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Jiang X, Ju S, Chen B, Jiang J, Shi Y, Ma T, Lin C, Xu X, Fu W, Dong Z. Safety and Effectiveness of Excimer Laser Ablation Combined With Drug-Coated Balloon for Atherosclerotic Obliterans in the Lower Extremity. J Endovasc Ther 2023; 30:721-729. [PMID: 35514287 DOI: 10.1177/15266028221092979] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the safety and effectiveness of excimer laser ablation (ELA) combined with drug-coated balloon (DCB) for atherosclerotic obliterans (ASO) of the lower extremities. MATERIALS AND METHODS From June 2019 to December 2020, all eligible patients were enrolled. Demographics, characteristics of lesions, complications, and follow-up information were collected and analyzed. The primary endpoint was major amputation-free survival (MAFS). Secondary endpoints included technical success, primary patency, bailout stent, distal embolization, target lesion reintervention (TLR), and ulcer healing rate. Major amputation-free survival and primary patency were calculated by Kaplan-Meier analysis. RESULTS A total of 71 patients were enrolled. Forty-eight (81.7%) patients presented critical limb ischemia (CLI) and 48.6% of them was calcification class 4 according to Peripheral Arterial Calcium Scoring System (PACSS). Chronic totally occluded (CTO) disease was the most common lesion in 66.0% of them and superficial femoral artery (SFA) was the most common segment in 59.6%. Technical success rate was 93.0%. One-year follow-up was finished in 25 (35.2%) patients. The primary patency and MAFS were 92.0%±27.6% and 96.0%±20.0% at 12 months, respectively. During the mean follow-up of 9.4±4.3 months, clinically-driven TLR occurred in 2 (2.8%) patients, and major and minor amputation occurred in 2 (2.8%) and 1 (1.4%) patient, respectively. CONCLUSION The early results demonstrated that ELA was an effective treatment in de novo, in-stent restenosis (ISR) and CTO lesions. Meanwhile, ELA could prepare the lumen for the use of DCB and reduce the implantation of stents, especially in segments unsuitable for stenting. Mid-term and long-term results need to be awaited.
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Affiliation(s)
- Xiaolang Jiang
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shuai Ju
- Department of Vascular and Wound Treatment Center, Jinshan Hospital, Fudan University, Shanghai, China
| | - Bin Chen
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junhao Jiang
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yun Shi
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tao Ma
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Changpo Lin
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xin Xu
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weiguo Fu
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhihui Dong
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Verma S, Hesser J, Mosquera SA. Cross Sectional Analysis of Impact of Seasonal Changes on Excimer Laser Ablation Performance on Polymethyl Methacrylate (PMMA). Vision (Basel) 2023; 7:50. [PMID: 37489329 PMCID: PMC10366815 DOI: 10.3390/vision7030050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/30/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023] Open
Abstract
Seasonal changes and varying degree of corneal hydration has been linked to excimer laser corneal ablation rates. The use of PMMA as a calibration material in refractive lasers is well established. However, PMMA ablation may be equally affected by seasonal variations in temperature and humidity, in turn affecting the calibration process. The aim of this work is to analyze the effect of seasonal changes in PMMA performance using SCHWIND AMARIS laser system. PET and PMMA ablations conducted in climate-controlled environment with 826 consecutive AMARIS systems manufactured over 6 years were retrospectively analyzed. Lasers were stratified depending on seasons and months of the year. Metrics like single laser pulse fluence, nominal number of laser pulses, mean performance, standard deviation, and technical performance of system were compared to global average values. Cyclic winter-summer variation was confirmed with seasons winter and summer showing statistically significant variations with respect to global values. Metric technical performance showed deeper PMMA ablation performance in summertime, with maximum seasonal deviation of 6%. Results were consistently confirmed in seasonal as well as monthly analyses. These findings could help minimize variance among laser systems by implementing compensation factors depending on seasons such that laser systems installed worldwide follow the same trend line of variation.
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Affiliation(s)
- Shwetabh Verma
- Biomedical Engineering Office, Research and Development, SCHWIND Eye-Tech-Solutions, 63801 Kleinostheim, Germany
| | - Juergen Hesser
- Interdisciplinary Center for Scientific Computing (IWR), Heidelberg University, 69117 Heidelberg, Germany
- Mannheim Institute for Intelligent Systems in Medicine (MIISM), Heidelberg University, 69117 Heidelberg, Germany
- Central Institute for Computer Engineering (ZITI), Heidelberg University, 69117 Heidelberg, Germany
- CZS Heidelberg Center for Model-Based AI, Heidelberg University, 69117 Heidelberg, Germany
| | - Samuel Arba Mosquera
- Biomedical Engineering Office, Research and Development, SCHWIND Eye-Tech-Solutions, 63801 Kleinostheim, Germany
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Oganesyan OG, Ashikova PM, Ivanova AV, Letnikova KB. [Transplantation of the Bowman's layer in combined treatment of recurrent pterygium]. Vestn Oftalmol 2023; 139:90-97. [PMID: 37379114 DOI: 10.17116/oftalma202313903190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Pterygium is among the most frequent indications for extraocular ophthalmic surgery. The main method of pterygium treatment - its excision - is often combined with transplantation, non-transplantation, medication and other methods. However, the frequency of pterygium recurrence can exceed 35%, and the cosmetic and refraction outcomes satisfy neither the patient, nor the surgeon. PURPOSE The study analyses the technical capability and feasibility for transplantation of the Bowman's layer in the treatment of recurrent pterygium. MATERIAL AND METHODS The transplantation of the Bowmen's layer was performed according to the developed technique on 7 eyes with recurrent pterygium (7 patients aged 34 to 63 years). The combined surgery technique consisted of pterygium resection, laser ablation, autoconjunctival plasty, exposure to a cytostatic drug, non-suture transplantation of the Bowman's layer. Maximum length of the follow-up was 36 months. Analysis involved data from refractometry, visometry (without correction and with spectacle correction), and optical coherence tomography of the retina. RESULTS There were no complications in any of the studied cases. The cornea and the transplant retained transparency throughout the entire follow-up duration. 36 months after surgery mean spectacle-corrected visual acuity amounted to 0.86±0.2, topographic astigmatism - 1.48±1.4 diopters. Recurrence of pterygium was not observed. All patients were satisfied with the cosmetic outcomes of the treatment. CONCLUSION Non-suture transplantation of the Bowmen's layer recovers normal anatomy, physiology and transparency of the cornea after repeat surgical intervention for pterygium. No pterygium recurrences were observed throughout the entire follow-up after treatment with the proposed combined technique.
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Affiliation(s)
- O G Oganesyan
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - P M Ashikova
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - A V Ivanova
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - K B Letnikova
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
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Napolitano R, Tonti E, Cifariello F, Sabater-Cruz N, Spadea L. Improving keratoconus management with central cor neal regularization and corneal collagen cross-linking protocol treatment. Clin Ter 2022; 173:274-279. [PMID: 35612343 DOI: 10.7417/ct.2022.2431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE To evaluate safety and efficacy of customized central corneal regularization (CCR), together with simultaneous accelerated corneal collagen cross-linking (A-CXL) - CCR-CXL protocol, to treat keratoconus-related corneal ectasia. DESIGN Retrospective, comparative observational case series. METHODS Patients that had undergone combined CCR-CXL protocol. Main inclusion criteria were keratoconus visual acuity deterioration and contact lens intolerance. All patients underwent complete ophthalmological evaluation, corrected distance visual acuity (CDVA) and Scheimpflug-corneal tomography. Central corneal regularization was performed by ablation using flying spot laser. Subsequently, the stroma was saturated with 0.17% riboflavin-5-phosphate added every 2 minutes, followed by A-CXL 9 mW/cm2 for 10 minutes. CDVA, medium keratometry value (Kmed), and total corneal morphological irregularity index (CMI) of patients were analyzed before surgery and after 1, 3 and 12 months. A P value of .05 or less was considered statistically significant. RESULTS 46 eyes of 39 keratoconus patients were treated. At 1 month, the mean CDVA (LogMar) increased from 0.19 ± 0.02 to 0.12 ± 0.02 (P < .05), and the difference remained stable at month 12. Kmax decrease was statistically significant from 57.02 ± 5.65 to 50.21 ± 4.48 (P < .05). CMI decreased significantly from 47.8 ± 2.84 to 30.1 ± 2.4 (P < .01). CONCLUSIONS CCR-CXL protocol is safe and effective in arresting keratectasia progression and increasing corneal optic regularity in keratoconus. These findings showed a significant improvement in CDVA, keratometry values and corneal optical aberrations after being treated with the CCR-CXL protocol.
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Affiliation(s)
- R Napolitano
- Eye Clinic, Policlinico Umberto 1, "Sapienza" University of Rome, Italy
| | - E Tonti
- Eye Clinic, Policlinico Umberto 1, "Sapienza" University of Rome, Italy
| | | | | | - L Spadea
- Eye Clinic, Policlinico Umberto 1, "Sapienza" University of Rome, Italy
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Wu X, Wang Z, Li T. The combination of excimer laser ablation and drug eluting balloon for treating superficial femoral arterial occlusion following stent implantation: A case report. Medicine (Baltimore) 2020; 99:e22935. [PMID: 33120851 PMCID: PMC7581093 DOI: 10.1097/md.0000000000022935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Recent research shows that in-stent restenosis (ISR) occurs in half of the patients treated with stenting of femoral and popliteal artery for lower extremity arteriosclerotic occlusive disease (LEASO). Combined therapy is mainly used clinically to obtain better medium- and long-term treatment outcomes and reduce the occurrences of reintervention, among which, the combination of excimer laser ablation (ELA) and drug eluting balloon (DEB) is a new and effective choice. PATIENT CONCERNS A 76-year-old male patient with ISR of right superficial femoral artery after stent implantation was reported. DIAGNOSIS Rechecking angiography indicated severe occlusion of the right superficial femoral artery. The physical examination showed that bilateral femoral and popliteal arteries were accessible whereas right dorsalis and posterior tibial arteries are unaccessible. Ankleolus brachial index (ABI) was 0.92 for left and 0.58 for right. INTERVENTIONS We performed the operation with ELA and drug balloon DEB on the right superficial femoral artery under local anesthesia and treated with oral antiplatelet drugs after operation. OUTCOMES The combination treatment was very successful, and postoperative lower extremity arteriogram showed the blood flow was fluent and fast. No recurrence was discovered 3 months after the operation and he had no obvious symptom of claudication. LESSONS The combination of ELA and DEB is useful and effective for ISR of peripheral vessel after stent implantation, and this surgical method is worthwhile but need further clinical research for safety confirmation.
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Affiliation(s)
- Xueliang Wu
- Department of Vascular and Glandular Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou
| | - Zhao Wang
- Department of General Surgery, Xingtai People's Hospital, Xingtai
| | - Tian Li
- Department of Vascular and Glandular Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou
- School of Basic Medicine, The Fourth Military Medical University, Xi’an, China
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Verma S, Kehrer T, Hesser J, Arba Mosquera S. Analysis of Impact of Humidity and Temperature on Excimer Laser Ablation of Polyethylene Terephthalate, Polymethylmethacrylate, and Porcine Corneal Tissue. Lasers Surg Med 2019; 52:627-638. [PMID: 31758590 DOI: 10.1002/lsm.23190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES To analyze the impact of humidity and temperature on excimer laser ablation of polyethylene terephthalate (PET), polymethylmethacrylate (PMMA) and porcine corneal tissue, and an ablation model to compensate for the temperature and humidity changes on ablation efficiency. STUDY DESIGN/MATERIALS AND METHODS The study was conducted using an AMARIS 1050RS (Schwind eye-tech-solutions) placed inside a climate chamber at ACTS. Ablations were performed on PET, PMMA, and porcine cornea. The impact of a wide range of temperature (~18°C to ~30°C) and relative humidity (~25% to ~80%) on laser ablation outcomes was tested using nine climate test settings. For porcine eyes, change in defocus was calculated from the difference of post-ablation to pre-ablation average keratometry readings. Laser scanning deflectometry was performed to measure refractive change achieved in PMMA. Multiple linear regression was performed using the least square method with predictive factors: temperature, relative humidity, time stamp. Influence of climate settings was modeled for pulse energy, pulse fluence, ablation efficiency on PMMA and porcine cornea tissue. RESULTS Temperature changes did not affect laser pulse energy, pulse fluence (PET), and ablation efficiency (on PMMA or porcine corneal tissue) significantly. Changes in relative humidity were critical and significantly affected laser pulse energy, high fluence and low fluence. The opposite trend was observed between the ablation performance on PMMA and porcine cornea. CONCLUSIONS The proposed well-fitting multi-linear model can be utilized for compensation of temperature and humidity changes on ablation efficiency. Based on this model, a working window for optimum operation has been found (temperature 18°C to 28°C and relative humidity 25% to 65%) for a maximum deviation of ±2.5% in ablation efficiency in PMMA and porcine corneal tissue. Lasers Surg. Med. © 2019 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Shwetabh Verma
- Biomedical Engineering Office, Research and Development, SCHWIND eye-tech-solutions, Kleinostheim, D-63801, Germany.,Experimental Radiation Oncology, University Medical Center Mannheim, Heidelberg University, Mannheim, D-68167, Germany.,Interdisciplinary Center for Scientific Computing (IWR), Heidelberg University, Heidelberg, 69120, Germany.,Central Institute for Computer Engineering (ZITI), Heidelberg University, Heidelberg, 69120, Germany
| | - Tobias Kehrer
- Department of Theoretical Physics III, University of Würzburg, Würzburg, 97074, Germany
| | - Jürgen Hesser
- Experimental Radiation Oncology, University Medical Center Mannheim, Heidelberg University, Mannheim, D-68167, Germany.,Interdisciplinary Center for Scientific Computing (IWR), Heidelberg University, Heidelberg, 69120, Germany.,Central Institute for Computer Engineering (ZITI), Heidelberg University, Heidelberg, 69120, Germany
| | - Samuel Arba Mosquera
- Biomedical Engineering Office, Research and Development, SCHWIND eye-tech-solutions, Kleinostheim, D-63801, Germany
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