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Although thoracoscopy has characteristics such as a small surgical incision and low stress response, post-surgical pain after a thoracoscopic operation is no less than that after a thoracotomy. Moreover, poor post-surgical pain management is likely to cause an increased incidence of postoperative pulmonary complications (PPCs) and chronic post-surgical pain. The serratus anterior plane block (SAPB) is a regional anesthesia method whereby local anesthetics (LAs) are injected into the serratus anterior space to block the lateral cutaneous branch of the intercostal nerve, long thoracic nerve, and dorsal thoracic nerve. The block range of the SAPB covers the incisions of video-assisted thoracoscopic surgery (VATS) and the site of the chest tube, which are often located in the antero-lateral chest wall. Therefore, the SAPB can achieve effective analgesia in VATS. For example, 0.125% to 0.25% levobupivacaine (20-25 ml) is widely used for thoracic surgery, which can achieve effective analgesia and avoid adverse reactions. Moreover, it has advantages compared with thoracic segmental epidural block (TEA) and thoracic paravertebral block (TPVB), such as simple operation, increased safety, fewer complications, and hemodynamic stability. In addition, adequate analgesia is helpful for pulmonary function recovery and reduces the incidence of PPCs. This article introduces the anatomical mechanism of the SAPB, diverse operation approaches, how to choose drugs and adjuvants, and the resulting impacted area range. It summarizes the advantages and disadvantages of the SAPB compared with other analgesic methods and posits that the SAPB is beneficial to the recovery of postoperative lung function, which provides more options for postoperative analgesia after VATS.

Amebiasis is a worldwide parasitic zoonosis, with symptoms of abdominal discomfort, indigestion, diarrhea, and even death. However, limited information about the prevalence of Entamoeba spp. in experimental nonhuman primates (NHPs) in southwestern China is available. The objective of the current study was to investigate the frequency and species identity of Entamoeba to evaluate potential zoonotic risk factors for Entamoeba spp. infection in experimental NHPs. A total of 505 fecal samples were collected from NHPs (macaques) and analyzed by PCR analysis the small subunit rRNA (SSU rRNA) gene of Entamoeba spp. Forty-seven specimens were positive for Entamoeba spp., and the prevalence of Entamoeba spp. was 9.31% (47/505). Significant differences in the prevalence rates among the three breeds (P = 0.002

Psoriasis is a chronic multisystem inflammatory disease that affects ~0.1–1.5% of the world population. The classic cutaneous manifestation of psoriasis is scaly erythematous plaques, limited or widely distributed. Moreover, psoriasis could be associated with comorbidities like psoriatic arthritis, metabolic syndrome, diabetes, cardiovascular disease, nephropathy, bowel disease, and brain diseases. In this review, we suggest that psoriasis should be classified as cutaneous psoriasis or systemic psoriasis and propose the classification for distinction. This would help to better understand and manage psoriasis.

Objective: A Cochrane Systematic Review published by Linde et al. in 2016 found moderate evidence suggesting that acupuncture is “at least non-inferior” to conventional prophylactic drug treatments (flunarizine, metoprolol, and valproic acid) for episodic migraine prophylaxis. The evidence for the efficacy of these conventional treatments must be verified to strengthen and validate the original comparison made in Linde et al.'s 2016 review. The aim of the current authors' systematic review was to verify the efficacy of the conventional treatments used in Linde et al.'s 2016 comparison with acupuncture. Materials and Methods: Search strategies were applied to find studies that could verify the efficacy of conventional treatments for treating episodic migraines. Relevant outcomes and dosages were extracted from the retrieved studies. Each study's quality was assessed, using the Cochrane's collaboration tool for assessing risk of bias and the Cochrane GRADE [Grading of Recommendations Assessment, Development, and Evaluation] scale. Results: There is high-quality evidence suggesting that prophylactic drug treatment, at the treatment dosage ranges used in Linde et al.'s 2016 review, reduced headache frequency at a 3-month follow-up, compared to placebo. Headache frequency at a 6-month follow-up, and responses (at least 50% reduction of headache frequency) at 3-month and 6-month follow-ups could not be assessed. Conclusions: These findings strengthened Linde et al.'s 2016 comparison of conventional treatments and acupuncture for reducing headache frequency at a 3-month follow-up. For episodic migraine prophylaxis, moderate evidence suggests that acupuncture is “at least non-inferior,” to now-proven, conventional treatments. This raises significant questions in the debate concerning claims that acupuncture is a placebo-based treatment and the prescriptions of proven conventional treatments that have similar effects as acupuncture.

Introduction The purpose of this study was to describe the results using the Nd:YAG laser to reopen blocked glaucoma tube shunts in three ocular chemical burn patients with Boston keratoprostesis type I (KPro) implantation. Methods The medical records of the three patients at Zhongshan Ophthalmic Centre were reviewed. Results Patient 1, who had glaucoma secondary to KPro implantation, had undergone Ahmed glaucoma valve (AGV) implantation to control an elevated intraocular pressure (IOP). One day after surgery, the tube was observed to be embedded in the residual lens capsule. The capsule was opened by one 1.5 mJ laser pulse, with a subsequent drop in the IOP. In patient 2, the AGV and KPro had been implanted simultaneously. One month after surgery, the IOP increased to 35 mmHg, estimated by palpation, and a vitreous gel was seen blocking the tube. A Nd:YAG laser pulse was used to open the occluded tube. In patient 3, the tube was blocked by iris tissue; Nd:YAG laser treatment opened the tube. Conclusions The cases described here indicate that Nd:YAG laser treatment seems to be a valuable option for opening an occluded AGV tube in patients with KPro implantation. The correct location of the tube tip, visualized through the KPro optic, is essential for laser treatment. Electronic supplementary material The online version of this article (10.1007/s40123-019-0186-6) contains supplementary material, which is available to authorized users.

To investigate the sleep quality and mental health status of healthcare professionals during the outbreak of coronavirus disease 2019 (COVID-19) in order to promote timely intervention and treatment. An Questionnaire Star of WeChat online survey was conducted at Hwamei Hospital, University of Chinese Academy of Sciences, NingBo, China. The questionnaire consisted of two parts including sociodemographic characteristics, and the Pittsburgh Sleep Quality Index (PSQI), the Generalized Anxiety Disorder (GAD-7) scale, a depression screening scale (Patient Health Questionnaire-9 [PHQ-9]) so as to investigate the sleep quality and mental health status of healthcare professionals during the outbreak of COVID-19.The data were analyzed with the t-test, χ2 test, one-way analysis of variance (ANOVA) and Pearson correlation, P

OBJECTIVE To determine the effects of glucocorticoids in enhancing athletic performance. DESIGN At least 2 independent reviewers conducted study selection and extracted demographic and outcome data. Relevant outcomes were stratified by administration time frame and the specific type of drug used. Study quality was assessed using the Cochrane Risk-of-Bias tool and the Cochrane Grading of Recommendations Assessment Development and Education scale. Where appropriate, meta-analyses were performed. Data sources: Embase, MEDLINE, and SPORTDiscus were searched from their beginning to April 2020. PARTICIPANTS Participants of any sex and training status aged 18 to 65 years were included. INTERVENTIONS AND MAIN OUTCOME MEASURES Any type of published randomized controlled trial (RCT) that examined any enhancement in sport as well as aerobic, anaerobic, or body compositional parameters for glucocorticoids compared with placebo. RESULTS There is low-to-moderate evidence suggesting that the administration of glucocorticoids may be more beneficial than placebo in enhancing athletic performance. short-term administration of glucocorticoids significantly improved time to exhaustion, maximal force, and total distance travelled. By contrast, acute administration of glucocorticoids predominantly yielded no changes to athletic performance, except for reductions in total work and maximal power output. CONCLUSIONS Although there is evidence suggesting glucocorticoids have ergogenic effects, these improvements may differ depending on the specific type of drug, dose, and the administration time frame and are also limited by small sample sizes. Therefore, there is a need for large, high-quality RCTs as this may influence future doping policy and athlete care.

Myofascial pain syndrome (MPS) is characterized by the presence of clinically detected myofascial trigger points (MTrPs). Diagnostic ultrasound (US) has been proposed as a method to strengthen the reliability of MTrP localization, thus potentially improving the efficacy and safety profile of interventional procedures. The objective is to evaluate the benefit and safety profile of any US-guided interventional procedure for MPS. Medline, Embase, PubMed, the Allied and Complementary Medicine Database (AMED), and Web of Science were systematically searched from their inception to May 2020 for any randomized controlled trial that evaluated treatment benefit and safety of any US-guided interventional procedure for MPS. The primary outcome of interest was pain severity. Additional outcomes of interest were function and adverse effects. The risk of bias was assessed using the Risk of Bias V.2.0 tool. eleven studies met all inclusion and exclusion criteria. Two studies (n=174) with a high risk of bias revealed some evidence supporting US guidance over blinded interventions for improvement in pain and function. Eight studies (n=483) with varying risks of bias were of head-to-head comparisons of different US modalities. These studies revealed that US-guided local anesthetic injections were inferior to US-guided pulse radiofrequency and US-guided dry needling (DN). US-guided DN was also found to be superior to US-guided platelet-rich-plasma injections but inferior to US-guided miniscalpel. Meanwhile, one study (n=21) with some concerns of bias found that US-guided local anesthetic injections were superior to non-steroidal anti-inflammatory drugs for pain outcomes and fewer adverse events. All US-guided procedures resulted in zero or minimal self-limited adverse events. Issues with clinical relevance, limited sample sizes, and small point estimates warrant more high-quality research to better characterize the possible value of US-guided injections.

IntroductionAthletes have attempted to glean the ergogenic benefits of recombinant human erythropoietin (rHuEPO) since it became available in the 1980s. However, there is limited consensus in the literature regarding its true performance-enhancing effects. In fact, some studies suggest there is no conclusive evidence; therefore, it is necessary to evaluate and quantify the strength of the evidence.ObjectiveTo determine the effects of erythropoietin on enhancing athletic performance.DesignAt least two independent reviewers conducted citation identification through abstract and full-text screening, and study selection, and extracted raw data on demographics, descriptions of interventions and all outcomes to predesigned abstraction forms. Outcomes were stratified by treatment periods and dosages. Study quality was assessed using the Cochrane Risk of Bias Tool and Cochrane Grading of Recommendations Assessment Development and Education (GRADE) scale. Where appropriate, quantitative analysis was performed.Data sourcesEMBASE, MEDLINE and SPORTDiscus were searched from their inception to January 2020.Eligibility criteriaTrials that examined any enhancement in sport in healthy participants aged 18–65 using rHuEPO compared with placebo were included.ResultsOverall, there is low-to-moderate quality evidence suggesting rHuEPO may be more beneficial than placebo in enhancing haematological parameters, pulmonary measures, maximal power output and time to exhaustion independent of dosage. However, these improvements are almost exclusively seen during maximal exercise intensities, which may be less relevant to athletic competition conditions.ConclusionDue to heterogeneity among trials, more high-quality randomised controlled trials with larger sample sizes in conditions that mirror actual competition are needed to further elucidate these effects.

This study aimed to describe the clinical features, surgical management of the eyelid and ocular surface, and outcomes of 16 patients implanted with a Boston type I keratoprosthesis (KPro). A retrospective, single-center, consecutive case series of 16 patients with Stevens–Johnson syndrome (1), ocular chemical burns (12), and ocular thermal burns (3) implanted with KPro was studied. All subjects were men aged 27–51 years. Surgical treatment and outcomes for eyelid malposition, symblepharon, and glaucoma were assessed. From September 2010 to February 2019, 29 patients were admitted to Zhongshan Ophthalmic Center for KPro implantation, of whom 16 (55%) required eyelid or ocular surface surgeries to maintain hydration and protect the corneal tissue, which is vulnerable to epithelial defects. Forty-one adnexal surgical procedures were performed. The most common indication for surgery was symblepharon, and the most frequent procedures were symblepharon lysis with ocular mucous membrane grafts and amniotic membranes (7) and full-thickness skin grafts to the eyelids (7). Preoperative conjunctival injection and corneal staining were documented in 9 (56%) and 8 (50%) eyes, respectively, and at up to 4 months postoperative follow-up (the last adnexal surgery before KPro) were recorded in 3 (19%, p = 0.03) and 2 (12%, p = 0.02) eyes, respectively. Glaucoma drainage devices were inserted in six patients. One patient with Stevens–Johnson syndrome underwent FP7 Ahmed glaucoma valve (AGV) implantation inferotemporally and developed plate exposure 2 months postoperatively. Five patients underwent FP8 AGV implantation with tube insertion into the vitreous cavity due to the scarred conjunctiva and limited subconjunctival space. In the study period, intraocular pressure (IOP) was in the normal range, and no tube or plate exposure was observed. The ocular environment is critical for successful KPro surgery. A multidisciplinary approach for any lid and ocular surface abnormality in ocular burns or Stevens–Johnson syndrome is important to improve the quality of the ocular surface and accommodate KPro and AGV, which is vital for maintaining vision after KPro surgery. FP8 AGV may be feasible for IOP control in adult KPro cases with restricted subconjunctival space.

Purpose: To describe the results of Boston keratoprosthesis implantation in a patient with Stevens–Johnson syndrome following autologous submandibular gland transplantation.Design: Observational case report.Methods: We report the case of a man diagnosed with Stevens–Johnson syndrome. Autologous submandibular gland transplantation was performed in the right eye in 2008 to ameliorate tear film deficiency. Due to the improvement in the microenvironment of the ocular surface, Boston keratoprosthesis implantation was performed in the right eye in 2011.Results: He maintained a VA of 20/100 for 12 months. At the last follow-up visit (54 months), his VA had declined to finger count level due to de novo glaucoma, which was treated with glaucoma drainage device implantation, cyclophotocoagulation and topical anti-glaucoma medications.Conclusions: The procedures described provide patients with end-stage ocular surface disease an option to lessen the severity of keratoconjunctivitis sicca and to regain their VA.

The objective of this study was to report clinical outcomes (functional and anatomic) of Boston keratoprosthesis (KPro) after severe chemical burns in Southern China. Nineteen patients (19 eyes) that sustained severe chemical injuries in Southern China were enrolled in this retrospective study in our hospital between May 2009 and June 2015. KPro implantation in these patients was performed by a single experienced surgeon (Jiaqi Chen). The parameters evaluated in this study included diagnosis, comorbidity, preoperative and postoperative visual acuity (VA), complications, KPro retention, histological and immunohistochemical results of retroprosthetic membrane (RPM) and mucous membrane over the optic cylinder. The mean age of the patients was 42.7 ± 11.3 years (range 29–62 years). All patients were male. Of the 19 included eyes, nine had acid burns, and 10 had alkali burns. Ten patients had previously undergone failed penetrating keratoplasty. The mean follow-up time was 41.3 ± 5.5 months (range 36–56 months). Preoperatively, the VA of the patients ranged from hand movement to light perception. Postoperatively, 17 patients (89.4%) achieved at least 20/200 once, and 7 patients (36.8%) achieved at least 20/200 and maintained this acuity until the last follow-up. The initial KPro was retained in 14 (73.6%) eyes and successfully replaced in one eye. Postoperative complications included RPM in 10 eyes, glaucoma in 6 eyes, retinal detachment in 2 eyes, corneal melting in 5 eyes, ischemic optic neuropathy in 1 eye, and overgrowth of the mucous membrane over the optical cylinder in 2 eyes. The histological and immunohistochemical results of the RPM showed granulomatous disorders and mucous membrane over the optic cylinder of conjunctival origin. KPro surgery can restore useful vision in patients suffering from severe chemical burns. However, postoperative VA declined with the development of complications, and ocular surface disorders caused by the chemical burns were associated with a greater incidence of KPro retention failure. The retention rate was comparable in patients using ipsilateral autologous corneal tissue with allograft corneal tissue. Science and Technology Foundation of Guangdong Province of China, Grant Number 2014A020212714.

Purpose:To evaluate complications and anatomical retention when using autologous ear cartilage as a carrier in type 1 Boston keratoprosthesis (Kpro) surgery. Methods: In New Zealand White rabbits, the Kpro was surgically implanted using autologous cartilage (n = 5) or ipsilateral autologous cornea (n = 1, control) as carrier. Eyes were followed up using slit-lamp photography, anterior segment optical coherence tomography, and histological analysis for 19 days to 24 months. Results: Kpros were retained in all eyes. One eye in the cartilage group had an uncomplicated course; 3 developed granulation tissue over the Kpros optic, 1 developed a retroprosthetic membrane, and 3 developed glaucoma. Two eyes had lacunae. The gap between the Kpros flange and cartilage carrier filled with fibrovascular tissue over time. The control eye developed corneal tissue thinning and an enlarged gap. Conclusion: Auricular cartilage carriers may encourage Kpro-graft adhesion in a rabbit model and may be useful in Kpro recipients who cannot use bandage contact lenses.

Liver hemangiomas are the most common benign liver tumors. The management of giant (≥5 cm) hemangioma of the liver remains controversial. The aim of this study was to assess the influence of tumor size on postoperative outcomes after hepatectomy in patients with giant hemangioma of the liver.Patients who were subjected to resection because of giant liver hemangioma between December 2006 and July 2012 were grouped by largest tumor size: 5-10 cm (group A) and 10-15 cm (group B). All patients underwent detailed preoperative assessments. Clinicopathologic features were analyzed, and univariate and multivariate analyses were used to determine risk factors that correlated independently with any complication, as well as the intraoperative red blood cell transfusion requirement. Long-term outcomes were assessed with a median follow-up of 56 months.One hundred and ninety patients, mean age 46 years, were included. The 146 patients with tumors 5-10 cm in size were compared with the remaining 44 patients with tumors 5-10 cm in size. The differences in postoperative morbidity (29.86 vs. 41.30%, P=0.150) and duration of hospitalization (11.06±7.02 vs. 12.17±7.74, P=0.465) between group A and group B did not reach statistical significance. Operation time, blood loss, and transfusion volume of group B were greater than those of group A. No perioperative deaths occurred and no recurrences were registered during follow-up in both groups. The results of univariate and multivariate analysis showed that diameter was not an independent risk factor of postoperative complications and intraoperative red blood cell transfusion.Giant hemangiomas should be monitored regularly. Asymptomatic tumors 5-10 cm in diameter can be managed conservatively even though they grow. When necessary, surgical treatment can be well justified because of low morbidity and mortality.

Chemical burns may produce severe and extensive damage to the ocular surface. The authors discuss the various keratoplasties used for ocular chemical burns and the development of KPro. Contraindications to KPro are described with the procedure, the postoperative management, the outcomes, and the complications. KPro I implantation is a promising surgical modality in eyes with severe chemical burns. Good patient selection and in-depth patient follow-up have a critical impact on patient outcomes.

Skin squamous cell carcinoma (SCC) is a subtype of very aggressive skin cancers. To investigate if epithelial-mesenchymal transition (EMT), a process for epitheloid cells losing their polarity and cohesiveness and transform into spindle-shaped cells, occurs in skin SCC. By using immunofluorescence, we defined the immunolocalization of vimentin, Keratin 17, β-catenin, E-cadherin, Ki-67 and involucrin, in SCC samples. Our results show reduced activity of involucrin and E-cadherin, and increased expression of Ki-67, β-catenin, Keratin 17 and vimentin in SCC. These data propose that EMT really occurs in poorly differentiated SCC and keratin 17 and involucrin may be another two biomarkers for EMT.

The aim of this study was to investigate the sensitization, pharmacokinetics, and absorption of FK506 after corneal transplantation.New Zealand albino rabbits were divided into normal and corneal transplantation groups. Each group was divided into 5 subgroups--saline, blank matrix, high-dose, medium-dose, and low-dose, respectively. There were 10 rabbits in each subgroup. One drop (25 μL) of FK506 was administered topically to both eyes of the rabbits 4 times daily for 30 days. Thirty days later, 5 rabbits of each subgroup were sacrificed after the administration of the last dose. Both eyes were enucleated; the left eye was used for pathologic examination and the right eye for the determination of FK506 distribution. The other 5 rabbits in each subgroup were sacrificed 14 days after the former 5 rabbits were sacrificed, and their eyes were enucleated for pathologic examination and tissue distribution determination as the former 5 rabbits in each subgroup (the second batch).Fluorescein staining and local ocular reaction provided evidence that there were no significant differences between control and FK506-instilled eyes in the rabbit model at any of the tested doses. Histologic examination revealed no ocular abnormality in the rabbits instilled with any doses of FK506 eyedrop. The peak serum concentration (C(max)) of systemic absorption ranged from 4.31±0.79 ng/mL to 14.89±6.85 ng/mL.Our study suggests that up to 0.1% FK506 administered 4 times a day (q.i.d.) topically is safe for the rabbit eye. However, further safety studies are required in view of systemic adverse effects.

Tacrolimus (FK506) has been used successfully as a systemic immunomodulator for more than 2 decades, and numerous studies have investigated its mechanisms of action. Systemic and topical tacrolimus have been investigated as treatments for ocular surface disorders that may have an immune-based inflammatory component. In these studies, tacrolimus has shown efficacy in corneal graft rejection, inflammatory conjunctival and corneal diseases, uveitis, and graft-versus-host disease. As these disorders are often refractory to other available treatments, ophthalmic or systemic tacrolimus is a welcome nontoxic adjunct or replacement to potentially toxic topical or systemic immunosuppressive therapies.

Conjugated linoleic acid (CLA) has been shown to reduce body fat mass in various experimental animals. It is valuable to identify its influence on enzymes involved in energy expenditure, apoptosis, fatty acid oxidation and lipolysis. We investigated isomer-specific effects of high dose, long treatment of CLA (75.4 μmol/L, 8 days) on protein and gene expression of these enzymes in cultured 3T3-L1 cells. Proteomics identified significant up- or down-regulation of 52 proteins by either CLA isomer. Protein and gene expression of uncoupling protein (UCP) 1, UCP3, perilipin and peroxisome proliferator-activated receptor (PPAR) α increased whereas UCP2 reduced for both CLA isomers. And eight-day treatment of trans-10,cis-12 CLA, but not cis-9,trans-11 CLA, significantly up-regulated protein and mRNA levels of PKA (P

Objective To analyze the relevant literature regarding the effect of tuina on postpartum milk secretion and thus summarize the clinical rules on tuina for lactation disorder.

The aim of this study was to investigate the effect of a topical FK506 nanospheric suspension in a rat model of penetrating keratoplasty.FK506 nanospheres were prepared by using a biodegradable poly (lactic-co-glycolic acid) copolymer (PLGA). Its distribution in the eye and blood after a single instillation was examined in rabbits. Sprague-Dawley (SD) rats received corneal heterografts and were topically treated with phosphate-buffered saline (PBS), PLGA, FK-506 0.01% (nanospheres), or dexamethasone 0.05% solutions twice a day for 28 days. Rejection index and graft-survival time were recorded and compared between the four groups. Three grafts were collected at different time points for immunohistochemical studies.In the cornea, the FK-506 concentration reached its peak within 1 h of a single eye-drop instillation and then decreased by half (1667.85 +/- 611.87 ng/g) at 8 h. FK-506 cannot be detected in rabbit blood. There were significant differences in the graft-survival time between the FK-506 nanosphere group (15.09 +/- 4.81 days) and the other three groups [PBS (7.90 +/- 1.20, t = -4.594, P0.001), PLGA (8.44 +/- 0.88, t = - 4.074, P = 0.001) and dexamethasone (10.44 +/- 1.42, t = -2.790, P = 0.012)]. The rejected corneas in the FK506 nanosphere group showed significantly fewer CD4, CD8, CD68, CD79, vascular endothelial growth factor, ICAM, and tumor growth factor-beta(1)-positive cells than those in the other groups.FK506 0.01% nanospheric-suspension eye drops delayed the occurrence of corneal allograft rejection and prolonged allograft survival time. The FK506 nanospheres may be valuable in suppressing corneal graft rejection.

Irisin is a newly discovered exercise-mediated myokine which regulates energy metabolism and has been the subject of much recent research. Irisin plays an important role in metabolic diseases making it a potential new target to combat obesity and its associated disorders, such as T2DM. However, the results of several recent studies investigating the effects of irisin have been controversial. The present review will introduce the discovery of irisin, the role of irisin in metabolic disorders, possible mechanisms, and unanswered questions for future research.

Objective To determine whether ectasia after laser in situ keratomileusis (LASIK) is related to residual corneal bed thickness. Design Retrospective noncomparative case series. Participants Thirty-two eyes of 16 patients with refractive errors of −4.00 to −18.00 diopters were examined. Intervention LASIK was performed. The topography of the posterior corneal surface was examined with the Orbscan slit scanning corneal topography/pachymetry system. Main outcome measures The difference in the elevation of posterior corneal surface regarding the best-fit sphere was measured. Results After surgery, mean bulge of 17.2 ± 7.2 μm was found in eyes with residual corneal bed of 250 μm or greater, whereas 41.0 ± 22.1 μm was seen in eyes with bed thickness less than 250 μm ( t = 4.29; P = 0.000). Conclusion Posterior corneal bulge is correlated with the residual corneal bed thickness. The risk of ectasia may be increased if the residual corneal bed is thinner than 250 μm.

BACKGROUND: We evaluated the safety and efficacy of laser in situ keratomileusis (LASIK) for the correction of low to moderate amounts of myopia (-1.25 to -6.00 D). METHODS: Photorefractive keratectomy (PRK) was performed on 432 eyes and LASEK on 137 eyes with a Chiron Keracor 116 excimer laser. Uncorrected and corrected visual acuity, corneal sensitivity, contrast sensitivity, and corneal topography were examined before and after surgery. RESULTS: One-year follow-up of 307 eyes in the PRK group and 103 eyes in the LASLK group was achieved. At 1 year, 83% (85 of 103) of LASLK eyes and 72% (221 of 307) of PRK eyes had an uncorrected visual acuity of 1.0 or better. Eighty-nine percent (92 of 103) of LASLK eyes and 83% (255 of 307) of PRK eyes had a refractive error within ±1.00 D of emmetropia; 71% (73 of 103) of LASLK eyes and 61% (188 of 307) of PRK eyes were within ±0.50 D of emmetropia. Contrast sensitivity and corneal sensitivity were reduced in both groups at the early postoperative stage but gradually returned to preoperative values; their recovery took about 3 months in LASIK eyes and 6 to 12 months in PRK eyes. CONCLUSION: LASIK is safe and more predictable than PRK to correct low to moderate amounts of myopia. Recovery from LASLK is faster than after PRK. [J Refract Surg 1997;13:528-534]

We report a rare complication of recurrent corneal epithelial cell ingrowth after corneal perforation induced by laser in situ keratomileusis. A corneal flap was made uneventfully with an automatic SCMD microkeratome (Howard Instruments, Inc.). During laser ablation, instead of random burning over the stromal bed, repeated ablation at a single location occurred because of a machine malfunction, resulting in corneal perforation. The flap was replaced and sutured to prevent leakage of aqueous humor. As the cornea healed, the patient's vision was compromised by scar formation, high irregular astigmatism, and epithelial ingrowth. The flap was reopened, and the epithelial cells were removed by thoroughly scraping the flap and stromal bed. However, corneal epithelial ingrowth recurred within a week. The recurrent and progressive epithelial ingrowth further decreased vision, and penetrating keratoplasty was recommended.

Purpose To investigate the protective effects of interleukin-1 receptor antagonist (IL-1ra) gene transfer in a rat model of corneal graft rejection. Methods We constructed a recombinant plasmid (pcDNA3.1-hIL-1ra) with high IL-1ra expression in eukaryotic cells. Using a Wistar-SD rat model of corneal graft rejection, we examined the effects of IL-1ra in vivo after cationic polymer jetPEI-mediated nonviral gene delivery. Four groups were included: negative controls (group I, n = 20), pcDNA3.1-hIL-1ra corneal stromal injection (group II, n = 34), pcDNA3.1-hIL-1ra anterior chamber injection (group III, n = 34), and 500 µg/ml IL-1ra protein subconjunctiva injection (group IV, n = 20). IL-1ra expression after transfection was evaluated by real-time polymerase chain reaction (RT-PCR) and western blotting. The rejection indices of corneal grafts were analysed in the different groups. The expression levels of transforming growth factor β1 (TGF-β1), inflammatory chemokines including RANTES, interleukin-1 (IL-1) and the numbers of CD4+ and CD8+ T cells in the grafts were determined by biochemical assays at different time points after corneal transplantation. Results Various degrees of inflammatory cell infiltration and graft neovascularisation were observed by histopathology. After injecting the pcDNA3.1-hIL-1ra plasmid into the cornea, IL-1ra mRNA and protein expression was detected in the corneal stroma and reached a peak on day 3. The graft survival curves indicated that the corneal transparency rates of grafts in the IL-1ra gene-treated group and the IL-1ra protein-treated group were higher compared with the untreated group (P

Vascular endothelial growth factor (VEGF) is one of the strongest regulators of physiological and pathological angiogenesis. VEGF receptor 2 (VEGFR-2), the primary receptor for VEGF, is thought to mediate major functional effects of VEGF. Previously, we have localized both VEGF and VEGFR-2 in human hair follicles. In this study, we further defined the expression and roles of VEGFR-2 on human hair follicle dermal papilla (DP) cells. The expression of VEGFR-2 on DP cells was examined by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot analysis separately, and localization of VEGFR-2 was defined by immunofluorescence. The effect of VEGF on DP cells was analyzed by MTT assays and specific inhibitors. Finally, the role of VEGF involved in the signaling pathways was investigated by Western blot. RT-PCR and Western blot analysis demonstrated the expression of VEGFR-2 on DP cells. Immunostaining for VEGFR-2 showed strong signal on cultured human DP cells in vitro. Exogenous VEGF(165) stimulated proliferation of DP cells in a dose-dependent manner. Furthermore, this stimulation was blocked by a VEGFR-2 neutralizing antibody (MAB3571) and an ERK inhibitor (PD98059). VEGF(165)-induced phosphorylation of ERK1/2 was abolished by MAB3571 and PD98059, while the phosphorylation of p38, JNK and AKT were not changed by VEGF(165). Taken together, VEGFR-2 is expressed on primary human hair follicle DP cells and VEGF induces proliferation of DP cells through VEGFR-2/ERK pathway, but not p38, JNK or AKT signaling.

To evaluate the feasibility, efficacy and postoperative complications of Descemet stripping endothelial keratoplasty (DSEK) with paediatric donor tissue.Retrospective non-comparative interventional case series. Seven consecutive cases (seven eyes) of pseudophakic bullous keratopathy were treated with DSEK using paediatric donor tissue and followed up for 12 to 18 months. Data collected included best spectacle-corrected visual acuity, spherical equivalent refractive error, corneal astigmatism, corneal curvature and endothelial cell density.DSEK was successfully performed in six out of seven eyes with paediatric donor graft; one paediatric donor graft perforated during dissection. All paediatric tissue was unfolded using the "hitch suture" technique and supported with plenty of air. No graft dislocation occurred. At 12 months postoperatively, the cornea was clear in all eyes; the best spectacle-corrected visual acuity ranged from 20/67 to 20/32; the average spherical equivalent refractive error was 1.9 (0.5) dioptres; the average corneal astigmatism was 2.2 (0.6) dioptres; the average corneal curvature was 45.2 (1.6) dioptres; and the average endothelial cell density was 2247.7 (74.3) cells/mm(2) (41.4 (3.7)% of endothelial cell loss).With high postoperative endothelial cell counts, low graft dislocation rate and absence of high myopic shifts, paediatric donor tissue can be successfully used in DSEK.

Severe cicatricial entropion is a serious condition, which may threaten the vision of the affected patient. To date, surgical repair of this condition has been difficult and associated with a high degree of failure. From February 2005 to February 2006, a prospective cohort study was conducted in which 14 patients with severe cicatricial entropion were recruited. Lengthening of the posterior lamella of the eyelid with acellular dermis allograft (ReDerm, Jieya company, Beijing, PR China) was performed followed by use of therapeutic contact lenses at the end of surgery. The patients were followed up regularly and were assessed for structural integrity, upper marginal reflex distance (U-MRD), vertical palpebral aperture, and lagophthalmos. The mean follow-up time was 18 months. Acellular dermis was effective in reducing the palpebral aperture (P = 0.002), lagophthalmos (P = 0.016), and lengthening the upper eyelid height by reducing U-MRD (P = 0.008). However, there were 2 cases of recurrence because of the shrinkage of graft (70%) and 3 cases of conjunctival granulomas postoperatively. Final outcome was good in 14 of 16 eyelids. We have found that acellular dermis grafting with insertion of therapeutic contact lenses is an effective and simple measure for rectifying severe cicatricial entropion both structurally and functionally.

PURPOSE To determine the efficacy and postoperative complications of complex deep lamellar endothelial keratoplasty (DLEK) when used for the management of complex bullous keratopathy with severe vision loss. METHODS Twelve consecutive eyes with severe bullous keratopathy and other associated intraocular abnormalities underwent complex DLEK which was combined with other intraocular surgeries such as vitrectomy, intraocular lens removal, and secondary intraocular lens implantation. An air bubble was used in 9 eyes and an air and C3F8 gas bubble in 3 eyes for tissue support. Prospective data of best spectacle-corrected visual acuity, corneal astigmatism, and curvature were collected on all 12 eyes preoperatively and at 6, 9, and 12 months postoperatively. Average donor endothelial cell density was recorded preoperatively and at 9 months postoperatively. RESULTS Preoperatively, severe visual loss was recorded at hand motions (n = 3), count fingers (n = 7), and 20/400 (n = 2). Best spectacle-corrected visual acuity improved in 83% of eyes with vision of 20/67 or better in 42% (5/12) and 20/100 or better in 66% (8/12) of eyes at 12 months postoperatively. Vision was not improved in three eyes due to coexistent retinal disease. Four aphakic eyes underwent secondary intraocular lens implantation later at 4-6 months after DLEK, and best spectacle-corrected visual acuity was increased from count fingers to 20/200 or better. At 12 months postoperatively, average corneal astigmatism and curvature were 2.3 +/- 0.5 diopters and 44.0 +/- 0.9 diopters, respectively. Average central corneal thickness at 12 months postoperatively (541.3 +/- 26.7 microm) was significantly thinner than that before surgery (673.8 +/- 77.5 microm, P < 0.01). Preoperative average donor endothelial cell density was 2685.1 +/- 193.9 cells/mm. At 9 months postoperatively, average endothelial cell density was 1920.1 +/- 94.0 cells/mm (27.3% of endothelial cell loss) in eyes with primary surgery and 1866.3 +/- 92.8 cells/mm (33.9% of endothelial cell loss) in eyes with secondary surgery. Postoperative complications usually occurred within 3 months of surgery. After surgery, 3 eyes showed narrow gaps between the border of the graft and the host. Epithelial bullae in these areas recurred in 2 eyes but disappeared within 3 months. There was one graft dislocation in this series, no pupillary block cases, and no primary graft failures. CONCLUSIONS In cases of complex bullous keratopathy with severe vision loss, DLEK combined with other intraocular surgeries is a feasible and effective procedure to significantly improve visual acuity to a functional level in most patients. DLEK can be used successfully in eyes with aphakia and other anterior segment abnormalities without a high risk of graft dislocation or failure. Mild postoperative complications usually occurred early after DLEK and did not affect visual outcomes and graft survival if managed appropriately.

To study the changes of tear film after recovery from acute conjunctivitis.This study involved 73 eyes of 56 consecutive patients who complained of dry eye after recovery from acute conjunctivitis at the Zhongshan Ophthalmic Center. Excluded were other factors that could affect the stability of the tear film. Tear film breakup time (BUT), Schirmer 1 test (S1T), tear meniscus height (TMH), and fluorescein staining (FL) were performed on both recovered and healthy eyes. The scores were measured at 3, 7, 14, 21, and 30 days after recovery.Compared with the results of the healthy eyes, most scores of BUT, S1T, TMH, and FL were all abnormal until day 30 after recovery from acute conjunctivitis. BUT decreased at 3, 7, 14, and 21 days (P0.05). S1T decreased at 3, 7, and 21 days (P0.05). TMH values became less than normal at 3, 7, and 14 days (P0.05). FL increased significantly at 7, 14, and 21 days (P0.05). At 30 days after recovery, all of the test scores returned to normal (P0.05).During acute conjunctivitis, inflammation and topical therapeutic agents can alter the tear film secretion, resulting in dry eye for nearly 1 month in recovered eyes. To minimize the effect of topical agents to the tear film, individualized treatment instead of frequent instillation of topical agents is recommended for acute conjunctivitis.

Cicatricial entropion with trichiasis can be a challenging problem to manage. This condition is caused by scarring of the tarsus and the inward rotation or the defect of the lid margin. A variety of biological materials have been used to reconstruct the disfigured lid margin. Tarsal wedge resection and modified grey line splitting with acellular human dermal allograft insertion by 10/0 nylon sutures passing through the eyelid margin allow for correction of the cicatricial entropion while providing a reconstructed lid margin. This technique produces satisfying cosmetic and functional results when used to treat mild to moderate cicatricial entropion with lid margin distortion.