Concordance of keratoconus in monozygotic twins before and after combined corneal crosslinking/photorefractive keratectomy (Athens Protocol) using Scheimpflug and OCT tomography.

PURPOSE: To describe the concordance of keratoconus (KC) expression in 2 pairs of monozygotic twins before and after a combined corneal crosslinking (CXL)/photorefractive keratectomy (PRK) procedure. SETTING: Private ambulatory eye surgery unit. DESIGN: Retrospective interventional twin study. METHODS: Two pairs of male monozygotic twins with KC were studied retrospectively. Improvement of flattest (K1) and steepest (K2) keratometry, index of height decentration (IHD), and corneal thickness at the thinnest point and corneal epithelial thickness measured by anterior segment optical coherence tomography and Scheimpflug tomography was compared between respective eyes of monozygotic twin siblings 1 to 5 years after the application of combined CXL and topography-guided PRK of part of the refractive error (the Athens Protocol). RESULTS: Significant improvement was noted in all the keratometric indices of all 8 eyes after the combined CXL/PRK procedure. The difference in K1, K2, IHD, corneal thickness at the thinnest point, and corneal epithelial thickness percentage improvement between the right eyes of each pair of twins was statistically significant 1 year and 5 years postoperatively (P < .05). Statistically significant discordance in the aforementioned parameters percentage improvement was similarly observed between the left eyes of each pair of twins (P < .05). CONCLUSIONS: Although a genetic predisposition in KC is well documented, the discordance in keratometric indices improvement after a CXL/PRK procedure between respective eyes of monozygotic twins suggests that environmental influences may contribute to the disease expression as well. Variable degree of synergy in a combined CXL/PRK procedure may also explain the aforementioned discordant improvement.

Comparative radiobiological analysis and preliminary results of Ultra hypofractionated accelerated radiotherapy for low-risk prostate cancer patients.

PURPOSE: Moderately accelerated hypofractionation (HypoAR) has been recently established as a standard radiotherapy scheme for low-risk prostate cancer. The application of ultra-hypofractionated regimens (ultra-HypoAR), with fraction size above 5 Gy, is also widely tested. METHODS: We applied Image Guided Radiation Therapy (IGRT) ultra-HypoAR delivered with Volumetric Modulated Arc Therapy (VMAT) technique in low-risk prostate cancer patients (5.75 Gy/fraction, 40.25 Gy total dose, two fractions per week). A comparative radiobiological analysis of Dose-Volume Ηistograms (DVH) obtained for target volumes and organs at risk was performed, investigating the advantages and disadvantages of ultra-HypoAR and conventional radiotherapy regimens (CRT). Early clinical results on efficacy and toxicity are also reported. RESULTS: We calculated the Normalized Total Dose (NTD) and NTD with time correction (NTD_T)-based biological Dose- Volume Histograms (bDVH) for bladder and rectum tissue late effects (α/ß=4 Gy) and early effects (α/ß=10 Gy). Ultra-HypoAR produced a significantly lower biological dose burden than CRT, for both early and late responding tissue components of the bladder and rectum, whether calculated for time-correction or not (p<0.0001). Our clinical experience showed that the ultra-HypoAR regimen produced minimal early and late radiation sequelae. The median PSA levels dropped from 9.1 to 0.75 and 0.45 ng/ml at 6 and 12 months, respectively, after the end of therapy. CONCLUSIONS: In conclusion, radiobiological analysis of DVHs and preliminary clinical experience predict a better efficacy and low early and late toxicity profile for the tested seven-fraction VMAT ultra-HypoAR regimen with IGRT.

Comparison of Planned Versus Achieved Central Stromal Thickness Reduction in LASIK Versus SMILE: A Contralateral Eye Study.

PURPOSE: To compare attempted versus achieved corneal stromal thickness reduction in a consecutive case series of patients undergoing laser in situ keratomileusis (LASIK) in one eye and small incision lenticule extraction (SMILE) in the other eye. METHODS: This prospective, randomized, contralateral eye study included 22 consecutive patients (44 eyes), one eye randomized to have myopic LASIK and the contralateral eye to have SMILE. Anterior segment optical coherence tomography was performed preoperatively and at 3 months postoperatively. For each of the treatment groups, the achieved maximum stromal thickness reduction was compared to the planned/attempted thickness. The deviation of planned versus achieved stromal thickness reduction was then compared between the two groups. RESULTS: At 3 months postoperatively, LASIK had a lower difference between planned versus attempted stromal thickness reduction compared to SMILE (13.72 ± 14.45 vs 24.00 ± 19.45 µm, P = .03). Graphical analysis revealed this deviation to be exaggerated in higher myopic errors, when a higher maximum stromal reduction was planned. The mean stromal reduction thickness was 83.40 ± 29.52 µm achieved versus 97.13 ± 25.69 µm mean planned ablation depth in the LASIK group (P < .001) compared to 76.45 ± 29.69 µm achieved versus 100.45 ± 26.56 µm planned ablation depth in the SMILE group (P < .001). CONCLUSIONS: LASIK had a significantly lower difference between planned versus achieved stromal thickness reduction when compared to SMILE (P = .03). This difference was more apparent in higher myopic corrections. [J Refract Surg. 2021;37(7):454-459.].

Comparison of effective corneal refractive centration to the visual axis: LASIK vs SMILE, a contralateral eye digitized comparison of the postoperative result.

PURPOSE: To define and compare the centration of the ablation effect in laser in situ keratomileusis (LASIK) with the corresponding effect in small-incision lenticule extraction (SMILE), in myopic laser vision correction to possibly explain the refractive performance differences noted between the two procedures in a contralateral eye study. SETTING: Private ambulatory eye surgery unit. DESIGN: Prospective randomized contralateral eye study. METHODS: In 22 consecutive patients (44 eyes), 1 eye was prospectively randomized to undergo myopic topography-guided LASIK treatment and the contralateral eye to undergo SMILE; digital image analysis of the achieved centration to the aimed corneal vertex was assessed for both procedures on perioperative Scheimpflug tangential curvature maps, using a proprietary digitized methodology. RESULTS: The radial displacement measured in micrometers in the above treated 44 eyes, between the attempted centration point on the corneal vertex vs the center of the measured effective anterior corneal curvature flattening was on average 130 ± 62 mm in the 22 eyes of LASIK group and 313 ± 144 mm in the 22 contralateral eyes of the SMILE group (P < .001). CONCLUSIONS: In this contralateral eye study, topography-guided myopic LASIK was found to achieve significantly better effective centration compared with myopic SMILE, in regard to digitally measured decentration of the effective refractive change achieved in the anterior corneal curvature from the corneal vertex. This may explain the previously reported superior visual outcomes in the LASIK group eyes when compared with the contralateral SMILE group eyes.

The Role of the Microbiome in Age-Related Macular Degeneration: A Review of the Literature.

BACKGROUND: Age-related macular degeneration (AMD) is a progressive, multifactorial, degenerative disease and the leading cause of severe visual loss in the elderly population. The exact pathogenesis of AMD remains elusive, being the combination of genetic, environmental, metabolic, and functional processes. A better understanding of the disease's pathophysiology can lead to new treatment targets. The human microbiome seems to be a potential therapeutic pathway for AMD, as it has been recently proven to play a role in its pathogenesis. SUMMARY: This review sheds light on the association between the microbiome and AMD. Key Messages: The current evidence based on the existing literature shows that there are differences in taxonomical and functional profiles in the human microbiome between patients with AMD and controls, suggesting that the microbiome is implicated in AMD onset and progression, being a link between AMD and nutrition/diet. Additionally, specific bacterial classes have been proposed as potential biomarkers for AMD diagnosis. Further randomized clinical studies with a large sample are needed to elucidate the role of the microbiome in AMD and to draw more solid conclusions.

Effect of Sacubitril/Valsartan on circulating catecholamine levels during a 6-month follow-up in heart failure patients. Timeo Danaos et dona ferentes?

We assessed the effect of Sacubitril/Valsartan on circulating catecholamine levels in patients with HF in an observational cohort study. We included 108 consecutive HF patients attending our HF Outpatients Clinic who were eligible to Sacubitril/Valsartan according to the PARADIGM-HF inclusion and exclusion criteria. We furthermore included 58 stable HF patients under optimal medical therapy as a control group. Norepinephrine and epinephrine were measured with immunoradiometric assays at baseline, at 3- and at 6-month time follow-up. Compared to baseline levels there was no change at three months in epinephrine (p = 0.177) or norepinephrine (p = 0.815) concentrations. At 6 months norepinephrine remained unchanged (p = 0.359). However, at 6 months we observed a significant increase in epinephrine levels compared to baseline [66 pg/mL (37-93) vs 38 pg/mL (18-74), p < 0.001]. In the control group no change was observed in epinephrine levels compared to baseline (p = 0.838). This study is the first to report on the effect of the new drug Sacubitril/Valsartan on circulating catecholamine levels in HF patients. Our data show a significant increase in epinephrine levels during a 6 month follow up in stable HF patients.

The diagnostic yield of fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography in recurrent testicular seminoma.

The use of positron emission tomography-computed tomography (PET-CT) scan imaging is undoubtedly a significant evolution in oncological urology, although at present of limited use in every day urology practice. The aim of this study is to highlight the indication and diagnostic accuracy of fluorine-18 fluorodeoxyglucose PET/CT in the staging of a patient with metachronous bilateral testicular seminoma, elevated tumor markers, and equivocal conventional imaging findings.

Vitamin D status in patients with knee or hip osteoarthritis in a Mediterranean country.

BACKGROUND: Vitamin D plays an important role in bone mineralization, remodeling, and maintenance and therefore its deficiency may be implicated in the pathogenesis of osteoarthritis (OA). Vitamin D status was evaluated in patients with knee or hip OA scheduled for joint replacement. The impact of anthropometric parameters such as gender, age, and body mass index on vitamin D levels was also examined. The study was conducted in a Mediterranean country (Greece). MATERIALS AND METHODS: We included 164 patients with knee or hip OA scheduled for joint replacement in this study. Serum levels of 25-hydroxyvitamin D (vitamin D) were measured in routine blood samples taken from the patients at their pre-admission visit, a week before the operation, using radioimmunoassay. RESULTS: The majority of patients were vitamin D deficient (81.7 %); 15.2 % of them were vitamin D insufficient (hypovitaminosis). Only 3 % of patients were vitamin D sufficient. There was a significantly positive association between vitamin D levels and male gender. CONCLUSION: These findings indicate a large percentage of vitamin D deficient patients with knee or hip OA, which is unexpected considering the high annual insolation in northern Greece. Many other possible predisposing factors for OA should be taken into consideration. Whether treatment with vitamin D supplements may provide beneficial effects to these patients and the stage of disease in which this treatment should commence remains an issue for further scientific investigation. LEVEL OF EVIDENCE: Level IV.

Ureteroscopic laser treatment of upper urinary tract urothelial cell carcinomas: can a tumour free status be achieved?

Introduction. In cases of anatomic or functional single kidney with urothelial tumours of the upper urinary tract, the endoscopic laser ablation has proven efficacious. Based on the knowledge that low-grade, low-stage upper tract transitional cell carcinomas rarely progress to invasive lesions, indications for endoscopic laser ablation have expanded to include patients with bilateral functioning kidneys and low-grade tumours. The question that remains to be answered is whether endoscopic laser ablation has the ability to completely eradicate upper urinary tract tumours. Methods. We performed in 25 patients in a period of 11 years 288 ureteroscopies and, if needed, laser ablation of upper urinary tract tumours in imperative indication. Results. In 32% of the patients the cancer remained even after several laser sessions. 64% of patients were tumour free after one or more laser sessions but remained clear only for the next 3 months. Only 1 patient was tumour free for a period of 68 months after 1 session of laser treatment. The procedure had low complication rates. Conclusion. The laser technology and the introduction of small diameter semirigid and flexible ureteroscopes made ablation of upper urinary tract tumours possible and safe. Nevertheless a complete resection of the carcinomas is rarely possible.

Feasibility and effectiveness of inhaled carboplatin in NSCLC patients.

BACKGROUND: Inhaled chemotherapy is under investigation as an alternative therapeutic modality for Non-Small Cell Lung Cancer. METHODS: 60 NSCLC patients were randomized into 3 groups in this study. 20/60 patients (group A-control group) received I.V. chemotherapy (carboplatin AUC ≈ 5.5 D1); 20/60 (group B) received 2/3 of I.V. predicted carboplatin dose by I.V. infusion and the rest 1/3 as aerosol (jet nebulised D1); and 20/60 (group C) received all the predicted I.V. dose of carboplatin as aerosol in 3 equally divided fractions D1-3. In all patients I.V. docetaxel 100/m(2) was as well administered (D1). Lung functional tests were performed in all groups before chemotherapy in the 3rd and 6th cycles. RESULTS: Group B had a statistically significant increase in survival compared to control group A [275 days (95% CI 249-300) vs. 211 (95% CI 185-236)]. In regard to lung functional tests, a statistically significant decline was observed only in FEV1 of group C in 6 months compared to the initial measurement. CONCLUSIONS: Inhaled carboplatin could be given as an alternative root of pulmonary drug delivery in selected patients, but further randomized studies remain to prove whether the inhaled chemotherapy is an efficient and safe treatment modality.

Obestatin/ghrelin ratio: a new activity index in inflammatory bowel diseases.

BACKGROUND: The aim was to determine obestatin and ghrelin serum levels and their ratio in inflammatory bowel disease (IBD) patients. METHODS: We measured the ghrelin and obestatin levels of 31 Crohn's disease patients and 22 patients with ulcerative colitis using a radioimmunoassay method. Circulating levels of the 2 hormones and their ratio were correlated with the disease type and activity, disease localization, and treatment. RESULTS: The mean ghrelin value was statistically significantly higher in patients with active disease (402.4 +/- 462.6 pg/mL) than in patients in remission (148.2 +/- 59.6 pg/mL) P = 0.0290, alpha = 0.05, whereas obestatin mean values were not (217.4 +/- 59.8 pg/mL in active disease and 189.0 +/- 46.8 pg/mL in patients with inactive disease P = 0.0607). When we evaluated the obestatin/ghrelin ratio between active and inactive disease, it was found that the ratio in active disease was statistically significantly lower (0.8 +/- 0.3) than in patients in remission (1.4 +/- 0.3) P < 0.001, alpha = 0.05. There is also a statistically significantly correlation between obestatin/ghrelin ratio and disease activity (P < 0,001). CONCLUSIONS: Ghrelin and obestatin seem to play a significant role in IBD pathogenesis. Further studies are needed to elucidate the role of these hormones as new biological markers of activity of IBD.

Clinical usage of the squamous cell carcinoma antigen in patients with penile cancer.

BACKGROUND: We present our initial experience with the use of the squamous cell carcinoma (SCC) antigen (SCCAg) in 16 men with penile SCC (SCC group), in four men with condyloma acuminatum (benign group), and in 32 blood donors (control group). METHODS: The SCCAg levels were measured at presentation and every 6 months (upper limit was 2 ng/mL). The mean follow-up time was 4 years. RESULTS: All non-SCC patients had normal SSCAg serum levels in contrast with the SCC patients. The presence of nodal and/or distant metastases resulted in statistically significant higher SCCAg levels, both at presentation and during the follow-up. In patients undergoing lymph node dissection with elevated SCCAg levels prior to the procedure, there was a statistically significant decrease of the SCCAg levels after the operation. CONCLUSION: The SCCAg level could be a serum marker that holds promise for clinical use in penile SCC. Sequential monitoring of SCCAg level might indicate developing of nodal and/or distant metastases and could be useful in following the response to treatment.