Excimer laser atherectomy combined with drug-eluting balloon for lower limb arteriosclerosis obliterans / 中华普通外科杂志

Objective To evaluate the efficacy of excimer laser atherectomy (ELA) combined with drug-coated balloon (DCB) in the treatment of lower limb arteriosclerosis obliterans.Methods From Sep 2016 to Dec 2018 42 patients (42 limbs) underwent ELA combined with DCB therapy.Results There were 27 males and 15 females.The mean age was (65.7 ±9.7) years.The average lesion length was (14.3 ±7.5) cm.The technical success rate was 100％ and the remission rate of clinical symptoms was 92.9％.Ankle-brachial index was significantly improved from (0.45 ± 0.15) pre-operation to (0.85 ± 0.13) postoperation (P =0.001).The mean follow-up was 10.9 months.At 3,6,and 12 months follow-up,the primary patency rate was 95.2％,92.8％ and 84.9％.The 1-year limb salvage rate was 95.2％.Conclusion ELA combined with DCB has a good 1-year results as our data reveal.

Early clinical outcomes of small incision lenticule extraction for different refractive myopia and astigmatism / 中华实验眼科杂志

Background Small incision lenticule extraction (SMILE) is increasingly applied in the correction of myopia and astigmatism.However,the early clinical outcomes of SMILE for different refractive myopia and astigmatism is seldom reported.Objective This study was to investigate the safety,efficacy,predictability and early stability after SMILE in low,moderate and high myopia.Methods A series of cases-observational study was carried out.A total of 195 eyes of 108 myopic patients were enrolled in Tianjin Eye Hospital from May to December 2012 under the informed consent.The patients were divided into the low (≤-3.00 D),moderate (＞-3.00 to-6.00 D) and high myopia (＞-6.00 D) groups according to different diopters,with 57 eyes,76 eyes and 62 eyes,respectively.SMILE was performed on all the eyes.The uncorrected visual acuity (UCVA)(LogMAR),best corrected visual acuity (BCVA) (LogMAR),equivalent sphere (SE),intraocular pressure,anterior segment and corneal topography were examined before operation and 1 day,1 week,1 month and 3 months after operation to evaluate the effective index (postoperative UCVA/preoperative BCVA),safety index (postoperative BCVA/preoperative BCVA),predictability and early stability of SMILE.The linear regression analysis was used to analyze the relationships between the attempted refraction and the achieved refraction postoperative 3 months in three groups.Results The percentage of UCVA (LogMAR)＜0.1 was 100％,97.1％ and 92.8％ in the low,moderate and high myopia group,respectively in 3 months after SMILE.The postoperative BCVA of all the operated eyes reached preoperative one.The residual SE was (-0.07±0.16),(-0.05 ±0.20) and (-0.08±0.27)D in the low,moderate and high myopia group,respectively in 3 months after SMILE.The percentage of residual SE±0.5 D was 100％,98.7％ and 93.6％ in the low,moderate and high group,and that of SE±1.0 D was 100％ in all of the groups.The postoperative corrected SE was gradually increased with the raise of predicted SE in the low,moderate and high myopia groups (r=0.942,0.959,0.957,all at P＜0.001).Conclusions SMILE is safe,effective,predictable and stable for the correction of low,moderate and high myopia.The corneal wound healing was slightly slower in the low myopia group than that in the moderate and high group.A slight regression of myopic power appears in high myopia eyes 3 months after SMILE.

Efficacy of 308-nm excimer laser combined with tazarotene gel for the treatment of plaque psoriasis / 中华皮肤科杂志

Objective To investigate the clinical efficacy and safety of 308-nm excimer laser combined with tazarotene gel for the treatment of plaque psoriasis.Methods Seventy-two patients with plaque psoriasis were randomly and equally divided into three groups according to a random number table:tazarotene group topically applying tazarotene gel once per night,308-nm excimer laser group treated with 308-nm excimer laser,combination group treated with both tazarotene gel and 308-nm excimer laser.Clinical efficacy was evaluated according to psoriasis area and severity index (PASI) score and response rate,and safety according to adverse reactions at week 2,4 and 8 after starting treatment.Results PASI score was significantly lower in the combination group at week 4 and 8 (4.75 ± 0.44 and 2.35 ± 0.37 respectively) than in the 308-nm excimer laser group (6.75 ± 0.57 and 4.67 ± 0.36 respectively,both P ＜ 0.05) and tazarotene group (8.75 ± 0.48 and 6.48 ± 0.45 respectively,both P ＜ 0.05),and significantly lower in the combination group at week 8 than at week 2 and 4 (both P ＜ 0.05).A significant increase was observed in the response rate at week 2,4,and 8 in the combination group (29.1％ (7/24),66.7％ (16/24) and 87.5％ (21/24) respectively) compared with the tazarotene group (12.5％ (3/24),41.7％ (10/24) and 62.5％ (15/24) respectively,all P＜ 0.05) and 308-nm excimer laser group (20.8％ (5/24),50.0％ (12/24) and 75.0％ (18/24) respectively,all P＜ 0.05).No systemic adverse reactions were observed in any of the 3 groups during the study,and there was no significant difference in the incidence of local adverse reactions between the combination group,tazarotene group and 308-nm excimer laser group (16.7％ (4/24) vs.12.5％ (3/24) vs.12.5％ (3/24),P ＞ 0.05).Conclusion The efficacy of 308-nm excimer laser combined with tazarotene gel is superior to that of tazarotene gel or 308-nm excimer laser alone in the treatment of plaque psoriasis.

Láser eximer y microscopia confocal: plataformas tecnológicas de la visión del futuro / Excimer laser and confocal microscopy: technological platforms of the future vision

Introducción: la Cirugía Refractiva es una subespecialidad de la Oftalmología, encargada de los procedimientos quirúrgicos dirigidos al tratamiento de los defectos refractivos. Objetivos: explicar los principios generales de funcionamiento de la microscopia confocal de la córnea, describir las características microscópicas de la córnea normal por microscopia confocal y enunciar los aspectos teóricos generales relacionados con la tecnología láser excimer. Desarrollo: la microscopia confocal es un método no invasivo para el estudio de imágenes microscópicas en tejidos vivos, donde la iluminación y la detección se encuentran en el mismo plano focal; además, la luz se refleja y pasa a través de un segundo lente objetivo. El láser excimer utiliza pulsos controlados de energía de luz ultravioleta de 193 nm de longitud de onda para aplicar ablación sobre el tejido estromal, lo cual produce un patrón de excisión refractivo y genera nuevos radios de curvatura. Asimismo, el término excimer es una forma química diatómica singular que solo existe en estado excitado y durante un tiempo minúsculo. Conclusiones: el estudio de la córnea por microscopia confocal permite la diferenciación de las subcapas del epitelio, el plexo nervioso subbasal, los queratocitos y nervios del estroma, así como las células del endotelio corneal. El láser excimer, posibilita el moldeamiento de la curvatura corneal, con vistas a lograr un resultado refractivo con mínimas alteraciones al tejido circundante; por tanto, a escala internacional, se ha convertido en la técnica quirúrgica prevaleciente para el tratamiento de las ametropías.

Introduction: refractive surgery is a subspecialty of the ophthalmology, responsible for the surgical procedures aimed at treating refractive defects. Objectives: to explain the general principles of functioning of the corneal confocal microscopy, to describe the microscopic features of normal cornea by confocal microscopy and to enunciate general theoretical aspects related to the excimer laser technology. General principles: confocal microscopy is a non-invasive method for studying microscopic images in living tissues, where the lighting and detection are in the same focal plane; moreover, the light is reflected and passes through a second objective lens. The excimer laser uses controlled ultraviolet light power pulses of 193 nm wavelength to apply ablation on the stromal tissue, which produces a refractive excision pattern and generates new curvature radii. Also, the term excimer is a single diatomic chemical form that only exists in excited state for a short time. Conclusions: the study of the cornea by confocal microscopy allows the differentiation of the epithelial sublayers, subbasal nervous plexus, keratocytes and stromal nerves, as well as corneal endothelial cells. The excimer laser facilitates the shaping of the corneal curvature to achieve a refractive outcome with minimal disruption to the surrounding tissue, so internationally it has become the prevailing surgical technique for the treatment of ametropies.

Cirugía refractiva: indicaciones, técnicas y resultados / Refractive surgery: indications, techniques and results

La cirugía refractiva se ha constituido en una desafiante subespecialidad de la Oftalmología. Importantes avances tecnológicos permiten la opción de tratamiento quirúrgico de los vicios de refracción. Las cirugías de miopía, hipermetropía y astigmatismo, han logrado excelentes resultados en eficacia, estabilidad y seguridad; permitiendo reducir o eliminar la dependencia de anteojos y lentes de contacto. Las técnicas más utilizadas son las queratorefractivas con láser excimer, especialmente la queratomileusis in situ con láser (LASIK) y la queratectomía fotorefractiva (PRK). Ambas dominan el campo del tratamiento quirúrgico de las ametropías bajas y moderadas. En las altas ametropías, y en pacientes con córneas de grosor insuficiente para el tratamiento con láser, está aumentando el uso de las técnicas intraoculares. Una de estas técnicas es el implante de lentes intraoculares fáquicos, en que se conserva el cristalino natural del paciente, y se utiliza hasta alrededor de los 50 años. Los vicios de refracción también se pueden corregir con lentes intraoculares seudofáquicos, que reemplazan el cristalino del paciente, y se usan de rutina en cirugía de catarata. En el área refractiva, están restringidos más bien a pacientes mayores de 50 años. Estos lentes tienen la posibilidad adicional, en casos seleccionados, de corregir la presbicia, que es, aún, el último desafío a ser resuelto en Cirugía Refractiva.

Refractive surgery has become a challenging subspeciality in Ophthalmology. Important technological advances, currently allow the option of surgical treatment of refractive errors. Surgical treatments of myopia, hyperopia, and astigmatism, have achieved excellent results in efficacy, stability and safety; allowing to reduce or eliminate the dependence on glasses and contact lenses. The most used techniques are keratorefractive with excimer laser, specially laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). Both dominate the field of surgical treatment for low and moderate refractive errors. In high refractive errors or patients with insufficient corneal thickness for laser treatment, the intraocular techniques are increasingly used. One of these techniques is the phakic intraocular lens implantation, in which the natural lens is preserved. That implant is used in patients up to 50 years of age. Refractive errors can be also corrected with pseudophakic intraocular lenses that replace the natural lens, and are used always in cataract sugery. Their refractive indication is usually restricted to patients 50 years or older. These lenses have the additional possibility, in selected cases, to correct the presbyopic condition, that to date is still the last challenge to be resolved in Refractive Surgery.

Wavefront-guided refractive surgery results of training-surgeons / Resultados das cirurgias refrativas guiadas por frentes de ondas de cirurgiões em treinamento

PURPOSE: To assess clinical outcomes and changes on higher-order aberrations (HOA) after wavefront-guided laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) for correction of myopia and myopic astigmatism performed by training-surgeons. METHODS: One hundred and seventy patients had customized LASIK (207 eyes) and PRK (103 eyes) performed by surgeons in-training using the LADARVision 4000 (Alcon, Fort Worth, TX). Preoperative and 1, 3, 6 and 12 months postoperative data of spherical equivalent (SE), best spectacle-corrected visual acuity (BSCVA) and uncorrected visual acuity (UCVA) were analysed. Wavefront changes were determined using the LADARWave Hartmann-Shack wavefront aberrometer and the pupil size was scaled for 6.5 mm. RESULTS: The mean SE in the LASIK group was -3.04 ±1.07 D and in the PRK group was -1.60 ± 0.59 D. At 1-year follow-up, (80.6 percent) (LASIK) and (66.7 percent) (PRK) were within ± 0.50 D of the intended refraction. The UCVA was 20/20 or better in (58.1 percent) (LASIK) and (66.7 percent) (PRK) of the operated eyes. A statistically significant positive correlation was found between achieved versus attempted refractive correction in both groups: LASIK (r=0.975, P<0.0005) and PRK (r=0.943, P<0.005). The higher-order aberrations (HO) RMS and coma did not changed signicantly in the PRK group between preoperative and 1-year follow-up. In the LASIK group the HO RMS and coma changed between preoperative and 1-month postoperative but remained statistically unchanged during 1-year follow-up. The spherical aberration showed statistically significant changes in both groups. CONCLUSIONS: Wavefront-guided LASIK and photorefractive keratectomy performed by training-surgeons were found to be similarly effective, predictable and stable.

OBJETIVO: Avaliar os resultados clínicos e mudanças nas aberrações de alta-ordem (HOA), após ceratomileuse assistida por excimer laser in situ (LASIK) e ceratectomia fotorrefrativa (PRK) guiados por frentes de onda para correção da miopia e astigmatismo miópico realizada por cirurgiões em treinamento. MÉTODOS: Estudo prospectivo de 170 pacientes submetidos a LASIK personalizado (207 olhos) e PRK (103 olhos) realizados por cirurgiões em treinamento utilizando o LADARVision 4000 (Alcon, Fort Worth, TX). Dados do equivalente esférico (SE), melhor acuidade visual corrigida (BSCVA) e acuidade visual não corrigida (UCVA) foram analisados no pré-operatório e com 1, 3, 6 e 12 meses de pós-operatório. As alterações de frentes de onda foram determinadas usando o aberrômetro Hartmann-Shack (LADARWave)e o tamanho da pupila foi determinado para 6,5 mm. RESULTADOS: A média do SE no grupo de LASIK foi -3,04 ± 1,07 D e no grupo de PRK foi -1,60 ± 0,59 D. No seguimento de um ano, (80,6 por cento) (LASIK) e (66,7 por cento) (PRK) estavam dentro de ± 0,50 D de equivalente esférico. A UCVA foi de 20/20, ou melhor, em (58,1 por cento) (LASIK) e (66,7 por cento) (PRK) dos olhos operados. Foi encontrada correlação positiva estatisticamente significante entre correção refrativa alcançada versus pretendida em ambos os grupos: LASIK (r=0,975, P<0,0005) e PRK (r=0,943, P<0,005). O HO RMS e coma não alteraram significantemente no grupo PRK entre pré-operatório e após um ano de seguimento. No grupo de LASIK o HO RMS e o coma alteraram entre pré-operatório e 1º mês de pós-operatório, mas permaneceram estatisticamente inalterados durante um ano de seguimento. Houve alterações estatisticamente significantes da aberração esférica em ambos os grupos. CONCLUSÕES: O LASIK e o PRK guiados por frentes de onda, realizados por cirurgiões em treinamento, mostraram ser similarmente eficazes, previsíveis e estáveis.

Motivación y satisfacción de los pacientes miopes sometidos a cirugía LASIK / Motivation and satisfaction of myopic patients undergoing LASIK surgery

Analizar la motivación y los niveles de satisfacción de los pacientes miopes sometidos a la cirugía refractiva con excímer láser. Se realizó una encuesta a 126 pacientes miopes (241 ojos), que asistieron a la consulta de cirugía refractiva en el Hospital Militar Dr Carlos Juan Finlay, los cuales fueron intervenidos con cirugía refractiva LASIK, con el propósito de analizar sus principales motivaciones y el grado de satisfacción obtenido después de transcurridos 3 meses de realizada la cirugía. Se estudiaron las siguientes variables: datos personales, motivación por la cirugía, refracción, agudeza visual, efectos secundarios y grado de satisfacción en general, así como su relación con las demás variables analizadas. La edad media de los encuestados fue de 30 años (de 20 a 54 años). Se encontró una mayor frecuencia de miopes en el sexo femenino (68,2 por ciento). La graduación previa fue de un rango de -1,50 D a -12 D de equivalente esférico, y en el momento de la encuesta en más del 90 por ciento de los pacientes era inferior a ± 1D. La motivación principal en el 82,9 por ciento de los pacientes fue mejorar la agudeza visual, en el 9,9 por ciento, la comodidad, en el 2,4 por ciento la intolerancia a lentes de contacto, en el 1,2 por ciento mejorar la imagen, y en el 1,6 por ciento por acceso a puestos de trabajo, así como la diferencia de la visión entre un ojo y otro. El grado de satisfacción de los encuestados fue: 96,3 por ciento muy contento, 2,8 por ciento bastante contento, 0,4 por ciento algo descontento y 0,4 por ciento muy descontento. El grado de satisfacción estuvo relacionado con la graduación previa del paciente. Los pacientes mßs contentos fueron los que se operaron para mejorar la agudeza visual. De forma general el grado de satisfacción (mßs del 98 por ciento) fue elevado. El grado de satisfacción de los pacientes intervenidos con LASIK fue aceptable o alto en la mayoría de los casos.

To analyze motivation and levels of satisfaction of myopic patients who under went Excimer laser refractive surgery. One hundred and twenty six myopic patients (241 eyes), who had gone to the Refractive Surgery service and operated on by LASIK refractive surgery at Dr Carlos J Finlay Military Hospital, were surveyed to analyze their main motivation and the level of satisfaction three months after surgery. The following variables were included personal data, motivation for surgery, refraction, visual acuity, side effects and general level of satisfaction as well as their relation with the other analyzed variables. The average age of surveyed patients was 30 years (20 to 54 years). Myopic females were more common (68,2 percent). The previous prescription ranged -1,50 to -12 D of spheral equivalent, and at the time of survey, it was under ± 1D. The main motivation found in 82.9 percent of patients was improvement of their visual acuity; 9,9 percent wanted more comfortability, 2,4 percent expressed intolerance to contact lenses, 1,2 percent desired to improve their image and 1,6 percent needed it to get access to new jobs, as well as vision differences between the eyes. The level of satisfaction was as follows: 96,3 percent of the surveyed people were very pleased, 2,8 percent pretty satisfied, 0,4 percent was little satisfied and 0,4 percent very unsatisfied. The level of satisfaction was related to the previous prescription of the eyes of the patient. The most satisfied patients were those who had undergone surgery to improve their visual acuity. Generally speaking, the level of satisfaction was high (over 98 percent). The level of satisfaction of the operated patients with LASIK was acceptable or high in most of cases.

LASIK-LASEK en defectos refractivos poscirugías de catarata / LASIK-LASEK in refractive defects after cataract surgeries

El tratamiento de la catarata es quirúrgico, se logran muy buenos resultados en la recuperación visual de los pacientes; no obstante, después de ella pueden encontrarse resultados inesperados. El propósito de este estudio fue evaluar las características de las personas estudiadas según su edad, los valores biométricos y queratométricos previos a la cirugía por catarata, la cirugía refractiva, y la técnica de excímer láser empleada en los pacientes operados, desde mayo de 2005 a julio de 2007, en el Instituto Cubano de Oftalmología Ramón Pando Ferrer. Se realizó un estudio descriptivo, longitudinal y prospectivo de los pacientes operados de catarata que tuvieron un defecto refractivo residual -error o sorpresa refractiva-, a los cuales se les realizó cirugía por láser excímer. Se evaluaron las características de las personas estudiadas según su edad, los valores biométricos y queratométricos previos a la cirugía por catarata, y a la cirugía refractiva, así como la técnica de excímer láser empleada. En este estudio se obtuvo un predominio de las edades entre 40 y 59 años, la sorpresa refractiva más frecuente fue la miopía, la longitud axial indujo una sorpresa refractiva, coadyuvada por el error queratométrico, el LASIK prevaleció como técnica refractiva y logró corregir las sorpresas refractivas halladas. La sorpresa refractiva presente en todos los pacientes fue la miopía. Se demostró que la longitud axial indujo una sorpresa refractiva y que esta fue la más importante en nuestros resultados, derivada del error queratométrico, a pesar de ser este último poco significativo.

The treatment of cataract is surgical, very good results in visual recovery of patients are achieved; however, some unexpected results may appear after surgery. The purpose of this study was to evaluate the characteristics of the studied persons by their age, the biometric and keratometric values before the cataract surgery, the refractive surgery and the excimer laser technique used in patients who were operated on from May 2005 to July 2007 at Ramón Pando Ferrer Cuban Institute of Ophthalmology. A prospective, longitudinal and descriptive study was conducted in those patients operated on from cataract, who developed a residual refractive defect - error or refractive surprise- and were performed an excimer laser surgery. The characteristics of the studied persons by their age, the biometric and keratometric values prior to the cataract surgery and the refractive surgery as well as the used excimer laser technique were evaluated. This study revealed the prevalence of the 40-59 years-old age group, the most frequent refractive error was myopia, the axial length induced a refractive surprise contributed by the keratometric error; LASIK was the refractive technique that managed to correct the found refractive surprises. The refractive surprise present in all the patients was myopia. It was shown that the axial length induced a refractive surprise that was the most important outcome derived from a keratometric error, despite the latter being not significant.

Evaluation of the predictability of ablation depth in photorefractive procedures by Zeiss MEL80 and VISX Star S4 excimer laser / 眼科

Objective To evaluate the predictability of ablated depth in photorefractive procedures by Zeiss MEL80 and VISX Star S4 excimer laser.Design Prospective,comparative case series.Participants 168 eyes of 84 people with myopia and cylinder.Main Outcome Measures Corneal thickness and ablated depth.Methods The thickness of cornea by Zeiss MEL80 and VISX Star S4 were measured by anterior segment OCT.The actuality ablated depth and calculated depth were compared.Results There were no significant differences between actuality ablated depth and calculated depth in Zeiss MEL80.And in VISX Star S4,the actuality ablated depth was more than calculated depth.Linear regression of changes in ablated depth on myopia and cylinder yielded the following formulaus:△ablated depth(VISX Star S4)= 2.324 *|myopia|+ 5.270 *|cylinder|-6.772.Conclusions Different excimer laser has different changes between actuality ablated depth and calculated depth.To guarantee the safety of LASIK,Ophthalmologists should know the characteristics of the excimer laser.