Iontophoresis-assisted corneal crosslinking using 0.1% riboflavin for progressive keratoconus.

AIM: To report the clinical results of iontophoresis-assisted epithelium-on corneal crosslinking (I-CXL) using 0.1% riboflavin in distilled water for progressive keratoconus. METHODS: In this prospective clinical study, we examined 94 eyes of 75 patients with progressive keratoconus who were treated with I-CXL using 0.1% riboflavin in distilled water. Best correct visual acuity (BCVA), Scheimpflug tomography, corneal topography, anterior segment optical coherence tomography, intraocular pressure, and endothelial cell density were evaluated at baseline and 1, 3, 6, 12, and 24mo after I-CXL. RESULTS: After 24mo I-CXL, compared to the level at baseline, BCVA significantly improved 0.14±0.07 (P=0.010); mean keratometry signifi-cantly decreased 0.72±1.97 (P=0.021); maximum keratometry significantly reduced 2.30±5.01 (P=0.014); central keratoconus index significantly reduced 0.04±0.08 (P=0.007). The demarcation line was visible in 83.1% of eyes at 1mo after treatment, with a depth of 298.95±51.97 µm, and gradually indistinguishable. One eye had repeat treatment. Intraocular pressure and endothelial cell density did not change significantly. CONCLUSION: I-CXL using 0.1% riboflavin halts keratoconus progression within 24mo, resulting in a significant improvement in visual and topographic parameters. Moreover, the depth of the demarcation line is similar to that previously reported in standard epithelium-off CXL procedures.

Riboflavin concentration in corneal stroma after intracameral injection.

AIM: To evaluate the enrichment of riboflavin in the corneal stroma after intracameral injection to research the barrier ability of the corneal endothelium to riboflavin in vivo. METHODS: The right eyes of 30 New Zealand white rabbits were divided into three groups. Different concentrations riboflavin-balanced salt solutions (BSS) were injected into the anterior chamber (10 with 0.5%, 10 with 1%, and 10 with 2%). Eight corneal buttons of 8.5 mm in diameter from each group were dissected at 30min after injection and the riboflavin concentrations in the corneal stroma were determined using high-performance liquid chromatography (HPLC) after removing the epithelium and endothelium. The other two rabbits in every group were observed for 24h and sacrificed. As a comparison, the riboflavin concentrations from 16 corneal stromal samples were determined using HPLC after instillation of 0.1% riboflavin-BSS solution for 30min on the corneal surface (8 without epithelium and 8 with intact epithelium). RESULTS: The mean riboflavin concentrations were 11.19, 18.97, 25.08, 20.18, and 1.13 µg/g for 0.5%, 1%, 2%, de-epithelialzed samples, and the transepithelial groups, respectively. The color change of the corneal stroma and the HPLC results showed that enrichment with riboflavin similar to classical de-epithelialized corneal collagen crosslinking (CXL) could be achieved by intracameral 1% riboflavin-BSS solution after 30min; the effect appeared to be continuous for at least 30min. CONCLUSION: Riboflavin can effectively penetrate the corneal stroma through the endothelium after an intracameral injection in vivo, so it could be an enhancing method that could improve the corneal riboflavin concentration in transepithelial CXL.

Progress of corneal collagen cross-linking combined with refractive surgery.

As a photochemical reaction that can stiffen the cornea, corneal collagen cross-linking (CXL) is the only promising method of preventing the progress of keratectasia, such as keratoconus and secondary ectasia following refractive surgery. The aim of CXL is to stabilize the underlying condition, with a small chance of visual improvement. Combining CXL with refractive surgery targeting both stabilization and reshaping of the corneal tissue for visual function improvement is a good treatment option. This review aims to provide a comprehensive and unbiased summary of the published research regarding combined CXL and refractive surgery, including measures and results, to help elucidate the future direction of CXL.

[Corneal collagen cross-linking in the treatment of progressive keratoconus-preliminary results].

OBJECTIVE: To evaluate the efficacy and safety of riboflavin-ultraviolet-A (UV-A)-induced corneal collagen cross-linking (CXL) in the management of progressive keratoconus. METHODS: It was a retrospective case series study. Twenty-three eyes of 13 patients with progressive keratoconus were included. Corneal collagen crosslinking was performed under topical anesthesia including corneal de-epithelization (8 mm diameter) and instillation of 0.1% riboflavin (in 20% dextran T500 solution) every 3 minutes for a total of 30 minutes. The irradiation is performed for another 30 min using a solid-state UV-A illuminator at 370 nm and an irradiance of 3 mW/cm(2). Average follow-up was 15.23 ± 3.39 months (range: 12 to 22 months). Visual acuity, corneal topography, in vivo confocal microscopy, and endothelial cell count were evaluated at baseline and at 1, 3, 6, and 12 months follow-up. RESULTS: Mean uncorrected visual acuity(UCVA) and best spectacle-corrected visual acuity (BSCVA) increased 0.115 ± 0.158 LogMAR (t = 3.418, P = 0.0026) and 0.114 ± 0.218 LogMAR (t = 2.441, P = 0.0236) 12 months postoperatively respectively. Interim analysis of treated eyes showed a flattening of the steepest simulated keratometry value (K-max) and astigmatism by an average of (1.893 ± 3.713) diopters (D) (t = 2.391, P = 0.0262) and (0.117 ± 1.488) D (t = 0.370, P = 0.715) respectively at 12 months. Central corneal thickness decreased by (27.5 ± 26.8) µm (t = 4.812, P = 0.000) and (1.54 ± 19.4) µm ( t = 0.147, P = 0.885) at one month and 12 months postoperatively respectively.Intraocular pressure, endothelial cell count, lens and fundus didn't change significantly at 12 months follow-up. CONCLUSIONS: CXL stabilised and improved the UCVA and BSCVA as well as the maximum k-readings at 1 year postoperatively in our cohort. It seems to be a safe and promising procedure to stop the progression of keratoconus.

Clinical evaluation of pranoprofen combined with fluorometholone eye drops on postoperative reaction of corneal cross-linking.

PURPOSE: To evaluate the efficacy and safety of pranoprofen eye drops for reducing postoperative ocular pain and inflammation after corneal cross-linking (CXL). METHODS: Twenty-seven patients (38 eyes) with keratoconus undergoing CXL were examined and randomly divided into control (12 cases; 18 eyes) and experimental groups (15 cases; 20 eyes). The patients in the control group were given fluorometholone eye drops, and those in the experimental group were administered with fluorometholone combined with pranoprofen eye drops．Corneal irritation and haze were compared between the two groups at 1 month postoperatively． RESULTS: At 1 to 3 days after surgery, the corneal irritation in the experimental group was significantly reduced compared with that in the control group (P<0.05), but there was no significant difference on 5 to 7 days postoperatively (P>0.05)．The average degree of haze in the experimental group was significantly lower than that in the control group 1 month after surgery (P<0.05), but there was no significant difference in the best-corrected vision acuity and intraocular pressure between the two groups. There were 2 cases with P<20 mmHg intraocular pressure in the control group. CONCLUSION: The combined use of fluorometholone and pranoprofen can significantly reduce inflammatory response, alleviate corneal irritation at early stage after CXL, effectively prevent and control the average of haze, and reduce the incidence of steroid-induced ocular hypertension after surgery．

[Clinical observation on high intensity focused ultrasound combined with transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma].

OBJECTIVE: To study on the efficacy, prognosis and security of high-intensity focused ultrasound (HIFU) combined with transcatheter arterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC). METHODS: Totally 72 HCC patients treated by HIFU from December 2009 to January 2011 were divided into two groups according to treatment methods: 40 cases in HIFU group, 32 cases in TACE + HIFU treatment group (combined group). Then set up a control group include 40 cases treated by only TACE in the same period (TACE group). The improvement of clinical symptoms, AFP, reduce rate of tumor volume, survival rate of 1 year after operation and postoperative complications in front and behind the treatment were analyzed. RESULTS: There was no significant statistical difference on the improvement of clinical symptoms in all these three groups (P > 0.05) after treatment for HCC. There is no significant statistical difference also on reduce rate of tumor volume and decrease rate of AFP in both HIFU group (35.0%, 41.4%) and TACE group (37.5%, 41.9%) (χ² = 0.054, P = 0.816; χ² = 0.002, P = 0.965). Both reduce rate of tumor volume (62.5%) and decrease rate of AFP (72.0%) in combined group were better than HIFU group (χ² = 5.394, P = 0.020; χ² = 5.098, P = 0.024) and TACE group (37.5%, 41.9%) (χ² = 4.448, P = 0.035; χ² = 5.062, P = 0.024). Kaplan-Meier survival curve showed that there was no significant statistical difference on short-term survival rate in the 3 groups. But the long-term survival rate of combined group was better than TACE group and HIFU group. CONCLUSION: TACE combined with HIFU is a effective, safe and noninvasive treatment method to HCC.

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

AIM: To evaluate the efficacy and safety of corneal collagen crosslinking (CXL) 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 CXL, 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.

[Expression of liver-intestine cadherin and its significance in hepatocellular carcinoma].

OBJECTIVE: To explore the expression and clinical significance of LI (liver-intestine)-cadherin mRNA and protein expression level in hepatocellular carcinoma. METHODS: Reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemical techniques were used to detect the expression of the LI-cadherin mRNA and protein in 56 cases of hepatocellular carcinoma, 44 cases of corresponding paracancerous tissues and 9 cases of normal liver tissues. The relationships with its clinicopathological characteristics were analyzed. RESULTS: The mRNA of LI-cadherin was expressed in 56 cases of hepatocellular carcinoma tissues and 44 cases of corresponding paracancerous tissues. But its expression was not detected in normal tissues. Semiquantitative analysis showed that the mRNA expression level of LI-caherin was greater in hepatocellular carcinoma tissues than that in corresponding paracancerous tissues (0.653 ± 0.147 vs 0.534 ± 0.138). The differences were statistically significant (P < 0.01). The positive rates of LI-cadherin protein were 64.29% (36/56) in hepatocellular carcinoma tissues, 22.73% (10/44) in paracancerous tissues and 0% (0/9) in normal tissues. CONCLUSION: The expression of LI-cadherin is up-regulated significantly in HCC. The over-expression of LI-cadherin protein is correlated with the lymph node metastasis and tumor thrombi in portal vein. It indicates that LI-cadherin may play an important role in the progression and metastasis of HCC.

[Expression of estrogen receptor and progesterone receptor in hilar cholangiocarcinoma and their clinical significances].

OBJECTIVE: To investigate the relationship between the expression of estrogen receptor (ER) and progesterone receptor (PgR) and histological type, pathological grading and clinical staging in hilar cholangiocarcinoma (HCCA). To evaluate their roles in the development of it. METHODS: ER and PgR were assessed in 42 specimens of HCCA by immunohistochemical assay. RESULTS: The positive rate of ER and PgR was 66.7% and 64.3%. The expression of ER and PgR was significantly different between poor and well tumor differentiation, as well as between papillary and sclerosing variant. CONCLUSION: The positive rate of ER and PgR was detected significantly in HCCA. They might be an important biological marker to evaluate the malignancy and prognosis of it.