Comparison of visual effects of FS-LASIK for myopia centered on the coaxially sighted corneal light reflex or the line of sight.

AIM: To compare visual quality after femtosecond laser in situ keratomileusis (FS-LASIK), between the coaxially sighted corneal light reflex (CSCLR) group and conventional ablation line of sight (LOS) group. METHODS: In total, 243 eyes (122 patients) were treated with centration on the CSCLR (visual axis) and 238 eyes (119 patients) treated with centration on the pupil center (LOS). Postoperative outcomes [uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA)], safety index, efficacy index, refractive outcome, ablation center distance from the visual axis, corneal high-order aberrations, subjective discomfort glare and shadowing incidence rate, and contrast sensitivity at 1, 3, and 6mo were measured and compared. RESULTS: The mean age was 27.77±7.1y in the CSCLR group and 26.03±7.70y in the LOS group. Preoperatively, the manifest refraction spherical equivalent (MRSE) was -6.68±2.60 D in the CSCLR group and -6.65±2.68 D in the LOS group. The postoperative UCVA, BSCVA, MRSE (-0.03±0.263 D in the CSCLR group, -0.05±0.265 D in the LOS group), efficacy index (1.04, 1.03), and safety index (1.09, 1.08) were not significantly different between the groups (all P>0.05). In total, 3% lost one line and more of BSCVA in the CSCLR group, as 9% in the LOS group postoperatively (P<0.05). The ablation center deviation was 0.20±0.15 mm from the visual axis (Pentacam system default setting; range, 0-0.75 mm) in the CSCLR group, and 0.43±0.22 mm (range, 0-1.32 mm) in the LOS group (P<0.0001). Statistically significant greater augmentation of total corneal higher-order aberrations (0.15±0.10 µm and 0.20±0.12 µm respectively, P=0.03) and vertical and horizontal coma (P<0.0001) were noted in the LOS group. Subjective discomfort glare and shadowing incidence rates were 8.59% and 17.5% in the CSCLR and LOS groups, respectively (P<0.05). The 1-month postoperative contrast sensitivity visual acuity in the CSCLR group was significantly higher than that in the LOS group on contrast (100%, 25%, 10%) with a dark background, but there was no significant difference between the groups at 3 or 6m. CONCLUSION: Myopic LASIK centered on the CSCLR achieves significantly lower induction of loss of BSCVA, corneal high-order aberrations, and lower risk of subjective discomfort glare and shadowing, and lower decline in early contrast sensitivity by comparison with centration on the LOS, giving advantages in visual quality postoperatively.

Comparison of corneal flap thickness using a FS200 femtosecond laser and a moria SBK microkeratome.

AIM: To evaluate differences in flap thickness resulting from use of an Alcon Wavelight FS200 femtosecond laser and a MORIA SBK microkeratome when making a 110-µm-thick corneal flap and to identify the potential factors that affect corneal flap thickness. METHODS: A prospective case study was performed on 120 eyes of 60 patients who were divided into two groups for LASIK, each group consisting of 60 eyes (30 patients). The corneal flaps were created using an Alcon Wavelight FS200 femtosecond laser or a MORIA SBK microkeratome. The central corneal flap thickness was calculated by subtraction pachymetry. Age, central corneal thickness (CCT), spherical equivalent refraction, mean keratometry, and corneal diameter were recorded preoperatively for analysis. RESULTS: Cutting of all flaps was easily performed without intraoperative complications. In the Alcon Wavelight FS200 femtosecond laser group, the mean right and left corneal flap thicknesses were 114.0±6.6 µm (range: 98-126) and 111.4±7.6 µm (range: 98-122), respectively. The difference (2.6±9.1 µm) in the corneal flap thickness between the right and left eyes was not significant (t=1.59, P=0.12). Stepwise regression analysis indicated that the resulting corneal flap thickness was unrelated to the patient's age, preoperative CCT, spherical equivalent refraction, mean keratometry, or corneal diameter. In the MORIA SBK microkeratome group, the mean right and left corneal flap thicknesses were 110.6±7.4 µm (range: 97-125 µm) and 108.2±6.1 µm (range: 78-123 µm), respectively. The difference in the corneal flap thickness between the right and left eyes (2.4±6.5µm) was not significant (t=2.039, P=0.0506). The corneal flap thickness was positively correlated with the preoperative CCT through stepwise regression analysis (r=0.297, P=0.021). The corneal flap thickness was not related to age, spherical equivalent refraction, mean keratometry, or corneal diameter. The corneal flap thickness was estimated using the following equation: Tflap=67.77+0.076 CCT (F=5.63, P=0.021). CONCLUSION: Both the Alcon Wavelight FS200 femtosecond laser and the MORIA SBK microkeratome produced 110-µm-thick corneal flaps. The central corneal flap thickness was positively correlated with the preoperative CCT in MORIA SBK microkeratome surgery.

[Comparison of cornea flap made by femtosecond laser and microkeratome in laser in situ keratomileusis].

OBJECTIVE: To determine flap thickness variation in 110 µm thickness flap made by FS200 femtosecond laser and sub-Bowman keratomileusis (SBK) microkeratome for studying the potential factors that affect the flap thickness. METHODS: It was a case-control study. Sixty patients were divided into two groups for laser in situ keratomileusis. The corneal flaps were made by using Alcon Wavelight FS200 femtosecond laser or MORIA SBK microkeratome. Central corneal flap thickness was calculated by subtraction pachymetry. Age, central corneal thickness (CCT), spherical equivalent refraction, mean keratometry and corneal diameter were recorded preoperatively for statistics. RESULTS: This study comprised 120 eyes of 60 patients; 60 eyes were treated with each group. In Alcon Wavelight FS200 femtosecond laser group, the mean corneal flap thickness in the right and left eyes was (114.0 ± 6.6) and (111.4 ± 7.6) µm, respectively. The difference in corneal flap thickness between the right eye and the left eye (2.6 ± 9.1) µm was not statistically significant (t = 1.59, P = 0.12). Corneal flap thickness had no relationship with the age, preoperatively CCT, spherical equivalent refraction, corneal curvature and corneal diameter through stepwise regression analysis. In SBK microkeratome group, the mean corneal flap thickness in the right eye and the left eye was (110.6 ± 7.4) and (108.2 ± 6.1) µm respectively. The difference in corneal flap thickness between the right eye and the left eye (2.4 ± 6.6) µm was not statistically significant (t = 2.019, P = 0.054). Corneal flap thickness was positively correlated with preoperative CCT through stepwise regression analysis (r = 0.29, P = 0.021). Corneal flap thickness equaled to 67.77 + 0.076· CCT (F = 5.63, P = 0.021). Corneal flap thickness had no relationship with the age, spherical equivalent refraction, corneal curvature and corneal diameter. CONCLUSIONS: Both FS200 femtosecond laser and SBK microkeratome can be used for making a good 110 µm thickness flap. Central corneal flap thickness was positively correlated with the preoperative CCT using the SBK microkeratome.

Effects of intensive control of blood glucose and blood pressure on microvascular complications in patients with type II diabetes mellitus.

AIM: To evaluate the effects of intensive control of blood glucose and blood pressure on microvascular complications in patients with type II diabetes by comparing the therapeutic effects of intensive and standard treatment in patients with type II diabetes. METHODS: A total of 107 patients with type II diabetes were randomly assigned into intensive and standard treatment groups. Patients in the intensive treatment group received preterax (perindopril/ indapamide) to control blood pressure, and gliclazide (diamicron) MR to control blood glucose. Patients in the standard treatment group received routine medications or placebo. Urinary microalbumin (UMA), urinary creatinine (UCR), the UMA/UCR ratio, and visual acuity were monitored according to the study design of the ADVANCE trial. Direct ophthalmoscopy and seven-field stereoscopic retinal photography were used to examine the fundi at baseline, and repeated after 5 years of treatment. RESULTS: The characteristics of patients in both groups were well balanced at baseline. After 5 years of treatment, visual acuity was found to be decreased in the standard group (P=0.04), but remained stable in the intensive group. The severity of diabetic retinopathy had not progressed in patients in the intensive group, but had deteriorated in the standard group (P=0.0006). The UMA/UCR ratio was not obviously changed in patients in the intensive group, whereas it was significantly increased in the standard group (P=0.00). CONCLUSION: Intensive control of blood glucose and blood pressure can decrease the incidence or slow the progression of microvascular complications in patients with type II diabetes, and maintain stable vision.

[Three kinds of phakic intraocular lens for correction of high myopia].

OBJECTIVE: To evaluate the efficacy, safety and stability of three kinds of phakic intraocular lens implantation for the correction of high myopia. METHODS: This study included 208 eyes of 110 patients with a mean age of 31 years (21 - 53) from December 2003 to December 2009. Angle-supported lens (Phakic 6H, OII) were inserted into 113 eyes, iris-fixated lens (Artisan, OPHTEC) were inserted into 53 eyes and implantable contact lens (ICL) (V4, STAAR) were inserted into 41eyes. The average follow-up time of the three groups were 54.0 months (3 - 72 months), 15.7 months (3 - 24 months) and 7.2 months (3 - 15 months) respectively. RESULTS: At 3 months and 12 months, the efficacy indexes of the three groups were all above 1.00. Only the angle-supported group was followed up to 72 months postoperatively when the efficacy index dropped to 0.85, but still UCVA was 1.0 (20/20) or better in 16% eyes and 0.5 (20/40) or better in 85% eyes. The safety indexes of the three groups were always above 1.00 during the follow up. In the angle-supported group, 46% eyes were within ± 0.50 D of the desired refraction and 68% eyes were within ± 1.00 D at 5 years postoperatively. In the iris-fixated group, 78% eyes were within ± 0.50 D of the desired refraction and 100% eyes were within ± 1.00 D at 1 years postoperatively. In the ICL group, 95% eyes were within ± 0.50 D of the desired refraction and 100% eyes were within ± 1.00 D at 3 months postoperatively. No statistically significant differences were found between preoperative and 3-month postoperative endothelial cell density in the ICL group. Also, there was no statistically significant reduction in endothelial cell density at 1 years in the iris-fixated group. However, when preoperative and 5-year postoperative measurements were compared in the angle-supported group, the total decrease in cell density is statistically significant (t = 9.769, P = 0.000). 16 eyes developed high IOP within 1 month postoperatively which resolved after intervention. In the three groups (angle-supported, iris-fixated and ICL), the most common complications were pupil ovalization, iris atrophy plus pigment dispersion and lens opacification respectively. CONCLUSION: Although phakic IOL implantation is predictable and safe for treatment of high myopia in short-term, the long-term complications should be concerned and treated well.

Ocular manifestations of Alport syndrome.

AIM: To analyze the clinical manifestation of Alport syndrome, especially the ocular features. METHODS: The physical, ophthalmologic and audiologic examination results of thirty-two patients with Alport syndrome were analyzed retrospectively. RESULTS: Thirty (93.7%) patients had some family history. All patients had renal disease: eighteen (56.3%) patients with chronic renal failure, four (12.5%) patients with renal insufficiency, and the other ten (31.3%) patients with hematuria. Twenty (62.5%) patients had sensorineural deafness. Thirteen (40.6%) patients had ocular deformity, five (15.7%) patients had typical ocular changes: three patients with anterior lenticonus, and two patients with macular flecks. CONCLUSION: Ocular anomalies are not requisite for the diagnosis of Alport syndrome. But its typical ocular features should be recognized by the ophthalmologists which supports the diagnosis.

[Expression and significance of GST-Pi and HIF-1alpha in bladder carcinoma].

BACKGROUND & OBJECTIVE: Multidrug resistance plays an important role in chemotherapy failure of bladder cancer, but its mechanism is unclear. Hypoxia in tumors is generally associated with chemoresistance. However, the correlation of nuclear transcription factor hypoxia-inducible factor-1 (HIF-1) to multidrug resistance transporter glutathione-S-transferase-Pi (GST-Pi) has not been investigated. This study was to explore the expression and significance of GST-Pi and its correlation to HIF-1alpha in bladder carcinoma by tissue microarray. METHODS: A tissue microarray containing 119 cases of bladder carcinoma and 6 cases of normal bladder tissue was built up. The expression of GST-Pi and HIF-1alpha was detected by SABC immunohistochemistry. RESULTS: In the 119 cases of bladder carcinoma, the positive rate of HIF-1alpha was 57.9%, the positive rate of GST-Pi was 67.2%. The positive rate of HIF-1alpha in G3 grade bladder carcinoma was 64.6%. Their expression was closely related to pathologic grade, clinical stage, and postoperative relapse after adjuvant chemotherapy (P<0.01). HIF-1alpha expression was positively related to GST-Pi expression (P<0.01). CONCLUSIONS: Overexpression of HIF-1alpha may be related to hypoxia. Co-expression of HIF-1alpha and GST-Pi is a object index for judging differentiation and chemoresistance of bladder cancer.

[Intravesial instillation of recombination interferon-alpha and pirarubicin in the prophylaxis of local recurrence after resection of the superficial bladder cancer].

BACKGROUND & OBJECTIVE: Superficial transitional cell carcinoma (TCC) of urinary bladder tends to recur after transurethral surgery. This study was designed to evaluate the effect of interferon-alpha (IFN-alpha)and pirarubicin (THP) on decreasing postoperative recurrence of superficial bladder cancer. METHODS: Recombinant IFN-alpha and THP has been used in clinical study. One week After operation, 68 patients were prospectively enrolled and divided into two groups randomly: IFN-alpha plus THP group and THP group. The protocols of chemoimmunoprophylaxis include 8 weekly and 10 monthly instillation of 3 x 10(7) IU IFN-alpha plus 40 mg THP in 40 ml 5% glucose via catheter. RESULTS: The follow-up period ranged from 6 to 32 months (median 18.2 months). The cytoscopy and cytology with cold cup biopsies had been carried out every 3 months for 2 years. Recurrence after instillation of IFN-alpha combining THP was observed in only 4 cases (12.1%), bladder irritation was found in 4 cases, fatigue in 3 cases, and rash in 1 case as well. Among the 35 cases in THP group, recurrence was found in 8 cases (22.8%), bladder irritation in 5 cases, fatigue in 3 cases. IFN-alpha plus THP yielded better effect than THP alone (P< 0.05),especially in grade 3 and stage PT1 bladder cancer. CONCLUSIONS: IFN-alpha working in coordination with THP would be an effective remedy to prevent the recurrence of bladder cancer. The intravesical IFN-alpha plus THP appears to be more effective against recurrence than THP alone. Further study is needed for side-effect and popularization in such way.

[An experimental study of the inhibition of tamoxifen on rat model of benign prostatic hyperplasia].

OBJECTIVES: To study the inhibitory mechanism of tamoxifen on benign prostatic hyperplasia. METHODS: The Wistar male adult rats were injected into muscle with testosterone propionate 4-6 mg/kg, simultaneously were irrigated into stomach with tamoxifen citrate 0.21 mg/kg. The partly rats of each group were decapitated at 7, 15 and 30 days, then their index numbers of prostate were calculated, and the structural changes of the prostatic histocyte were observed in the light microscopy and scan electronic microscopy. RESULTS: At the 7th, 15th, and 30th day, the index numbers of prostate of those rats which had been injected only with testosterone propionate were higher than that of the control group and the irrigating group(P < 0.05). The hyperplasia of the prostatic epithelial cells and the ground substance of those rats, which had been irrigated with tamoxifen citrate, had not happened in light microscopy and the scan electronic microscopy. CONCLUSIONS: Tamoxifen could block the effect of the estrogen, which could suppress the prostatic hyperplasia. This study could provide the experimental evidences for using Tamoxifen to treat the human benign prostatic hyperplasia.