Prospective Objective Analysis of Corneal Haze Following Customized Transepithelial PRK Without Mitomycin C Combined With Accelerated Corneal Cross-Linking Versus Corneal Cross-Linking Alone.

PURPOSE: To compare haze and refractive outcomes in patients undergoing combined accelerated corneal cross-linking (A-CXL) and selective wavefront-guided transepithelial photorefractive keratectomy (WG-transPRK) without mitomycin C (MMC) versus those undergoing A-CXL. METHODS: This prospective study analyzed 95 eyes (86 patients) with progressive keratoconus from October 2018 to October 2022. The first group underwent CXL combined with corneal or ocular WG-transPRK (CXL+PRK, n = 52), targeting higher order aberrations (HOAs). The second underwent CXL only (n = 43), both following the same accelerated CXL protocol without MMC on the SCHWIND Amaris laser platform (SCHWIND eye-tech-solutions). Baseline and postoperative evaluations (1, 3, 6, and 12 months) included uncorrected (UDVA) and corrected (CDVA) distance visual acuity, manifest refraction, tomography, corneal HOAs, and optical coherence tomography (OCT) scans. A patented machine learning algorithm objectively detected and quantified stromal haze on OCT scans in grayscale units. RESULTS: In both groups, anterior corneal haze reflectivity and subepithelial haze peaked at 3 months postoperatively, then progressively decreased at 6 and 12 months. Haze did not differ between groups at any time point. By 12 months, CDVA increased by 2.5 lines in the CXL+PRK group (P < .001) and by 0.7 lines in the CXL group (P = .10), and maximum keratometry decreased from 51.70 ± 5.10 to 47.90 ± 7.90 diopters (D) (CXL+PRK group) (P < .001) and from 51.20 ± 5.10 to 50.30 ± 4.60 D (CXL group) (P = .004). Corneal HOAs decreased in both groups but more in the CXL+PRK group. CONCLUSIONS: Combining CXL with WG-transPRK without MMC does not result in increased haze when compared to A-CXL alone. This combined approach achieves greater improvements in visual, topographic, and aberrometric parameters. [J Refract Surg. 2024;40(9):e583-e594.].

Enhancing the Automated Detection of Implantable Collamer Lens Vault Using Generative Adversarial Networks and Synthetic Data on Optical Coherence Tomography.

PURPOSE: To investigate the efficacy of incorporating Generative Adversarial Network (GAN) and synthetic images in enhancing the performance of a convolutional neural network (CNN) for automated estimation of Implantable Collamer Lens (ICL) vault using anterior segment optical coherence tomography (AS-OCT). METHODS: This study was a retrospective evaluation using synthetic data and real patient images in a deep learning framework. Synthetic ICL AS-OCT scans were generated using GANs and a secondary image editing algorithm, creating approximately 100,000 synthetic images. These were used alongside real patient scans to train a CNN for estimating ICL vault distance. The model's performance was evaluated using statistical metrics such as mean absolute percentage error (MAPE), mean absolute error (MAE), root mean squared error (RMSE), and coefficient of determination (R2) for the estimation of ICL vault distance. RESULTS: The study analyzed 4,557 AS-OCT B-scans from 138 eyes of 103 patients for training. An independent, retrospectively collected dataset of 2,454 AS-OCT images from 88 eyes of 56 patients, used prospectively for evaluation, served as the test set. When trained solely on real images, the CNN achieved a MAPE of 15.31%, MAE of 44.68 µm, and RMSE of 63.3 µm. However, with the inclusion of GAN-generated and algorithmically edited synthetic images, the performance significantly improved, achieving a MAPE of 8.09%, MAE of 24.83 µm, and RMSE of 32.26 µm. The R2 value was +0.98, indicating a strong positive correlation between actual and predicted ICL vault distances (P < .01). No statistically significant difference was observed between measured and predicted vault values (P = .58). CONCLUSIONS: The integration of GAN-generated and edited synthetic images substantially enhanced ICL vault estimation, demonstrating the efficacy of GANs and synthetic data in enhancing OCT image analysis accuracy. This model not only shows potential for assisting postoperative ICL evaluations, but also for improving OCT automation when data paucity is an issue. [J Refract Surg. 2024;40(4):e199-e207.].

Asymmetric All-Femtosecond Laser-Cut Corneal Allogenic Intrastromal Ring Segments.

PURPOSE: To describe a novel technique for cutting asymmetric allogenic segments using the femtosecond laser for the management of cases of keratoconus with non-coinciding astigmatism and coma axes. METHODS: Four eyes of 2 patients with irregular keratoconus and asymmetric allogenic segments were included. Visual, refractive, tomographic, and aberrometric outcomes, and optical coherence tomography (OCT) sections were measured preoperatively and 6 months postoperatively. Evaluations included slit-lamp examination, manifest refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuity, and simulated and maximum anterior keratometry (Kmax) using anterior segment OCT. RESULTS: Spherical and cylindrical refractive errors decreased from -2.38 ± 2.96 and -2.94 ± 2.16 to -1.81 ± 2.77 (P = .04) and -1.75 ± 2.07 (P = .01) diopters (D), respectively, 6 months postoperatively. There was an average gain of three lines of CDVA. Kmax decreased from 50.02 ± 1.99 to 47.89 ± 3.05 D (P= .03) and coma from 1.05 ± 0.21 to 0.21 ± 0.19 D (P = .01). CONCLUSIONS: Asymmetric femtosecond laser-cut allogenic segments allow a higher level of customization based on size, shape, and arc length, in contrast to the limited range of available synthetic asymmetrical segments. [J Refract Surg. 2023;39(12):856-862.].

Corneal Allogenic Intrastromal Ring Segments (CAIRS) for Corneal Ectasia: A Comprehensive Segmental Tomography Evaluation.

PURPOSE: To evaluate the visual, refractive, and tomographic results of patients with corneal ectasia treated with corneal allogenic intrastromal ring segments (CAIRS) insertion without concomitant corneal cross-linking. METHODS: Fifty-two eyes from 39 patients with stable corneal ectasia and unsatisfactory visual acuity with contact lenses were included. All patients underwent CAIRS insertion with no concomitant corneal procedure at the American University of Beirut Medical Center between September 2019 and July 2022. Visual, refractive, topographic, aberrometric, epithelial, stromal, and segment thickness data were measured relative to baseline at 1 week, 1 month, and at least 3 months postoperatively. Evaluations included slit-lamp examination, manifest refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuity, and tomography using anterior segment optical coherence tomography. RESULTS: Mean follow-up time was 6.9 ± 5.2 months. UDVA and CDVA improved from 0.97 ± 0.47 and 0.56 ± 0.19 preoperatively to 0.52 ± 0.21 (P < .001) and 0.23 ± 0.19 (P < .001) 3 months postoperatively. Manifest refraction spherical equivalent and cylinder improved from -6.71 ± 6.51 and -4.02 ± 2.24 diopters (D) preoperatively to -3.78 ± 4.07 D (P < .001) and -2.35 ± 1.98 D (P < .001) 3 months postoperatively, respectively. Maximum anterior keratometry and vertical coma decreased from 58.09 ± 7.92 D and 1.56 ± 1.09 µm to 52.48 ± 6.69 D (P < .001) and 0.43 ± 0.77 µm, respectively (P < .001). Corneal epithelium thickened proximal to the allogenic segment by 7.25 µm (P < .001), whereas stromal elevation at the cone decreased from 38.61 ± 18.5 to 23.82 ± 13.4 µm, respectively (P < .001). No major complications were observed and only 1 eye lost one line of CDVA. CONCLUSIONS: Treatment of corneal ectasia with CAIRS improved visual, refractive, topographic, and tomographic parameters. Epithelial thickening central to CAIRS, along with anterior stromal flattening is postulated to contribute to tomographic flattening and regularization. [J Refract Surg. 2023;39(11):767-776.].

Extended Dehydration of Corneal Allogenic Intrastromal Ring Segments to Facilitate Insertion: The Corneal Jerky Technique.

PURPOSE: The aim of this study was to describe a new technique to facilitate the insertion of corneal allogenic intrastromal ring segments. METHODS: A single-segment corneal allogenic intrastromal ring segment (CAIRS) was trephined from donor corneas and allowed to markedly dehydrate for 75 minutes before the start of the procedure with a room humidity of 35% to 45%. The duration of the insertion step and the intrastromal segment size at 1 week as measured by optical coherence tomography were compared with previously performed single-segment CAIRS procedures using the conventional technique. RESULTS: A total of 41 eyes of 36 patients underwent 1-segment CAIRS insertion of the same trephination size (750 µm). Fifteen eyes underwent the conventional insertion procedure, and 26 eyes had a dehydrated segment inserted. The time taken to insert the CAIRS analyzed by surgical video recording starting after the femtosecond tunnel creation and initiation of the insertion to the segment ironing step was 282 ± 103 and 97 ± 23 seconds for the conventional and the dehydrated segment technique, respectively ( P < 0.001). Anterior segment optical coherence tomography performed 1 week postoperatively revealed similar segment thickness and width of 471.3 ± 54.1 µm and 1285.1 ± 191.0 µm for the conventional allogenic segments and 483.4 ± 58.3 µm and 1227.2 ± 165.2 µm for the dehydrated segments ( P = 0.515 and 0.314, respectively). CONCLUSIONS: Markedly dehydrated corneal allogenic segments are easier and faster to insert than the nondehydrated ones while maintaining similar sizes intrastromally. This dehydration technique makes the procedure similar to the one with synthetic segments and hence reduces the learning curve.

Current landscape of clinical trials for HPV-positive head and neck squamous cell carcinoma (HNSCC).

This study aims to determine the current state of clinical trials regarding HPV-positive head and neck squamous cell carcinoma (HNSCC). Clinical trials were filtered to fit the study's aim using Clinicaltrials.gov: trials concerning HNSCC specifically those related to HPV done between January 2005 and December 2020 were extracted and information regarding location, duration, phases, patient recruitment, trial status, results, primary outcome, type of intervention and publication status were collected and analysed. As a result, 123 trials were included. North American countries (USA and Canada) conducted more than two-thirds of the trials (72.4%) compared to European countries and the rest of the world. Trials in phase II constituted more than half of those included in this study (53.7%). From the 123 trials included in this study, only 30 had their NCT identification number linked to publications, but less than half (46.7%) of the publications stemmed from trials with results. Drug combination was the most widely studied treatment modality. Despite falling in the middle of the spectrum with respect to the number of trials when compared to other diseases, our research highlights the need for even more trials tackling multiple aspects of HPV-positive HNSCC.

COVID-19 and Liver Dysfunction.

Introduction The pandemic of coronavirus disease 2019 (COVID-19) has caused over four million deaths, depleting resources and healthcare workers; therefore, in an attempt to stratify patients, the relationship between liver enzymes and clinical outcome was studied. This study aimed to assess the pattern and impact of liver enzymes on the clinical outcome of hospitalized patients with COVID-19 in Lebanon and look for possible confounding factors. Methodology This was a single-centered retrospective cohort study conducted between December 2020 and March 2021 on 230 patients diagnosed with COVID-19. Liver function tests (LFTs) and other laboratory values on admission and peak hospitalization were analyzed using SPSS. Results The prevalence of abnormal liver tests among the sample population with severe COVID-19 infection were as follows: aspartate aminotransferase (AST), 77%; alanine aminotransferase (ALT), 49%; alkaline phosphatase (ALP), 12%; and gamma-glutamyl transferase (GGT), 37%. A severe COVID-19 infection was more likely present in patients with abnormal levels of AST (p = 0.015), ALP (p = 0.03), and GGT (p = 0.022). ANOVA test revealed no significant relationship between AST levels at peak hospitalization and the treatments received by the patient. Conclusion Abnormal liver function tests of patients at admission may be an indicator of more severe disease. In the context of scarce resources created by the pandemic, it becomes essential to establish a reliable predictor for a severe outcome of COVID-19 infection and manage accordingly.