται σε 1200 τμήματα και για κάθε τμήμα υπολογίζεται: η μέση τιμή, η τυπική απόκλιση και ο συντελεστής μεταβλητότητας (coefficient of variation) μέσω λογισμικού που αναπτύχθηκε σε γλωσσά προγραμματισμού Visual Basic 6.0. Τα αποτελέσματα εκφράζονται και αριθμητικά και γραφικά υπό τη μορφή έγχρωμων χαρτών που είναι παρόμοιοι με αυτούς της τοπογραφίας και η επαναληψιμότητα εκφράζεται μέσω του συντελεστή μεταβλητότητας. Αποτελέσματα. Ακόμη και αν οι σφαίρες βαθμονόμησης έχουν καλύτερα αποτελέσματα ως προς τη επαναληψιμότητα (CoV0 5%), υπάρχουν και περιοχές όπου η επαναληψιμότητα μειώνεται αισθητά (CoV>1.25%D). Το φαινόμενο αυτό είναι πιο αισθητό στη κεντρική και περιφερική ζώνη για τις πιο κυρτές και πιο πεπλατυσμένες σφαίρες (6.50 χιλ. και 10.0 χιλ. ) και κυρίως για το σύστημα της TechnoMed C-Scan. Στους κερατοειδείς τα αποτελέσματα είναι κοντινά και για τα δυο συστήματα σε αντίθεση με τις σφαίρες βαθμονόμησης, και τα καλύτερα αποτελέσματα παρουσιάζονται στη παρακεντρική περιοχή. Η μείωση της επαναληψιμότητας είναι ανάλογη με τη αύξηση της ανωμαλίας. Στους κερατοειδείς με ανώμαλο αστιγματισμό παρουσιάζονται διαμορφώσεις επαναληψιμότητας η μεταβλητότητας (Variability), που σχετίζονται με τη διαμόρφωση του αρχικού τοπογραφικού χάρτη: οι κυρτότερες περιοχές του κερατοειδή δίνουν μεγαλύτερες τιμές μεταβλητότητας (μικρότερη επαναληψιμότητα) σε σχέση με άλλες περιοχές επάνω στο χάρτη που είναι πιο πεπλατυσμένες. Τα αριθμητικά αποτελέσματα προσφέρονται για περαιτέρω στατιστική ανάλυση. Συμπεράσματα. Προτείνουμε μια μέθοδο που επιτρέπει τον ακριβή προσδιορισμό της μεταβλητότητας (επαναληψιμότητας) σε τοπογραφικές μετρήσεις του κερατοειδούς. Η μέθοδος αναπαράστασης των αποτελεσμάτων γραφικά και αριθμητικά βελτιώνει την ερμηνεία και διευκολύνει τη χωρική συσχέτιση των χαρτών μεταβλητότητας με αυτούς της τοπογραφίας. Δεδομένης της εξάπλωσης των εξατομικευμένων επεμβάσεων καθοδηγούμενων από laser, είναι πιθανό ότι οι χάρτες μεταβλητότητας μπορούν να προσφέρουν βοήθεια στους κλινικούς στην κατεύθυνση της εκτίμησης τοπογραφικών χαρτών που προέρχονται από ασθενείς με ανωμάλους κερατοειδείς που πρόκειται να υποστούν εξατομικευμένη διόρθωση

Allergy Associated Myocardial Infarction: A Comprehensive Report of Clinical Presentation, Diagnosis and Management of Kounis Syndrome

Kounis syndrome (KS) has been defined as acute coronary syndrome (ACS) in the context of a hypersensitivity reaction. Patients may present with normal coronary arteries (Type I), established coronary artery disease (Type II) or in-stent thrombosis and restenosis (Type III). We searched PubMed until 1 January 2020 for KS case reports. Patients with age &lt;18 years, non-coronary vascular manifestations or without an established diagnosis were excluded. Information regarding patient demographics, medical history, presentation, allergic reaction trigger, angiography, laboratory values and management were extracted from every report. The data were pulled in a combined dataset. From 288 patients with KS, 57.6% had Type I, 24.7% Type II and 6.6% Type III, while 11.1% could not be classified. The mean age was 54.1 years and 70.6% were male. Most presented with a combination of cardiac and allergic symptoms, with medication being the most common trigger. Electrocardiographically, 75.1% had ST segment elevation with only 3.3% demonstrating no abnormalities. Coronary imaging was available in 84.8% of the patients, showing occlusive lesions (32.5%), vascular spasm (16.2%) or normal coronary arteries (51.3%). Revascularization was pursued in 29.4% of the cases. In conclusion, allergic reactions may be complicated by ACS. KS should be considered in the differential diagnosis of myocardial infarction with non-obstructive coronary arteries

Unilateral sulcus implantation of the crystalens HD.

To evaluate the results after unilateral sulcus implantation of the Crystalens HD (Bausch &amp; Lomb) accommodative intraocular lens (IOL). This retrospective interventional case series comprised six eyes from three patients who underwent cataract surgery and bilateral Crystalens HD accommodative IOL implantation. The Crystalens HD was implanted in the bag in one eye (non-sulcus group) and, due to posterior capsule rupture, the lens was positioned in the ciliary sulcus in the fellow eye (sulcus group). Mean patient age was 66.3 ± 4.9 years (range: 60 to 72 years). Mean follow-up was 14.3 ± 3.2 months (range: 12 to 18 months) for the non-sulcus group and 14 ± 2 months (range: 12 to 16 months) for the sulcus group. Uncorrected distance visual acuity improved from 20/100 to 20/33 in the non-sulcus group and from 20/63 to 20/32 in the sulcus group during last follow-up. Corrected distance visual acuity improved from 20/35 to 20/20 in the non-sulcus group and from 20/27 to 20/23 in the sulcus group. Regarding near vision, all eyes in the sulcus group and 66.7% of eyes in the non-sulcus group achieved J1-J2 (Birkhauser reading chart). None of the eyes had any intra- (except posterior capsule rupture in the sulcus cases) or postoperative complications. Based on this small series, ciliary sulcus implantation of the Crystalens HD seems to be associated with no significant morbidity and provides satisfactory visual acuity outcomes

Case Report Transepithelial Phototherapeutic Keratectomy Using a 213-nm Solid-State Laser System Followed by Corneal Collagen Cross-Linking with Riboflavin and UVA Irradiation

properly cited. Purpose. To present a case of a keratoconic patient who underwent epithelial removal with transepithelial phototherapeutic keratectomy (t-PTK) using a 213-nm solid-state laser system followed by corneal collagen cross-linking (CXL) with riboflavin and ultraviolet-A (UVA) irradiation. Methods. Case report. Results. A twenty-four-year-old male with keratoconus underwent CXL treatment after epithelial removal with t-PTK using a solid-state laser system. No intra-or early postoperative complications were found. One month postoperatively, uncorrected visual acuity (UCVA) improved from 20/63 to 20/32 while best spectaclecorrected visual acuity (BSCVA) improved from 20/40 to 20/25. Corneal topography revealed a significant improvement which remained stable during the six-month followup period. Conclusions. Epithelial removal with t-PTK before CXL could improve patient&apos;s visual outcome

Simultaneous topography-guided PRK followed by corneal collagen cross-linking for keratoconus.

To present the results after simultaneous photorefractive keratectomy (PRK) followed by corneal collagen cross-linking (CXL) for progressive keratoconus. Twelve patients (14 eyes) with progressive keratoconus were prospectively treated with customized topography-guided PRK with the Pulzar Z1 (wavelength 213 nm, CustomVis) immediately followed by corneal collagen CXL with the use of riboflavin and ultraviolet A irradiation. Mean follow-up was 10.69+/-5.95 months (range: 3 to 16 months). Mean preoperative spherical equivalent refraction (SE) was -3.03+/-3.23 diopters (D) and defocus was 4.67+/-3.29 D; at last follow-up SE and defocus were statistically significantly reduced to -1.29+/-2.05 D and 3.04+/-2.53 D, respectively (P&lt;.01). Preoperative mean (logMAR) uncorrected visual acuity was 0.99+/-0.81 and best spectacle-corrected visual acuity was 0.21+/-0.19, which improved postoperatively to 0.16+/-0.15 and 0.11+/-0.15, respectively. The mean steepest keratometry was reduced from 48.20+/-3.40 D preoperatively to 45.13+/-1.80 D at last follow-up. Simultaneous PRK followed by CXL seems to be a promising treatment capable of offering functional vision in patients with keratoconus