Rupture of 40-year-old silicone gel breast implants: a case report.

BACKGROUND: Implant rupture is one of the complications of breast augmentation surgery. The rupture of silicone implants is often insidious, potentially causing problems at any time. This is a case report of the rupture of 145-cc breast implants manufactured by Dow Corning Corporation and their removal at 40 years after augmentation. CASE PRESENTATION: A 70-year-old female patient was admitted for the removal of a lump in the upper and inner quadrants of the right breast. After a detailed examination, a rupture of the bilateral breast implants was diagnosed. Explantation without replacement was performed; the entire procedure proceeded smoothly. Immunohistochemical staining revealed siliconoma with lymphoid hyperplasia and calcification in the bilateral breasts with no signs of malignancy. CONCLUSIONS: Silicone breast augmentation is one of the most popular aesthetic surgical procedures worldwide. Therefore, it is important to educate patients on the need for close monitoring of their implants after augmentation through magnetic resonance imaging or ultrasound to facilitate early detection of any changes before a rupture occurs. Early detection of the implant rupture, in turn, will facilitate early and effective management.

Genetic polymorphisms of apolipoprotein E in nonarteritic anterior ischemic optic neuropathy.

PURPOSE: To elucidate the potential role of genetic polymorphisms of apolipoprotein E (APOE) in nonarteritic anterior ischemic optic neuropathy (NAION) and the association between APOE and NAION-induced ocular impairments. METHODS: A total of 73 NAION patients and 73 sex- and age-matched healthy controls were recruited for the study. Genomic DNA was isolated from peripheral blood samples. The alleles and genotypes of APOE were explored. The interaction between APOE and medical comorbidities was assessed by the multifactor dimensionality reduction (MDR) method. Among 81 affected eyes of NAION patients, an additional association study of APOE isoforms with visual impairments was carried out. RESULTS: The allele and genotype frequencies for APOE showed significant differences when comparing NAION cases and controls. Multivariate analysis adjusted for age, sex, hypertension, dyslipidemia, diabetes mellitus, cardiovascular disease, and cerebrovascular disease revealed that the ε3/ε4 genotype (OR = 3.86, 95% CI = 1.13-13.25, p = 0.032) and ε4 allele (OR = 3.55, 95% CI = 1.05-11.99, p = 0.041) were strong independent risk factors for NAION. Compared to eyes with the ε3/ε3 + ε2/ε4 genotype, individuals with the ε4/ε4 + ε3/ε4 genotype had worse visual field defects (VFDs) and thinner macular ganglion cell complex (mGCC) thicknesses with larger focal loss of volume (FLV) and general loss of volume (GLV). Compared to ε4 noncarriers, ε4 carriers also tended to have more serious VFD and mGCC loss. CONCLUSIONS: APOE polymorphisms conferred a significant risk of NAION and were significantly related to ocular impairments caused by NAION.

Early Retinal Microcirculation in Nonfunctioning Pituitary Adenomas Without Visual Field Defects Using Optical Coherence Tomography Angiography.

BACKGROUND: For patients with nonfunctioning pituitary adenoma (NFPA) without manifesting visual acuity impairment or visual field defect (VFD), more sensitive and objective assessment methods will allow earlier detection before irreversible damage to the visual system. This study aimed to evaluate retinal vessel densities (VDs) alterations in these patients using optical coherence tomography angiography and to determine its diagnostic abilities. METHODS: Between patients with NFPA without VFDs and age-matched, sex-matched healthy control individuals, comparisons of visual field metrics, retinal structural thickness, and microcirculation were conducted after adjusting for axial length (AL) and signal index of scans. Receiver operating characteristic (ROC) curves were further depicted to assess the diagnostic performance of significant parameters. To explore the impact of symptom duration, tumor size, and axial length on the significant parameters, multivariate regression analysis was conducted. RESULTS: This cross-sectional study reviewed 107 patients with NFPA. Twenty-seven eyes of patients with NFPA without VFDs and 27 eyes of healthy controls were enrolled. Compared with healthy controls, patients with NFPA without VFDs had similar foveal avascular zone areas and perimeters, macular ganglion cell complex (mGCC) and peripapillary retinal nerve fiber layer thicknesses, and macular VDs. Only the VD in the radial peripapillary capillary (RPC) segment of the inferior temporal (IT) sector was much lower in the patient group. The 2 largest area under the ROC curves were the focal loss volume (FLV) of the mGCC and the VD in the RPC of the IT sector, both of which were significantly related to symptom duration and tumor size. CONCLUSIONS: At the early stage of NFPA before VFD and retinal thickness thinning, fundus microcirculation impairments may occur initially in the microvascular density of the RPC segment of the IT sector. The FLV and the VD of RPC at the IT sector may provide a basis for the early diagnosis of NFPA without VFD in clinical practice.

Is 3-Dimensional Scanning Really Helpful in Implant-Based Breast Reconstruction?: A Prospective Study.

BACKGROUND: Breast reconstruction is an integral part of breast cancer treatment, and implant-based breast reconstruction is the most commonly used method worldwide. However, there is still no technique that allows surgeons to predict the volume of the required implant. Although computed tomography and magnetic resonance imaging provide adequate representations of the breast, these procedures are time-consuming, expensive, and expose patients to radiation. Therefore, there is a need for safer, noninvasive alternatives for preoperative breast volume measurements. PATIENTS AND METHODS: This study is a prospective review of 12 patients with early-stage breast cancer who underwent nipple-sparing mastectomy and immediate breast reconstruction with implants. Preoperatively, the Artec Eva 3D scanner was used to acquire volumetric measurements of the breasts. Intraoperatively, the volume of the mastectomy specimen was measured using the water displacement method. Correlations among the preoperative breast, mastectomy specimen, and estimated and final implant volumes were analyzed through Pearson correlation coefficient. A correction prediction factor of 85% was applied where necessary. Patient and physician satisfaction were evaluated 3 months postoperatively. RESULTS: Our study found a statistically significant correlation between the preoperative breast volumes measured by the Artec Eva 3D scanner and intraoperative mastectomy specimen volumes (r = 0.6578). There was no correlation between the preoperative breast volumes and final implant volumes, mastectomy specimen volumes and final implant volumes, and estimated implant volumes and final implant volumes. CONCLUSIONS: Although the Artec Eva 3D scanner can offer relatively accurate measurement of breast volumes, multiple studies still need to be done to determine how these data can be applied to the mastectomy procedure and breast implant selection. It may be more applicable for preoperative planning in breast augmentation surgery. Future surgeons should also take into account that variabilities in natural breast size, tumor size, cancer stage, and in patient and physician preferences all influence the outcome of breast reconstruction surgery.

Modified Simultaneous Double Eyelid Blepharoplasty and Ptosis Correction With a Single-Knot, Continuous, Nonincisional Technique.

BACKGROUND: "Double eyelid" blepharoplasty is one of the most common cosmetic operations among Asian populations. Some patients might present with concomitant mild to moderate blepharoptosis, even though they choose initially to undergo blepharoplasty for cosmetic reasons. OBJECTIVE: Using nonincisional double eyelid surgery without ptosis correction tends to produce unsatisfactory results. We introduce our modified suture method for the simultaneous correction of blepharoptosis during double eyelid blepharoplasty. MATERIALS AND METHODS: We carried out a retrospective review on 13 patients who underwent simultaneous nonincisional ptosis correction and double eyelid surgery, using a single-knot continuous technique, from January 2017 to December 2019. A superior tarsal (Müller's) muscle tagging suture was utilized to achieve an accurate tucking during surgery and create a double upper lid fold simultaneously. RESULTS: The mean patient age was 31.8 years (range=23-54), and 9 patients (69%) were female. The mean marginal reflex distance 1 increased from 2.46±0.36 mm preoperatively to 4.07±0.61 mm postoperatively with a statistically significant difference. Most patients showed favorable results with an average of 10.8 months of follow-up and minimal complications. CONCLUSIONS: This simultaneous double eyelid blepharoplasty technique using a single-knot, continuous, nonincisional technique is relatively easy and effective, with minimal downtime and few postoperative complications, and avoids scarring for patients with mild to moderate blepharoptosis.

Severe burn injury from the common Asian practice of heat application in patients with diabetic neuropathy.

This was the first study to analyse patients who sustained severe self-induced burns from this common Asian practice. There is a need to raise public awareness and physician attention about the consequences of preventable burn injuries and the importance of first aid in patients with diabetic neuropathy. Retrospective data on 16 consecutive patients who had diabetes and neuropathy admitted to the plastic surgery ward at the Tri-Service General Hospital from January 1, 2015, to February 2, 2021 with burn injuries because of heat applications were collected and analysed for this study. Age, gender, season, first aid adequacy, comorbidity, interventions, total body surface area (TBSA), degree of burn, aetiology, length of stay (LOS), and status at discharge were reviewed. The mean age of the 16 patients was 65.13 years. The most common burn aetiology was contact (50%), followed by scald (37.5%) and radiation burns (12.5%). TBSA burn averaged ± standard deviation 1.54 ± 1.22. Seven patients (44%) had wound infections, and three patients underwent amputations. The average LOS was 28.2 days. Asian practice of heat application is the common aetiology of severe and preventable burn injuries. Education about neuropathy and the consequences of a burn injury should be provided to patients with diabetes.

Risk factors that predict major amputations and amputation time intervals for hospitalised diabetic patients with foot complications.

Diabetes-related lower extremity amputations are an enormous burden on global health care and social resources because of the rapid worldwide growth of the diabetic population. This research aimed to determine risk factors that predict major amputation and analyse the time interval from first hospitalisation to amputation by using standard management protocols and Kaplan-Meier survival curves. Data from 246 patients with diabetes mellitus and diabetic foot ulcers from the Division of Plastic and Reconstructive Surgery of the Department of Surgery at XXX Hospital between January 2016 and May 2020 were analysed. Univariate and multivariate analyses of 44 potential risk factors, including invasive ulcer depth and C-reactive protein levels, showed statistically significant differences for those at increased risk for major amputation. The median time from hospitalisation to lower extremity amputation was approximately 35 days. Most patients with abnormal C-reactive protein levels and approximately 70% of patients with ulcers invading the bone were at risk for lower extremity amputations within 35 days. Therefore, invasive ulcer depth and C-reactive protein levels are significant risk factors. Other potential risk factors for major amputation and the time intervals from first hospitalisation to amputation should be analysed to establish further prediction strategies.

Negative Pressure Wound Therapy in Conjunction With Artificial Dermis for Burned Hand Reconstruction.

INTRODUCTION: Proper wound care along with the use of skin grafts over deep burn wounds has been the standard treatment. However, the goal in burn wound care has shifted from achieving a satisfactory survival rate to improving long-term form and function of the healed wound, which is sometimes hindered by scar contracture. This has prompted surgeons to find alternative ways to treat burn wounds without compromising function. Among burn cases, hand injuries are the most problematic when it comes to delicate function recovery. METHODS: This study presents the results of conjunctive use of a bilayer artificial dermis, negative pressure wound therapy, and split-thickness skin grafts for grafting over acute burn wounds and scar-releasing defects after severe hand burns. RESULTS: Three months after the operation, the scar was soft and pliable, the aesthetic outcome was good, and the patients gained much improvement in hand function and quality oflife. CONCLUSIONS: The combined technique achieved a good scar quality and aesthetic effect on burned hands as well as excellent functional outcome, which resulted in major improvements and an independent life for the patient.

Clinical efficacy of optical coherence tomography in sellar mass lesions: a meta-analysis.

PURPOSE: Although optical coherence tomography (OCT) of the eyes has been studied to detect and monitor sellar masses, there is no recommendation for selecting the most effective measurement of OCT in clinical practice. Thus, we conducted a meta-analysis to examine the efficacy of OCT in sellar mass lesions. METHODS: We conducted a literature search in PubMed and EMBASE through April 26, 2020. The primary outcomes were the thickness of the peripapillary retinal nerve fiber layer (pRNFL) and the macular ganglion cell complex (mGCC). The secondary outcomes included the thickness of the macular ganglion cell and inner plexiform layer (mGCIPL) and macular thickness. Random-effects models were used in all meta-analyses. Additionally, we conducted meta-regressions and subgroup analyses. RESULTS: We included 22 studies, involving 1347 eyes of patients and 1198 eyes of controls. When compared with the control group, the reductions in pRNFL, mGCC and macular thickness in the patient group were significantly different, whereas significant thinning of the mGCIPL was restricted to the nasal hemiretina. Furthermore, we found that before visual field (VF) defects occurred, significant thinning of the pRNFL and mGCC thickness could be detected by OCT. The change in OCT parameters also showed different patterns in different types of pituitary adenomas. CONCLUSIONS: Sellar mass lesions were associated with the changes in OCT measurements. The characteristic patterns of the OCT parameters may refine the diagnostic accuracy. Moreover, the alterations of OCT metrics before VF defects indicate the efficacy of OCT in early detection. Different types of pituitary adenomas may vary in OCT measurements, and their specific features warrant further research efforts.

Efficacy of intracameral preservative-free triamcinolone acetonide in pediatric cataract surgery: a meta-analysis.

PURPOSE: The aim of this study is to evaluate the efficacy of intracameral preservative-free triamcinolone acetonide (TA) on reducing inflammatory reactions after pediatric cataract surgery. METHODS: Researches were comprehensively searched in PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to 30 November, 2019. Data of interest were extracted and analyzed by Review Manager 5.2. The primary outcome was cell deposits. The secondary outcomes included posterior synechias, fibrinous anterior chamber reaction, visual axis obscuration, and posterior capsule opacification. The odds ratio (OR), weight mean difference (WMD), and their 95% confidence intervals (95% CI) were used to assess the strength of the association. RESULTS: In total, 45 articles were obtained. Finally, 5 studies with a total of 308 eyes were enrolled in this meta-analysis. Among these, 134 eyes underwent intracameral TA treatment and 174 eyes did not. In intracameral TA treatment group, the incidence of cell deposits (OR = 0.35, 95% CI 0.16-0.76, P = 0.008), posterior synechias (OR = 0.44, 95% CI 0.23-0.86, P = 0.02), and fibrinous anterior chamber reaction (OR = 0.12, 95% CI 0.01-1.05, P = 0.05) were lower compared to those in patients without intracameral TA treatment. Meanwhile, the incidence of visual axis obscuration (OR = 0.10, 95% CI 0.01-0.85, P = 0.04) and posterior capsule opacification (OR = 0.09, 95% CI 0.02-0.55, P = 0.009) were also reduced significantly. The intraocular pressure (IOP) was evaluated at the first month postoperatively (WMD = 0.84 mmHg, 95% CI 0.14-1.53, P = 0.02), but within the normal range. There was no difference of IOP between two groups at 6 months or above after operation (P = 0.93). CONCLUSIONS: The intracameral preservative-free TA in pediatric cataract surgery contributed to much less inflammatory reaction with the normal IOP range.

Emerging insights into the relationship between hyperlipidemia and the risk of diabetic retinopathy.

Hyperlipidemia is correlated with a series of health problems. Notably, aside from its established role in promoting cardiovascular morbidity and mortality, hyperlipidemia has also been considered for modulating the risk and the severity of multiple metabolic disorders. According to the results of epidemiologic investigations, several certain circulating lipoprotein species are correlated with the prevalence of diabetic retinopathy, suggesting that the physiological and pathological role of these lipoproteins is analogous to that observed in cardiovascular diseases. Furthermore, the lipid-lowering treatments, particularly using statin and fibrate, have been demonstrated to ameliorate diabetic retinopathy. Thereby, current focus is shifting towards implementing the protective strategies of diabetic retinopathy and elucidating the potential underlying mechanisms. However, it is worth noting that the relationship between major serum cholesterol species and the development of diabetic retinopathy, published by other studies, was inconsistent and overall modest, revealing the relationship is still not clarified. In this review, the current understanding of hyperlipidemia in pathogenesis of diabetic retinopathy was summarized and the novel insights into the potential mechanisms whereby hyperlipidemia modulates diabetic retinopathy were put forward.

Efficacy of mineralocorticoid receptor antagonist for central serous chorioretinopathy: a meta-analysis.

PURPOSE: To evaluate the efficacy of mineralocorticoid receptor antagonist (MRA) for patients with central serous chorioretinopathy (CSCR). METHODS: The Pubmed, Embase, and the Cochrane Central Register of Controlled Trials were comprehensively searched up to February 2020, to identify the studies comparing the efficacy of MRA with placebo/observation or photodynamic therapy (PDT) for CSCR. The primary outcomes were maximal subretinal fluid height and central macular thickness (CMT). The secondary outcomes included subfoveal choroidal thickness (SFCT) and best-corrected visual acuity (BCVA). Data of interest were extracted and analyzed by R version 3.6.0. The weighted mean difference and their 95% confidence intervals were used to assess the strength of the association. RESULTS: Ten studies including 284 affected eyes were involved, with 168 undergoing MRA treatment, 60 taking placebo/observation, and 56 receiving PDT. The pooling results showed that MRA was significantly more effective in resolving maximal subretinal fluid height (P < 0.01) and diminishing CMT (P < 0.01) than placebo/observation, while PDT could achieve significantly better CMT reduction than MRA (P = 0.03). For BCVA improvement and SFCT reduction, no statistical difference was detected among the groups of MRA, observation, placebo, or PDT (P > 0.05). CONCLUSION: MRA is an effective therapy for the management of CSCR, which is only slightly inferior to PDT in terms of CMT reduction. For patients who could not afford PDT, MRA could function as an alternative treatment with acceptable efficacy and safety.

[Cognitive ability to mental disorders among medical workers in ear-nose-throat departments and its impact on doctor-patient relationship].

OBJECTIVE: To investigate the cognitive ability and coping strategy to mental disorders among medical workers in ear-nose-throat departments and its impact on doctor-patient relationship.
 Methods: A total of 78 medical workers (including doctors, nurses, and technicians) in ear-nose-throat departments from 10 general hospitals in Hunan Province were investigated by self-compiled questionnaire on the perspective and coping strategy to mental disorders among medical workers.
 Results: Mental disorders except depression and schizophrenia were poorly understood in respondents, and many of their coping strategies were inappropriate. Furthermore, subjects tend to avoid too much contact with psychiatric patients for being afraid of the mental disorders. The poorer understanding of mental disorders, the more inappropriate coping strategies in dealing with mental disorders (P<0.001). Moreover, there was a significant difference in inappropriate coping strategies to mental disorders between patients being abused and patients not being abused (P=0.017). Factors such as education background (P=0.031) and the hospital level (P=0.038) also impacted the coping strategies to mental disorders.
 Conclusion: Among all mental disorders, only depression and schizophrenia are coped with the right way in medical workers of ear-nose-throat departments. In addition, obviously negative attitude and avoidance are found in dealing with mental disorders by medical workers. Importantly, poor cognitive ability to mental disorders is the main reason for hurting doctor-patient relationship in the ear-nose-throat departments.

Retinal structural and microvascular deterioration independent of optic neuritis in aquaporin-4 antibody-positive neuromyelitis optica spectrum disorders: An optical coherence tomography angiography study.

PURPOSE: To assess the retinal structural and microvascular change in aquaporin-4 antibody (AQP4) positive neuromyelitis optica spectrum disorder (NMOSD) patients and the correlation with clinical features. METHODS: A cross-sectional study was performed with optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) to measure retinal structure and microvascular parameters in AQP4 positive NMOSD patients. RESULTS: Sixty-two NMOSD patients (44 eyes with ON, NMOSD+ON; 77 eyes without ON, NMOSD-ON) and 62 healthy controls (HC, 124 eyes) were included. BCVA was worse in NMOSD patients compared to HC (p<0.001). Peripapillary retinal nerve fiber layer (pRNFL, p<0.001) and ganglion cell complex (GCC, p<0.001) was thinner in NMOSD+ON eyes compared to NMOSD-ON eyes and HC. Compared to HC, pRNFL (p = 0.002) and GCC (p = 0.001) was thinner in NMOSD-ON eyes. The vessel density (VD) in superficial capillary plexus (SCP, NMOSD+ON vs HC p<0.001, NMOSD-ON vs HC p = 0.002) and radial peripapillary capillary (RPC, NMOSD+ON vs HC p<0.001, NMOSD-ON vs HC p = 0.001) were also lower in NMOSD patients than HC independent of the history of ON. ON frequency and BCVA were correlated with the thickness of pRNFL and GCC, and VD in SCP and RPC (all p<0.001). EDSS was correlated with thickness of GCC (p = 0.008), and VD in SCP (p = 0.013), DCP (p<0.001) and RPC (p = 0.009). CONCLUSIONS: Subclinical degradation of retinal structure and microvasculature was found in NMOSD patients before the occurrence of ON, and was correlated with clinical disability. Retinal parameter might be a tool to estimate the disease progression and investigate the pathogenesis of NMOSD.

Significant retinal microvascular impairments in multiple sclerosis assessed through optical coherence tomography angiography.

PURPOSE: Multiple sclerosis (MS) is associated with different ocular disorders. This study aimed to investigate the retinal microvascular changes detected by optical coherence tomography angiography (OCTA) in eyes with MS with or without a history of optic neuritis (ON). METHODS: A comprehensive literature search was conducted in the Web of Science, Embase, PubMed, and Cochrane Library databases on September 26, 2021 for articles focused on OCTA manifestations in the eyes of MS patients compared with healthy controls. RevMan Manager (v.5.4) and Stata (v.14.1) were used to analyze the main differences and publication risks. Weighted mean differences and 95% confidence intervals were calculated for continuous estimates. This study also included subgroup analysis between three groups: eyes with multiple sclerosis and with optic neuritis (MSON); eyes with multiple sclerosis and without optic neuritis (MSNON); and healthy controls. RESULTS: Thirteen studies with a total of 1803 eyes were identified, including 957 eyes with MS and 846 eyes of healthy controls. The vessel density of the MS eyes decreased significantly in most areas of the radial peripapillary capillary. A marked reduction in the macular superficial capillary plexus of MS eyes regardless of ON history was also confirmed. CONCLUSION: The results suggest that MS patients demonstrated significant retinal microvasculature impairment regardless of ON history, compared to healthy controls. Retinal vessel density attenuation detected by OCTA may serve as a reliable early marker of MS.

Full-Thickness Skin Graft from the Submental Triangle for Facial Defect Reconstruction.

Full-thickness skin grafting plays an important role in facial reconstruction for excessive skin defects or possible eye, nose, or lip distortion after a malignant tumor excision. For esthetic consideration, full-thickness skin grafts of the retroauricular region can be used, but the amount of skin is limited. The skin of the submental triangle has similar cutaneous features and provides a large graft. We aimed to evaluate the feasibility of using full-thickness skin grafts harvested from the submental triangle to reconstruct facial skin defects. We retrospectively analyzed 14 cases treated at a single institution to evaluate the clinical and esthetic outcomes, and patients' satisfaction. During 6-24 months of follow-up, the wounds healed with well-matched color, texture, and contour. No obvious hypertrophies or distortions were observed. Additionally, the removal of redundant submental triangle skin resulted in the secondary gain of double chin reduction. All patients were satisfied with the appearance of both donor and recipient sites. In conclusion, the submental triangle is a good possible option for full-thickness skin grafts used to resurface facial skin defects. Using this approach, both donor and recipient sites can achieve satisfactory esthetic outcomes.

Comparative Evaluation of Tissue Adhesives and Sutures in the Management of Facial Laceration Wounds in Children.

BACKGROUND: This study evaluated tissue adhesives in comparison to sutures for treating facial lacerations in children. METHODS: We retrospectively analyzed data from September 2017 to August 2022 involving pediatric facial lacerations managed with either tissue adhesives or sutures. RESULTS: Among 50 children, 20 received tissue adhesives, and 30 received sutures. Both methods showed comparable outcomes in terms of wound complications such as dehiscence (adjusted odds ratio = 1.56, 95% CI = 0.08-31.25) and infection (adjusted odds ratio = 2.17, 95% CI = 0.08-58.80). The cosmetic outcomes, assessed using the Hollander Wound Evaluation Score, were also consistent between groups (adjusted beta = -0.55, 95% CI = -1.15-0.05). Notably, those treated with tissue adhesives reported greater satisfaction (adjusted beta = 1.13, 95% CI = 0.63 -1.63) and experienced significantly less pain (adjusted beta = -3.03, 95% CI = -4.15--1.90). CONCLUSIONS: Both techniques displayed similar rates of infection, dehiscence, and cosmetic outcomes. However, tissue adhesives were associated with increased patient comfort, especially in terms of reduced pain and greater satisfaction.

Comparison of Visual Outcomes and Optical Quality of Femtosecond Laser-Assisted SMILE and Visian Implantable Collamer Lens (ICL V4c) Implantation for Moderate to High Myopia: A Meta-analysis.

PURPOSE: To compare visual outcomes and optical quality of femtosecond laser-assisted small incision lenticule extraction (SMILE) and Visian Implantable Collamer Lens (ICL V4c; STAAR Surgical) implantation for moderate to high myopia. METHODS: For this systematic review and meta-analysis, the Cochrane, PubMed, Embase, and Chinese databases (Wan-fang data and CNKI) were comprehensively searched to identify studies comparing SMILE and ICL V4c implantation. Data of interest were extracted and analyzed by Stata V.16.0 software (StataCorp). The weighted mean differences and their 95% confidence intervals were used to assess the strength of the association. RESULTS: Twelve studies incorporating 1,390 eyes of 822 patients were included. The analysis revealed ICL V4c implantation had a significantly higher safety index and lower high order aberrations, coma, and spherical aberration than SMILE in treating moderate to high myopia (P < .05). Subgroup analysis revealed such differences were more prominent in patients with high myopia who had shorter follow-up duration. When follow-up was longer than 6 months, the differences in safety index and total HOAs became nonsignificant (P > .05). The two procedures had no difference in efficacy index, postoperative visual acuity, spherical equivalent, trefoil, Objective Scatter Index, or modulation transfer function cut-off frequency (P > .05). CONCLUSIONS: Both SMILE and ICL V4c implantation were safe and efficient for moderate to high myopia. Compared with SMILE, ICL V4c implantation might provide better postoperative visual quality in patients with high myopia in the early postoperative period. [J Refract Surg. 2022;38(6):332-338.].

Microvascular alterations detected by optical coherence tomography angiography in non-arteritic anterior ischaemic optic neuropathy: a meta-analysis.

PURPOSE: To evaluate microvascular alterations with optical coherence tomography angiography (OCTA) in eyes with non-arteritic anterior ischaemic optic neuropathy (NAION) and the unaffected fellow eyes. DESIGN: Systematic review and meta-analysis. METHODS: A comprehensive literature search was conducted in the PubMed and Embase databases through 6 September 2020, to identify the studies on NAION and the unaffected fellow eyes using OCTA. Eligible studies and data of interest were extracted and analysed by RevMan Software v. 5.4 and Stata Software v.14.0. The weighted mean differences and 95% confidence intervals were used to assess the strength of the association. RESULTS: Seventeen observational comparative studies, including 379 eyes with NAION, 175 unaffected contralateral eyes and 470 eyes of healthy controls, were identified. Compared to those of the healthy controls, the perfusion density (PD) of radial peripapillary capillary (RPC) and peripapillary superficial capillary plexus (ppSCP) of NAION were significantly lower. Moreover, the PD of the macular SCP (mSCP) in NAION was significantly reduced in the whole image, superior quadrant and temporal quadrant, while the macular deep capillary plexus (mDCP) showed a decreasing PD only within the whole image. Between unaffected fellow eyes and healthy eyes, significant differences of PD were demonstrated in the whole image and some peripapillary regions of the RPC and ppSCP. CONCLUSION: Our results suggested that compared to those of healthy controls, the eyes affected by NAION and unaffected fellow eyes demonstrated significant microvascular impairments in different regions. Between acute and non-acute NAION, macular OCTA parameters showed different characteristic patterns.

Research hotspots and trends for axon regeneration (2000-2021): a bibliometric study and systematic review.

BACKGROUND: Axons play an essential role in the connection of the nervous system with the rest of the body. Axon lesions often lead to permanent impairment of motor and cognitive functions and the interaction with the outside world. Studies focusing on axon regeneration have become a research field with considerable interest. The purpose of this study is to obtain an overall perspective of the research field of axonal regeneration and to assist the researchers and the funding agencies to better know the areas of greatest research opportunities. METHODS: We conducted a bibliometric analysis and Latent Dirichlet Allocation (LDA) analysis of the global literature on axon regeneration based on the Web of Science (WoS) over the recent 22 years, to address the research hotspots, publication trends, and understudied areas. RESULTS: A total of 21,018 articles were included, which in the recent two decades has increased by 125%. Among the top 12 hotspots, the annual productions rapidly increased in some topics, including axonal regeneration signaling pathway, axon guidance cues, neural circuits and functional recovery, nerve conduits, and cells transplant. Comparatively, the number of studies on axon regeneration inhibitors decreased. As for the topics focusing on nerve graft and transplantation, the annual number of papers tended to be relatively stable. Nevertheless, the underlying mechanisms of axon regrowth have not been completely uncovered. A lack of notable research on the epigenetic programs and noncoding RNAs regulation was observed. The significance of cell-type-specific data has been highlighted but with limited research working on that. Functional recovery from neuropathies also needs further studies. CONCLUSION: The last two decades witnessed tremendous progress in the field of axon regeneration. There are still a lot of challenges to be tackled in translating these technologies into clinical practice.