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Purpose: To determine intraoperative changes in corneal thickness and outcomes of corneal collagen crosslinking (CXL) using 2 intraoperative regimens: riboflavin-dextran or hypotonic riboflavin., Setting: Cornea and refractive surgery practice, Teaneck, New Jersey, USA., Design: Prospective randomized case series., Methods: Eyes with keratoconus or corneal ectasia were treated. All eyes received preloading with riboflavin 0.1% in 20% dextran. During ultraviolet-A (UVA) exposure, patients were randomly assigned to 1 of 2 study arms; that is, riboflavin-dextran or hypotonic riboflavin. Intraoperative pachymetry was measured before and after the corneal epithelium was removed, after initial riboflavin loading, and after UVA light exposure. Patients were evaluated for maximum keratometry (K), uncorrected distance visual acuity (UDVA), corrected distance visual acuity, corneal thickness, and endothelial cell count (ECC)., Results: Forty-eight eyes were treated. After removal of the epithelium and riboflavin loading, the mean pachymetry was 430 μm and 432 μm in the standard group and hypotonic group, respectively. Immediately after 30-minute UVA administration, the mean pachymetry was 302 μm and 342 μm, respectively. There was no statistically significant difference in the postoperative maximum K change, UDVA, corneal thickness, or ECC between the 2 groups., Conclusions: The cornea thinned substantially during the CXL procedure. The use of hypotonic riboflavin rather than riboflavin-dextran during UVA administration decreased the amount of corneal thinning during the procedure by 30%, from 128 μm to 90 μm. However, there were no significant differences in clinical efficacy or changes in ECC or function between groups postoperatively. In general, corneal thinning during CXL did not seem to compromise the safety of the endothelium., Financial Disclosures: Dr. Hersh is a consultant to Avedro, Inc. Dr. Rosenblat has no financial or proprietary interest in any material or method mentioned., (Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

One of the problems of percutaneous transluminal coronary angioplasty is acute occlusion during the procedure, the main cause of serious complications and emergency coronary bypass surgery. Acute occlusion is generally related to severe intimal dissection and/or thrombosis. In animal experiments, it is possible to treat intimal dissection and dessicate thrombi by balloon laser angioplasty. Using this method, a programmed laser energy may be delivered to the arterial wall via a fiber optic system linked to a Nd:Yag laser during classical balloon inflation. This has been proposed for the treatment of acute coronary occlusion. Between September 1989 and August 1990, 923 patients underwent coronary angioplasty at the Centre Cardiologique du Nord. Peroperative acute occlusions occurred 52 times (3.9%) in 52 patients. Sixteen patients who were "candidates" for emergency coronary bypass surgery (residual stenosis > or = 75%; delayed flow; myocardial ischaemia) were treated by laser balloon angioplasty, 14 with success (87%). Two patients had to be operated as an emergency. There were no hospital deaths. The average follow-up was 4.7 months for the 14 non-operated patients. Systematic control coronary angiography was refused by 2 asymptomatic patients. In the other 12 patients investigated 1 to 17 months after the procedure, there were 10 restenoses (76%), 6 of which were treated by repeat angioplasty and 3 by coronary bypass surgery. These results show that balloon laser angioplasty is very effective in the treatment of peroperative acute occlusions, enabling emergency coronary bypass surgery to be avoided in 87% of cases, but it is associated with a very high restenosis rate which is difficult to accept.

Recurrent angina with reversible ECG changes within days of a myocardial infarction is a serious clinical entity associated with a high incidence of reinfarction and death. In this study, we report a one-year experience of the treatment and outcome of patients presenting early post-myocardial infarction angina. Out of 32 patients who underwent coronary angiography, 3 were treated medically, 4 were operated upon and 25 had coronary angioplasty at the same time as coronary angiography with a 100 p. 100 immediate success rate. Four early reocclusions were redilated successfully. While in hospital 3 of these 32 patients had myocardial infarct extension (very moderate in 2 cases with CPK less than 500 and a patent artery), and there was no death. During an 8-month follow-up period there were 3 late deaths and 2 reinfarctions; 4 patients were operated upon and 4 were redilated. Thus, angioplasty has a high success rate in early post-myocardial infarction angina, enabling most patients to get through an unstable phase. In some patients, however, the course of the disease is marred by secondary adverse events.