Stromal lenticule addition keratoplasty with corneal crosslinking for corneal ectasia secondary to FS-LASIK:a case series

●AIM:To explore the clinical efficacy and safety of stromal lenticule addition keratoplasty(SLAK)with corneal crosslinking(CXL)on patients with corneal ectasia secondary to femtosecond laser-assisted in situ keratomileusis(FS-LASIK).●METHODS:A series of 5 patients undertaking SLAK with CXL for the treatment of corneal ectasia secondary to FS-LASIK were followed for 4-9mo.The lenticules were collected from patients undertaking small incision lenticule extraction(SMILE)for the correction of myopia.Adding a stromal lenticule was aimed at improving the corneal thickness for the safe application of crosslinking and compensating for the thin cornea to improve its mechanical strength.●RESULTS:All surgeries were conducted successfully with no significant complications.Their best corrected visual acuity(BCVA)ranged from 0.05 to 0.8-2 before surgery.The pre-operational total corneal thickness ranged from 345-404μm and maximum keratometry(Kmax)ranged from 50.8 to 86.3.After the combination surgery,both the corneal keratometry(range 55.9 to 92.8)and total corneal thickness(range 413-482μm)significantly increased.Four out of 5 patients had improvement of corneal biomechanical parameters(reflected by stiffness parameter A1 in Corvis ST).However,3 patients showed decreased BCVA after surgery due to the development of irregular astigmatism and transient haze.Despite the onset of corneal edema right after SLAK,the corneal topography and thickness generally stabilized after 3mo.●CONCLUSION:SLAK with CXL is a potentially beneficial and safe therapy for advanced corneal ectasia.Future work needs to address the poor predictability of corneal refractometry and compare the outcomes of different surgical modes.

冠状动脉扩张研究现状

冠状动脉扩张现象通常是在冠状动脉造影过程中被偶然发现,其作为一种较为罕见的冠状动脉表型,引起了许多研究者的兴趣。目前尽管有较多关于冠状动脉扩张的研究,但对于其病因和治疗方案仍有较大的争议。本文总结了近年来的冠状动脉扩张相关研究,从多方面阐述了冠状动脉扩张的研究进展,以期为后续研究提供支持和帮助。

Changes in posterior corneal elevation after small incision lenticule extraction for different myopic diopters

●AIM:To study the changes and effect factors of posterior corneal surface after small incision lenticule extraction(SMILE)with different myopic diopters.●METHODS:Ninety eyes of 90 patients who underwent SMILE were included in this retrospective study.Patients were allocated into three groups based on the preoperative spherical equivalent(SE):low myopia(SE≥-3.00 D),moderate myopia(-3.00 D>SE>-6.00 D)and high myopia(SE≤-6.00 D).Posterior corneal surfaces were measured by a Scheimpflug camera preoperatively and different postoperative times(1wk,1,3,6mo,and 1y).Posterior mean elevation(PME)at 25 predetermined points of 3 concentric circles(2-,4-,and 6-mm diameter)above the best fit sphere was analyzed.●RESULTS:All surgeries were completed uneventfully and no ectasia was found through the observation.The difference of myopia group was significant at the 2-mm ring at 1 and 3mo postoperatively(1mo:P=0.017;3mo:P=0.018).The effect of time onΔPME was statistically significant(2-mm ring:P=0.001;4-mm ring:P<0.001;6-mm ring:P<0.001).The effect of different corneal locations onΔPME was significant except 1wk postoperatively(1mo:P=0.000;3mo:P=0.000;6mo:P=0.001;1y:P=0.001).Posterior corneal stability was linearly correlated with SE,central corneal thickness,ablation depth,residual bed thickness,percent ablation depth and percent stromal bed thickness.●CONCLUSION:The posterior corneal surface changes dynamically after SMILE.No protrusion is observed on the posterior corneal surface in patients with different degrees of myopia within one year after surgery.SMILE has good stability,accuracy,safety and predictability.

屈光手术联合预防性角膜胶原交联矫正屈光不正的疗效及安全性研究进展

角膜屈光手术是一种安全、有效的屈光不正矫正方式。尽管因术后角膜组织完整性改变,导致角膜生物力学稳定性下降,但术后角膜结构绝大多数是安全的。如果术前存在危险因素,如屈光度数高、角膜薄、角膜地形图形态欠规则、散光度数高、双眼对称性差、过敏体质、有揉眼习惯等,术后有可能发生屈光回退和角膜膨隆。角膜胶原交联术可增强角膜生物力学,有效阻止角膜膨隆、圆锥角膜或其他扩张性疾病的发生和发展。近年来,国内外一些研究者相继尝试一种新型的屈光手术设计,即角膜屈光手术联合预防性角膜胶原交联术,以期改善屈光术后角膜的生物力学稳定性,进而潜在预防角膜扩张和屈光回退。多项研究已经观察到联合手术具有良好的视力和屈光预后,尤其是对于术前评估角膜存在相对扩张风险的患者。本文将主要从有效性、安全性、可预测性、稳定性及并发症5个方面综述该联合手术矫治屈光不正的疗效及安全性。

微创旋切术治疗乳腺导管扩张症的临床效果

目的探讨微创旋切术治疗乳腺导管扩张症的临床效果。方法回顾性分析2018年1月至2021年6月青岛市黄岛区人民医院收治的60例脓肿期乳腺导管扩张症患者,根据不同治疗方法分为对照1组、对照2组与观察组,每组各20例。对照1组采用常规开放手术,对照2组采用经皮穿刺抽液术,观察组采用微创旋切术。比较三组手术相关指标、乳导管直径、视觉模拟评分法(VAS)评分、并发症总发生率及复发率。结果观察组手术时间、切口长度、切口愈合时间均短于对照1组,且术中出血量少于对照1组(P<0.05)。观察组手术时间、切口长度、切口愈合时间长于对照2组,且术中出血量多于对照2组(P<0.05)。干预2周后,观察组乳导管直径短于对照1组和对照2组,VAS评分低于其他两组(P<0.05)。观察组复发率低于对照1组及对照2组(P<0.05)。三组并发症总发生率比较,差异无统计学意义(P>0.05)。结论将微创旋切术应用于脓肿期乳腺导管扩张症患者的治疗中,乳导管直径、VAS评分及复发率优于常规开放手术及经皮穿刺抽液术,手术相关指标优于常规开放手术。

Diagnosis and management of gastric antral vascular ectasia

Gastric antral vascular ectasia (GAVE) is an uncommon but often severe cause of upper gastrointestinal (GI) bleeding, responsible of about 4% of non-variceal upper GI haemorrhage. The diagnosis is mainly based on endoscopic pattern and, for uncertain cases, on histology. GAVE is characterized by a pathognomonic endoscopic pattern, mainly represented by red spots either organized in stripes radially departing from pylorus, defined as watermelon stomach, or arranged in a diffused-way, the so called honeycomb stomach. The histological pattern, although not pathognomonic, is characterized by four alterations:vascular ectasia of mucosal capillaries, focal thrombosis, spindle cell proliferation and fibrohyalinosis, which consist of homogeneous substance around the ectatic capillaries of the lamina propria. The main differential diagnosis is with Portal Hypertensive Gastropathy, that can frequently co-exists, since about 30% of patients with GAVE co-present a liver cirrhosis. Autoimmune disorders, mainly represented by Reynaud's phenomenon and sclerodactyly, are co-present in about 60% of patients with GAVE; other autoimmune and connective tissue disorders are occasionally reported such as Sjogren's syndrome, systemic lupus erythematosus, primary biliary cirrhosis and systemic sclerosis. In the remaining cases, GAVE syndrome has been described in patients with chronic renal failure, bone marrow transplantation and cardiac diseases. The pathogenesis of GAVE is still obscure and many hypotheses have been proposed such as mechanical stress, humoural and autoimmune factors and hemodynamic alterations. In the last two decades, many therapeutic options have been proposed including surgical, endoscopic and medical choices. Medical therapy has not clearly shown satisfactory results and surgery should only be considered for refractory severe cases, since this approach has significant mortality and morbidity risks, especially in the setting of portal hypertension and liver cirrhosis. Endoscopic therapy, particularly treatment with Argon Plasma Coagulation, has shown to be as effective and also safer than surgery, and should be considered the first-line treatment for patients with GAVE-related bleeding.

Corneal collagen crosslinking for corneal ectasia of post-LASIK: one-year results

AIM: To evaluate the efficacy and safety of corneal collagen crosslinking (01) to prevent the progression of post-laser in situ keratomileusis (LASIK) corneal ectasia. METHODS: In a prospective, nonrandomized, single-centre study, CXL was performed in 20 eyes of 11 patients who had LASIK for myopic astigmatism and subsequently developed keratectasia. The procedure included instillation of 0.1% riboflavin-20% dextrane solution 30 minutes before UVA irradiation and every 5 minutes for an additional 30 minutes during irradiation. The eyes were evaluated preoperatively and at 1-, 3-, 6-, and 12-month intervals. The complete ophthalmologic examination comprised uncorrected visual acuity, best spectacle-corrected visual acuity, endothelial cell count, ultrasound pachymetry, corneal topography, and in vivo confocal microscopy. RESULTS: CXL appeared to stabilise or partially reverse the progression of post-LASIK corneal ectasia without apparent complication in our cohort. UCVA and BCVA improvements were statistically significant (P<0.05)beyond 12 months after surgery (improvement of 0.07 and 0.13 logMAR at 1 year, respectively). Mean baseline flattest meridian keratometry and mean steepest meridian keratometry reduction (improvement of 2.00 and 1.50 diopters (D), respectively) were statistically significant (P < 0.05) at 12 months postoperatively. At 1 year after 01, mean endothelial cell count did not deteriorate. Mean thinnest cornea pachymetry increased significantly. CONCLUSION: The results of the study showed a long-term stability of post-LASIK corneal ectasia after crosslinking without relevant side effects. It seems to be a safe and promising procedure to stop the progression of post-LASIK keratectasia, thereby avoiding or delaying keratoplasty.

Massive gastric antral vascular ectasia successfully treated by endoscopic band ligation as the initial therapy

Gastric antral vascular ectasia(GAVE) accounted for 4% of non-variceal gastrointestinal hemorrhage.Even though unclear pathogenesis,GAVE often associated with chronic renal failure,autoimmune diseases and cirrhosis.Asymptomatic lesions were reasonably not to treated.The treatment options for GAVE are nonendoscopic and endoscopic treatments.For the pharmacological treatment,some success were reported for the use of octreotide,thalidomide and tranexamic acid.While the endoscopic treatment is the mainstay for treatment of symptomatic lesions.The endoscopic ablative therapies such as argon plasma coagulation was reported with good clinical outcomes.However,these treatment options had some limitation due to the need of special equipment and multiple sessions needed to control the bleeding.We reported another treatment option using the routine-achievable instrument such as endoscopic band ligation as an initial treatment which also provided a good treatment outcome and less sessions.

Transjugular intrahepatic portosystemic shunt as bridge-to-surgery in refractory gastric antral vascular ectasia

Gastric antral vascular ectasia(GAVE) may cause gastrointestinal bleeding(GIB). The treatment of GAVE relies on endoscopic approaches such as electrocoagulation(argon plasma coagulation, laser therapy, heater probe therapy, radiofrequency ablation), cryotherapy, and band ligation. In refractory cases, antrectomy may be considered. In the event of an associated cirrhosis and portal hypertension, it has been suggested that antrectomy could be an option, provided the mortality risk isn't considered too great. We report the case of a 67-year-old cirrhotic patient who presented with GAVE related GIB, unresponsive to multiple endoscopic treatments. The patient had a good liver function(model for end-stage disease 10). After a multidisciplinary meeting, a transjugular intrahepatic portosystemic shunt(TIPS) procedure was performed, in order to treat the cirrhosis associated ascites. The outcome was successful. An antrectomy was then performed, with no recurrence of GIB and no transfusion need during three months of follow up. In this case, the TIPS procedure achieved a complete ascites regression, allowing a safer surgical treatment of the GAVE-related GIB.

Endoscopic resolution and recurrence of gastric antral vascular ectasia after serial treatment with argon plasma coagulation

AIM To evaluate long-term endoscopic resolution and recurrence rate of gastric antral vascular ectasia(GAVE) after argon plasma coagulation(APC) treatment.METHODS This was an IRB-approved retrospective single center study that included patients endoscopically treated for GAVE between 1/1/2008 to 12/31/2014. The primary and secondary end points of the study were rate of endoscopic resolution of GAVE after APC treatment and recurrence rate of GAVE after endoscopic resolution, respectively. Endoscopic resolution of GAVE was defined as no endoscopic evidence of GAVE after treatment with APC. Recurrence of GAVE was defined as endoscopic reappearance of GAVE after prior resolution.RESULTS Twenty patients met the study criteria. Median age(range) of the patients was 59.5 years(42-74 years). GAVE was associated with underlying cirrhosis in 16(80%) patients. Indications for initial esophagogastroduodenoscopy(EGD) included hematemesis and/or melena(9/20, 45%), iron deficiency anemia(6/20, 30%), screening or surveillance of varices(4/20, 20%), and occult gastrointestinal bleeding(1/20, 5%). The patients were treated with a total of 55 APC sessions(range 1-7 sessions). Successful endoscopic resolution of GAVE wasachieved in 8 out of 20 patients(40%). There was no correlation between number of treatment sessions and GAVE treatment success(P = NS). Recurrence of GAVE was noted on a subsequent EGD in 2 out of 8 patients(25%) with prior endoscopic resolution of GAVE. Median follow-up period for the study population was 627 d(range 63-1953 d).CONCLUSION Endoscopic resolution rate of GAVE was low(40%) with a 25% recurrence rate after treatment with APC. These rates suggest that APC treatment of GAVE may not be optimal in many circumstances.

Long term efficacy and stability of corneal collagen cross linking for post-LASIK ectasia: an average of 80mo follow-up

This study was designed to evaluate efficacy and stability of corneal collagen crosslinking(CXL) in halting the progression of post-laser in situ keratomileusis(LASIK) ectasia and provide long-term follow-up results with an average of 80 mo. Patients with post-LASIK ectasia were treated with CXL between December 2007 and January 2012. Main outcome measures were uncorrected distance visual acuities(UDVA) and corrected distance visual acuities(CDVA), minimum and maximum keratometry(K) values, spherical and cylindrical refraction, and corneal thickness. The study evaluated 17 eyes for 13 patients(8 men, 5 women) with mean age of 31y(range 23 to 39) and mean follow-up of 80.7±15(range 57 to 102)mo. UDVA and CDVA improved from logMAR 0.53±0.36(20/63) to 0.49±0.4(20/50)(P=0.43) and from 0.18±0.17(20/28) to 0.16±0.16(20/27)(P=0.55) respectively. In 15 eyes UDVA and in 13 eyes CDVA either remained stable or improved ≥1 Snellen lines(88.2%) and(76.5%) respectively. Although statistically insignificant, spherical and cylindrical refraction decreased post-CXL from-1.26±2.87 to-0.38±2.32 diopters(D)(P=0.054) and from-3.80±2.47 to-3.04±2.18 D(P=0.13) respectively. Kmax significantly decreased from 44.23±3.76 to 42.85±3.08 D(P=0.013) and Kmin decreased from 41.07±3.61 to 40.00±2.65 D(P=0.057). Corneal thickness decreased from 470±42 to 460±41 μm, but was statistically non-significant(P=0.063). Therefore, CXL is effective in halting and partially reversing the progression of postLASIK ectasia on the long-term(mean follow-up of more than 80mo), thus highlighting the stability and maintained effect of CXL for such cases.

Clinical outcomes after implantation of a new intrastromal corneal ring with 140-degree of arc in patients with corneal ectasia

AIM：To evaluate the clinical and tomographic outcomes after implantation of a new intrastromal corneal ring segment（ICRS） with 140-degrees of arc in eyes with corneal ectasia.METHODS：We evaluated patients with corneal ectasia implanted with Ferrara 140° ICRS from April 2010 to February 2015.Outcome measures included preoperative and postoperative corrected distance visual acuity（CDVA）,keratometry simulated（K） reading,tomographic astigmatism and asphericity.All patients were evaluated using the Pentacam Scheimpflug system.RESULTS：The study evaluated 58 eyes.The mean followup was 16.81±10.8 mo.The CDVA（logM AR） improved from 0.5±0.20（20/60） to 0.3±0.21（20/40）（P〈0.01）.The average K reduced from 49.87±7.01 to 47.34±4.90 D（P〈0.01）.The asphericity changed from-0.60±0.86 to-0.23±0.67 D（P〈0.01）.The mean preoperative tomographic astigmatism decreased from-8.0±3.45 to-4.53±2.52 D（P〈0.01）.CONCLUSION：The new ICRS model with 140-degrees of arc effectively improve the visual acuity and reduce the high astigmatism usually found in patients with corneal ectasia.

Detection of active bleeding from gastric antral vascular ectasia by capsule endoscopy

Gastric antral vascular ectasia(GAVE) has been recognized as one of the important causes of occult and obscure gastrointestinal bleeding.The diagnosis is typically made based on the characteristic endoscopic features,including longitudinal row of flat,reddish stripes radiating from the pylorus into the antrum that resemble the stripes on a watermelon.These appearances,however,can easily be misinterpreted as moderate to severe gastritis.Although it is believed that capsule endoscopy(CE) is not helpful for the study of the stomach with its large lumen,GAVE can be more likely to be detected at CE rather than conventional endoscopy.CE can be regarded as "physiologic" endoscopy,without the need for gastric inflation and subsequent compression of the vasculature.The blood flow of the ecstatic vessels may be diminished in an inflated stomach.Therefore,GAVE may be prominent in CE.We herein describe a case of active bleeding from GAVE detected by CE and would like to emphasize a possibility that CE can improve diagnostic yields for GAVE.

Successful treatment of refractory gastric antral vascular ectasia by distal gastrectomy:A case report

Gastric antral vascular ectasia(GAVE) is an uncommon and often neglected cause of gastric hemorrhage. The treatments for GAVE include surgery,endoscopy and medical therapies. Here,we report an unusual case of GAVE. A 72-year-old man with a three-month history of recurrent melena was diagnosed with GAVE. Endoscopy revealed the classical "watermelon stomach" appearance of GAVE and complete pyloric involvement. Melena reoccurred three days after argon plasma coagulation treatment,and the level of hemoglobin dropped to 47 g/L. The patient was then successfully treated with distal gastrectomy with Billroth Ⅱ anastomosis. We propose that surgery should be considered as an effective option for GAVE patients with extensive and severe lesions upon deterioration of general conditions and hemodynamic instability.

Post photorefractive keratectomy corneal ectasia

Dear Editor,We write to describe two cases of corneal ectasia occurred after photorefractive keratectomy.Due to the wide diffusion of refractive surgery,many ophthalmologists attempted to identify the risk factors and prevention methods to avoid such severe complication of this technique.

Clinical features of coronary artery ectasia in the elderly

ObjectiveTo 与冠的动脉 ectasia (CAE ) 在老病人调查发生，成像和临床的特征 .MethodsA 回顾的分析与 CAE 在病人上被进行经历了在 2006 年 1 月和 2012 年 12 月之间的冠的 angiography。根据年龄，注册病人被划分成二个组(老组，年龄 ≥；65 年；非老的组，年龄 <；65 年) 。临床的特征，成像特征和二个组的 5 年的幸存率是在老病人的 CAE 的 compared.ResultsThe 流行是 0.33% 。在老组的病人被发现有女性的显著地更高的比例(30.1% 对 10.1% ， P <；0.001 ) ，三容器的疾病(60.5% 对 45.2% ， P = 0.003 ) 并且局部性的 ectasia (55.0% 对 40.2% ， P = 0.003 ) 。另外，身体团索引(20.90 ±；2.71 kg/m 2 对 22.31 ±；2.98 kg/m 2, P <；0.001 ) 并且当前的吸烟者的百分比(45.0% 对 64.6% ， P <；0.001 ) 在老组是显著地更低的。累积幸存曲线与非老的组相比在老组在后续表明了减少的 5 年的累积幸存(88.0% 对 96.0% ， P = 0.002 ) 。但是免费幸存率没能显示出二之间的重要差别的 5 年的事件组织(31.0% 对 35.0% ， P = 0.311 ) 在老病人的 CAE 的 .ConclusionThe 流行是 0.33% ，它关于 CAE 病人的全部数字的 1/3。在之间有重要差别老并且有 CAE 的非老的病人以冠的动脉疾病冒险因素和冠的动脉 ectatic 特征。CAE 可能与增加的死亡风险被联系在老。

Antithrombotic treatment strategy for patients with coronary artery ectasia and acute myocardial infarction: A case report

BACKGROUND There is no consensus on the antithrombotic treatment strategy for patients with coronary artery ectasia(CAE).CASE SUMMARY This case reports the dynamic observation of a patient for 48 mo after a diagnosis of CAE with acute myocardial infarction(AMI).The first antithrombotic agents used were aspirin(100 mg/d)and clopidogrel(75 mg/d).During the sixth month of observation,a second AMI occurred involving the same culprit vessel;therefore,antithrombotic agents were changed to aspirin(100 mg/d)and ticagrelor(90 mg twice per day).Twelve months after the second AMI,an attempt to reduce the dosage ticagrelor failed;therefore the original dose was continued.The CAE was relatively stable during the following 4 years.CONCLUSION This case indicates that a combination of aspirin and ticagrelor may be more effective for CAE patients with AMI than aspirin and clopidogrel.

Upper gastrointestinal bleeding from duodenal vascular ectasia in a patient with cirrhosis

We report a cirrhotic patient with duodenal vascular ectasia and spontaneous bleeding. The bleeding was successfully controlled with argon plasma coagulation. Duodenal vascular ectasia may be a cause of upper gastrointestinal bleeding in patients with cirrhosis, and argon plasma coagulation may be effective and safe to achieve hemostasis of this lesion.

Multivessel coronary artery ectasia and severe calcification in a patient with pheochromocytoma:a case report

Multivessel coronary artery ectasia with severe calcification is rare among patients with coronary artery disease. A 74-year-old Chinese woman suffered from acute myocardial infarction on a background of 50 years of poorly controlled hypertension secondary to pheochromocytoma, which was surgically removed in June 2012 prior to the presentation. Coronary angiography revealed total occlusion of the proximal left anterior descending artery, and multiple ectasias with severe calcification in the left main, circumflex and right coronary artery. After an aspiration thrombectomy and balloon angioplasty, grade 3 coronary flow was restored in the left descending coronary artery. No cardiac events were found in the 12-month follow-up. We conclude that multivessel coronary artery ectasia and severe calcification may be present in patients with a long-standing history of hypertension secondary to pheochromocytoma.

Long-term efficacy of endoscopic coagulation for different types of gastric vascular ectasia

AIM: To examine the long-term therapeutic efficacies of endoscopic cauterization for gastric vascular ectasia, according to the type of lesion. METHODS: Thirty-eight patients with hemorrhagic gastric vascular ectasia (VE) were treated by endoscopic cauterization: 13 by heater probe coagulationand 25 by argon plasma coagulation. Depending on the number of lesions, 14 and 24 patients were classified into localized VE (≤ 10; LVE) and extensive VE (> 10; EVE), respectively. The patients were followedup by repeated endoscopic examinations after the therapy, and the incidences of VE recurrence and rebleeding from the lesions were evaluated. RESULTS: Although the VE lesions disappeared initially in all the patients after the therapy, the recurrence of VE developed in 25 patients (66%) over a mid-term observation period of 32 mo, and re-bleeding occurred in 15 patients (39%). The recurrence of VE was found in all patients with EVE, with re-bleeding occurring in 14 patients (58%). In contrast, only 1 patient (7%) with LVE showed recurrence of the lesions and complicating hemorrhage. Both the cumulative recurrence-free rates and cumulative re-bleeding-free rates were significantly lower in the EVE group than in the LVE group (P < 0.001 and P < 0.001, respectively). Moreover, the cumulative re-bleeding-free rate in the EVE group was 47.6% at 1 year and 25.4% at 2 years in patients with chronic renal failure, which were significantly lower than the rates in the patients without chronic renal failure (83.3% and 74.1%, respectively) (P < 0.05). CONCLUSION: The recurrence of VE and re-bleeding from the lesions was more frequent in the patients with EVE, especially in those with complicating renal failure.