Optimal interval for delayed retrieval surgery with reciprocating morcellators after enucleation of giant prostatic hyperplasia in holmium laser enucleation of the prostate

Objective:The aim of this research was to evaluate the efficiency of reciprocating morcellation for removing giant benign prostatic hyperplasia during holmium laser enucleation of the prostate,investigate whether performing morcellation as a two-stage procedure improves tissue retrieval efficiency,and seek to determine the optimal interval between the two surgeries.Methods:This study included nine cases of holmium laser enucleation of the prostate with an enucleated prostate weight exceeding 200 g,indicative of substantial prostate enlargement.Morcellation was performed on Day 0(n=4),Day 4(n=1),Day 6(n=1),and Day 7(n=3).The intervals were compared regarding the morcellation efficiency,beach ball presence,and pathology.Results:The mean estimated prostate volume was 383(range 330e528)mL;the median enucleation weight was 252(interquartile range[IQR]222,342)g;and the median enucleation time was 83(IQR 62,100)min.The mean morcellation efficiency was 1.44(SD 0.55)g/min on Day 0 and 13.69(SD 2.46)g/min on day 7.The morcellation efficiency was 4.15 g/min and 10.50 g/min on Day 4 and Day 6,respectively,with significantly higher in the two-stage group compared to one-stage group(11.0 g/min vs.1.5 g/min;p=0.014).Efficiency was strongly correlated with intervals(p<0.001);the incidences of beach balls were 100%(4/4)and 60%(3/5)in the immediate and two-stage surgery groups,respectively.Conclusion:The efficiency of two-stage morcellation with reciprocating morcellators was highly related to the postoperative interval,with the maximum efficiency reached on Day 7.

Evaluation of the Clinical Efficacy of Full Femtosecond Laser Surgery in the Treatment of Myopia

Objective:To evaluate the clinical effect of full femtosecond laser surgery in the treatment of myopia patients.Methods:120 myopia patients admitted to our hospital from January 2022 to June 2023 were selected.According to the random number table method,60 patients in the observation group underwent full femtosecond laser surgery,and 60 patients in the control group underwent femtosecond laser-assisted in situ keratomileusis(FS-LASIK)surgery.The clinical effects of the two groups were compared.Results:10 days postoperatively and 6 months after operation,the visual acuity level of the observation group was higher than that of the control group,the postoperative corneal asphericity coefficient and corneal full-thickness were lower than those of the control group,and the total effective rate 6 months after operation was higher than that of the control group(P<0.05).Conclusion:Full femtosecond laser surgical treatment can improve the postoperative visual acuity of patients with myopia,enhance the corneal asphericity coefficient(Q)and corneal full-thickness,and exert significant clinical effects.

Corneal astigmatic outcomes after femtosecond laser-assisted cataract surgery combined with surface penetrating arcuate keratotomies

AIM:To evaluate corneal astigmatic outcomes of femtosecond laser-assisted arcuate keratotomies(FAKs)combined with femtosecond-laser assisted cataract surgery(FLACS)over 12mo follow-up.METHODS:Totally 145 patients with bilateral cataracts and no ocular co-morbidities were recruited to a singlecentre,single-masked,prospective randomized controlled trial(RCT)comparing two monofocal hydrophobic acrylic intraocular lenses.Eyes with corneal astigmatism(CA)of>0.8 dioptres(D)received unpaired,unopened,surface penetrating FAKs at the time of FLACS.Visual acuity,subjective refraction and Scheimpflug tomography were recorded at 1,6,and 12mo.Alpins vectoral analyses were performed.RESULTS:Fifty-one patients(61 eyes),mean age 68.2±9.6y[standard deviation(SD)],received FAKs.Sixty eyes were available for analysis,except at 12mo when 59 attended.There were no complications due to FAKs.Mean pre-operative CA was 1.13±0.20 D.There was a reduction of astigmatism at all post-operative visits(residual CA 1mo:0.85±0.42 D,P=0.0001;6mo:0.86±0.35 D,P=0001;and 12mo:0.90±0.39,P=0.0001).Alpins indices remained stable over 12mo.Overall,the cohort was under-corrected at all time points.At 12mo,61%of eyes were within±15 degrees of pre-operative astigmatic meridian.CONCLUSION:Unpaired unopened penetrating FAKs combined with on-axis phacoemulsification are safe but minimally effective.CA is largely under-corrected in this cohort using an existing unmodified nomogram.The effect of arcuate keratotomies on CA remained stable over 12mo.

Case report:simultaneous femtosecond laser astigmatic keratotomy and toric intraocular lens implantation in femtosecond laser-assisted cataract surgery in a patient with surgically induced high corneal astigmatism

Background:Femtosecond laser astigmatic keratotomy(FSAK)and toric intraocular lens(IOL)implantation have been studied individually for comparison to treat astigmatism at cataract surgery.We report a case of surgically induced high corneal astigmatism by laser thermal keratoplasty(LTK)in a patient with cataract who was successfully treated with simultaneous combination of FSAK and toric IOL implantation with femtosecond laser-assisted cataract surgery(FLACS).This is the first report of both procedures combined simultaneously,with or without history of LTK.Case Description:A 68-year-old male presented with a history of LTK with two enhancements each eye in 2004,with subsequent surgically induced high corneal astigmatism,and with age-related nuclear cataract of both eyes.IOL master demonstrated+7.71 diopters of astigmatism at 163 degree right eye and+3.29 diopters of astigmatism at 4 degree left eye.After extensive discussion of the risks and benefits,the patient agreed to undergo FLACS with FSAK with two 61 degrees of relaxation incisions(RIs)and toric IOL(Alcon SN6AT9)right eye;FLACS with toric IOL(Alcon SN6AT7)alone left eye.At 2-year follow-up,uncorrected visual acuity was 20/30 right eye,20/25 left eye.His best corrected visual acuity was 20/25(+0.25+1.00 axis 21)right eye and 20/20(plano+0.25 axis 90)left eye;his best corrected near visual acuity was J1+with add+2.50 diopters right eye and left eye.Conclusions:Patients with age-related cataract and LTK induced high corneal astigmatism can hardly be sufficiently treated with FSAK or toric IOL alone at the time of cataract surgery.An effective way is to combine large FSAK and toric IOL of the highest cylindrical power of T9,in our case,simultaneously,which can achieve an excellent long term visual outcome.

Small incision lenticule extraction and femtosecond-assisted laser in situ keratomileusis in patients with deep corneal opacity:case series

AIM:To report the safety,efficacy,and accuracy of small-incision lenticule extraction(SMILE)or femtosecondassisted laser in situ keratomileusis(FS-LASIK)for the correction of myopia or myopic astigmatism in patients with deep corneal opacity denoted by anterior segment optical coherence tomography(AS-OCT).METHODS:Four patients with monocular corneal opacity(3 due to mechanical injury,1 due to a firecracker wound)were recruited and treated with refractive surgery(3 for SMILE,1 for FS-LASIK combined with limbal relaxing incision(LRI).Preoperative ocular manifestations,surgical details,postoperative visual outcomes,corneal opacity parameters,and corneal topography were analyzed.RESULTS:Preoperatively,spherical diopter ranged from-3.0 D to-4.75 D with cylinder ranging from-0.75 to-5.0 D,and corrected distance visual acuity(CDVA)ranging from 20/25 to 20/20.One eye’s corneal opacity was located in the central zone and three were in the mid-peripheral optical zone.Three patients underwent uneventful SMILE in both eyes,whilst one patient underwent FS-LASIK for high astigmatism in both eyes and LRI in the right eye.CDVA of the eye with corneal opacity ranged from 20/22to 20/20 one to six weeks postoperatively.Two patients achieved better CDVA and no patients lost Snellen lines.The postoperative diopter was within±0.75 D for all eyes.Significant edema existed above the corneal opacity in one eye and dissipated soon.No eccentric corneal topography or morphological anomaly of the corneal cap or flap was observed.CONCLUSION:The cases demonstrate that SMILE or FS-LASIK is safe and effective to treat myopic astigmatism combined with deep corneal opacity lesions after comprehensive preoperative evaluation and appropriate candidate selection.FS-LASIK combined with LRI is also sufficient for correcting high astigmatism due to corneal scarring.

Endovenous laser treatment vs conventional surgery for great saphenous vein varicosities: A propensity score matching analysis

BACKGROUND Varicosis is a common venous condition,which is typically treated surgically.However,selection of the optimal surgical approach can be challenging.Previous studies comparing endovenous laser treatment(EVLT)and conventional surgery were retrospective and observational in nature and the results may therefore have been influenced by selection bias and the presence of other confounding factors.In this study,we used propensity score matching to reduce selection bias when comparing EVLT and conventional surgery for the treatment of varicose great saphenous veins.METHODS We retrospectively reviewed the records of 1063 patients treated for primary varicosis of the great saphenous vein at the Second Affiliated Hospital of Xuzhou Medical University between January 2009 and December 2019.Among them,56 patients were excluded owing to additional small saphenous varicose vein involvement,81 owing to recurring varicose veins,83 owing to complicated varicose veins(CEAP clinical classification C5-C6),and 6 owing to perioperative phlebitis.Finally,772 patients were enrolled in this study.Standard demographic and clinicopathological data were collected from the medical records of the patients.For propensity score matching,522 patients(261 who underwent EVLT and 261 who underwent conventional surgery)were randomly matched 1:1 by age,sex,onset time,smoking status,presence of diabetes,family history,stress therapy,C class,and the affected leg.RESULTS Of the 772 patients included in the study,467 underwent EVLT and 305 underwent conventional surgery.There were significant differences in age,onset time,smoking and diabetes status,and family history between the two groups.Following propensity score matching,no significant differences in patients’characteristics remained between the two groups.ELVT was associated with a shorter operation time and hospital stay than conventional surgery,both before and after propensity score matching.There were no differences in complications between the two groups after propensity score matching.Patients who underwent EVLT had a higher recurrence rate during the two-year follow-up period than those who underwent conventional surgery(33.33%vs 21.46%,χ^(2)=11.506,P=0.001),and a greater percentage of patients who underwent EVLT experienced pain one week after the procedure(39.85%vs 19.54%,P=0.000).CONCLUSION EVLT may not always be the best option for the treatment of great saphenous vein varicosis.

Corneal neuromediator profiles following laser refractive surgery

Laser refractive surgery is one of the most commonly performed procedures worldwide.In laser refractive surgery,Femtosecond Laser in Situ Keratomileusis and Refractive Lenticule Extraction have emerged as promising alternatives to microkeratome Laser in Situ Keratomileusis and Photorefractive Keratectomy.Following laser refractive surgery,the corneal nerves,epithelial and stromal cells release neuromediators,including neurotrophins,neuropeptides and neurotransmitters.Notably,nerve growth factor,substance P,calcitonin gene-related peptide and various cytokines are important mediators of neurogenic inflammation and corneal nerve regeneration.Alterations in neuromediator profiles and ocular surface parameters following laser refractive surgery are attributed to the surgical techniques and the severity of tissue insult induced.In this review,we will discuss the(1)Functions of neuromediators and their physiological and clinical significance;(2)Changes in the neuromediators following various laser refractive surgeries;(3)Correlation between neuromediators,ocular surface health and corneal nerve status;and(4)Future directions,including the use of neuromediators as potential biomarkers for ocular surface health following laser refractive surgery,and as adjuncts to aid in corneal regeneration after laser refractive surgery.

Effect of femtosecond laser-assisted steepest-meridian clear corneal incisions on preexisting corneal regular astigmatism at the time of cataract surgery

AIM:To investigate the clinical efficacy and safety of femtosecond laser-assisted steepest-meridian clear corneal incisions for correcting preexisting corneal astigmatism performed at the time of cataract surgery.METHODS:This prospective case series study comprised consecutive age-related cataract patients with corneal regular astigmatism(range:+0.75 to+2.50 D)who had femtosecond laser-assisted steepest-meridian clear corneal incisions(single or paired).Corneal astigmatism was performed with the Pentacam preoperatively and 3 mo postoperatively.Total corneal astigmatism and steepestmeridian measured in the 3-mm central zone were used to guide the location,size and number of clear corneal incision.The vector analysis of astigmatic change was performed using the Alpins method.RESULTS:Totally 138 eyes of 138 patients were included.The mean preoperative corneal astigmatism was 1.31±0.41 D,and was significantly reduced to 0.69±0.34 D(equivalent to difference vector)after surgery(P<0.01).The surgically-induced astigmatism was 1.02±0.54 D.The correction index(ratio of target induced astigmatism and surgically-induced astigmatism:0.72±0.36)as well as the magnitude of error(difference between surgically-induced astigmatism and target induced astigmatism:-0.29±0.51)represented a slight under correction.For angle of error,the arithmetic mean was 1.11±13.70,indicating no significant systematic alignment errors.CONCLUSION:Femtosecond-assisted steepest-meridian clear corneal incision is a fast,customizable,adjustable,precise,and safe technique for the reduction of low to moderate corneal astigmatism during cataract surgery.

Selective laser trabeculoplasty as adjunctive treatment for open-angle glaucoma vs following incisional glaucoma surgery in Chinese eyes

BACKGROUND Selective laser trabeculoplasty(SLT)is a relatively safe and effective therapy in lowering intraocular pressures(IOP)for glaucoma.AIM To study the long-term effects of SLT on IOP and number of glaucoma medications used in Chinese eyes.METHODS This is a retrospective study in which 75 eyes of 70 patients with open-angle glaucoma(OAG,n=36)and eyes with prior glaucoma surgery(PGS,n=39)were included.Changes in mean IOP and number of glaucoma medications used evaluated at 1 d,1 wk,1 mo,3 mo,6 mo,12 mo,and 36 mo after laser treatment.RESULTS All patients(33 male,37 female)were Chinese.The mean age was 44.34±16.14years.Mean pre-SLT IOP was 22.75±2.08 mmHg in OAG and 22.52±2.62 mmHg in PGS.Mean IOP was significantly reduced 1 d,1 wk,1 mo and 3 mo after laser treatment(P<0.05,respectively).Whereas,there were no significant differences between baseline and SLT treated groups at the 6th month both in OAG(P=0.347,P>0.05)and in PGS(P=0.309,P>0.05).Six months after SLT treatment,some patients received retreatment of SLT or were given more topical IOP-lowering medication to control the IOP.By the end of our study,the average IOP decreased to 20.73±1.82 mmHg in OAG and 20.49±1.53 mmHg in PGS groups.The number of glaucoma medications used was significantly reduced until the end of 3 years compared to baseline.CONCLUSION SLT could reduce IOP as adjunctive treatment both in OAG and PGS groups.SLT significantly reduced the number of glaucoma medications used 3-years following treatment in glaucoma patients.

Nd:YAG water mist laser treatment for giant gestational gingival tumor: A case report

BACKGROUND This case of gestational gingival tumor is huge and extremely rare in clinical practice.As the growth location of this gingival tumor is in the upper anterior tooth area,it seriously affects the pregnant woman's speech and food,causing great pain to the patient.The use of Nd:YGA water mist laser to remove the gingival tumor resulted in minimal intraoperative bleeding,minimal adverse reactions,and good postoperative healing,which is worthy of clinical promotion and application.CASE SUMMARY The patient,a pregnant woman,reported a large lump in her mouth on the first day of postpartum treatment.Based on medical history and clinical examination,the diagnosis was diagnosed as gestational gingival tumor.Postoperative pathological biopsy also confirmed this diagnosis.The use of Nd:YAG water mist laser to remove the tumor resulted in minimal intraoperative bleeding,clear surgical field of view,short surgical time,and good postoperative healing.CONCLUSION In comparison to traditional surgery,Nd:YAG water mist laser surgery is minimally invasive,minimizes cell damage,reduces bleeding,ensures a clear field of vision,and virtually eliminates postoperative edema,carbonization,and the risk of cross infection.It has unique advantages in oral soft tissue surgery for pregnant patients.Therefore,the clinical application of Nd:YAG water mist laser for the treatment of gestational gingival tumors is an ideal choice.

Femtosecond laser corneal refractive surgery for the correction of high myopic anisometropic amblyopia in juveniles

AIM： To evaluate the effects of femtosecond laser-assisted in situ keratomileusis（FS-LASIK） and small-incision lenticule extraction（SMILE） to correct high myopic anisometropic amblyopia in juvenile patients. METHODS： From November 2013 to January 2015, 33 amblyopic patients with high myopic anisometropic amblyopia were studied. FS-LASIK（30 eyes） or SMILE（3 eyes） was performed in the amblyopic eyes. Visual acuity, refraction, contrast sensitivity, stereoacuity and complications were evaluated. Patients completed followup examinations at 3 d, 1 mo, 3 mo and the last follow-up time（mean 8.17±3.23 mo） after surgery. RESULTS： The mean age at surgery was 9.04±3.04 y（range 6-16 y）. The mean spherical equivalent in the amblyopic eyes was significantly decreased from-10.00±2.39 D preoperatively to-0.06±1.06 D at 1 mo,-0.19±1.33 D at 3 mo and-0.60±1.43 D at approximately 8 mo postoperatively（P〈0.05 for all）. The mean myopic anisometropia was significantly decreased from-9.45±2.33 D preoperatively to ＋0.37±1.48 D at 1 mo,-0.46±1.47 D at 3 mo and-0.09±1.83 D at approximately 8 mo（P〈0.05 for all）. The logarithm of the minimum angle of resolution（log MAR） for uncorrected and corrected distance visual acuity（UDVA and CDVA, respectively） of the amblyopic eye improved from 1.74±0.35 and 0.98±0.63 preoperatively to 0.45±0.31 and 0.41±0.33 at approximately 8 mo after surgery, respectively. The logM AR CDVA at 3 d, 1, 3 and 8 mo postoperatively improved by means of 1.42, 2.22, 2.96, and 4.39 lines, and a gain of more than two lines accounted for 45%, 50%, 74% and 86% of all patients, respectively. The contrast sensitivity of both amblyopic eyes and dominant eyes at 0.5, 2, 8 cycles perdegree was significantly improved postoperatively（P〈0.05 for all）. Of the 33 pediatric patients, no patients had near stereopsis preoperatively and seven patients（21.2%） recovered near stereopsis（400″ to 60″） at approximately 8 mo after surgery. No intraoperative or postoperative complications occurred in any patient.CONCLUSION： FS-LASIK or SMILE can be promising alternative methods to correct high myopic anisometropic amblyopia in juvenile patients who have failed with traditional approaches.

Comparing corneal outcome between femtosecond laser-assisted cataract surgery and conventional phaco surgery in Fuchs’endothelial dystrophy patients:a randomized pilot study with 6mo follow up

AIM:To compare the corneal outcome in Fuchs’endothelial dystrophy(FED)patients between femtosecond laser-assisted cataract surgery(FLACS)and conventional phaco surgery(CPS).METHODS:This was a randomized controlled study comparing one eye surgery by FLACS and the contralateral eye operated by CPS(stop and chop technique)in FED patients.Central corneal thickness,corneal light backscatter,corneal densitometry,and central corneal endothelial cell count and hexagonality(noncontact endothelial cell microscope),and corrected distance visual acuity(CDVA)were assessed preoperatively and at day 1,40,and 180 postoperatively.RESULTS:Totally 31 patients(16 women)were included.At day 40 postoperatively,the mean endothelial cell loss(ECL)was 23.67%by FLACS and 17.30%by CPS(P=0.53).At day 180 postoperatively,ECL was 25.58%in FLACS and 21.32%in CPS(P=0.69).Densitometry data in all layers and all annuli from anterior layer to posterior layer in annuli 0-2,2-6,6-10 and 10-12,total densitometry with all layers and all annuli was performed.A significant difference was found in 6-10(posterior layer)at day 1 with-1.42 grayscale units(GSU;95%CI:-2.66 to-0.19,P=0.02).In 10-12(anterior layer,central layer and all layers)at day 40 were significant different with 7.7(95%CI:1.89 to 13.50,P=0.009),3.97(95%CI:0.23 to 7.71,P=0.03),4.73 GSU(95%CI:0.71 to 8.75,P=0.02),respectively.In the remaining parameters we found no difference between the two groups(P>0.05).Three CPS eyes suffered from corneal decompensation.CONCLUSION:There is no significant difference in corneal outcome between FLACS and CPS.Endothelial cell density and pentacam corneal outcome may be inadequate as outcome parameters in FED patients.

Comparing the intraoperative complication rate of femtosecond laser-assisted cataract surgery to traditional phacoemulsification

AIM: To compare the complication rate of femtosecond laser-assisted cataract surgery(FLACS) and traditional phacoemulsification for the first 18 mo of FLACS use at a private surgical center in Hawaii.METHODS: A retrospective chart review was conducted from January 2012 to June 2013. The first 273 consecutive eyes receiving FLACS and 553 eyes receiving traditional phacoemulsification were examined.All surgeries were performed at a single surgical center in Hawaii. The presence of intraoperative complications was used as the main outcome measure. Approval was obtained from the institutional review board of the University of Hawaii.RESULTS: The overall complication rate for FLACS was 1.8%, while that of the traditional procedure was5.8%(P 【0.05). A majority of the surgeons(80%) had a lower complication rate while using FLACS.CONCLUSION: FLACS is comparable in safety, if not safer, than traditional cataract surgery when performed by qualified cataract surgeons on carefully selected patients.

Comparison of corneal flap thickness using a FS200femtosecond laser and a moria SBK microkeratome

AIMTo evaluate differences in flap thickness resulting from use of an Alcon Wavelight FS200 femtosecond laser and a MORIA SBK microkeratome when making a 110-&#x000b5;m-thick corneal flap and to identify the potential factors that affect corneal flap thickness.

Differences in energy and corneal endothelium between femtosecond laser-assisted and conventional cataract surgeries：prospective,intraindividual,randomized controlled trial

AIM： To compare intraoperative phacoemulsification parameters and its effect on the corneal endothelium of eyes undergoing femtosecond laser-assisted cataract surgery（FLACS） versus conventional phacoemulsification（CP） cataract surgery.METHODS： Two hundred eyes from one hundred patients were included in a prospective, non-blinded, randomized, controlled, intraindividual clinical study. One hundred eyes underwent FLACS while their one hundred fellow eyes underwent CP. All surgeries were performed using the Victus？ femtosecond laser platform and Infinity？ Vision System phacoemulsification machine. Primary outcome measure was endothelial cell density 6 mo after surgery. Secondary outcome measures included central corneal thickness（CCT）, average cell area, standard deviation, coefficient of variation and hexagonality before surgery and 6 mo after surgery and endothelial cell density loss during this period were also evaluated. Intraoperative efficiency parameters [cumulative dissipated energy（CDE）, total intraocular surgery time, total ultrasound time, total phacoemulsification time, total torsional energy time, total aspiration time, ultrasound energy, torsional amplitude and fluid required during surgery] were also collated. RESULTS： Data from these patients was not considered for analysis. Data from 92 patients were analysed. Postoperative endothelial cell density（cells/mm2） between groups（2211.88±392.49 CP; 2246.31±403.48 FLACS） was not statistically significant（P=0.869）. Total ultrasound time, torsional energy time, CDE and fluid requirements were significantly lower the FLACS group（P〈0.05）. Other parameters did not show statistically significant difference between FLACS and CP.CONCLUSION： FLACS displays significant improvements in phacoemulsification parameters in comparison to CP. There are no significant differences in corneal endothelium measures between FLACS and CP.

Human lens epithelial cell apoptosis and epithelial to mesenchymal transition in femtosecond laser-assisted cataract surgery

AIM： To evaluate human lens epithelium cell apoptosis and epithelial to mesenchymal transition （EMT） induced by femtosecond laser in femtosecond laser assisted cataract surgery （FLACS）. METHODS： Sixty cataract patients with N2 to N3 stage according to the LOCS III were enrolled in this study and divided into three groups randomly： FLACSl group （cataract surgery by FLACS with LenSx）, FLACS2 group （cataract surgery by FLACS with LensAR） and manual group （cataract surgery by phacoemulsification）. Patients in two FLACS groups performed anterior capsulotomy by LenSx or LensAR laser system. Patients in the manual group were performed continuous curvilinear capsulorrhexis （CCC） manually. The anterior capsules were fixed right after moved out of eye. Hematoxylin-eosine staining, immunofluorescence staining and real-time PCR were performed in order to observe human lens epithelium cells changes after cataract surgery. RESULTS： The capsule cutting edge was shown irregularity and roughness in two FLACS groups and smooth edge in manual capsulotomy by pathologic staining. Irregularities of the cell configuration with partly swollen and destroyed nuclei were observed in two FLACS groups. Femtosecond laser could induce a significantly higher cell apoptosis in human lens epithelium cell than manually performed CCC （P〈0.05）. Lens epithelium cells apoptosis were correlated with femtosecond laser duration according to Pearson correlation analysis. Decreased N-cadherin expression, alpha-SMA and FSP-1 level in two FLACS groups showed the inhibition of cell EMT. CONCLUSION： Femtosecond laser may affect the apoptosis and EMT of lens epithelium cells which are under the peeled central lens capsule.

Dry eye and corneal sensitivity after small incision lenticule extraction and femtosecond laser-assisted in situ keratomileusis:a Meta-analysis

AIM：To assess the corneal sensitivity and the incidences of dry eye after small incision lenticule extraction（SMILE） and femtosecond laser-assisted in situ keratomileusis（FSLASIK）.METHODS：The Meta-analysis was performed using Rev Man 5.3.We searched on Pub Med from inception to March 2016.Summary weighted mean difference（WMD） and 95% confidence intervals（CIs） were used to analyze the datum.Random-effects or fixed-effects models were chosen up to between-study heterogeneity.The main outcomes were composed of the Ocular Surface Disease Index（OSDI） scores,tear film break-up time（TBUT）,Schirmer Test and corneal sensitivity.RESULTS：Eight eligible studies including 772 eyes（386 in SMILE group and 386 in FS-LASIK group） were identified.The parameters have no significiant difference heterogeneity between SMILE and FS-LASIK group preoperatively.There were significant differences between the two groups in OSDI scores at one and three months postoperatively,in TBUT at one and three months postoperatively,in corneal sensitivity at one week,about one month and three months postoperatively.However,there was no significant difference observed in Schirmer Test at the follow-up periods.CONCLUSION：Compare to FS-LASIK,dry eye and the corneal sensitivity recover better in the SMILE group,in first three months after the surgery.

Profitability analysis of a femtosecond laser system for cataract surgery using a fuzzy logic approach

AIM：To define the financial and management conditions required to introduce a femtosecond laser system for cataract surgery in a clinic using a fuzzy logic approach.METHODS：In the simulation performed in the current study,the costs associated to the acquisition and use of a commercially available femtosecond laser platform for cataract surgery（VICTUS,TECHNOLAS Perfect Vision GmbH,Bausch ＆ Lomb,Munich,Germany） during a period of 5y were considered.A sensitivity analysis was performed considering such costs and the countable amortization of the system during this 5y period.Furthermore,a fuzzy logic analysis was used to obtain an estimation of the money income associated to each femtosecond laser-assisted cataract surgery（G）. RESULTS：According to the sensitivity analysis,the femtosecond laser system under evaluation can be profitable if 1400 cataract surgeries are performed per year and if each surgery can be invoiced more than $500.In contrast,the fuzzy logic analysis confirmed that the patient had to pay more per surgery,between $661.8 and $667.4 per surgery,without considering the cost of the intraocular lens（IOL）.CONCLUSION：A profitability of femtosecond laser systems for cataract surgery can be obtained after a detailed financial analysis,especially in those centers with large volumes of patients.The cost of the surgery for patients should be adapted to the real flow of patients with the ability of paying a reasonable range of cost.

Femtosecond laser-assisted cataract surgery(FLACS)in resident training

This article reviews the history of the femtosecond laser in ophthalmology and its subsequent introduction into the field of cataract surgery.It discusses the innovations that this technology has brought to the field.The article also describes the current system of teaching cataract surgery to ophthalmology residents in the United States and then examines how femtosecond laser-assisted cataract surgery(FLACS)can be a beneficial part of residency education.

The use of lens anterior capsule disc for corneal endothelium protection during femtosecond laser-assisted cataract surgery in eyes with low endothelial cell density

Dear Editor,Cataract surgery affects the endothelial cells with a risk for corneal edema,decompensation,and a decrease in visual acuity.^(1-3)Previous studies had reported endothelial cell loss rates in standard ultrasound phacoemulsification cataract surgery(PCS)ranged from 4.5%to 42.6%,where there is a strong association between total ultrasound energy,nuclear density,surgical technique,and surgeon's skill.^(4-7)The reduction in corneal endothelial cell density(ECD)was even greater in eyes with FECD and primary corneal guttata that had cataract surgery and lens implantation,ranging from 17.3%to 24%.^(8)