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P2653Visually Guided Laser Ablation in patients with paroxysmal and persistent atrial fibrillation - a single center experience
摘要： Predictive value of left atrial emptying fraction and late gadolinium enhancement for the clinical outcomes in atrial fibrillation patients undergoing ablation. Background: A dimension, volume and function of left atrium (LA) and late gadolinium enhancement (LGE) of the LA are known as a prognostic factor for the clinical outcome of atrial fibrillation (AF) ablation. However, which of those parameters provide a best predictive power remains unclear. Purpose: We aimed to compare the efficiency of prediction among those parameters using echocardiography and cardiac magnetic resonance (CMR). Methods: Eighty-eight consecutive patients (67 males; 56±10 years old; 45 persistent AF) underwent transthoracic echocardiography (TTE) and CMR was performed one day before AF ablation. LA anterior-posterior dimension (LAD) was measured at the phase of maximal LA size on M-mode of TTE. Maximal and minimal volume indexed to body surface area (LVAi) from CMR and Area Length Method ALM. Phasic volumes were used to calculate LA emptying fraction (LAEF) ([maximum-minimum LAV]/maximum LAVx100). LGE was defined as areas with thresholds of 6-SD above mean signal in unenhanced LV wall. The LGE stage was defined based on delayed enhancement (DE) volume area divided by LA volume (Stage 1: ≤5%, Stage 2: ≤5%, Stage 3: ≤25%, Stage 4: ≤35%). Results: During mean follow-up duration: 10±3 months, AT/AF recurred in 19/88 patients (21.5%; 3/43 in PAF; 16/45 in PeAF). Compared to patients without recurrence, those with recurrence had larger maximal/minimal LAVi (maximal: 54±21 VS. 45±16, p=0.07; minimal: 40±22 VS. 26±14, p=0.02) and LAD (45.5±6.5 VS. 40.1±5.8, p=0.001) and lower LAEF (24±10 VS. 45±16, P=0.001). ROC analysis for recurrence showed that LAEF had the largest area under curve (AUC =0.86, p=0.0001) compared to maximal LAVi, minimal LAVi and LAD. LGE stage was insignificantly higher in patients with recurrence (3.6±0.7 VS. 2.9±0.9, p=0.46). Cut-off value of LAEF for freedom from recurrence was 31.0% (sensitivity = 0.82, specificity = 0.78, p=0.001). In case of PeAF, only lower LAEF (23±11 VS. 40±7, p=0.001) and larger LAD (45.5±7.1 VS. 40.5±6.3, p=0.02) were significantly related with recurrence. Adjusting clinical risk factor, Cox-regression analysis showed that LAEF was only independent predictor for freedom from recurrence (HR = 0.88; 95% CI; 0.82–0.95; p=0.001). Conclusion: LAEF measured by CMR was superior to maximal/minimal LAVi, LAD and LGE stage in predicting the AT/AF recurrence after AF ablation. Moreover, patients with PeAF and LAEF>31% had excellent clinical outcome.
关键词： left atrial emptying fraction,ablation,atrial fibrillation,late gadolinium enhancement,clinical outcomes
更新于2025-09-23 15:19:57
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Extrusion of Femtosecond Laser-Implanted Intrastromal Corneal Ring Segments in Keratoconic Eyes: Prevalence, Risk Factors, and Clinical Outcomes
摘要： Purpose. To evaluate the prevalence, possible risk factors, and clinical results of femtosecond laser implanted intrastromal corneal ring segment (ICRS) extrusion in keratoconic eyes. Patients and Methods. This is a retrospective observational study evaluating 333 eyes of 269 patients who were subjected to femtosecond laser-implanted Keraring ICRS in the Sohag Refractive Center, Sohag, Egypt, from January 2014 to January 2019. The study included eyes with channels created by a femtosecond laser (60 kHz IntraLase femtosecond system; Advanced Medical Optics, Santa Ana, California, USA) with implantation of Keraring intrastromal corneal ring segments (Mediphacos, Belo Horizonte, Brazil). Patient data and causes of Keraring extrusions were identi?ed as being those rings that migrated or showed melting of the cornea with no other reason which required segment removal. Results. Seven eyes were found to ?t the criteria of ring extrusion (2.1%) out of the 333 eyes which had Keraring implantation. All extruded rings were from patients with keratoconus grade 3, with eccentric cones, and with femtosecond creation of the tunnel. Four eyes belonging to 3 patients (57.1%) had a history of vernal Keratoconjunctivitis, yet they did not show signs of activity at the time of implantation. They reported excessive rubbing just before they presented with conjunctival hyperemia and foreign body sensation. Five eyes (71.4%) showed chronic sun exposure. The mean minimal corneal thickness was 401.85 μm (range 384–420 μm), while the mean maximum keratometry was 61 D (range 55.18–68.96 D). Most of the extruded rings had large arcs. Six eyes had crosslinking (CXL) at the same session of the Keraring implantation. The simultaneous CXL treatment is considered as a possible signi?cant risk factor for ring extrusion. Conclusion. ICRS is an e?ective reversible option for patients with keratoconus who are intolerant to hard contact lenses, yet the choice of cases and ring segments is mandatory for satisfactory results. Moreover, meticulous history taking and examination reduces the incidence of complications including extrusion.
关键词： clinical outcomes,risk factors,keratoconus,femtosecond laser,extrusion,intrastromal corneal ring segment
更新于2025-09-23 15:19:57
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Comparison of Clinical Outcomes of CO2 Laser-Assisted Blepharoplasty Using Two Different Methods
摘要： Numerous methods have been developed for blepharoplasty, including carbon dioxide (CO2) laser-assisted blepharoplasty. Although the superiority of CO2 laser compared with the scalpel for blepharoplasty has been proposed, to the best of our knowledge, no study has compared the clinical outcomes of blepharoplasty with the CO2 laser alone versus the combined use of a scalpel and CO2 laser. In the present randomized clinical trial, 21 healthy patients underwent bilateral upper eyelid blepharoplasty. For each patient, an initial skin incision was made using the CO2 laser (setting, continuous emission; ultrapulse mode; 3 W of power) on 1 side and a scalpel on the other side. The remaining blepharoplasty steps were conducted using the CO2 laser (setting, continuous emission; 9 W of power) in both groups. The patients were evaluated on postoperative days 1, 3, 7, 14, and 30 using the postoperative repair criteria, including edema and ecchymosis. The Manchester scar scale was used to evaluate the results at 60 days after surgery. Our comparison of the 2 methods showed no signi?cant differences at 1 month after surgery using the evaluation criteria. The scar index was not signi?cantly different after 60 days, despite lower scores in the scalpel group. In upper eyelid blepharoplasty, making an initial incision with a scalpel, followed by use of a laser provides advantages similar to those found by performing the entire procedure with a CO2 laser alone.
关键词： Scalpel,CO2 Laser-Assisted Blepharoplasty,Clinical Outcomes,Upper Eyelid Blepharoplasty
更新于2025-09-19 17:13:59
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Comparison of the selected parameters of the anterior segment of the eye between femtosecond laser-assisted cataract surgery, microincision cataract surgery, and conventional phacoemulsification
摘要： The purpose of our study was to compare the selected parameters of the anterior segment of the eye in patients after femtosecond laser-assisted cataract surgery (FLACS) with the results of microincision cataract surgery (MICS) and conventional phacoemulsi?cation surgery (CPS). This single-center prospective randomized comparative observational study included 87 patients. Patients were randomly selected into group A (FLACS), group B (MICS) and group C (control group). All the surgeries were performed by the same experienced surgeon. Preoperative and postoperative parameters were evaluated: best-corrected visual acuity (BCVA), endothelial cell density (ECD), endothelial cell loss percentage (ECL%), central corneal thickness (CCT), central anterior and posterior corneal astigmatism induction, posterior corneal elevation map were measured. Intraoperative parameters: effective phacoemulsi?cation time (EPT), balanced salt solution use (BSS use), total surgical time and suction time were analyzed. Examination was performed preoperatively and on the ?rst, seventh day, one and six months postoperatively. The follow up period was 6 months. There was no statistically signi?cant difference in BCVA, central anterior and posterior astigmatism induction between studied groups. The ECL% was statistically signi?cant lower in the group A on the 7th day, 1 month and 6-months postoperatively (P < .05). The CCT was statistically signi?cant lower in the group A and in the group B than in the group C on the 7th postoperative day (P = .002). However, in the 6 months follow-up there was no statistically signi?cant difference in the CCT between studied groups (P = .133). We observed statistically signi?cant difference in change of the posterior corneal elevation map at the periphery assessed within the 90° to 120°meridian range between group A, group B and group C at every timepoint postoperatively (P < .05). The EPT and BSS use were statistically signi?cant lower whilst total surgery time was statistically signi?cant higher in the FLACS group (P < .05). To conclude in the 6 months follow-up there was statistically signi?cant difference found between eyes undergoing FLACS, MICS and CPS with respect to the posterior corneal elevation map assessed within the studied range, ECL%, EPT, BSS use and total surgery time. Postoperative BCVA, central anterior and posterior astigmatism induction, CCT were comparable between studied groups.
关键词： conventional phacoemulsi?cation surgery,femtosecond laser-assisted cataract surgery,clinical outcomes,manual phacoemulsi?cation,intraoperative parameters,microincision cataract surgery
更新于2025-09-12 10:27:22
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Clinical outcomes of 4-point scleral fixated 1-piece hydrophobic acrylic equiconvex intraocular lens using polytetrafluoroethylene suture
摘要： Purpose: To report the visual outcomes and complications of scleral fixated intraocular lenses (IOLs) using Gore-Tex suture. Methods: The current study is a retrospective noncomparative case series including patients who underwent scleral fixation of IOL (Akreos AO60) using Gore-Tex suture from August 2015 to March 2017 at a university teaching center. Primary outcome measures were visual acuity and complications at last follow-up. Results: The current study included 49 eyes of 48 patients. Mean follow-up duration postsurgery was 6.9 months (range: 0.9–29.4 months). The indications for secondary IOL surgery were dislocated IOL in 16/49 (33%), subluxed IOL in 9/49 (18%), dislocated or subluxed crystalline lens in 9/49 (18%), traumatic cataract in 8/49 (16%), and complicated cataract surgery in 7/49 (14%). Mean best-corrected logMAR visual acuity improved from 1±0.7 (20/200 Snellen equivalent) preoperatively to 0.5±0.5 (20/63 Snellen equivalent) at last follow-up. There were no intraoperative complications noted. Early postoperative complications included significant persistent corneal edema (longer than 1 week) in 4/49 (8.2%), ocular hypertension (intraocular pressure $25 mmHg) in 8/49 (16.3%), hypotony (intraocular pressure #5 mmHg) in 6/49 (12.2%), cystoid macular edema 3/21 (6.1%), IOL tilt 2/49 (4.1%), hyphema in 2/49 (4.1%), and vitreous hemorrhage in 5/49 (4.8%). There was one case of recurrent retinal detachment. One patient presented with an erosion of the Gore-Tex suture through the conjunctiva resulting in a purulent scleritis 6 months after the initial surgery, and was managed with removal of the IOL, debridement, and cryotherapy. Forty-one of 49 patients completed 3-month follow-up, among which visual acuity improved, deteriorated, or remained same compared to baseline in 27/49 (55.1%), 8/49 (16.3%), and 6/49 (12.2%) eyes, respectively. Conclusion: In the current study, visual acuity outcomes were generally favorable. The complications were largely transient. Significant complications included a suture-related infection, which required removal of the IOL, and a recurrence of a retinal detachment.
关键词： secondary intraocular lens,scleral fixation,clinical outcomes,Gore-Tex
更新于2025-09-09 09:28:46
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The effects of repeated applications of antimicrobial photodynamic therapy in the treatment of residual periodontal pockets: a systematic review
摘要： The aim of this study was to assess the effects of repeated applications of antimicrobial photodynamic therapy (aPDT) on the non-surgical periodontal treatment of residual pockets. This work was performed and reported according to the Cochrane and PRISMA recommendations, respectively, and registered at the PROSPERO registry (number CRD42017058403). An extensive search of the biomedical literature was conducted on four databases from January 1960 to August 2018, followed by hand searching. Analysis of the quality of the selected studies was based on the risk of bias. Only two randomised controlled clinical trials (RCTs) met the inclusion criteria although they had unclear risk of bias. One study showed that repeated applications of aPDT in association with conventional non-surgical treatment during periodontal maintenance improved all clinical outcomes after 6 months. The other study, which assessed the effects of repeated applications of aPDT in association with ultrasound debridement on periodontal pathogens, showed no significant reduction of the main pathogens after 3–6 months but reported reductions of probing pocket depth and C-reactive protein after 3 and 6 months, respectively, compared to mechanical therapy alone. Concluding, it was not possible to state that repeated applications of aPDT, in association with non-surgical treatment of residual pockets, have effective clinical effects in the periodontal maintenance therapy. Although one can consider that aPDT is a promising adjuvant therapy, it is still necessary to carry out more RCTs with low risk of bias in order to confirm or refute the benefits of multiple applications for residual periodontal pockets.
关键词： Periodontitis,Photodynamic therapy,Clinical outcomes,Periodontal pocket,root planing
更新于2025-09-04 15:30:14