Objective Enhanced recovery after surgery(ERAS)protocols have revolutionized postoperative care by integrating minimally invasive techniques and patient-centered strategies to reduce physical and psychological trauma....Objective Enhanced recovery after surgery(ERAS)protocols have revolutionized postoperative care by integrating minimally invasive techniques and patient-centered strategies to reduce physical and psychological trauma.However,the cognitive and experiential dimensions of surgical incisions under ERAS remain underexplored,particularly in non-Western populations.This study aims to explore patients’perceptions and preferences regarding laparoscopic incisions under ERAS,providing evidence to optimize incision planning and perioperative education.Methods A qualitative descriptive study was conducted at the Department of Surgery,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,between November 2022 and February 2023.The participants were adults(≥18 years)who underwent elective laparoscopic abdominal surgery under ERAS,excluding those with cognitive impairments,language barriers,or emergency procedures.Semi-structured interviews,covering physical function,social function,emotional function,self and others’acceptance,and confidence in the nature and treatment of the disease,were audio-recorded and transcribed verbatim and guided by a thematic framework co-developed by surgeons,nurses,and psychologists.The data were analyzed via the framework method to identify themes related to incision experiences.Results This qualitative study included 16 participants,8(50%)females and 6(37.5%)cancer patients,with a mean age of 41.5±12.2 years.Qualitative analysis revealed that the participants experienced minimal psychological distress and great emphasis on pain management and expressed specific concerns regarding the location,size,and cosmetic appearance of the incision.They also voiced high expectations for preventing incision complications and sought information regarding postoperative care.There was notable variation in preferences regarding the choice of incision site before surgery.Participants with cancer focused on disease cure rather than aesthetics.Conclusion Personalized preoperative discussions,incision site selection,and postoperative education are critical for increasing patient satisfaction.Laparoscopic incisions under ERAS minimally impact psychological well-being,but location-specific discomfort and aesthetic preferences require attention.展开更多
AIMTo determine the surgically induced astigmatism (SIA) in Straight, Frown and Inverted V shape (Chevron) incisions in manual small incision cataract surgery (SICS).
BACKGROUND Necrotizing fasciitis is a fulminant necrotizing soft tissue disease with a high fatality rate.It always starts with impact on the deep fascia rapidly and might result in secondary necrosis of the subcutane...BACKGROUND Necrotizing fasciitis is a fulminant necrotizing soft tissue disease with a high fatality rate.It always starts with impact on the deep fascia rapidly and might result in secondary necrosis of the subcutaneous tissue,fascia,and muscle.Thus,timely and multiple surgical operations are needed for the treatment.Meanwhile,the damage of skin and soft tissue caused by multiple surgical operations may require dermatoplasty and other treatments as a consequence.CASE SUMMARY Here,we report a case of 50-year-old male patient who was admitted to our hospital with symptoms of necrotizing fasciitis caused by cryptoglandular infection in the perianal and perineal region.The symptoms of necrotizing fasciitis,also known as the cardinal features,include hyperpyrexia,excruciatingly painful lesions,demonstration gas in the tissue,an obnoxious foul odor and uroschesis.The results of postoperative pathology met the diagnosis.Based on the premise of complete debridement,multiple incisions combined with thread-dragging therapy(a traditional Chinese medicine therapy)and intensive supportive therapies including comprising antibiotics,nutrition and fluids were given.The outcome of the treatment was satisfactory.The patient recovered quickly and achieved ideal anal function and morphology.CONCLUSION Timely and effective debridement and multiple incisions combined with thread-dragging therapy are an integrated treatment for necrotizing fasciitis.展开更多
Dear Editor, I am Dr.Daniela Alvarez-AscenciofromtheGlaucoma Department at Asociacion Para Evitar la Ceguera (APEC)in Mexico City, Mexico. I write to present a successful case of cyclodyalisis repair in a direct visua...Dear Editor, I am Dr.Daniela Alvarez-AscenciofromtheGlaucoma Department at Asociacion Para Evitar la Ceguera (APEC)in Mexico City, Mexico. I write to present a successful case of cyclodyalisis repair in a direct visualization technique that was performed on a patient after a microincisional glaucoma surgery (MIGS) complication.展开更多
Kalman's Filter Technique for the separation of overlapping incisions of an a.c.oscillopolarogram is presented,the experimental verifications were carried out in various systems with the ions of Pb^(2+),Tl^+,In^(3...Kalman's Filter Technique for the separation of overlapping incisions of an a.c.oscillopolarogram is presented,the experimental verifications were carried out in various systems with the ions of Pb^(2+),Tl^+,In^(3+)and Cd^(2+).The results showed that the concentration of the depolarizer can be determined directly and easily with this technique in the presence of interference elements.展开更多
Background/Aims: Inguinal incisions are a common route of access in vascular surgery. Due to anatomical challenges and a diverse bacterial flora in this area, surgical site infections (SSI) represent a common, debilit...Background/Aims: Inguinal incisions are a common route of access in vascular surgery. Due to anatomical challenges and a diverse bacterial flora in this area, surgical site infections (SSI) represent a common, debilitating and sometimes life-threatening complication. The INVIPS-Trial evaluates the role of Negative Pressure Wound Therapy (NPWT) on closed inguinal incisions in elective vascular surgery to prevent SSI and other wound complications. Methods: This randomized controlled trial (RCT) registered at ClinicalTrials.gov (Identifier: NCT01913132) compares the effects of a NPWT dressing (PICO, Smith & Nephew, UK) and the center’s standard wound dressing (Vitri Pad, ViTri Medical, Sweden) on postoperative wound complications, especially SSI. The study includes two distinct vascular procedures with different SSI risk profiles: endovascular aortic repair (EVAR) and open surgical approaches involving the common femoral artery (OPEN). Results: Four hundred ninety-five groin incisions in both treatment arms are anticipated to be included in the EVAR group and 147 inguinal incisions in both treatment arms in the OPEN group. Since a large percentage of inguinal vascular procedures in both groups but especially in the EVAR group are performed bilaterally, many patients can serve as their own control by randomly receiving NPWT on one and the standard dressing on the contralateral inguinal incision. Conclusions: This ongoing RCT attempts to elucidate the potential benefit of NPWT on closed inguinal incisions after different vascular procedures. Outcome and conclusions of this trial could have implications on postoperative wound care of patients in both vascular surgery and other surgical specialties.展开更多
AIM:To investigate the clinical efficacy and safety of femtosecond laser-assisted steepest-meridian clear corneal incisions for correcting preexisting corneal astigmatism performed at the time of cataract surgery.METH...AIM:To investigate the clinical efficacy and safety of femtosecond laser-assisted steepest-meridian clear corneal incisions for correcting preexisting corneal astigmatism performed at the time of cataract surgery.METHODS:This prospective case series study comprised consecutive age-related cataract patients with corneal regular astigmatism(range:+0.75 to+2.50 D)who had femtosecond laser-assisted steepest-meridian clear corneal incisions(single or paired).Corneal astigmatism was performed with the Pentacam preoperatively and 3 mo postoperatively.Total corneal astigmatism and steepestmeridian measured in the 3-mm central zone were used to guide the location,size and number of clear corneal incision.The vector analysis of astigmatic change was performed using the Alpins method.RESULTS:Totally 138 eyes of 138 patients were included.The mean preoperative corneal astigmatism was 1.31±0.41 D,and was significantly reduced to 0.69±0.34 D(equivalent to difference vector)after surgery(P<0.01).The surgically-induced astigmatism was 1.02±0.54 D.The correction index(ratio of target induced astigmatism and surgically-induced astigmatism:0.72±0.36)as well as the magnitude of error(difference between surgically-induced astigmatism and target induced astigmatism:-0.29±0.51)represented a slight under correction.For angle of error,the arithmetic mean was 1.11±13.70,indicating no significant systematic alignment errors.CONCLUSION:Femtosecond-assisted steepest-meridian clear corneal incision is a fast,customizable,adjustable,precise,and safe technique for the reduction of low to moderate corneal astigmatism during cataract surgery.展开更多
The improvement of antibiotic rational use in China was studied by usage analysis of combination antibiotic therapy for type Ⅰ incisions in 244 hospitals. Five kinds of hospitals, including general hospital, maternit...The improvement of antibiotic rational use in China was studied by usage analysis of combination antibiotic therapy for type Ⅰ incisions in 244 hospitals. Five kinds of hospitals, including general hospital, maternity hospital, children＇s hospital, stomatological hospital and cancer hospital, from 30 provinces were surveyed. A systematic random sampling strategy was employed to select outpatient prescriptions and inpatient cases in 2011 and 2012. A total of 29 280 outpatient prescriptions and 73 200 inpatient cases from 244 hospitals in each year were analyzed. Data were collected with regards to the implementation of the national antibiotic stewardship program（NASP）, the overall usage and the prophylactic use of antibiotic for type Ⅰ incisions. Univariate analysis was used for microbiological diagnosis rate before antimicrobial therapy, prophylactic use of antibiotics for typeⅠincision operation, and so on. For multivariate analysis, the use of antibiotics was dichotomized according to the guidelines, and entered as binary values into logistic regression analysis. The results were compared with the corresponding criteria given by the guidelines of this campaign. The antibiotic stewardship in China was effective in that more than 80% of each kind of hospitals achieved the criteria of recommended antibiotics varieties. Hospital type appeared to be a factor statistically associated with stewardship outcome. The prophylactic use of antibiotics on type Ⅰ incision operations decreased by 16.22%（P〈0.05）. The usage of combination antibiotic therapy for type Ⅰ incisions was also decreased. Region and bed size were the main determinants on surgical prophylaxis for type Ⅰ incision. This national analysis of hospitals on antibiotic use and stewardship allows relevant comparisons for bench marking. More efforts addressing the root cause of antibiotics abuse would continue to improve the rational use of antibiotics in China.展开更多
Objective:To explore the clinical application of skin wound adhesive(glue)in skin incisions.Methods:Data from 46 patients who underwent surgery in our hospital between June 2024 and August 2024 were collected,focusing...Objective:To explore the clinical application of skin wound adhesive(glue)in skin incisions.Methods:Data from 46 patients who underwent surgery in our hospital between June 2024 and August 2024 were collected,focusing on breast surgery incisions as the study subject,with follow-up observations conducted for 1–2 weeks.Results:All incisions healed well without splitting,allergic reactions,or infections,and no adverse reactions were observed.Conclusion:The application of skin wound adhesive(glue)in breast surgery incisions is effective and safe;the adhesive process is convenient for external body incisions,eliminates the need for suture removal,shortens patient surgery and hospital stays,and reduces incision infection risk,resulting in satisfactory incision healing outcomes.展开更多
Purpose To investigate the efficacy of image-guided accurate limbal relaxing incisions(LRIs)for astigmatism correction during cataract surgery.Methods Consecutive cataract patients with regular corneal astigmatism ran...Purpose To investigate the efficacy of image-guided accurate limbal relaxing incisions(LRIs)for astigmatism correction during cataract surgery.Methods Consecutive cataract patients with regular corneal astigmatism ranging from 0.75 to 2.50 D,intended for cataract surgery with image-guided LRIs,were recruited in this prospective cohort study.The efficacy of astigmatism correction was evaluated 3 months after surgery,and compared among eyes with preoperative corneal with-the-rule(WTR),against-the-rule(ATR)and oblique astigmatism.Higher-order aberrations and visual quality indices obtained with iTrace were further compared between eyes with single and paired LRIs.Results Totally,108 eyes of 108 patients were analyzed.The mean total surgical induced astigmatism(tSIA)vector of all participants was 0.76±0.38 D(range:0.11–1.79 D,preoperative vs.postoperative astigmatism:1.46±0.41 vs.0.78±0.44 D,P<0.001).Eyes with WTR astigmatism showed higher tSIA(0.89±0.32 D vs.0.42±0.21 D vs.0.48±0.36 D,respectively,P<0.001),as well as higher correction index and lower difference vector and index of success than ATR and oblique astigmatism groups(all P<0.05).Eyes with paired LRIs exhibited better corneal average height of modulation transfer function,a better corneal performance index and a better quality of vision index than those with single LRI(all P<0.05).Conclusions Image-guided LRIs can effectively correct low-to-moderate corneal astigmatism during cataract surgery,especially in eyes with WTR astigmatism.展开更多
Postoperative visual acuity can be limited by post-keratoplasty astigmatism,even with a clear corneal graft.Astigmatism management can be performed by selective suture removal,adjustment of sutures,optical correction,...Postoperative visual acuity can be limited by post-keratoplasty astigmatism,even with a clear corneal graft.Astigmatism management can be performed by selective suture removal,adjustment of sutures,optical correction,photorefractive procedures,wedge resection,intra-ocular lens implantation,intracorneal ring segments,relaxing incisions with or without compression sutures and repeated keratoplasty.Relaxing incisions can be made in the graft,graft-host interface or host cornea.Despite the unpredictability of the method because the flat and steep meridians are usually not orthogonal after penetrating keratoplasty,with asymmetric power distribution,all the studies showed an overall reduction of refractive,keratometric or topographic astigmatism,ranging from 30%to 72%with manual or femtosecond-assisted techniques.Most patients with astigmatism higher than 6 diopters had residual cylinder less than or equal to 3 diopters,which can be treated by laser excimer ablation or secondary intraocular lens implantation.展开更多
Background:To evaluate the accuracy and safety of micro radial and arcuate keratotomy incisions constructed by a femtosecond laser system with a curved contact patient interface in porcine eyes.Methods:Partial thickne...Background:To evaluate the accuracy and safety of micro radial and arcuate keratotomy incisions constructed by a femtosecond laser system with a curved contact patient interface in porcine eyes.Methods:Partial thickness micro radial and arcuate keratotomy incisions were constructed in porcine eyes with a femtosecond laser system and evaluated for precision of depth,quality,and consistency.Optical coherence tomography was used to determine the accuracy and precision of incision depth.Corneal endothelial safety was assessed by a fluorescent live/dead cell viability assay to demonstrate laser-induced endothelial cell loss.Quality was evaluated by ease of opening and examination of interfaces.Results:In two micro radial incision groups,intended incision depths of 50%and 80%resulted in mean achieved depths of 50.01%and 77.69%,respectively.In three arcuate incision groups,intended incision depths of 80%,600μm or 100μm residual uncut bed thickness resulted in mean achieved depths of 80.16%,603.03μm and residual bed of 115μm,respectively.No loss of endothelial cell density occurred when the residual corneal bed was maintained at a minimum of 85-116μm.The incisions were easy to open,and interfaces were smooth.Conclusions:A femtosecond laser system with curved contact interface created precise and reproducible micro radial and arcuate keratotomy incisions.Accuracy and precision of the incision depth and preservation of endothelial cell density demonstrated the effectiveness and safety of the system.展开更多
Background Keyhole surgery has developed since the 1990s as a less invasive therapeutic strategy for intracranial lesions, initially for the treatment of intracranial aneurysms. The purpose of this study was to descri...Background Keyhole surgery has developed since the 1990s as a less invasive therapeutic strategy for intracranial lesions, initially for the treatment of intracranial aneurysms. The purpose of this study was to describe and evaluate the results of surgical treatment of lesions in the anterior fossa and sellar region via a supraorbital keyhole approach using eyebrow incisions. Methods Between April 1994 and July 2003, 54 patients with lesions in the anterior fossa and sellar region were operated on via the supraorbital keyhole approach. The surgical results were studied retrospectively and compared with that of patients with lesions at the same locations but treated via a conventional subfrontal approach.Results No significant difference in curative effect was found between the conventional subfrontal approach and the supraorbital keyhole approach. However, the supraorbital approach required a much smaller skin incision, causing less surgical trauma, while achieving excellent surgical exposure and good recovery. Conclusion The supraorbital keyhole approach using an eyebrow incision is safe, effective, and both suitable and convenient for treating lesions in the anterior fossa and sellar region, with almost no adverse consequences on the facial features of patients.展开更多
Purpose: The purpose of the study is to compare the surgical access and post-operative outcome of two intra-oral incisions used for approaching a mandibular body fracture. Methods: This clinical trial involved 60 pati...Purpose: The purpose of the study is to compare the surgical access and post-operative outcome of two intra-oral incisions used for approaching a mandibular body fracture. Methods: This clinical trial involved 60 patients with mandibular body fractures who were randomly allocated to control and study groups. The fractures were approached using the routine vestibular incision in the control group and crevicular incision with vertical release in the study group. The effects of incision design on the post-surgical outcome variables like swelling, trismus, paresthesia, wound healing and gingival recession were statistically analysed with non-parametric tests by using SPSS 22.0 software. Comparison of continuous variables between the groups and time points was done using Mann Whitney test and Friedman test respectively. Chi-square test was used to compare proportions between groups. Dunn's test with Bonferroni correction was used for pair wise comparisons. Results: The study group demonstrated favourable surgical outcome in the immediate postoperative phase as compared to the control group. The difference in mouth opening, swelling and neurosensory impairment between the two groups was found to be statistically significant (p < 0.05). Conclusion: Crevicular incision was found to be an ideal alternative to vestibular incision in achieving surgical access and fixation of mandibular body fractures with reduction in postoperative patient discomfort and better surgical outcome.展开更多
BackgroundTo compare the arithmetic mean (M-SIA) and the summated vector mean of surgically induced astigmatism (SVM-SIA) according to the incision site after phakic intraocular lens (Visian implantable collamer lens ...BackgroundTo compare the arithmetic mean (M-SIA) and the summated vector mean of surgically induced astigmatism (SVM-SIA) according to the incision site after phakic intraocular lens (Visian implantable collamer lens (ICL), STAAR Surgical) implantation.MethodsThis study comprised 121 eyes of 121 consecutive patients undergoing ICL surgery through a 3.0-mm temporal or superior clear corneal incision. The magnitude and the axis of corneal astigmatism preoperatively and 3 months postoperatively were measured using an automated keratometer. The M-SIA and the SVM-SIA were determined according to the incision site.ResultsThe magnitude of corneal astigmatism significantly increased from 1.23 ± 0.59 D preoperatively to 1.46 ± 0.72 D postoperatively in the temporal incision group (Wilcoxon signed-rank test, P < 0.001), but it significantly decreased from 1.09 ± 0.36 D preoperatively to 0.86 ± 0.41 D postoperatively in the superior incision group (P < 0.001). The M-SIA was 0.48 ± 0.30 D, and the SVM-SIA was 0.23 ± 0.52 D at a meridian of 82° in the temporal incision group. The M-SIA was 0.57 ± 0.30 D, and the SVM-SIA was 0.47 ± 0.45 D at a meridian of 1° in the superior incision group.ConclusionsICL implantation induces the M-SIA by approximately 0.5 D, but the SVM-SIA decreased to 50% and 80% of the M-SIA in magnitude through temporal and superior incisions, respectively. The direction of the SVM-SIA showed a tendency toward corneal flattening to the incisional site. It should be noted that the M-SIA is somewhat different from the SVM-SIA according to the incision site.展开更多
Objective:To explore the clinical effect of improved incision in the extraction of impacted mandibular wisdom teeth.Methods:160 patients who were treated in our hospital from October,2024 to April,2025 and had their m...Objective:To explore the clinical effect of improved incision in the extraction of impacted mandibular wisdom teeth.Methods:160 patients who were treated in our hospital from October,2024 to April,2025 and had their mandibular impacted wisdom teeth removed according to the doctor’s advice were randomly divided into observation group and control group.The observation group used modified incision,while the control group used traditional triangular incision.The operation time,intraoperative visual analogue scale(VAS)pain score,pain VAS score on the 1st,2nd and 3rd day after operation,facial swelling on the 2nd day after operation,mouth opening limitation on the 2nd day after operation and the incidence of dry socket after operation were recorded and compared between the two groups.Results:There was no significant difference in operation time between the two groups(p>0.05).The VAS score of pain in the observation group was significantly lower than that in the control group at each time point during and after operation(p<0.05).On the second day after operation,the facial swelling and mouth opening limitation in the observation group were significantly lighter than those in the control group(p<0.05).The incidence of dry socket in the observation group was 1.25%(1/80),which was significantly lower than that in the control group(8.75%,7/80),and the difference was statistically significant(p<0.05).Conclusion:The application of modified triangular incision in the extraction of impacted mandibular wisdom teeth can effectively relieve the pain during and after operation,reduce postoperative facial swelling and mouth opening limitation,and reduce the incidence of dry socket.展开更多
The dynamic relationship between field management and reservoir characterization has often been a puzzle,especially in complex deepwater channel systems.Reservoir management and infill drilling success cases were ofte...The dynamic relationship between field management and reservoir characterization has often been a puzzle,especially in complex deepwater channel systems.Reservoir management and infill drilling success cases were often due to improved understanding of deepwater depositional systems and geological controls on channel architecture and the general distribution of individual rock facies.For confined to weakly-confined slope channel complexes,some controls on the degree of channel avulsion and aggradation are the interplay between flow hydraulics,sediment calibre,depositional gradient,and the interaction of the flow with underlying substrate.This work aims at documenting the stratigraphic characterization of a Miocene deepwater channel system in a brownfield with focus on the historical evolution of the framework interpretation as well as applications of the recent updates in field management.The initial stratigraphic model(2005)was done using the layer cake concept with minimal incision,continuous shales and limited vertical connectivity based on observations from available seismic data(pre-baseline survey acquisition)and limited well control.This was modified in 2009 following acquisition of a 4D Monitor 1 seismic volume and 3 years production data from 20 wells to a more erosive model with compensationally stacked channel complexes of similar width.With new 4D Monitor 2 acquired in 2014,broadband processed seismic data in 2020,a total of 36 wells and 11 years of production,an updated framework has recently been built.In the new framework,two key fairways namely the Upper and the Lower Fairway were delineated,each comprising of 8 and 6 channel complexes,respectively.A conceptual basin-fill sequence was utilized,as well as a genetic classification of the channel complexes into erosional-confined systems,meandering systems,and levee-confined channel systems.The cut-and-fill behaviors of the individual complexes have been tied to changes in depositional gradient,sediment sand vs mud ratio,interaction of the flow with the substrate,and this has impacted the degree of channel amalgamation,avulsion and the degree of preservation of both internal and external levees.At flow unit scale,potential inter,and intra-reservoir connection pathways and compartments defined through integrated use of excess pressures,geobody attributes,well production and 4D data,have been very helpful in defining reservoir connection windows,injector-producer connectivity,and channel compartments.The implication is that this exercise or study has provided renewed insights into infill drill-well opportunities,well production performance as well as overall field management strategy.展开更多
Cataract surgery is still the most common surgery performed worldwide.It has evolved tremendously in terms of incision,from 12 mm to 1.8 mm,in terms of capsulotomy from envelope type to automated capsulorhexis,and fro...Cataract surgery is still the most common surgery performed worldwide.It has evolved tremendously in terms of incision,from 12 mm to 1.8 mm,in terms of capsulotomy from envelope type to automated capsulorhexis,and from rigid intraocular lens to foldable intraocular lenses.Manual small incision cataract surgery(MSICS)remains a valuable technique,particularly in rural and underserved areas,due to its cost-effectiveness and simplicity.Its low logistics and favorable outcomes are particularly useful for managing the cataract backlog in developing countries.This review highlights the history and evolution of MSICS,and the reasons for the advent and popularity of this technique,especially in developing countries.It reviews the various recent modifications of the technique,for example,from a superior incision approach to temporal incision to customized MSICS,2 mm MSICS,and astigmatism-correcting MSICS.It provides an overview of its applicability in complicated scenarios(viz.,small pupil,compromised cornea,pseudoexfoliation,subluxated cataract,etc.).It briefly reviews the clinical trials on MSICS and its comparison with phacoemulsification.Finally,the review emphasizes why every ophthalmic surgeon must know MSICS,its relevance in postgraduate teaching,and the role of MSICS simulators for the same.Overall,the review presents a comprehensive picture of the present status of this technique in the surgical armamentarium of ophthalmology.展开更多
AIM:To investigate the response of the anterior and posterior corneal surface in femtosecond laser-assisted convex stromal lenticule addition keratoplasty(SLAK)combined with cross-linking(CXL)for treating keratoconus ...AIM:To investigate the response of the anterior and posterior corneal surface in femtosecond laser-assisted convex stromal lenticule addition keratoplasty(SLAK)combined with cross-linking(CXL)for treating keratoconus at the first 3mo of follow-up.METHODS:In this prospective observational study,20 eyes of 20 keratoconus patients who underwent SLAK combined with CXL were included.The morphological indices in keratometry and elevation data were recorded from the Sirius at baseline and 1 and 3mo postoperatively.The mean values of maximum keratometry(K_(max)),flat keratometry(K_(1)),and steep keratometry(K_(2))at the central,3-mm,5-mm,and 7-mm areas were measured from the curvature map.The changes in anterior and posterior corneal elevation under the best-fit sphere(BFS)radius at seven points horizontally of the center,3-mm,5-mm,and 7-mm area from the center at both nasal(N)and temporal(T)side were measured from elevation map.RESULTS:For the front corneal curvature,K_(1),and K_(2) at 3-mm,5-mm,and 7-mm of the anterior corneal surface increased significantly 1mo postoperatively(all P<0.05)and remained unchanged until 3mo(P>0.05).For the back corneal curvature,K_(1) and K_(2) along the 3-mm back meridian significantly decreased after month 1(P=0.002,0.077,respectively).Posterior K_(2)-readings along the 5-mm and 7-mm did not change after surgery(P>0.05).Anterior BFS decreased 1mo(P<0.001)postoperatively but remained unchanged until 3mo after SLAK(P>0.05).There was no change in posterior BFS before and after the surgery(P>0.05).Anterior elevation at N5,N3,central,and T5 points and posterior elevation at central and T7 points shifted backward 1mo postoperatively(all P<0.05)and remained stable until 3mo(P>0.05).CONCLUSION:The myopic SLAK combined with CXL is an economical alternative for stabilizing the corneal surface in severe keraoconus.“Pseudoprogression”occurs in the early phase postoperatively,but it is not an indicator of keratoconus progression.展开更多
基金supported by the Applied Research Grant Program of the Academy of Social Sciences of Zhejiang University(No.2020XZA108)Medical Science and Technology Project of Zhejiang Province(No.2023KY798)Key Project in the Agricultural and Social Development Sector of the Science and Technology Bureau of Hangzhou(No.20231203A09).
文摘Objective Enhanced recovery after surgery(ERAS)protocols have revolutionized postoperative care by integrating minimally invasive techniques and patient-centered strategies to reduce physical and psychological trauma.However,the cognitive and experiential dimensions of surgical incisions under ERAS remain underexplored,particularly in non-Western populations.This study aims to explore patients’perceptions and preferences regarding laparoscopic incisions under ERAS,providing evidence to optimize incision planning and perioperative education.Methods A qualitative descriptive study was conducted at the Department of Surgery,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,between November 2022 and February 2023.The participants were adults(≥18 years)who underwent elective laparoscopic abdominal surgery under ERAS,excluding those with cognitive impairments,language barriers,or emergency procedures.Semi-structured interviews,covering physical function,social function,emotional function,self and others’acceptance,and confidence in the nature and treatment of the disease,were audio-recorded and transcribed verbatim and guided by a thematic framework co-developed by surgeons,nurses,and psychologists.The data were analyzed via the framework method to identify themes related to incision experiences.Results This qualitative study included 16 participants,8(50%)females and 6(37.5%)cancer patients,with a mean age of 41.5±12.2 years.Qualitative analysis revealed that the participants experienced minimal psychological distress and great emphasis on pain management and expressed specific concerns regarding the location,size,and cosmetic appearance of the incision.They also voiced high expectations for preventing incision complications and sought information regarding postoperative care.There was notable variation in preferences regarding the choice of incision site before surgery.Participants with cancer focused on disease cure rather than aesthetics.Conclusion Personalized preoperative discussions,incision site selection,and postoperative education are critical for increasing patient satisfaction.Laparoscopic incisions under ERAS minimally impact psychological well-being,but location-specific discomfort and aesthetic preferences require attention.
文摘AIMTo determine the surgically induced astigmatism (SIA) in Straight, Frown and Inverted V shape (Chevron) incisions in manual small incision cataract surgery (SICS).
基金the Young Talent Program of LongHua Hospital Shanghai University of Traditional Chinese Medicine,No.RC-2019-01-01and the Shanghai Three-year Action Plan of Further Accelerated Development in Traditional Chinese Medicine,No.ZY(2018-2020)-CCCX-1007.
文摘BACKGROUND Necrotizing fasciitis is a fulminant necrotizing soft tissue disease with a high fatality rate.It always starts with impact on the deep fascia rapidly and might result in secondary necrosis of the subcutaneous tissue,fascia,and muscle.Thus,timely and multiple surgical operations are needed for the treatment.Meanwhile,the damage of skin and soft tissue caused by multiple surgical operations may require dermatoplasty and other treatments as a consequence.CASE SUMMARY Here,we report a case of 50-year-old male patient who was admitted to our hospital with symptoms of necrotizing fasciitis caused by cryptoglandular infection in the perianal and perineal region.The symptoms of necrotizing fasciitis,also known as the cardinal features,include hyperpyrexia,excruciatingly painful lesions,demonstration gas in the tissue,an obnoxious foul odor and uroschesis.The results of postoperative pathology met the diagnosis.Based on the premise of complete debridement,multiple incisions combined with thread-dragging therapy(a traditional Chinese medicine therapy)and intensive supportive therapies including comprising antibiotics,nutrition and fluids were given.The outcome of the treatment was satisfactory.The patient recovered quickly and achieved ideal anal function and morphology.CONCLUSION Timely and effective debridement and multiple incisions combined with thread-dragging therapy are an integrated treatment for necrotizing fasciitis.
文摘Dear Editor, I am Dr.Daniela Alvarez-AscenciofromtheGlaucoma Department at Asociacion Para Evitar la Ceguera (APEC)in Mexico City, Mexico. I write to present a successful case of cyclodyalisis repair in a direct visualization technique that was performed on a patient after a microincisional glaucoma surgery (MIGS) complication.
文摘Kalman's Filter Technique for the separation of overlapping incisions of an a.c.oscillopolarogram is presented,the experimental verifications were carried out in various systems with the ions of Pb^(2+),Tl^+,In^(3+)and Cd^(2+).The results showed that the concentration of the depolarizer can be determined directly and easily with this technique in the presence of interference elements.
基金an unrestricted unconditional research grant 15,550 USD and donation of 100 PICO dressing kits from Smith and Nephew in 201312,900 USD from the Swedish SUS Stiftelser och Fonder:Grant-number 95407ClinicalTrials.gov(Identifier:NCT01913132).
文摘Background/Aims: Inguinal incisions are a common route of access in vascular surgery. Due to anatomical challenges and a diverse bacterial flora in this area, surgical site infections (SSI) represent a common, debilitating and sometimes life-threatening complication. The INVIPS-Trial evaluates the role of Negative Pressure Wound Therapy (NPWT) on closed inguinal incisions in elective vascular surgery to prevent SSI and other wound complications. Methods: This randomized controlled trial (RCT) registered at ClinicalTrials.gov (Identifier: NCT01913132) compares the effects of a NPWT dressing (PICO, Smith & Nephew, UK) and the center’s standard wound dressing (Vitri Pad, ViTri Medical, Sweden) on postoperative wound complications, especially SSI. The study includes two distinct vascular procedures with different SSI risk profiles: endovascular aortic repair (EVAR) and open surgical approaches involving the common femoral artery (OPEN). Results: Four hundred ninety-five groin incisions in both treatment arms are anticipated to be included in the EVAR group and 147 inguinal incisions in both treatment arms in the OPEN group. Since a large percentage of inguinal vascular procedures in both groups but especially in the EVAR group are performed bilaterally, many patients can serve as their own control by randomly receiving NPWT on one and the standard dressing on the contralateral inguinal incision. Conclusions: This ongoing RCT attempts to elucidate the potential benefit of NPWT on closed inguinal incisions after different vascular procedures. Outcome and conclusions of this trial could have implications on postoperative wound care of patients in both vascular surgery and other surgical specialties.
文摘AIM:To investigate the clinical efficacy and safety of femtosecond laser-assisted steepest-meridian clear corneal incisions for correcting preexisting corneal astigmatism performed at the time of cataract surgery.METHODS:This prospective case series study comprised consecutive age-related cataract patients with corneal regular astigmatism(range:+0.75 to+2.50 D)who had femtosecond laser-assisted steepest-meridian clear corneal incisions(single or paired).Corneal astigmatism was performed with the Pentacam preoperatively and 3 mo postoperatively.Total corneal astigmatism and steepestmeridian measured in the 3-mm central zone were used to guide the location,size and number of clear corneal incision.The vector analysis of astigmatic change was performed using the Alpins method.RESULTS:Totally 138 eyes of 138 patients were included.The mean preoperative corneal astigmatism was 1.31±0.41 D,and was significantly reduced to 0.69±0.34 D(equivalent to difference vector)after surgery(P<0.01).The surgically-induced astigmatism was 1.02±0.54 D.The correction index(ratio of target induced astigmatism and surgically-induced astigmatism:0.72±0.36)as well as the magnitude of error(difference between surgically-induced astigmatism and target induced astigmatism:-0.29±0.51)represented a slight under correction.For angle of error,the arithmetic mean was 1.11±13.70,indicating no significant systematic alignment errors.CONCLUSION:Femtosecond-assisted steepest-meridian clear corneal incision is a fast,customizable,adjustable,precise,and safe technique for the reduction of low to moderate corneal astigmatism during cataract surgery.
基金supported by the Major Program of National Fund of Philosophy and Social Science of China(No.15ZDC037)
文摘The improvement of antibiotic rational use in China was studied by usage analysis of combination antibiotic therapy for type Ⅰ incisions in 244 hospitals. Five kinds of hospitals, including general hospital, maternity hospital, children＇s hospital, stomatological hospital and cancer hospital, from 30 provinces were surveyed. A systematic random sampling strategy was employed to select outpatient prescriptions and inpatient cases in 2011 and 2012. A total of 29 280 outpatient prescriptions and 73 200 inpatient cases from 244 hospitals in each year were analyzed. Data were collected with regards to the implementation of the national antibiotic stewardship program（NASP）, the overall usage and the prophylactic use of antibiotic for type Ⅰ incisions. Univariate analysis was used for microbiological diagnosis rate before antimicrobial therapy, prophylactic use of antibiotics for typeⅠincision operation, and so on. For multivariate analysis, the use of antibiotics was dichotomized according to the guidelines, and entered as binary values into logistic regression analysis. The results were compared with the corresponding criteria given by the guidelines of this campaign. The antibiotic stewardship in China was effective in that more than 80% of each kind of hospitals achieved the criteria of recommended antibiotics varieties. Hospital type appeared to be a factor statistically associated with stewardship outcome. The prophylactic use of antibiotics on type Ⅰ incision operations decreased by 16.22%（P〈0.05）. The usage of combination antibiotic therapy for type Ⅰ incisions was also decreased. Region and bed size were the main determinants on surgical prophylaxis for type Ⅰ incision. This national analysis of hospitals on antibiotic use and stewardship allows relevant comparisons for bench marking. More efforts addressing the root cause of antibiotics abuse would continue to improve the rational use of antibiotics in China.
文摘Objective:To explore the clinical application of skin wound adhesive(glue)in skin incisions.Methods:Data from 46 patients who underwent surgery in our hospital between June 2024 and August 2024 were collected,focusing on breast surgery incisions as the study subject,with follow-up observations conducted for 1–2 weeks.Results:All incisions healed well without splitting,allergic reactions,or infections,and no adverse reactions were observed.Conclusion:The application of skin wound adhesive(glue)in breast surgery incisions is effective and safe;the adhesive process is convenient for external body incisions,eliminates the need for suture removal,shortens patient surgery and hospital stays,and reduces incision infection risk,resulting in satisfactory incision healing outcomes.
基金supported by research grants from the National Key Research and Development Program of China,China(2022YFC2502800)National Natural Science Foundation of China,China(82271069,82371040,82122017,81870642,81970780,81470613 and 81670835)+2 种基金Special Project of Shanghai Public Health Research,China(2024GKQ36)Science and Technology Innovation Action Plan of Shanghai Science and Technology Commission,China(23Y11909800)Outstanding Youth Medical Talents of Shanghai"Rising Stars of Medical Talents"Youth Development Program,Shanghai Municipal Health Commission Project,China(2024ZZ1025 and 20244Z0015).
文摘Purpose To investigate the efficacy of image-guided accurate limbal relaxing incisions(LRIs)for astigmatism correction during cataract surgery.Methods Consecutive cataract patients with regular corneal astigmatism ranging from 0.75 to 2.50 D,intended for cataract surgery with image-guided LRIs,were recruited in this prospective cohort study.The efficacy of astigmatism correction was evaluated 3 months after surgery,and compared among eyes with preoperative corneal with-the-rule(WTR),against-the-rule(ATR)and oblique astigmatism.Higher-order aberrations and visual quality indices obtained with iTrace were further compared between eyes with single and paired LRIs.Results Totally,108 eyes of 108 patients were analyzed.The mean total surgical induced astigmatism(tSIA)vector of all participants was 0.76±0.38 D(range:0.11–1.79 D,preoperative vs.postoperative astigmatism:1.46±0.41 vs.0.78±0.44 D,P<0.001).Eyes with WTR astigmatism showed higher tSIA(0.89±0.32 D vs.0.42±0.21 D vs.0.48±0.36 D,respectively,P<0.001),as well as higher correction index and lower difference vector and index of success than ATR and oblique astigmatism groups(all P<0.05).Eyes with paired LRIs exhibited better corneal average height of modulation transfer function,a better corneal performance index and a better quality of vision index than those with single LRI(all P<0.05).Conclusions Image-guided LRIs can effectively correct low-to-moderate corneal astigmatism during cataract surgery,especially in eyes with WTR astigmatism.
文摘Postoperative visual acuity can be limited by post-keratoplasty astigmatism,even with a clear corneal graft.Astigmatism management can be performed by selective suture removal,adjustment of sutures,optical correction,photorefractive procedures,wedge resection,intra-ocular lens implantation,intracorneal ring segments,relaxing incisions with or without compression sutures and repeated keratoplasty.Relaxing incisions can be made in the graft,graft-host interface or host cornea.Despite the unpredictability of the method because the flat and steep meridians are usually not orthogonal after penetrating keratoplasty,with asymmetric power distribution,all the studies showed an overall reduction of refractive,keratometric or topographic astigmatism,ranging from 30%to 72%with manual or femtosecond-assisted techniques.Most patients with astigmatism higher than 6 diopters had residual cylinder less than or equal to 3 diopters,which can be treated by laser excimer ablation or secondary intraocular lens implantation.
文摘Background:To evaluate the accuracy and safety of micro radial and arcuate keratotomy incisions constructed by a femtosecond laser system with a curved contact patient interface in porcine eyes.Methods:Partial thickness micro radial and arcuate keratotomy incisions were constructed in porcine eyes with a femtosecond laser system and evaluated for precision of depth,quality,and consistency.Optical coherence tomography was used to determine the accuracy and precision of incision depth.Corneal endothelial safety was assessed by a fluorescent live/dead cell viability assay to demonstrate laser-induced endothelial cell loss.Quality was evaluated by ease of opening and examination of interfaces.Results:In two micro radial incision groups,intended incision depths of 50%and 80%resulted in mean achieved depths of 50.01%and 77.69%,respectively.In three arcuate incision groups,intended incision depths of 80%,600μm or 100μm residual uncut bed thickness resulted in mean achieved depths of 80.16%,603.03μm and residual bed of 115μm,respectively.No loss of endothelial cell density occurred when the residual corneal bed was maintained at a minimum of 85-116μm.The incisions were easy to open,and interfaces were smooth.Conclusions:A femtosecond laser system with curved contact interface created precise and reproducible micro radial and arcuate keratotomy incisions.Accuracy and precision of the incision depth and preservation of endothelial cell density demonstrated the effectiveness and safety of the system.
文摘Background Keyhole surgery has developed since the 1990s as a less invasive therapeutic strategy for intracranial lesions, initially for the treatment of intracranial aneurysms. The purpose of this study was to describe and evaluate the results of surgical treatment of lesions in the anterior fossa and sellar region via a supraorbital keyhole approach using eyebrow incisions. Methods Between April 1994 and July 2003, 54 patients with lesions in the anterior fossa and sellar region were operated on via the supraorbital keyhole approach. The surgical results were studied retrospectively and compared with that of patients with lesions at the same locations but treated via a conventional subfrontal approach.Results No significant difference in curative effect was found between the conventional subfrontal approach and the supraorbital keyhole approach. However, the supraorbital approach required a much smaller skin incision, causing less surgical trauma, while achieving excellent surgical exposure and good recovery. Conclusion The supraorbital keyhole approach using an eyebrow incision is safe, effective, and both suitable and convenient for treating lesions in the anterior fossa and sellar region, with almost no adverse consequences on the facial features of patients.
文摘Purpose: The purpose of the study is to compare the surgical access and post-operative outcome of two intra-oral incisions used for approaching a mandibular body fracture. Methods: This clinical trial involved 60 patients with mandibular body fractures who were randomly allocated to control and study groups. The fractures were approached using the routine vestibular incision in the control group and crevicular incision with vertical release in the study group. The effects of incision design on the post-surgical outcome variables like swelling, trismus, paresthesia, wound healing and gingival recession were statistically analysed with non-parametric tests by using SPSS 22.0 software. Comparison of continuous variables between the groups and time points was done using Mann Whitney test and Friedman test respectively. Chi-square test was used to compare proportions between groups. Dunn's test with Bonferroni correction was used for pair wise comparisons. Results: The study group demonstrated favourable surgical outcome in the immediate postoperative phase as compared to the control group. The difference in mouth opening, swelling and neurosensory impairment between the two groups was found to be statistically significant (p < 0.05). Conclusion: Crevicular incision was found to be an ideal alternative to vestibular incision in achieving surgical access and fixation of mandibular body fractures with reduction in postoperative patient discomfort and better surgical outcome.
文摘BackgroundTo compare the arithmetic mean (M-SIA) and the summated vector mean of surgically induced astigmatism (SVM-SIA) according to the incision site after phakic intraocular lens (Visian implantable collamer lens (ICL), STAAR Surgical) implantation.MethodsThis study comprised 121 eyes of 121 consecutive patients undergoing ICL surgery through a 3.0-mm temporal or superior clear corneal incision. The magnitude and the axis of corneal astigmatism preoperatively and 3 months postoperatively were measured using an automated keratometer. The M-SIA and the SVM-SIA were determined according to the incision site.ResultsThe magnitude of corneal astigmatism significantly increased from 1.23 ± 0.59 D preoperatively to 1.46 ± 0.72 D postoperatively in the temporal incision group (Wilcoxon signed-rank test, P < 0.001), but it significantly decreased from 1.09 ± 0.36 D preoperatively to 0.86 ± 0.41 D postoperatively in the superior incision group (P < 0.001). The M-SIA was 0.48 ± 0.30 D, and the SVM-SIA was 0.23 ± 0.52 D at a meridian of 82° in the temporal incision group. The M-SIA was 0.57 ± 0.30 D, and the SVM-SIA was 0.47 ± 0.45 D at a meridian of 1° in the superior incision group.ConclusionsICL implantation induces the M-SIA by approximately 0.5 D, but the SVM-SIA decreased to 50% and 80% of the M-SIA in magnitude through temporal and superior incisions, respectively. The direction of the SVM-SIA showed a tendency toward corneal flattening to the incisional site. It should be noted that the M-SIA is somewhat different from the SVM-SIA according to the incision site.
文摘Objective:To explore the clinical effect of improved incision in the extraction of impacted mandibular wisdom teeth.Methods:160 patients who were treated in our hospital from October,2024 to April,2025 and had their mandibular impacted wisdom teeth removed according to the doctor’s advice were randomly divided into observation group and control group.The observation group used modified incision,while the control group used traditional triangular incision.The operation time,intraoperative visual analogue scale(VAS)pain score,pain VAS score on the 1st,2nd and 3rd day after operation,facial swelling on the 2nd day after operation,mouth opening limitation on the 2nd day after operation and the incidence of dry socket after operation were recorded and compared between the two groups.Results:There was no significant difference in operation time between the two groups(p>0.05).The VAS score of pain in the observation group was significantly lower than that in the control group at each time point during and after operation(p<0.05).On the second day after operation,the facial swelling and mouth opening limitation in the observation group were significantly lighter than those in the control group(p<0.05).The incidence of dry socket in the observation group was 1.25%(1/80),which was significantly lower than that in the control group(8.75%,7/80),and the difference was statistically significant(p<0.05).Conclusion:The application of modified triangular incision in the extraction of impacted mandibular wisdom teeth can effectively relieve the pain during and after operation,reduce postoperative facial swelling and mouth opening limitation,and reduce the incidence of dry socket.
文摘The dynamic relationship between field management and reservoir characterization has often been a puzzle,especially in complex deepwater channel systems.Reservoir management and infill drilling success cases were often due to improved understanding of deepwater depositional systems and geological controls on channel architecture and the general distribution of individual rock facies.For confined to weakly-confined slope channel complexes,some controls on the degree of channel avulsion and aggradation are the interplay between flow hydraulics,sediment calibre,depositional gradient,and the interaction of the flow with underlying substrate.This work aims at documenting the stratigraphic characterization of a Miocene deepwater channel system in a brownfield with focus on the historical evolution of the framework interpretation as well as applications of the recent updates in field management.The initial stratigraphic model(2005)was done using the layer cake concept with minimal incision,continuous shales and limited vertical connectivity based on observations from available seismic data(pre-baseline survey acquisition)and limited well control.This was modified in 2009 following acquisition of a 4D Monitor 1 seismic volume and 3 years production data from 20 wells to a more erosive model with compensationally stacked channel complexes of similar width.With new 4D Monitor 2 acquired in 2014,broadband processed seismic data in 2020,a total of 36 wells and 11 years of production,an updated framework has recently been built.In the new framework,two key fairways namely the Upper and the Lower Fairway were delineated,each comprising of 8 and 6 channel complexes,respectively.A conceptual basin-fill sequence was utilized,as well as a genetic classification of the channel complexes into erosional-confined systems,meandering systems,and levee-confined channel systems.The cut-and-fill behaviors of the individual complexes have been tied to changes in depositional gradient,sediment sand vs mud ratio,interaction of the flow with the substrate,and this has impacted the degree of channel amalgamation,avulsion and the degree of preservation of both internal and external levees.At flow unit scale,potential inter,and intra-reservoir connection pathways and compartments defined through integrated use of excess pressures,geobody attributes,well production and 4D data,have been very helpful in defining reservoir connection windows,injector-producer connectivity,and channel compartments.The implication is that this exercise or study has provided renewed insights into infill drill-well opportunities,well production performance as well as overall field management strategy.
文摘Cataract surgery is still the most common surgery performed worldwide.It has evolved tremendously in terms of incision,from 12 mm to 1.8 mm,in terms of capsulotomy from envelope type to automated capsulorhexis,and from rigid intraocular lens to foldable intraocular lenses.Manual small incision cataract surgery(MSICS)remains a valuable technique,particularly in rural and underserved areas,due to its cost-effectiveness and simplicity.Its low logistics and favorable outcomes are particularly useful for managing the cataract backlog in developing countries.This review highlights the history and evolution of MSICS,and the reasons for the advent and popularity of this technique,especially in developing countries.It reviews the various recent modifications of the technique,for example,from a superior incision approach to temporal incision to customized MSICS,2 mm MSICS,and astigmatism-correcting MSICS.It provides an overview of its applicability in complicated scenarios(viz.,small pupil,compromised cornea,pseudoexfoliation,subluxated cataract,etc.).It briefly reviews the clinical trials on MSICS and its comparison with phacoemulsification.Finally,the review emphasizes why every ophthalmic surgeon must know MSICS,its relevance in postgraduate teaching,and the role of MSICS simulators for the same.Overall,the review presents a comprehensive picture of the present status of this technique in the surgical armamentarium of ophthalmology.
基金Supported by the Social Development Grant of Shaanxi Province(No.2022SF-404)the Science and Technology Program of Xi’an,China(No.23YXYJ0010,No.23YXYJ0037)+1 种基金the Research Project of Xi’an Health Commission(No.2024ms05)the Technology Innovation Supporting Program of Shaanxi(No.2024RS-CXTD-11).
文摘AIM:To investigate the response of the anterior and posterior corneal surface in femtosecond laser-assisted convex stromal lenticule addition keratoplasty(SLAK)combined with cross-linking(CXL)for treating keratoconus at the first 3mo of follow-up.METHODS:In this prospective observational study,20 eyes of 20 keratoconus patients who underwent SLAK combined with CXL were included.The morphological indices in keratometry and elevation data were recorded from the Sirius at baseline and 1 and 3mo postoperatively.The mean values of maximum keratometry(K_(max)),flat keratometry(K_(1)),and steep keratometry(K_(2))at the central,3-mm,5-mm,and 7-mm areas were measured from the curvature map.The changes in anterior and posterior corneal elevation under the best-fit sphere(BFS)radius at seven points horizontally of the center,3-mm,5-mm,and 7-mm area from the center at both nasal(N)and temporal(T)side were measured from elevation map.RESULTS:For the front corneal curvature,K_(1),and K_(2) at 3-mm,5-mm,and 7-mm of the anterior corneal surface increased significantly 1mo postoperatively(all P<0.05)and remained unchanged until 3mo(P>0.05).For the back corneal curvature,K_(1) and K_(2) along the 3-mm back meridian significantly decreased after month 1(P=0.002,0.077,respectively).Posterior K_(2)-readings along the 5-mm and 7-mm did not change after surgery(P>0.05).Anterior BFS decreased 1mo(P<0.001)postoperatively but remained unchanged until 3mo after SLAK(P>0.05).There was no change in posterior BFS before and after the surgery(P>0.05).Anterior elevation at N5,N3,central,and T5 points and posterior elevation at central and T7 points shifted backward 1mo postoperatively(all P<0.05)and remained stable until 3mo(P>0.05).CONCLUSION:The myopic SLAK combined with CXL is an economical alternative for stabilizing the corneal surface in severe keraoconus.“Pseudoprogression”occurs in the early phase postoperatively,but it is not an indicator of keratoconus progression.
