FABP4, GINS2 and CBX7 Expression in Cancer Cervix Tissues: Clinical, Pathological and Prognostic Implications.

Background & Objective: Cervical cancer spreads to the pelvic lymph nodes, leading to a high incidence of cancer recurrence and unfavorable survival rates. Therefore, there is an urgent need to detect new predictive biomarkers for the early assessment of pelvic lymph node status in patients with cervical cancer. The current study aimed to assess the expression of FABP4, GINS2, and CBX7 in cervical cancer tissue to detect their prognostic and predictive roles in developing lymph node metastases in patients with that cancer type. Methods: We collected the tissues from patients with cervical cancer and evaluated the expression of FABP4, GINS2, and CBX7 using immunohistochemistry. We evaluated the association between their expression and clinicopathological and prognostic parameters. Results: A high expression of FABP4 and GINS2 and a low expression of CBX7 were found to be positively associated with the old age group, large tumor size, high grade and lymphovascular involvement, para-uterine organ infiltration, advanced FIGO stage, chemotherapeutic resistance, and tumor recurrence. Conclusion: We demonstrated the oncogenic roles of FABP4 and GISN2 in addition to the on-co-suppressive roles of CBX7 in cervical cancer and their association with poor clinicopathological criteria and poor survival. Our results may indicate that FABP4, GISN2, and CBX7 could be considered predictive biomarkers of the occurrence of lymph node metastases in the cancer of the cervix preoperatively, which could be beneficial in the accurate preoperative design therapy.

How to Differentiate between Resistant and Susceptible Wheat Cultivars for Leaf Rust Fungi Using Antioxidant Enzymes and Histological and Molecular Studies?

Eight wheat cultivars, Sakha-94, Giza-171, Sids-1, Sids-12, Sids-13, Shandweel-1, Misr-1, and Misr-2, were evaluated for leaf rust at the seedling and adult stages in the 2021 and 2022 seasons. Biochemical, histological, and genetic analyses were performed to determine the link between cultivars that were either sensitive or resistant to the disease. Misr-2 and Giza-171 cultivars had the highest levels of resistance to leaf rust races in 2021 (LTCGT, STSJT, and TTTST) and 2022 (MBGJT, TTTKS, and TTTTT) at the seedling stage. However, at the adult stage, Sakha-94, Giza-171, Misr-1, and Misr-2 cultivars had the highest levels of resistance; consequently, they had the lowest final disease severity and the lowest values of AUDPC. The correlation between the seedling reaction and adult reaction was non-significant, with values of 0.4401 and 0.4793 in the 2021 and 2022 seasons, respectively. Throughout the biochemical, histological, and genetic analyses, it was observed that catalase, peroxidase, and polyphenol oxidase activities significantly increased in the resistant cultivars. The discoloration of superoxide (O2-) and hydrogen peroxide (H2O2) significantly decreased in resistant and moderately resistant wheat cultivars (Sakha-94, Giza-171, Misr-1, and Misr-2); higher hydrogen peroxide (H2O2) and superoxide (O2-) levels were recorded for the susceptible cultivars compared to the resistant cultivars. Molecular markers proved that the Lr50 gene was detected in the resistant cultivars. Puccinia triticina infections negatively affected most histological characteristics of flag leaves, especially in susceptible cultivars. The thickness of the blade (µ), the thickness of the upper and lower epidermis (UE and LE), the thickness of mesophyll tissue (MT), and bundle length and width in the midrib were decreased in susceptible cultivars such as Sids-1, Sids-13, and Shandwel-1 compared with resistant cultivars.

Oxytocin versus a combination of tranexamic acid and ethamsylate in reducing intraoperative bleeding during abdominal myomectomy: a randomized clinical trial.

OBJECTIVE: Myomectomy is the preferred surgical approach to manage uterine fibroids. However, uterine fibroids are highly vascular tumors and, consequently, extremely susceptible to problems from myomectomy-related hemorrhage. Hence, we aim to compare oxytocin efficacy and safety profile versus tranexamic acid (TA) with ethamsylate for reducing bleeding during myomectomy. METHODS: This randomized, double-blinded multicenter study was performed between 20th August 2020 and 20th October 2020 at El-Galaa Teaching Hospital, El Hussein University Hospital, Al-Azhar University Hospitals of Assiut, and Al-Azhar University Hospitals of Damietta. One hundred and eighty patients were enrolled and divided into three groups: group (1) received an injection of 30 IU of oxytocin in 500 ml of normal saline; group (2) received injections of 1 g of TA, 250 mg of Ethamsylate, and 110 ml of normal saline IV; and group (3) received an injection of 110 ml of normal saline IV just before surgical incision. RESULTS: In 180 premenopausal women, oxytocin and TA with ethamsylate had no significant value in lowering intraoperative blood loss compared with the placebo for abdominal myomectomy (666.25 ± 183.03, 630.72 ± 145.83, and 646.67 ± 168.92, respectively (P = 0.506)). Non-significant trends were observed for a reduction in operation time (P = 0.760), intra/postoperative blood transfusion (P = 0.624), hospital stay (P = 0.986), postoperative fever (P = 0.659), and wound infection (P = 1). CONCLUSION: Oxytocin and TA with ethamsylate had no significant value in lowering intraoperative blood loss compared with the placebo for abdominal myomectomy which opens a new question about the role of the use of the hemostatic drug during myomectomy especially in centers with limited resources and had higher rates. TRIAL REGISTRATION: The study was registered on Pan African Clinical Trials Registry with the following number: PACTR202008739887429 and was approved on 24/08/2020.

A prospective multicentre study evaluating the outcomes of the abdominal wall dehiscence repair using posterior component separation with transversus abdominis muscle release reinforced by a retro-muscular mesh: filling a step.

BACKGROUND: This study aimed to evaluate the results of posterior component separation (CS) and transversus abdominis muscle release (TAR) with retro-muscular mesh reinforcement in patients with primary abdominal wall dehiscence (AWD). The secondary aims were to detect the incidence of postoperative surgical site occurrence and risk factors of incisional hernia (IH) development following AWD repair with posterior CS with TAR reinforced by retromuscular mesh. METHODS: Between June 2014 and April 2018, 202 patients with grade IA primary AWD (Björck's first classification) following midline laparotomies were treated using posterior CS with TAR release reinforced by a retro-muscular mesh in a prospective multicenter cohort study. RESULTS: The mean age was 42 ± 10 years, with female predominance (59.9%). The mean time from index surgery (midline laparotomy) to primary AWD was 7 ± 3 days. The mean vertical length of primary AWD was 16 ± 2 cm. The median time from primary AWD occurrence to posterior CS + TAR surgery was 3 ± 1 days. The mean operative time of posterior CS + TAR was 95 ± 12 min. No recurrent AWD occurred. Surgical site infections (SSI), seroma, hematoma, IH, and infected mesh occurred in 7.9%, 12.4%, 2%, 8.9%, and 3%, respectively. Mortality was reported in 2.5%. Old age, male gender, smoking, albumin level < 3.5 gm%, time from AWD to posterior CS + TAR surgery, SSI, ileus, and infected mesh were significantly higher in IH. IH rate was 0.5% and 8.9% at two and three years, respectively. In multivariate logistic regression analyses, the predictors of IH were time from AWD till posterior CS + TAR surgical intervention, ileus, SSI, and infected mesh. CONCLUSION: Posterior CS with TAR reinforced by retro-muscular mesh insertion resulted in no AWD recurrence, low IH rates, and low mortality of 2.5%. Trial registration Clinical trial: NCT05278117.

Tooth auto-transplantation: A bibliometric analysis of the top 100 most-cited articles.

BACKGROUND/AIM: Tooth auto-transplantation has recently gained high clinical acceptance. The aim of this study was to identify the top 100 most-cited articles regarding tooth auto-transplantation, to analyse multiple citations and publication metrics and to outline the historical scientific advancements in this field. MATERIALS AND METHODS: An advanced search of the Clarivate Analytics' Web of Science 'Core Collection' and Elsevier's Scopus databases utilising specific keywords related to tooth auto-transplantation between 1971 and 2021 was performed. The retrieved articles were ranked in descending order based on their Web of Science citation counts and further cross-matched with citation data from Scopus. The extracted data included citation counts, citation density, level of evidence, year of publication, contributing authors names and institutes, corresponding author's address, journal of publication, journal local citations index, cumulative growth index, keywords and keywords Plus. Data analysis was performed using descriptive statistics and graphical mapping. RESULTS: A total of 1290 articles were retrieved. The top 100 most-cited articles received a total of 4899 (Web of Science) and 5250 (Scopus) citations. Among these, cohort studies (29%) and case series (18%) were the most common study designs. Scandinavian countries produced major contributions in defining the top 100 most-cited articles and ranked within the top 5 countries based on the number of publications and citations per year. The greatest contributing authors were Schwartz O (n = 12), Andreasen JO (n = 8) and Paulsen HU (n = 6), and they were affiliated with Copenhagen, Denmark. The top contributing journals were American Journal of Orthodontics and Dentofacial Orthopedics, International Journal of Oral and Maxillofacial Surgery, Oral Surgery Oral Medicine Oral Pathology Oral Radiology, European Journal of Orthodontics, Dental Traumatology and Journal of Oral and Maxillofacial Surgery. CONCLUSION: This bibliometric analysis revealed a large geographical scientific interest and broad development in the field of tooth auto-transplantation spanning multiple dental disciplines.

Physiological response and oxidative stress of grass carp (Ctenopharyngodon idellus) under single and combined toxicity of polystyrene microplastics and cadmium.

The harm of microplastics (MPs) to aquatic ecosystems is caused by their stable and non-degradable properties. Additionally, the pollutants such as heavy metals in the water are easy to be adsorbed on their surface with their small particle size and large specific surface area, resulting in environmental pollution. Therefore, the study on the mixture toxicity of MPs and heavy metals has theoretical significance for the risk assessment of aquatic ecosystems. In the present study, 10 nm polystyrene (PS) and cadmium (Cd) were used, and their individual and mixture acute toxicities on grass carp (Ctenopharyngodon idellus) were examined. The results indicated that the mortality of the fish increased with the concentration from 10 mg L-1 to 20 mg L-1, and the existence of PS-MPs elevated the Cd concentrations in the fish and accelerated the death. Whether the Cd and/or the PS-MPs concentrations caused varying degrees of damage to the gills, kidney, liver, and muscles of the grass carp, especially under the highest concentrations (20 mg L-1 Cd + 300 µg L-1 PS-MPs). Moreover, low concentrations of PS-MPs alone (30 µg L-1 PS-MPs) significantly increased the superoxide dismutase (SOD) activity in the kidney and liver, reaching 12.43% and 14.38%, respectively (P < 0.05). The peroxidase (POD) activity was increased only in the kidney, up to 25.95% (P < 0.05). Also, significant reductions in SOD and POD activities were observed in the combination of high concentration of Cd (20 mg L-1) and 300 µg L-1 PS-MPs (P < 0.05). To the best of our knowledge, there are few studies on the impact of combined toxicity of PS-MPs and Cd on grass carp under laboratory conditions. Therefore, these findings may provide a theoretical guarantee for pollution prevention and control in the aquatic ecosystem.

Toll-Like Receptor 2 is Involved in Abnormal Pregnancy in Mice Infected with Toxoplasma gondii During Late Pregnancy.

Infection with Toxoplasma gondii during pregnancy causes failure of pregnancy maintenance, resulting in fetal death, abortion, stillbirth, or premature birth, but the mechanism of disease onset remains unclear. Although Toll-like receptor 2 (TLR2) is expressed on antigen-presenting cells and trophoblasts, the role of TLR2 in T. gondii infection during pregnancy is unknown. In this study, we investigated the role of TLR2 in congenital toxoplasmosis using TLR2-deficient (TLR2-/-) mice. T. gondii infection on gestational day 12.5 (Gd12.5) induced more abnormal pregnancy, including premature birth and stillbirth, in wild-type mice than in TLR2-/- mice. Multiple calcifications were observed in the placentas of the infected wild-type mice. At Gd18.5 (6days postinfection), the parasite numbers in the placenta and uterus and the histological changes did not differ significantly between the wild-type and TLR2-/- mice. However, T. gondii infection reduced the mRNA expression of interleukin-12p40 (IL-12p40) and increased IL-4 and IL-10 mRNAs in the placentas of the wild-type mice. In contrast, the placentas of the TLR2-/- mice showed no changes in the expression of these cytokines, including IL-6 and tumor necrosis factor α, in response to T. gondii infection. Serum interferon-γ levels were significantly lower in the infected TLR2-/- mice than in the infected wild-type mice on Gd18.5. Thus, the TLR2-/- mice were less susceptible to the induction of immune responses by T. gondii infection during late pregnancy. Therefore, TLR2 signaling may play a role in the development of disease states during pregnancy, specifically placental hypofunction.

Fluctuation of salivary alpha-amylase activity levels and vital signs during dental implant surgery.

BACKGROUND: Salivary alpha-amylase (sAA) activity level is thought to be an indicator of mental stress. However, the relationship between sAA activity levels and mental stress in patients during dental implant treatment has not been studied. In the present study, we aimed to examine the correlation between sAA activity levels and changes in patients' vital signs during dental implant surgery. RESULTS: Levels of sAA activity were higher after surgery when compared to before-surgery measurements. A significant positive correlation was found between sAA activity and heart rate (HR) (rs=0.434, p=0.007) as well as a positive correlation with oxygen level (rs=0.392, p=0.016). CONCLUSION: Levels of sAA activity tended to increase after the surgical procedures, as did patients' stress levels. SpO2 and sAA activity levels were inversely correlated. There was a positive significant correlation between HR and sAA activity, though there was no correlation between blood pressure and sAA activity levels. Salivary alpha-amylase may be a valuable indicator of stress and anxiety in dental patients undergoing dental implant surgery.

Topical Difluprednate for Early Corneal Graft Rejection After Penetrating Keratoplasty.

PURPOSE: To evaluate the safety and efficacy of topical difluprednate ophthalmic emulsion use for prophylaxis of corneal graft rejection in patients undergoing penetrating keratoplasty. METHODS: This study reviewed the charts of patients undergoing penetrating keratoplasty who were treated with difluprednate (DP) ophthalmic emulsion postoperatively. At each follow-up visit, patients were followed for signs of graft rejection, cataract development, and intraocular pressure rise in addition to routine ocular examination. RESULTS: The charts of 36 patients (38 eyes) who underwent penetrating keratoplasty (PKP) (27 eyes) and PKP triple (11 eyes) were reviewed. All eyes were followed up for at least 8 months postoperatively. Five grafts developed rejection and three grafts subsequently failed. Six eyes had an increase of IOP that required use of antiglaucoma drops. Three eyes were switched from difluprednate to prednisolone acetate (PA) after persistent rise of IOP failed to respond to antiglaucoma drops. None of these cases needed glaucoma surgery. Two patients developed cataract during the follow-up period (out of 12 phakic eyes). CONCLUSION: Topical difluprednate is potentially effective and safe in preventing graft rejection after penetrating keratoplasty. Larger prospective clinical trials are warranted.

Role of Multidetector Computed Tomography (CT) Virtual Hysteroscopy in the Evaluation of Abnormal Uterine Bleeding in Reproductive Age.

BACKGROUND: Abnormal uterine bleeding (AUB) may be acute or chronic and is defined as bleeding from the uterine corpus that is abnormal in regularity, volume, frequency, or duration and occurs in the absence of pregnancy. It is a widespread complaint in the primary care units. The prevalence of abnormal bleeding is up to 30% among women of reproductive age. OBJECTIVE: To assess the role of CT virtual hysteroscopy in the evaluation of the uterine cavity in cases with abnormal uterine bleeding in reproductive age. METHODS: Cross sectional study was performed at Obstetrics and Gynecology Department and Radiology Department, Zagazig University hospitals, Egypt, on 124 women with abnormal uterine bleeding in reproductive age, and their uterine cavity was evaluated by both row multidetector computed tomography (MDCT) scanner and Office hysteroscopy. RESULTS: Mean age of studied group was 28.54 ± 5.99 years, and virtual hysteroscopy showed sensitivity 91.1% and specificity 85.3% in detection of abnormalities within uterine cavity. It showed sensitivity 91.1% and specificity 85.3% in cases of endometrial polyps. It yielded 88.5 % sensitivity and 100 % specificity in cases with submucous fibroids, while it yielded only 57.9 % sensitivity and 82.9% specificity in cases of thick endometrium. CONCLUSION: Virtual CT hysteroscopy is a good negative test in cases of abnormal uterine bleeding but has some limitations that decrease its sensitivity.

Diagnostic accuracy of CA125 and HE4 in ovarian carcinoma patients and the effect of confounders on their serum levels.

OBJECTIVES: To evaluate the diagnostic accuracy of serum cancer antigen 125 (CA125) and human epididymis protein 4 (HE4) in the prediction of malignant ovarian masses then to analyze the effect of personal criteria and medical diseases on this accuracy. STUDY DESIGN: This prospective study was performed in Zagazig University Hospital. The eligibility criteria for inclusion were; consecutive women, at any age ≥18 years, with established diagnosis of ovarian mass based on symptoms, signs, and imaging techniques. All patients underwent personal and medical history taking, preoperative serum CA125 and HE4 (cutoff 35 IU/mL and 150 pmol/L, respectively) assessment then postoperative histopathologic examination of lesions as a reference standard. RESULTS: Among the included 140 patients, 62 were confirmed to have ovarian malignancy and 78 had benign lesions. Serum CA125 ≥35 IU/mL was associated with ovarian malignancy at sensitivity 91.9%, specificity 53.8%, and accuracy 70.7%. Raising its cutoff to 67.5 IU/mL decreased the sensitivity 83.9%, increased the specificity 80.7% with accuracy 82.1%. The combination of HE4 and CA125 showed sensitivity 75.8%, specificity 93.5%, and accuracy 85.7%. Women suffering from both diabetes mellitus and hypertension showed a significant decrease in CA125 concentration P = 0.02 with false negative results in (5/11) of them, making its sensitivity 54.5% in this condition. CONCLUSIONS: The performance of CA125 in cancer ovary prediction can be improved by increasing its cutoff or by combining CA125 with HE4. Diabetes mellitus and hypertension can influence CA125 performance while HE4 is independent on these factors. This can be an additional value of the introduction of HE4 in cancer ovary prediction protocols.

Dienogest Versus Leuprolide Acetate for Recurrent Pelvic Pain Following Laparoscopic Treatment of Endometriosis.

OBJECTIVE: To compare the efficacy and safety of dienogest (DNG) with depot leuprolide acetate (LA) in patients with recurrent pelvic pain following laparoscopic surgery for endometriosis. DESIGN: Prospective randomized trial. SETTING: Zagazig University hospitals, Egypt. PATIENTS: Two hundred and forty-two patients with recurrent pelvic pain following laparoscopic surgery for endometriosis. INTERVENTION: Dienogest (2 mg/day, orally) or depot LA (3.75 mg/4 weeks, intramuscularly) for 12 weeks. MAIN OUTCOME MEASURES: A visual analogue scale was used to test the intensity of pain before and after the end of treatment. RESULTS: There was highly significant reduction in pelvic pain, back pain and dyspareunia in both groups with mean of difference in dienogest group (28.7 ± 5.3, 19.0 ± 4.3 and 20.0 ± 3.08 mm, respectively) and in LA group (26.2 ± 3.01, 19.5 ± 3.01 and 17.9 ± 2.9 mm, respectively). The most frequent drug-related adverse effects in dienogest group were vaginal bleeding and weight gain (64.5 and 10.8%, respectively) which were significantly higher than LA group (21.5 and 3.3%, respectively). While the most frequent drug-related adverse effects in LA group were hot flushes and vaginal dryness (46.3 and 15.7%, respectively) which were significantly higher than dienogest group (15.7 and 3.3%, respectively). CONCLUSION: Daily dienogest is as effective as depot LA for relieving endometriosis-associated pelvic pain, low back pain and dyspareunia. In addition, dienogest has acceptable safety, tolerability and lower incidence of hot flushes. Thus, it may offer an effective and well-tolerated treatment in endometriosis.

Cataract surgery on the previous corneal refractive surgery patient.

Cataract surgery in cases with previous corneal refractive surgery may be a major challenge for the ophthalmologist. The refractive outcome of the case deserves special attention in the preoperative planning process, which should be tailored for the type of prior refractive procedure: incisional, ablative under a flap, or on the corneal surface. Avoiding refractive surprise after cataract surgery in these cases is principally dependent on the accuracy of the intraocular lens calculation, together with the selection of the appropriate biometric formula for each case. Modern techniques for cataract surgery help surgeons to move toward the goal of cataract surgery as a refractive procedure free from refractive error. We give practical guidelines for the cataract surgeon in the management of these challenging cases.

Optical Profile Following High Hyperopia Correction With a 500-Hz Excimer Laser System.

PURPOSE: To evaluate corneal higher order aberrations after LASIK for the correction of high hyperopia using a 500-Hz excimer laser and optimized ablation profile. METHODS: Retrospective consecutive study including 51 eyes of 28 patients (age range: 21 to 54 years) with high hyperopia or hyperopic astigmatism (sphere ≥ 5.00 diopters). All cases underwent LASIK using the sixth generation Amaris excimer laser (SCHWIND eye-tech-solutions, Kleinostheim, Germany) and a femtosecond laser platform for flap creation. Postoperative changes in corneal higher order aberrations for the 4-, 5-, and 6-mm pupil diameters and corneal asphericity for 4.5 and 8 mm were represented at the end of the 6-month follow-up. RESULTS: A significant increase in corneal root mean square higher order, spherical, and coma aberrations was observed 6 months after surgery (P < .01). Corneal asphericity for the 4.5-mm (Q45) and 8-mm (Q8) corneal diameter also changed significantly during the postoperative period (P < .01). Strehl ratio change was not statistically significant (P = .77). CONCLUSIONS: Correction of high hyperopia with LASIK significantly induces corneal higher order aberrations regardless of the physiologic level of photopic and mesopic pupil conditions.

Free latissimus dorsi myocutaneous flap for pelvic floor reconstruction following pelvic exenteration.

INTRODUCTION: Pelvic floor defects following pelvic exenteration constitute a challenge to the reconstructive surgeon. Whenever the common reconstruction options such as the gluteus maximus myocutaneous flap (GLM) and the vertical rectus abdominis myocutaneous flap (VRAM) are not feasible, free tissue transfer will be the only remaining option. Being one of the most reliable and versatile flaps used for microsurgical reconstruction, the free latissimus dorsi (LD) muscle flap provides an adequate solution to this problem. PATIENTS AND METHODS: We describe our experience with 12 consecutive patients who underwent the free transfer of LD free flap for secondary reconstruction of the pelvic floor and perineum following pelvic exenteration for management of locally advanced pelvic malignancies in Klinikum Oldenburg from 2007 to 2014. RESULTS: Recurrent cancer of the anal canal was the most common pathology necessitating the performance of pelvic exenteration. Thrombosis of the vascular anastomosis was reported in two cases and ended with total flap loss in one of them. Functional limitations arose in two patients postoperatively. The mean hospital stay was 25 days. CONCLUSION: Free LD myocutaneous flap provides an adequate solution for reconstruction of pelvic defects resulting from radical oncological resections in cases where the use of locoregional flaps, such as the gluteus maximus flap and the vertical rectus abdominis flap, is not feasible because of an extensive defect, disruption of the vascular pedicle, or due to planning for bilateral stomas placement.

Refractive surgery following corneal graft.

PURPOSE OF REVIEW: To review the different surgical procedures for management of postkeratoplasty refractive errors after total suture removal. RECENT FINDINGS: There are different surgical options to address residual refractive errors that frequently occur after corneal transplantation. The correction can be done on the corneal surface or intraocular with intraocular lens (IOL) implantation which requires complete tectonic and refractive stability after suture removal. The most commonly used procedures are photorefractive keratectomy, laser in-situ keratomileusis and Phakic IOLs. Keratoplasty has been profited by recent advances in refractive surgery. Custom excimer laser ablation is an alternative way to treat irregular errors. New IOL modalities are good practical options for a wide range of errors. Femtosecond laser, as a new option in the toolbox, can modify corneal grafting refractive results and assist corrective refractive procedures. SUMMARY: Although being the most successful organ transplantation, keratoplasty is usually followed by significant ametropia. Different corrective modalities exist and the choice should fit ocular conditions, patient requirements, surgeon skills and the available technologies. Recent advances in ophthalmic surgery have improved the outcomes.

Femtosecond laser cataract surgery: updates on technologies and outcomes.

PURPOSE: To describe femtosecond laser cataract surgery and discuss the published peer-reviewed articles to have a fair evaluation of this new technology and its comparisons to conventional phacoemulsification surgery. METHODS: The technology information released in this article comes from the key individuals in each of the U.S. Food and Drug Administration-approved companies and from the available commercial information. Bibliographic research was performed in PubMed and MEDLINE for the published prospective or retrospective clinical studies. RESULTS: The femtosecond laser has been reported to be safe intraoperatively and postoperatively, with less cornea and macula effect than conventional phacoemulsification. The incision is integrated, stable, and aberration free. Many studies reported the high precision of the capsulotomy over manual continuous curvilinear capsulorhexis, which favors less intraocular lens tilt, higher optical quality, and more accurate premium intraocular lens centration. The lens fragmentation is effective with significant reduction of the phacoemulsification power and effective phacoemulsification time. The refractive difference between femtosecond laser and standard phacoemulsification is minimal, with no difference in corrected distance visual acuity, but the optical quality and the internal aberrations results are significantly better for femtosecond laser phacoemulsification. CONCLUSIONS: Femtosecond laser cataract surgery is a good addition to cataract surgery despite its few remarkable advantages among experienced phacoemulsification surgeons.

Comparative outcomes of bimanual MICS and 2.2-mm coaxial phacoemulsification assisted by femtosecond technology.

PURPOSE: To compare the efficacy and safety outcomes of bimanual microincision cataract surgery (MICS) versus 2.2-mm coaxial phacoemulsification assisted by Femtosecond LenSx (Alcon-LenSx Inc., Aliso Viejo, CA). METHODS: This prospective, randomized, observational, comparative case series comprised 50 cataractous eyes of 50 patients receiving femtosecond laser refractive lens surgery followed by a bimanual MICS technique with two 1-mm incisions (25 patients) (FemtoMICS group) and a coaxial phacoemulsification technique with a 1-mm paracentesis and a 2.2-mm principal incision (25 patients) (FemtoCoaxial group). The main outcomes measures were: ultrasound power, effective phacoemulsification time, postoperative spherical equivalent, higher-order aberrations (corneal and internal), corneal thickness, endothelial cell count, macular thickness, and complications during and after surgery. Both groups were absolutely comparable for all variables preoperatively. RESULTS: Mean ultrasound power was 1.8% ± 0.9% for MICS and 14.7% ± 4.9% for 2.2-mm incisions (P < .001). Effective phacoemulsification time values for MICS and 2.2-mm incisions were 1.5 ± 0.9 and 4.5 ± 2.9 sec, respectively (P = .002). Mean postoperative spherical equivalent was −0.26 for FemtoMICS and −0.33 for FemtoCoaxial (P > .05). The efficacy index at 1 month postoperatively was 160.2% for FemtoMICS and 149% for FemtoCoaxial. No significant differences were found in corneal thickness, endothelial cell count, and macular thickness. Complications included posterior capsule rupture (4%) and anterior capsule rupture with no posterior capsule tear (4%) for FemtoMICS and bridges due to incomplete capsulorhexis (4%) for FemtoCoaxial. CONCLUSIONS: MICS and coaxial phacoemulsification techniques assisted by the Femtosecond LenSx achieved excellent safety and efficient outcomes. The FemtoMICS technique was surgically and statistically more efficient than the FemtoCoaxial technique.

Femtosecond laser assisted cataract surgery followed by coaxial phacoemulsification or microincisional cataract surgery: differences and advantages.

PURPOSE OF REVIEW: This review outlines the advantages and the differences of femtosecond laser-assisted cataract surgery (FLACS) following a coaxial or microincision cataract surgery phacoemulsification in the surgical outcome and greater control of cataract surgery. RECENT FINDINGS: FLACS offers minimal tissue damage and extreme precision during corneal incision creation, continuous circular capsulorhexis (CCC) and nuclear fragmentation. It also allows diminishing the mean average ultrasound power to emulsify the nucleus followed by a coaxial or a biaxial procedure. The impact of reduced phacoemulsification energy on the corneal endothelium is an interesting topic that is being investigated. Despite its benefits, this technology has relevant financial issues and a high learning curve. SUMMARY: FemtoMICS appears to be surgically and statistically more efficient than the FemtoCoaxial technique and Femtoincisions prove to be stable and do not change the corneal high order aberration significantly with favorable results of the triplanar configuration.

Femtosecond laser cataract incision morphology and corneal higher-order aberration analysis.

PURPOSE: Analysis of the femtosecond laser refractive lens surgery corneal incision configuration and corneal higher-order aberration (HOA) effect from the first postoperative day. METHODS: High-resolution anterior segment optical coherence tomography was used to assess 20 eyes undergoing femtosecond laser refractive lens surgery with 2.2-mm minimal incision. The primary incision (tri-planar) actual length, cord length, surface angle, surface irregularity, and regional pachymetry values and the secondary incision (uni-planar) length, angle, surface irregularity, and pachymetry values were analyzed. Hartmann-Shack aberrometer was used to assess corneal HOAs to correlate the effect. Assessment was done preoperatively and 1 month postoperatively. RESULTS: The actual length, cord length, and surface angle means for the primary incision in the first postoperative day and month were 1.50 ± 0.1 and 1.47 ± 0.2 mm (P = .5), 1.41 ± 0.1 and 1.42 ± 0.2 mm (P = .8), and 27° ± 4° and 23° ± 5° (P = .07), respectively. The length and surface angle for the secondary incision in the first postoperative day and month were 1.17 ± 0.01 and 1.04 ± 0.1 mm (P = .05) and 52° ± 3° and 42° ± 5° (P = .007). The regional pachymetry values for the primary and secondary incisions were significantly increased in the first postoperative day and then significantly decreased after 1 month. All irregularities occurred in the posterior surface (endothelium): 2 cases of posterior gap (first day) and 1 case of posterior retraction (first month). The HOAs had not significantly changed preoperatively and after 1 month. CONCLUSIONS: The femtosecond laser refractive lens surgery incision is stable and does not significantly change the HOA.