Collaborative multidisciplinary management and expertise of cT2-3 locally advanced operable esophageal squamous cell carcinoma: a report of two cases.

Background: The accurate clinical staging of esophageal squamous cell carcinoma (ESCC) is pivotal for guiding treatment strategies. However, the current precision in staging for clinical T (cT)2 and cT3 stages remains unsatisfactory. This article discusses the role of multidisciplinary teams (MDTs) in the clinical staging and formulation of neoadjuvant treatment strategies for locally advanced operable ESCC. These challenges underscore the importance of precise staging in the decision-making process for appropriate therapeutic interventions. Case Description: Through the lens of two patient case studies with locally advanced resectable ESCC, the article showcases the intricate process of treatment planning undertaken by MDTs. It captures a range of expert perspectives from Japan, China, Hong Kong (China), Korea, the USA, and Europe, focusing on the challenges of differentiating between cT2 and cT3 stages of the disease, which is a critical determinant in the management and therapeutic approach for patients. Conclusions: The article concludes that the accurate staging of ESCC is a cornerstone in determining the most suitable treatment strategies. It underscores the vital role that MDTs play in both clinical staging and the decision-making process for treatment. Highlighting the limitations in current diagnostic methods, the article emphasizes the urgent need for advanced research and the refinement of diagnostic tools to improve the precision of staging, particularly between the cT2 and cT3 stages. It suggests that future research should consider whether a reclassification of these stages could be warranted to enhance treatment planning and outcomes for patients with ESCC.

Rutin ameliorates inflammatory pain by inhibiting P2X7 receptor in mast cells

Rutin is a natural anti-inflammatory ingredient widely found in medicinal plants. Studies have shown that rutin inhibits mast cell degranulation and the release of inflammatory mediators. Mast cell P2X7 receptor mediates mast cell degranulation and serves as a therapeutic target for inflammatory pain. Herein, the aim of this study was to investigate whether the anti-inflammatory mechanism of rutin is related to the mast cell P2X7 receptor. Our results showed that rutin could inhibit [Ca2+]i elevation induced by 5 mM ATP or 30 μM BZATP in a concentration-dependent manner in mouse peritoneal mast cells. Rutin also suppressed the inward current mediated by P2X7 receptor. In vivo, rutin could significantly inhibit the mechanical hypersensitivity induced by 100 mM ATP that is associated with P2X7 receptor in mast cells. Moreover, molecular docking revealed the high affinity between rutin and the P2X7 receptor crystal structure. Collectively, this study demonstrated that rutin attenuated inflammatory pain by inhibiting the activity of P2X7 receptor in mast cells. (AU)

Seizure Outcome After Surgery for Refractory Epilepsy Diagnosed by 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET/MRI): A Systematic Review and Meta-Analysis.

OBJECTIVE: When magnetic resonance imaging (MRI) fails to detect an underlying epileptogenic lesion, the odds of a good outcome after epilepsy surgery are significantly lower (20%-65% compared with 60%-90% if a lesion is detected). We investigated the possible effects of introducing hybrid 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET)/MRI into the decision algorithm for patients with lesioned and nonlesioned drug-resistant epilepsy. METHODS: Three databases were searched from January 1990 to October 2022. We registered the protocol with International Platform of Registered Systematic Review and Meta-analysis Protocols. Studies in which 18F-FDG PET/MRI was conducted with ≥12 months of postsurgical follow-up in patients with refractory epilepsy. Random-effects meta-analysis was used to calculate the proportion of patients with good outcomes. Metaregression was used to investigate sources of heterogeneity. RESULTS: We identified 8105 studies, of which 23 (1292 patients in total) were included. The overall good postoperative outcome rate was 71% (95% confidence interval 63.6-74.9). Good outcome was associated with the location of the refractory epileptic lesion (temporal lobe or extratemporal; risk ratio 1.27 [95% confidence interval 1.01-1.52], P = 0.009); Length of postoperative follow-up ≥40 months included in the same study accounted for 0.6% of the observed heterogeneity. CONCLUSIONS: Seventy-one percent of patients with refractory epilepsy and 18F-FDG PET/MRI epileptogenic lesion features had a good outcome of epilepsy after surgery. Our findings can be incorporated into routine preoperative consultations and emphasize the importance of the complete resection of the temporal lobe epileptogenic zone for 18F-FDG PET/MRI detection when safe and feasible.

Rutin ameliorates inflammatory pain by inhibiting P2X7 receptor in mast cells.

Rutin is a natural anti-inflammatory ingredient widely found in medicinal plants. Studies have shown that rutin inhibits mast cell degranulation and the release of inflammatory mediators. Mast cell P2X7 receptor mediates mast cell degranulation and serves as a therapeutic target for inflammatory pain. Herein, the aim of this study was to investigate whether the anti-inflammatory mechanism of rutin is related to the mast cell P2X7 receptor. Our results showed that rutin could inhibit [Ca2+]i elevation induced by 5 mM ATP or 30 µM BZATP in a concentration-dependent manner in mouse peritoneal mast cells. Rutin also suppressed the inward current mediated by P2X7 receptor. In vivo, rutin could significantly inhibit the mechanical hypersensitivity induced by 100 mM ATP that is associated with P2X7 receptor in mast cells. Moreover, molecular docking revealed the high affinity between rutin and the P2X7 receptor crystal structure. Collectively, this study demonstrated that rutin attenuated inflammatory pain by inhibiting the activity of P2X7 receptor in mast cells.

Peripheral T lymphocyte and immunocyte subset dynamics: markers of neoadjuvant therapy outcomes in esophageal squamous cell carcinoma.

Purpose: In patients with resectable esophageal squamous cell carcinoma (ESCC), neoadjuvant therapy increased the curative resection rate, disease-free survival, and overall survival for patients with resectable ESCC. However, the efficacy of neoadjuvant therapy varies among different patients. We aim to compare the differences in the characteristics of peripheral blood T lymphocyte subsets before and after neoadjuvant therapy in patients with different curative efficacy. Method: This study enrolled 266 ESCC patients who received neoadjuvant therapy and esophagectomy from August 2018 to August 2022. The postoperative pathological results divided patients into the major pathological response (MPR) and non-MPR groups. Compare the differences in peripheral blood T lymphocyte subsets and analyze the trend of changes in T lymphocyte subsets at different phases of treatment. Propensity score matching was used to reduce the influence of potential confounding factors. Results: Prior to the neoadjuvant therapy, particularly before the second cycle, the MPR group exhibited significantly higher ratios of CD4/CD8 (P=0.009) and helper T cells (TH ratio, P=0.030) compared to the non-MPR group. In contrast, the suppressor T cell ratio (TS ratio) was lower (P=0.016) in the MPR group. The difference in peripheral blood lymphocyte subsets between the two groups of patients who underwent neoadjuvant chemoradiotherapy is significant. Conclusion: In peripheral blood, T lymphocyte subsets varied significantly based on the effectiveness of neoadjuvant treatment. Prior to the second cycle of neoadjuvant therapy, a higher CD4/CD8 and TH ratio, coupled with a decreased TS ratio, might suggest enhanced treatment outcomes.

Pretreatment Low Serum Sodium as a Prognostic Factor for Patients with Esophageal Cancer Treated with Radiotherapy or Chemoradiotherapy.

Low serum sodium levels have been associated with poor prognoses for several cancers. However, the prognostic value of low serum sodium levels in esophageal carcinoma (EC) has not been well elucidated. We examined the prognostic value of low baseline serum sodium levels before radiotherapy or chemoradiotherapy for EC patients. A retrospective analysis of data from EC patients who received radiotherapy or chemoradiotherapy at a single cancer center was performed. Patients were divided into low serum sodium level (≤140.0 mmol/L) or high serum sodium level (>140.0 mmol/L) groups according to the median pretreatment serum sodium level. The Kaplan-Meier model and Cox proportional hazards model were used for survival analyses. The 5-year progression-free survival (PFS) and overall survival (OS) rates in the whole group were 16.9% and 21.8%, respectively. The PFS and OS rates of patients in the low serum sodium levels group were significantly lower than those in the high serum sodium levels group (p < 0.001). A similar association between PFS/OS and sodium levels was observed in the treatment subgroups. The univariate analysis showed that low serum sodium levels, Karnofsky performance status (KPS), clinical N stage, tumor site, clinical stage, and treatment mode were the influencing factors of OS. Multivariate analyses indicated that low baseline serum sodium levels were an independent prognostic marker of poor PFS (HR, 1.744; 95% CI, 1.248-2.437; p = 0.001) and OS (hazard ratio (HR), 2.125; 95% confidence interval (CI), 1.555-2.904; p < 0.001). Pretreatment levels of low serum sodium could be a new and helpful serum biomarker of the prognosis of EC patients receiving radiotherapy or chemoradiotherapy.

A Meta-Analysis of 5-Hydroxytryptamine Receptor 1B Polymorphisms With Risk of Major Depressive Disorder and Suicidal Behavior.

Purpose: Previous association studies have investigated whether genetic polymorphisms in HTR1B influenced individuals' susceptibility to major depressive disorder (MDD), anti-depressant response (ADR) and suicidal behavior. However, equivocal evidence was obtained. In this meta-analysis, we aimed to examine the association of HTR1B polymorphisms with risk of MDD, ADR and suicidal behavior. Materials and Methods: Studies evaluating the association between HTR1B polymorphisms and risk of MDD, ADR and suicidal behavior were searched in Pubmed, Ovid Medline, web of science and China National Knowledge Infrastructure databases. Summary odds ratios (ORs), 95 % confidence intervals (CIs) and p-values were calculated using a fixed or random effects model. Results: Meta-analysis findings revealed a significantly increased risk of MDD with rs6296 GC and GC/CC genotypes (GC vs. GG: OR = 1.26, 95% CI, 1.07-1.48; GC/CC vs. GG: OR = 1.22, 95% CI, 1.04-1.43, respectively). Moreover, rs6298 CT genotype was significantly associated with an increased risk of suicidal behavior (CT vs. CC: OR = 1.48, 95% CI, 1.16-1.88). However, both rs6296 and rs130058 were not significant risk factors for lethal suicidal behavior. Conclusion: This meta-analysis identified that rs6296 and rs6298 in HTR1B may be significantly related to the risk of MDD and lethality of suicide attempts, respectively. Further studies are required to assess the markers in larger cohorts.

Textural features based enhanced contrast CT images predicts prognosis to concurrent chemoradiotherapy in stage III esophageal squamous cell cancer.

INTRODUCTION: To study the relationship between the tumor heterogeneity based on CT and overall survival (OS) in oesophageal squamous cell carcinoma treated with chemotherapy and radiation therapy (CRT). METHODS: Fifty-seventh clinical patients who underwent definitive CRT were analyzed. The results were analyzed in terms of whole-tumor texture, with quantification of entropy, mean gray-level intensity for fine to coarse textures (filters 1.0-2.5, respectively). The association between texture parameters and survival time was assessed by Kaplan-Meier analysis and a Cox proportional hazards model. RESULTS: The median, 1 and 3 years OS, were 20.2 months, 75.4%, and 32.1%. In the univariate analysis performed using the log-rank test found global entropies (P= 0.0119), global mean (P= 0.088), global Std (P= 0.0209), and global uniformity (P= 0.0284) were found to be significant OS prognostic factors for filter value 1.0. Cox proportional hazards models that included a combination of pretreatment GlobalStd and post-treatment volume yields the best performance in predicting OS. Kaplan-Meier curves show that the patients in the high-risk group have significantly worse OS (log-rank test, P= 0.0009) and progression-free survival (PFS) (log-rank test, P= 0.0019) than those in the low-risk group. CONCLUSION: Pretreatment texture parameters are associated with survival time, and the combination of post volume performed better in survival models.

Tumor Compactness based on CT to predict prognosis after multimodal treatment for esophageal squamous cell carcinoma.

We aimed to establish a risk model using computed tomography-based compactness to predict overall survival (OS) and progression-free survival (PFS) after multimodal treatment for esophageal squamous cell carcinoma (ESCC). We extracted pre-treatment computed tomography-based tumor data (volume, surface area, and compactness) for 512 cases of ESCC that were treated at 3 centers. A risk model based on compactness was trained using Cox regression analyses of data from 83 cases, and then the model was validated using two independent cohorts (98 patients and 283 patients). The largest cohort (283 patients) was then evaluated using the risk model to predict response to radiotherapy with or without chemotherapy. In the three datasets, the pre-treatment compactness risk model provided good accuracy for predicting OS (P = 0.012, P = 0.022, and P = 0.003) and PFS (P < 0.001, P = 0.003, and P = 0.005). Patients in the low-risk group did not experience a significant OS benefit from concurrent chemoradiotherapy (P = 0.099). Furthermore, after preoperative concurrent chemoradiotherapy, the OS outcomes were similar among patients in the low-risk group who did and did not achieve a pathological complete response (P = 0.127). Tumor compactness was correlated with clinical T stage but was more accurate for predicting prognosis after treatment for ESCC, based on higher C-index values in all three datasets. The compactness-based risk model was effective for predicting OS and PFS after multimodal treatment for ESCC. Therefore, it may be useful for guiding personalized treatment.

Downregulation of microRNA-21 inhibited radiation-resistance of esophageal squamous cell carcinoma.

BACKGROUND: MicroRNA-21 (miR-21) was previously reported being dysregulated in many kinds of cancer including esophageal squamous cell carcinoma (ESCC). In the present study, we aimed to investigate the role of miR-21 in ESCC, especially in its effects on radiation-sensitivity of ESCC. METHODS: Expression of miR-21 was detected in 63 pairs ESCC tumor and adjacent non-tumoral tissues using qRT-PCR, correlation between miR-21 and clinicopathological feature of ESCC was analyzed. The role of miR-21 in the proliferation, cell cycle and apoptosis of ESCC cells during irradiation were studied. RESULTS: MicroRNA-21 expression was significantly increased in ESCC tumor tissues. Expression of miR-21 was positively associated with advanced clinical stage. Under irradiation, overexpression of miR-21 increased cell proliferation and cells in S phase, and inhibited cell apoptosis of ESCC cells. In contrast, knockdown of miR-21 had an opposite effect. CONCLUSIONS: Downregulation of miR-21 inhibited the radiation-resistance of ESCC, whereas overexpression of miR-21 increased the radiation-resistance. MiR-21 is a potential novel target for developing specific treatment interventions in ESCC in future.

External beam radiation and high-dose-rate brachytherapy for elderly patients with gastroesophageal junction adenocarcinoma.

PURPOSE: The aim of this study was to retrospectively observe and analyze the long-term treatment outcomes of 96 elderly patients with gastroesophageal junction adenocarcinoma (GEJAC) who were treated with californium-252 (252Cf) neutron brachytherapy (NBT) in combination with external beam radiotherapy (EBRT) with or without chemotherapy. MATERIAL AND METHODS: From January 2002 to November 2012, 96 patients with GEJAC underwent treatment. The total radiation dose to the reference point via NBT was 8-25 Gy-eq in 2 to 5 fractions, with 1 fraction per week. The total dose via EBRT was 40-54 Gy, which was delivered over a period of 4 to 5.5 weeks with normal fraction. RESULTS: The median survival time for the 96 patients was 15.3 months, and the 1-, 2-, 3-, and 5-year rates of overall survival (OS) were 62.5%, 33.7%, 20.1%, and 7.9%, respectively. The 1-, 2-, 3-, and 5-year rates for local-regional control (LRC) were 78.7%, 57.9%, 41.8%, and 26.4%, respectively. The patients' age was an independent factor that was significantly associated with OS (p = 0.006) and LRC (p = 0.0005), according to univariate analysis. The 3-year OS (LRC) was 31.9% (62.9%) for patients aged 70-74 years and 16.1% (19.5%) for patients aged ≥ 75 years. From the time of treatment completion to the development of local-regional recurrence or death, 5 (5.2%) patients experienced fistula and 7 (7.3%) experienced massive bleeding. CONCLUSIONS: The clinical data indicated that NBT in combination with EBRT produced favorable local control and long-term survival rates for elderly patients with GEJAC, and that the side effects were tolerable. The patient's age could be used to select the appropriate treatment in an elderly patient.

Does cervical lymph node recurrence after oesophagectomy or definitive chemoradiotherapy for thoracic oesophageal squamous cell carcinoma benefit from salvage treatment?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'Does cervical lymph node recurrence after oesophagectomy or definitive chemoradiotherapy for thoracic oesophageal squamous cell carcinoma benefit from salvage treatment?' Altogether, 659 articles were found using the reported search, of which 8 represented the best evidence to answer the clinical question. The authors, journal, date, country of publication, patient group studied, study type, relevant outcomes and results of these articles were tabulated. All were retrospective or institutional reports. Seven of the 8 articles suggested that cervical lymphadenectomy (LD) or multimodal treatment with LD and radiotherapy (RT)/chemoradiotherapy (CRT) was associated with good outcomes in patients with cervical lymph node (LN) recurrence after curative oesophagectomy for thoracic oesophageal squamous cell carcinoma (ESCC). Salvage cervical LD was the main treatment and could achieve locoregional disease control and prolonged survival. It was safe with no postoperative mortality, although minor LD complications such as recurrent laryngeal nerve palsy were observed. Most reports highlighted that a solitary cervical LN relapse after curative oesophagectomy could be considered a good prognostic indicator for salvage cervical LD or multimodal treatment. Patients with microscopic residual tumour after salvage cervical LD or suspected extensive metastasis might benefit from a combination of LD and CRT. One article described salvage RT alone, again with a positive effect on survival. Conversely, data suggested that salvage LD in patients after definitive CRT for thoracic ESCC was not likely to control locoregional disease.

Safety and outcome of external beam radiation and neutron brachytherapy in elderly patients with esophageal squamous cell cancer.

PURPOSE: The aim of this study was to retrospectively observe and analyze the long-term treatment outcomes of 191 elderly patients with esophageal squamous cell cancer (ESCC) who were treated with californium-252 (252Cf) neutron brachytherapy (NBT) in combination with external beam radiotherapy (EBRT). MATERIAL AND METHODS: From January 2002 to November 2012, 191 patients with ESCC underwent NBT in combination with EBRT. The total radiation dose to the reference point via NBT was 8-25 Gy-eq in two to five fractions with one fraction per week. The total dose via EBRT was 50-60 Gy, which was delivered over a period of 5 to 6 weeks with normal fractionation. RESULTS: The median survival time for the 191 patients was 23.6 months, and the 5-year rates for overall survival (OS) and local-regional control (LRC) were 28.7% and 54.2%, respectively. The patients' age was a factor that was significantly associated with OS (p = 0.010), according to univariate analysis. The 5-year OS (LRC) was 37.3% (58.6%) for patients aged 70-74 years and 14.5% (47.9%) for patients aged > 74 years (p = 0.010 and p = 0.038). In multivariate analysis, age and clinical N stage were associated with OS and LRC (p = 0.011 [0.041] and p = 0.005 [0.005]). From the time of treatment completion to the development of local-regional recurrence or death, 5 (2.6%) patients experienced fistula and 15 (7.9%) experienced massive bleeding. The incidence of severe late complications was related to older age (p = 0.027), higher NBT dose/fraction (20-25 Gy/5 fractions), and higher total dose (> 66 Gy). CONCLUSIONS: The clinical data indicated that NBT in combination with EBRT produced favorable local control and long-term survival rates for elderly patients with ESCC, and that the side effects were tolerable. Patient's age, clinical stage N status, and radiation dose could be used to select the appropriate treatment for elderly patients.

Concurrent versus sequential chemoradiotherapy for esophageal cancer among Chinese population: a meta-analysis.

AIMS AND BACKGROUND: Esophageal cancer can cause substantial mortality and there is controversy about the effectiveness of concurrent and sequential chemoradiotherapy (CRT) for this disease. METHODS AND STUDY DESIGN: Based on established criteria, we searched electronic databases including PubMed, Excerpta Medica Database (Embase), China National Knowledge Infrastruction (CNKI), Wanfang, and Weipu databases up to March 2014 to collect eligible studies. Relative risks (RRs) and their 95% confidence intervals (CIs) were calculated. Q and I2 test were applied to test statistical heterogeneities among studies. Publication bias of total effective rate was evaluated through a funnel plot and sensitive analysis was conducted. RESULTS: We identified 10 Chinese studies including 1024 esophageal cancer patients. The RRs of total effective rate and 1-, 2-, and 3-year survival rate for concurrent versus sequential CRT were 1.15 (95% CI 1.07 to 1.24), 1.15 (95% CI 1.05 to 1.26), 1.44 (95% CI 1.21 to 1.73), and 1.66 (95% CI 1.37 to 2.01), respectively, all with statistically significant differences (p<0.05). With regards to incidence of leukocytopenia, the RR for concurrent versus sequential CRT was 1.14 (95% CI 1.03 to 1.26) with significant difference (p<0.05). However, the RR of incidence of radiation esophagitis was 1.09 (95% CI 0.96 to 1.22) for concurrent versus sequential CRT without significant differences (p = 0.17). CONCLUSIONS: Concurrent CRT was superior to sequential CRT for esophageal cancer management among Chinese people. Though higher toxic effects were revealed in concurrent CRT, it was tolerable. Therefore, concurrent CRT could be applied into esophageal cancer treatments for Chinese patients.

Endoscopy-assisted vitrectomy for treatment of severe endophthalmitis with retinal detachment.

UNLABELLED: To decrease evisceration of eyes, endoscopy-assisted pars plana vitrectomy is a choice for patients with severe endophthalmitis accompanied with retinal detachment and corneal edema. PURPOSE: To evaluate surgical outcomes using an intraocular videoendoscope for vitrectomy in patients with severe endophthalmitis with retinal detachment. METHODS: From December 2006 to August 2009, the medical records of 21 patients undergoing endoscopy-assisted vitrectomy for endophthalmitis with retinal detachment were studied. Only patients with ≥18 months follow-up were included. RESULTS: Intraocular infections were under control in 19 of the 21 patients. Postoperatively, the visual acuity of three of the patients ranged from 2/100 to 20/100 (14.3 %), two of the patients left with finger counting (9.5 %), eight had hand motion (38.1 %), six had light perception (28.6 %), and the other two had their eyes eviscerated (9.5 %) because of recurrent and uncontrollable infection. CONCLUSIONS: In patients with severe endophthalmitis accompanied with retinal detachment and marked corneal opacity, it is appropriate to conduct endoscopy-assisted pars plana vitrectomy to decrease evisceration of eyes.

In vivo laser scanning confocal microscopy of the cornea in patients with silicone oil tamponade after vitreoretinal surgery.

PURPOSE: To evaluate the morphological changes in the cornea by in vivo laser scanning confocal microscopy (LSCM) in a large case series with silicone oil endotamponade after vitreoretinal surgery and to explore the value of LSCM in the early detection of silicone keratopathy (SK). METHODS: Ninety-nine patients (99 eyes) with silicone oil endotamponade after vitreoretinal surgery were included in the current study. Slit-lamp examination and measurement of intraocular pressure (IOP) were performed first. Then the central corneas of the subjects' eyes were examined by in vivo LSCM. The analysis of images of each corneal layer was performed and the endothelial cellular density (ECD), endothelial cellular area (ECA), coefficient of variation of cell size (CoV), and percentage of hexagonal cells (PHC) were measured. Moreover, the total size of stromal deposits was measured, and the correlation between the size of deposits and the parameters of endothelial cells was analyzed. RESULTS: Clinically recognizable abnormalities involving the cornea were identified in only 12 eyes (12.1%) under slit-lamp biomicroscopy, whereas in vivo LSCM revealed morphological abnormalities in 40 eyes (40.4%). The manifestations of endothelial lesions varied from decreased cellular density, increased polymegathism and pleomorphism to hyperreflective silicone oil membrane or droplets adhering to the endothelium. Moreover, hyperreflective deposits with various shapes could be identified in both posterior and anterior stroma, along with the infiltration of Langerhans cells beneath the epithelium. The average ECD and PHC of eyes with corneal abnormalities were significantly lower than those of normal corneas, whereas the average ECA and CoV were significantly larger (all Ps < 0.001). The patients with corneal abnormalities were significantly older than those others (P = 0.003). The rate of pseudophakic and aphakic eyes having corneal abnormalities was significantly higher than that of phakic eyes (P = 0.045). Interestingly, the total size of stromal deposits had a significant negative correlation with ECD and PHC but a significant positive correlation with ECA and CoV (all Ps < 0.001). Further correlation analysis performed in groups divided according to the lens status showed similar results and even stronger correlations in aphakic and pseudophakic eyes, whereas no statistically significant correlations were found in phakic eyes. CONCLUSIONS: In vivo LSCM was a useful tool in the early detection of corneal abnormalities caused by silicone oil injection, including varying corneal endothelium lesions and stromal abnormalities. Pseudophakic or aphakic eyes, as well as those of older patients, should receive more attention because they are more inclined to develop silicone keratopathy.