ABSTRACT
@#AIM:To compare dry eye symptoms and signs before and after three kinds surgery, femtosecond laser-assisted laser <i>in situ</i> keratomileusis(FS-LASIK), transepithelial photorefractive keratectomy(T-PRK), small incision lenticule extraction(SMILE)using ocular surface analyzer(Oculus Keratograph). <p>METHODS:Totally 98 patients(196 eyes)undergoing corneal refractive surgery from January 2017 to May 2017 were recruited. They were divided into three groups, namely, FS-LASIK group, T-PRK group and SMILE group. All patients underwent observation and assessment in the following order: ocular surface disease index(OSDI), tear meniscus height(TMH), measure using the infrared pattern of Oculus Keratograph. The first tear film break-up time(FBUT)and average tear break-up time(ABUT)measure using the infrared pattern of Oculus Keratograph, corneal fluorescein staining(FL), Schirmer Ⅰ test(SⅠt). <p>RESULTS:1)OSDI index: There was statistically significant difference between the three groups(<i>F</i><sub>groups</sub>=2.799, <i>P</i><sub>groups</sub><0.05). However, the difference in the OSDI values of different time points in each group was statistically significant(<i>F</i><sub>time</sub>=85.942, <i>P</i><sub>time</sub><0.001). The OSDI index were significantly increased at 1wk, 1 and 3mo after operation in each group. All groups recovered to the preoperative level at 6mo after operation. After 3mo, there was an inter-group difference in the OSDI values(<i>P</i>=0.019), and the OSDI values of the T-PRK group were higher than those of the other two groups. 2)TMH: There was statistically significant difference among the three groups postoperatively(<i>F</i><sub>groups</sub>=1.720, <i>P</i><sub>groups</sub><0.05). The TMH values of different time points in each group were significantly different(<i>F</i><sub>time</sub>=11.202, <i>P</i><sub>time</sub><0.001). The TMH values of each group were significantly reduced after 1wk and 1mo and were restored to preoperative levels after 3 and 6mo. After 3mo, there was a difference TMH among the three groups(<i>P</i>=0.004), and the inferior TMH in the SMILE group was higher than that of the other two groups. 3)FBUT: There was statistically significant difference among the three groups after surgery(<i>F</i><sub>groups</sub>=1.428, <i>P</i><sub>groups</sub>=0.245). The difference in FBUT values between different time points in each group was statistically significant(<i>F</i><sub>time</sub>=4.511, <i>P</i><sub>time</sub>=0.001). The FBUT values of each group were significantly reduced after 1wk and 1mo, and recovered to preoperative levels after 3mo and 6mo. There was no significant difference in FBUT between different groups at each time points(<i>P</i>>0.05). 4)ABUT: There was statistically significant difference in ABUT among the three groups after surgery(<i>F</i><sub>groups</sub>=1.290, <i>P</i><sub>groups</sub><0.05). However, the difference in ABUT values between different time points in each group was statistically significant(<i>F</i><sub>time</sub>=10.294, <i>P</i><sub>time</sub><0.001). The ABUT values of each group were significantly reduced after 1wk and 1mo, and recovered to preoperative levels after 3mo and 6mo. There was a statistical difference in ABUT values between different groups after 1mo(<i>P</i>=0.008); among them, the ABUT value of the SMILE group was higher than that of the T-PRK group and the FS-LASIK group. 5)FL: There was no statistical difference in the FL score between the three groups(<i>F</i><sub>groups</sub>=0.816, <i>P</i><sub>groups</sub>=0.445). The differences in the FL scores at different points in each group were statistically significant(<i>F</i><sub>time</sub>=5.539, <i>P</i><sub>time</sub>=0.004). The FL score of each group was significantly higher than before surgery at 1wk and 1mo, and recovered to preoperative levels at 3mo and 6mo after surgery. There was no statistical difference in the FLs between different groups at different points in time(<i>P</i>>0.05). 6)SⅠt: There was no statistically significant difference in SⅠt values among the three groups after surgery(<i>F</i><sub>groups</sub>=0.225, <i>P</i><sub>groups</sub>=0.799). The difference in SⅠt values between different time points in each group was statistically significant(<i>F</i><sub>time</sub>=4.604, <i>P</i><sub>time</sub>=0.003). The SⅠt values of each group were slightly higher than the preoperative values afyer 1wk and 3mo, but they were all within normal values. There was no significant difference between the SⅠt values of 1mo or 6mo after operation and the preoperative level. There was no statistical difference in SⅠt values between different groups at each points in time(<i>P</i>>0.05).<p>CONCLUSION:The three types of corneal refractive surgery FS-LASIK, T-PRK, and SMILE all cause different degrees of dry eyes within a certain period of time after surgery, but they can gradually recover later. After SMILE surgery, the stability of the tear film recovered faster, while the symptoms after T-PRK surgery improved the least.
ABSTRACT
<p><b>BACKGROUND</b>Elevated fibrinogen (Fg) level is a known risk factor for ischemic stroke. There are few clinical trials on oral fibrinogen-depleting therapies for secondary ischemic stroke prevention. We aimed to assess the effects of one-year therapy with oral lumbrokinase enteric-coated capsules on secondary ischemic stroke prevention.</p><p><b>METHODS</b>This is a multicenter, randomized, parallel group and controlled study that began treatment in hospitalized patients with ischemic stroke and continued for 12 months. Patients were randomized to either the control group that received the standard stroke treatment or the fibrinogen-depleting group that received the standard stroke treatment plus enteric-coated lumbrokinase capsules. The NIH Stroke Scale scores (NIHSSs) and plasma Fg level were recorded. The carotid artery intima-media thickness (IMT) and status of plaques were examined through carotid ultrasound examination. Primary outcomes included all-cause mortality, any event of recurrent ischemic stroke/transient ischemic attack (TIA), hemorrhagic stroke, myocardial infarction and angina, and other noncerebral ischemia or hemorrhage. Kaplan-Meier survival analysis and the Long-rank test were used to compare total vascular end point incidence between the two groups. Comparison of median values between two groups was done by the Student t test, one-way analysis of variance (ANOVA), or non-parametric rank sum test.</p><p><b>RESULTS</b>A total of 310 patients were enrolled, 192 patients in the treatment group and 118 patients in the control group. Compared to the control group, the treatment group showed favorable outcomes in the Fg level, carotid IMT, the detection rate of vulnerable plaques, the volume of carotid plaques, NIHSS scores, and incidence of total vascular (6.78% and 2.08%, respectively) and cerebral vascular events (5.93% and 1.04%, respectively) (P < 0.05). In the treatment group, the volume of carotid plaques was significantly related to the carotid IMT, the plaque diameter, width and number (P = 0.000, 0.000, 0.000, 0.022; F = 13.51, 2.52, 11.33, -3.29, but there was a weak correlation with the Fg level (P = 0.056). After 1-year therapy, the incidence of overall vascular end points was reduced by 4.7%.</p><p><b>CONCLUSION</b>Long-term oral fibrinogen-depleting therapy may be beneficial for secondary ischemic stroke prevention.</p>