Apical Thickness Research Articles

Soft and hard tissue evaluation for vestibular socket therapy of immediately placed implants in infected and non-infected sockets: a 1-year prospective cohort study

BackgroundImmediate implant placement using vestibular socket therapy (VST) proved to offer a successful treatment option in compromised sockets. However, the presence of active signs infection complicates immediate implants in sockets with defective labial plates, due to the possible contamination of the implant or the bone graft with existing infected tissues or oral environment via the fistula. This study, therefore, aims to explore the success of immediate implant placement using VST in managing infected compromised sockets.MethodsWe included 26 age- and sex-matched patients with 41 implants sites. Thirteen patients had 19 infected (group I) and 13 had 21 non-infected type 2 sockets (group N). Both groups were treated using vestibular socket therapy (VST) and a 6-day protocol. Implant survival, changes in facial bone thickness, and mid, mesial, and distal mucosal levels were evaluated 1 year after implant placement. The Mann–Whitney U test was used to compare both groups. Furthermore, the Wilcoxon signed-rank test was used to study changes with time within each group. The statistical significance level was set at P < 0.05.ResultsAll implants survived; no significant difference was found between groups N and I regarding apical, mid, and crestal bone thickness and soft tissue level, except at the mesial papilla, where the recession was significantly more in group N than in group I. Changes over time were statistically significant in the apical, mid, and crestal bone thickness in both groups. The mean bone thickness gain ranged from 0.85 to 2.4 mm and 0.26–1.63 mm in groups I and N, respectively. Additionally, the mean mucosal recession ranged from 0.29 to 0.51 mm and 0.39–1.47 mm in groups I and N, respectively.ConclusionWithin the limitations of this study immediate implant placement in type II infected sockets using the 6-day protocol and VST achieved 100% implant survival, while maintaining the regenerated facial bone thickness with minimal mucosal recession.Trial registrationThe protocol for this study was registered on clinicaltrials.gov at 3/10/2021 (registration number NCT04787224).

Evaluation of Radicular Dentin Thickness in Maxillary and Mandibular Central Incisor, Canine, and Premolar Teeth.

Background This study aimed to compare the radicular dentin thickness in single-rooted maxillary and mandibular anterior and premolar teeth by measuring on four different surfaces (buccal, lingual, mesial, and distal) at three different levels (apical, middle, and coronal). Methods A total of 150 single-rooted human anterior and premolar teeth were included in the present study. The teeth were sectioned at the cemento-enamel junction (CEJ; coronal), 4 mm away from the apex (apical), and the midpoint between these two distances (middle).First, the teeth were divided buccolingually into two parts, and the dentin thickness in the mesial/distal region was measured. Subsequently, both parts were divided again to measure the dentin thickness in the buccal/lingual region. All measurements were recorded, and statistical analysis was performed. Results Apical radicular dentin thickness was significantly less than CEJ (p < 0.001). The maxillary central incisor, maxillary, and mandibular canine exhibited the maximum radicular dentin thickness, whereas the mandibular premolars showed the minimum. Radicular dentin thicknesses on the lingual and buccal surfaces were significantly higher than those on other surfaces (p < 0.001). Conclusion The lowest radicular dentin thickness values were observed in the premolars, especially on mesial and distal surfaces. Considering these areas as danger zones and paying attention during dental procedures are essential to avoid possible complications.

A study on alveolar ridge augmentation guided by orthodontic forced eruption in patients with severe periodontitis

Objective: To evaluate the clinical effect of alveolar bone augmentation in teeth with severe periodontitis using orthodontic forced eruption. Methods: Twelve patients (5 males and 7 females) with severe periodontitis and malocclusion who visited the Department of Orthodontics and Department of Periodontology, Peking University School and Hospital of Stomatology from October 2018 to May 2022 were included in this retrospective study. The age was (38.8±6.6) years (24-49 years). A total of 16 maxillary incisors that could not be retained due to severe periodontitis were included. The orthodontic fixed appliance was used to extrude the teeth. Cone-beam CT (CBCT) images of the patients before and after orthodontic forced eruption were collected. The voxel-based registration was used to superpose the images before and after orthodontic forced eruption. The height, thickness, and apical alveolar bone area were measured on the sagittal plane. The alveolar bone volume before and after orthodontic forced eruption was measured using three-dimensional reconstruction technique, and the influencing factors related to the alveolar volume change were analyzed. Results: The results of this study showed that the eruption distance of the teeth was (2.37±0.82) mm, and the alveolar bone height increased by (1.11±0.79) and (0.98±0.79) mm (t=3.73, P=0.010; t=4.85, P<0.001). The proximal and distal alveolar bone height increased by (1.10±0.78) and (0.86±1.08) mm, respectively (t=5.59, P<0.001; t=3.18, P=0.006). The alveolar bone thickness decreased (0.30±0.31) mm (t=-3.75, P=0.002) and alveolar bone area increased (6.84±5.86) mm2 (t=3.71, P<0.001). The alveolar bone volume increased (53±49) mm3 (t=4.38, P<0.001). The alveolar bone volume was moderately positively correlated with eruption distance, apical and mesial alveolar bone thickness (r=0.55, P=0.028; r=0.63, P=0.008; r=0.67, P=0.005). Conclusions: Orthodontic forced eruption results in a favorable increase of the alveolar bone in the upper incisor that cannot be retained due to severe periodontitis, which provides better periodontal hard tissue conditions for subsequent dental implant.

Comparison of corneal measurements using two different Scheimpflug analyzers in Sirius and Pentacam devices

The aim was to compare measurements of anterior segment biometry parameters using two Scheimpflug tomographies, Pentacam and Sirius to assess the agreement. Prospective cross-sectional observational study. A total of 60 eyes of 30 healthy subjects were included and evaluated with Pentacam followed by Sirius imaging. Corneal indices were performed with two modalities in both eyes including; apical corneal thickness (ACT), corneal thickness at pupil site(PCT), thinnest corneal thickness (TCT), anterior chamber depth (ACD), chamber angle, chamber volume, cornea volume, mean front keratometry (FKm), the radius of corneal curvature at the anterior and posterior surface in steep and flat meridian, anterior astigmatism values, pupil diameter, and horizontal corneal diameter. The Bland–Altman graph and ICC (intra-class correlation were used to establish an agreement and present the similarity of the findings. Most parameters showed perfect agreement. In both devices, the ICC was more than 0.91 in all measurements except for ACD (ICC = 0.820), cylinder axis (ICC = 0.520), TCT(ICC = 0.881), ACT(ICC = 0.672), PCT (ICC = 0.882), chamber angle (ICC = 0.362), pupil diameter(ICC = 0.137). Pentacam yielded higher values that were significant in five parameters including 3.47 μm for TCT, 4.29 µm for PCT, 10.03 mm3 for chamber volume,2.67 mm3 for cornea volume, and 1.49 mm for pupil diameter but there was only a statistically significant difference in cornea volume and pupil diameter (p-value < 0.001). However, in Pentacam only the chamber angle value was 6.44 mm3 lower than Sirius, with a statistically significant difference (p-value < 0.001). Although these two devices had some statistically different results, it seems that they have a good agreement and correlation in most parameters.

Quantification of the apical palatal bone index for maxillary incisor immediate implant assessment: A retrospective cross-sectional study

BackgroundApical palatal bone is important in immediate implant evaluation. Current consensus gives qualitative suggestions regarding it, limiting its clinical decision-making value. ObjectivesTo quantify the apical palatal bone dimension in maxillary incisors and reveal its quantitative correlation with other implant-related hard tissue indices to give practical advice for pre-immediate implant evaluation and design. Material and methodsA retrospective analysis of immediate implant-related hard tissue indices in maxillary incisors obtained by cone beam computed tomography (CBCT) was conducted. Palatal bone thickness at the apex level (Apical-P) on the sagittal section was selected as a parameter reflecting the apical palatal bone. Its quantitative correlation with other immediate implant-related hard tissue indices was revealed. Clinical advice of pre-immediate implant assessment was given based on the quantitative classification of Apical-P and its other correlated immediate implant-related hard tissue indices. ResultsApical-P positively correlated with cervical palatal bone, whole cervical buccal-palatal bone, sagittal root angle, and basal bone width indices. while negatively correlated with apical buccal bone, cervical buccal bone, and basal bone length indices. Six quantitative categories of Apical-P are proposed. Cases with Apical-P below 4 mm had an insufficient apical bone thickness to accommodate the implant placement, while Apical-P beyond 12 mm should be cautious about the severe implant inclination. Cases with Apical-P of 4–12 mm can generally achieve satisfying immediate implant outcomes via regulating the implant inclination. ConclusionsQuantification of the apical palatal bone index for maxillary incisor immediate implant assessment can be achieved, providing a quantitative guide for immediate implant placement in the maxillary incisor zone.

Establishing quantitative radiographic criteria for the diagnosis of pleuroparenchymal fibroelastosis

PurposePleuroparenchymal Fibroelastosis (PPFE) is a type of pulmonary fibrosis most commonly occurring at the apices. Patients with PPFE have an increased risk of adverse effects from lung biopsy and in the post-surgical setting. Here, we investigated simple and reproducible measurements on chest CT to evaluate their predictive value in diagnosing PPFE. MethodsWe analyzed a cohort of patients with histologically-proven PPFE and compared them to a cohort of patients diagnosed with “biapical scarring” (BAS) on chest CT. We measured plueuroparenchymal thickness using several independent parameters on chest CT. We also assessed other radiologic and clinical characteristics to identify if any were predictive of PPFF. ResultsOur analysis demonstrated the average greatest apical thickness with a cut off of 4.5 mm yielded a sensitivity of 94.4% and a specificity of 88.9%, and an area under the curve of 97.2%. Single greatest apical thickness with a cut off of 7.5 mm had a sensitivity of 100% and a specificity of 88.9%, with the area under the curve of 97.8%. Average greatest upper lobe thickness with a cut off of 8.0 mm had a sensitivity of 88.9% and a specificity of 100%, with an area under the curve of 98.2%. Single greatest upper lobe thickness with a cut off of 8.5 yielded both a sensitivity and specificity of 94.4% and an area under the curve of 94.3%. ConclusionMeasurements described above are highly sensitive and specific for the diagnosis of PPFE and warrant investigation with a larger cohort of patients.

Regenerative Therapy for the Permanent Immature Teeth: A Long Term Study. An Original Research.

Endodontics faces several clinical difficulties while treating young necrotic permanent teeth. The use of regenerative endodontic procedures (REPs) enables apical closure, improved canal wall thickness, and root growth. The objective of this study was to assess the effects of these regenerative procedures on immature necrotic permanent teeth. This prospective clinical study was conducted at the tertiary care hospital for the study period of 2 years. This study includes 30 necrotic permanent immature teeth that were studied in 30 subjects of both genders. A standard REP protocol was used to treat every tooth. A follow-up visit was scheduled for each patient at timely intervals. Various study parameters as well as the demographics were assessed at each visit. To examine various parameters, a calibrated endodontist also performed a radiographic evaluation. Our findings point to excellent rates of survival, clinical success, and apical pathological resolution for 29 teeth. After 2 years, there were significant variations in the root thickness area and the average root length. The apical diameter significantly decreased during the research period, with 30.8% of the instances exhibiting full apical closure. Apical diameter, root length, and thickness changed more frequently in teeth with the level of the immaturity of the root, although the variations were not significant. REP treatment for teeth preceded symptom relief. Increased root thickness, root length, and apical closure were seen at 30 months, even if the clinically meaningful change was not attained in all patients.

P124 A TAKOTSUBO SYNDROME MIMICKING AN APICAL HYPERTROPHIC CARDYOMYOPATHY: A CASE REPORT

Abstract A 70–year–old woman was admitted to our Intensive Care Unit (ICU) with high levels Hs–TnT. Coronaries were normal and ventriculography was suggestive for Takotsubo Syndrome (TS). In the acute phase she developed a cardiogenic shock and transthoracic echocardiography (TTE) showed a dilated left ventricle (LV) with iperkinesia of basal segments and biventricular apex and mid –ventricular akinesia, with a severely reduced left ventricular ejection fraction (LVEF 20%). Seven days after admission to Cardiac Rehabilitation Unit, a TTE showed LV apical hypertrophy (max thickness 18 mm), hypokinesia of hypertrophic segments, hypercontractility of basal segments and LVEF 55%. These features could have been suggestive for a coexisting apical hypertrophic cardiomyopathy (HCM). The EKG showed T wave inversions in precordial and inferior leads, not present at admission, this observation being against the presence of a pre–existing unknown HCM. Cardiac Magnetic Resonance (CMR) showed T1 and T2 mapping imagines for oedema in LV infero–lateral, basal segments and apical region, a subepicardial stria of late gadolinium enhancement in infero–lateral basal segment. These patterns were reported as suggestive for myocarditis rather than TS. Recent infectious or autoimmune diseases were excluded. Further TTE showed reversed LV parameters, normal kinesis of all segments, LVEF 66%, with a persistence of negative T waves at EKG. Discussion Our patient developed a classical TS with LV apical ballooning and hyperkinesia of basal segments with uncommon right ventricular hypokinesia. A peculiar finding was the transient apical LV thickness that was seen through TTE, mimicking an apical hypertrophic cardiomyopathy. Such a finding has already been described in few case reports; however, the nature and the physiopathology of that apical thickness was never proved. Through CMR we noted that, in the same region where TTE detected apical hypertrophy, there was a consistent amount of oedema which could be the reason of pseudo–hypertrophy findings. Our experience confirms the importance of integrating CMR in the diagnostic algorithm as already supported in consensus statements. In our case CMR played a key–role in the exclusion of a coexisting apical hypertrophic cardiomyopathy.

P122 CONTRAST–ENHANCED ECHOCARDIOGRAPHY IN BETTER STUDYING (OR EXCLUDING) HYPERTROPHIC CARDIOMYOPATHY. TWO CASES

Abstract Aim of this case–series report is to elucidate the potential role of contrast echocardiography (C–Echo) to optimize and improve the study of patients with Hypertrophic Cardiomyopathy (HCM). However, this report is also aimed to demonstrate the role of C–Echo in excluding a HCM diagnosis. Case 1. A young male patient, 27 y–o, presented to our Emergency Department (ED) because of chest pain and dyspnea. He referred a diagnosis of HCM without LVOT obstruction. Trans–Thoracic Echocardiogram (TTE) demonstrate a severe hypertrophy of interventricular septum with a maximum diastolic thickness of 25 mm. There was no a significant LVOT gradient. Contrast enhanced echocardiography, by left ventricle opacification (LVO) (Sonovue, Bracco Imaging, Milan, Italy), demonstrated: an interventricular septum thickness of 32 mm (7 mm more than TTE measurement); a clear touching of mid–ventricular walls with a max systolic gradient of 40 mmHg (figure 1). This aspect was no clearly detectable by TTE alone. Case 2. A young male patient, 31 y–o, presented to our ED because of palpitations. At 12–leads ECG he presented a sinus rhythm with frequent monomorphic premature ventricular complexes (PVC). A TTE was performed. It put a suspicion of left ventricle (LV) APICAL HCM, because of an apical diastolic thickness of 26 mm. A contrast enhanced echocardiography by LVO (Sonovue, Bracco Imaging, Milan, Italy) was planned. It allowed to excluding a HCM by demonstrating a LV apical false tendon mimicking endocardial border (figure 2). LV false tendons are fibromuscular bands that traverse LV cavity and are generally considered to be benign. Thay may also contain conduction tissue (Purkinje fibers) and have been identified as a source of ventricular arrhythmias. They are most commonly located near the LV apex. Conclusion It is possible to conclude that, by LV cavity opacification optimization of echocardiographic planes and views, C–Echo represents a suitable tool for: 1) a more accurate LV wall thickness (WT) measurement; 2) acquiring additional informations about intraventricular gradients in patients with HCM. In addition, C–Echo allows to exclude a HCM diagnosis in presence of LV apical false tendons.

Impact of accommodative insufficiency and accommodative/vergence therapy on ciliary muscle thickness in the eye.

Recent evidence suggests that the ciliary muscle apical fibres are most responsive to accommodative load; however, the structure of the ciliary muscle in individuals with accommodative insufficiency is unknown. This study examined ciliary muscle structure in individuals with accommodative insufficiency (AI). We also determined the response of the ciliary muscle to accommodative/vergence therapy and increasing accommodative demands to investigate the muscle's responsiveness to workload. Subjects with AI were enrolled and matched by age and refractive error with subjects enrolled in another ciliary muscle study as controls. Anterior segment optical coherence tomography was used to measure the ciliary muscle thickness (CMT) at rest (0D), maximum thickness (CMTMAX) and over the area from 0.75 mm (CMT0.75) to 3 mm (CMT3) posterior to the scleral spur of the right eye. For those with AI, the ciliary muscle was also measured at increasing levels of accommodative demand (2D, 4D and 6D), both before and after accommodative/vergence therapy. Sixteen subjects with AI (mean age = 17.4 years, SD = 8.0) were matched with 48 controls (mean age = 17.8 years, SD = 8.2). On average, the controls had 52-72 μm thicker ciliary muscles in the apical region at 0D than those with AI (p = 0.03 for both CMTMAX and CMT 0.75). Differences in thickness between the groups in other regions of the muscle were not statistically significant. After 8 weeks of accommodative/vergence therapy, the CMT increased by an average of 22-42 μm (p ≤ 0.04 for all), while AA increased by 7D (p < 0.001). This study demonstrated significantly thinner apical ciliary muscle thickness in those with AI and that the ciliary muscle can thicken in response to increased workload. This may explain the mechanism for improvement in signs and symptoms with accommodative/vergence therapy.

Evaluation of Pericardial Thickening and Adhesion Using High-Frequency Ultrasound

Routine echocardiography using a standard-frequency ultrasound probe has insufficient spatial resolution to clearly visualize the parietal pericardium (PP). High-frequency ultrasound (HFU) has enhanced axial resolution. The aim of this study was to use a commercially available high-frequency linear probe to evaluate apical PP thickness (PPT) and pericardial adhesion in both normal pericardium and pericardial diseases. From April 2002 to March 2022, 227 healthy individuals, 205 patients with apical aneurysm (AA) and 80 patients with chronic constrictive pericarditis (CP) were recruited to participate in this study. All subjects underwent both standard-frequency ultrasound and HFU to image the apical PP (APP) and pericardial adhesion. Some subjects underwent computed tomography (CT). Apical PPT was measured using HFU and found to be 0.60±0.01mm (0.37-0.87mm) in normal control subjects, 1.22±0.04mm (0.48-4.53mm) in patients with AA, and 2.91±0.17mm (1.13-9.01mm) in patients with CP. Tiny physiologic effusions were observed in 39.2% of normal individuals. Pericardial adhesion was detected in 69.8% of patients with local pericarditis due to AA and 97.5% of patients with CP. Visibly thickened visceral pericardium was observed in six patients with CP. Apical PPT measurements obtained by HFU correlated well with those obtained by CT in those patients with CP. However, CT could clearly visualize the APP in only 45% of normal individuals and 37% of patients with AA. In 10 patients with CP, both HFU and CT demonstrated equal ability to visualize the very thickened APP. Apical PPT measured using HFU in normal control subjects ranged from 0.37 to 0.87mm, consistent with previous reports from necropsy studies. HFU had higher resolution in distinguishing local pericarditis of the AA from normal individuals. HFU was superior to CT in imaging APP lesions, as CT failed to visualize the APP in more than half of both normal individuals and patients with AA. The fact that all 80 patients with CP in our study had significantly thickened APP raises doubt regarding the previously reported finding that 18% of patients with CP had normal PPT.

Evaluation of Eyelid, Angle, and Anterior Segment Parameters Using Scheimpflug Camera and Topography System in Obstructive Sleep Apnea Syndrome.

The purpose of the study was to investigate the eyelid hyperlaxity, anterior segment, and corneal topographic parameters in patients with obstructive sleep apnea syndrome (OSAS) using Scheimpflug camera and topography system. In this prospective and cross-sectional clinical study, 32 eyes of 32 patients with OSAS and thirty-two eyes of 32 healthy subjects were evaluated. The participants with OSAS were selected from those with an apnea-hypopnea index ≥ 15. The minimum corneal thickness (ThkMin), apical corneal thickness (ACT), central corneal thickness (CCT), pupillary diameter (PD), aqueous depth (AD), aqueous volume (AV), anterior chamber angle (ACA), horizontal anterior chamber diameter (HACD), corneal volume (CV), simulated K readings (sim-K), front and back corneal keratometric values at 3 mm, RMS/A values, highest point of ectasia on the anterior and posterior corneal surface (KVf, KVb), symmetry indices and keratoconus measurements were taken by combined Scheimpflug-Placido corneal topography and compared with healthy subjects. Upper eyelid hyperlaxity (UEH) and floppy eyelid syndrome were also evaluated. There were no statistically significant difference between groups in terms of age, gender, PD, ACT, CV, HACD, simK readings, front and back keratometric values, RMS/A-KVf and KVb values, symmetry indices, and keratoconus measurements (p>0.05). ThkMin, CCT, AD, AV, and ACA values were significantly higher in OSAS group compared to the control (p<0.05). UEH was detected in two cases in the control group (6.3%) and in 13 cases in the OSAS group (40.6%) and the difference was significant (p<0.001). The anterior chamber depth, ACA, AV, CCT, and UEH increase in OSAS. These ocular morphological changes occurring in OSAS may explain why these patients prones to normotensive glaucoma.

CBCT assessment of alveolar bone wall morphology and its correlation with tooth angulation in the anterior mandible: a new classification for immediate implant placement.

This study aimed to quantify alveolar bone morphology, demonstrate the relationship between tooth angulation and alveolar bone thickness, and introduce a new classification for anterior mandibular teeth related to immediate implant placement (IIP). Cone-beam computed tomography (CBCT) images of 211 anterior mandibular teeth were analyzed in sagittal slices to measure the thickness of the facial alveolar bone crest (FAB1) and apex (FAB2), and the lingual alveolar bone crest (LAB1) and apex (LAB2). Tooth angulation was classified as 1°-10°, 11°-20°, and >20° according to the tooth's long axis and alveolar bone wall. Spearman correlation coefficients were used to evaluate correlations between the variables. FAB1 and LAB1 were predominantly thin (<1 mm) (84.4% and 73.4%, respectively), with the lateral incisors being thinnest. At the apical level, FAB2 and LAB2 were thick in 99.5% and 99.1% of cases, respectively. Significant differences were documented in FAB2 (P=0.004), LAB1 (P=0.001), and LAB2 (P=0.001) of all mandibular teeth. At all apical levels of the inspected teeth, a significant negative correlation existed between TA and FAB2. Meanwhile, TA showed a significant positive correlation with LAB2 of the lateral incisors and canines. These patterns were then divided into class I (thick facial and lingual alveolar bone), class II (facially inclined teeth) with subtype A (1°-10°) and subtype B (11°-20°), and class III (lingually inclined teeth) with subtype A (1°-10°) and subtype B (11°-20°). Mandibular anterior teeth have predominantly thin facial and lingual crests, making the lingual bone apical thickness crucial for IIP. Although anchorage can be obtained from lingual bone, tooth angulation and tooth types had an impact on IIP planning. Hence, the new classification based on TA and alveolar bone wall may enable rational clinical planning for IIP treatment.

A Prognostic Score for the Prediction of Local Treatment Failure in Plaque Brachytherapy of Uveal Melanoma

To develop a prognostic score that correlates to a low, medium, and high incidence of treatment failure after plaque brachytherapy of uveal melanoma (UM). All patients who have received plaque brachytherapy for posterior UM at St. Erik Eye Hospital in Stockholm, Sweden from 1995 through 2019 were included (n=1636). Treatment failure was defined as tumor recurrence, lack of tumor regression, or any other condition requiring a secondary transpupillary thermotherapy (TTT), plaque brachytherapy, or enucleation. The total sample was randomized into 1 training and 1 validation cohort, and a prognostic score for the risk for treatment failure was developed. In multivariate Cox regression, low visual acuity, tumor distance to the optic disc ≤2 mm, American Joint Committee on Cancer (AJCC) stage, and a tumor apical thickness of >4 (for Ruthenium-106) or >9 mm (for Iodine-125) were independent predictors of treatment failure. No reliable threshold could be identified for tumor diameter or cancer stage. In competing risk analyses of the validation cohort, the cumulative incidence of treatment failure, as well as of secondary enucleation, increased with the prognostic score: In the low, intermediate, and high-risk classes, the 10-year incidence of treatment failure was 19, 28, and 35% and of secondary enucleation 7, 19, and 25 %, respectively. Low visual acuity, American Joint Committee on Cancer stage, tumor thickness, and tumor distance to the optic disc are independent predictors of treatment failure after plaque brachytherapy for UM. A prognostic score was devised that identifies low, medium, and high risk for treatment failure.

Correlations among Corneal Biomechanical Parameters, Stiffness, and Thickness Measured Using Corvis ST and Pentacam in Patients with Ocular Hypertension.

To preliminary explore the correlations among corneal biomechanical parameters, stiffness, and thickness in patients with ocular hypertension (OHT) before and after treatment with topical antiglaucoma medications. This was a retrospective study that included 35 eyes with newly diagnosed OHT. Axial length (AL), apical corneal thickness, and minimum corneal thickness were measured using Pentacam. The lengths, velocities, and times of the first and second corneal applanations (A1L, A1V, A1T, A2L, A2V, and A2T, respectively); the highest concavity radius; highest concavity peak distance (PDHC); highest concavity deformation amplitude (DAHC); highest concavity time (HCT); pachymetry (PACH); stress-strain index (SSI); stiffness parameter-A1 (SP-A1); deformation amplitude ratio (DA ratio); integrated radius (IR); Ambrosio's relational thickness horizontal (ARTh); corneal biomechanical index; noncorrected intraocular pressure (IOPnct); and biomechanically corrected IOP (bIOP) values were measured using the corneal visualization Scheimpflug technology (Corvis ST/CST). After 5 weeks of treatment, Goldman applanation tonometer-IOP, IOPnct, bIOP, PACH, A1T, A2V, SSI, SP-A1, and ARTh decreased, but A1V, A2T, PDHC, DAHC, DA ratio, and IR increased significantly (all p < 0.05). SP-A1 and A1T were positively associated with premedication IOP and IOP changes, whereas A1V, A2T, PDHC, and IR were negatively associated (all p < 0.05). DAHC and DA ratio had significantly negative correlations with IOP variations. PDHC was found to be positively correlated with AL (p < 0.05). A positive relationship was noted between SP-A1 and HCT before medication (p < 0.05). SP-A1 was significantly and consistently associated with IOP. HCT might be correlated with SP-A1. SP-A1 and CST parameters could serve as potential biomarkers for evaluating OHT treatment efficacy.

Topical Dexamethasone as an Adjuvant to Mineralocorticoid Receptor Antagonists for the Treatment of Recalcitrant Central Serous Chorioretinopathy

A previous report demonstrated efficacy of mineralocorticoid antagonist with adjuvant topical dexamethasone (MRA+DEX) in resolving subretinal fluid (SRF) in a chronic central serous chorioretinopathy (CSCR) patient. This pilot study investigates the use of MRA+DEX to treat recalcitrant, chronic CSCR patients. Retrospective review of chronic, recalcitrant CSCR patients unresponsive to MRA alone who were treated with MRA+DEX and followed for up to 3 months. Apical SRF thickness and visual acuity were measured. Ten eyes of eight chronic, recalcitrant patients were included with an average follow-up of 109 days. Mean percent reduction in apical fluid thickness at one month and at last follow-up after adding dexamethasone (DEX) was 33% and 52%, respectively. Five eyes (50%) achieved complete resolution of SRF. Three eyes (30%) showed partial response and two (20%) eyes had no response. There was no significant change in visual acuity. MRA+DEX decreased SRF in some recalcitrant, chronic CSCR patients. Large prospective studies are needed to evaluate the utility of MRA+DEX in these chronic CSCR patients. [Ophthalmic Surg Lasers Imaging Retina 2022;53:659-665.].

The prognostic implication of visual acuity at the time of uveal melanoma diagnosis

BackgroundVisual outcomes after primary tumour treatment of uveal melanoma (UM) have been investigated repeatedly. This study evaluates the correlation between best-corrected visual acuity (BCVA) before treatment with clinicopathological factors and patient survival.Subjects/MethodsPre-treatment BCVA was examined in relation to tumour dimensions and location, and survival in a retrospective cohort of 1809 patients who underwent plaque brachytherapy. BCVA was also correlated to tumour histological factors in a second cohort of 137 enucleated eyes.ResultsThe mean BCVA of the tumour eye prior to plaque brachytherapy was LogMAR 0.42 (SD 0.46). Patients with low BCVA (LogMAR ≥ 1.00) did not differ in age (p = 0.19) and had similar frequency of ciliary body involvement (p = 0.99) but had tumours with greater apical thickness (p < 0.0001), greater diameter (p < 0.0001) and shorter distance to the optic disc and fovea (p < 0.0001). There were no significant relations between low BCVA and any of 13 examined tumour histological factors at a Bonferroni-corrected significance level (p > 0.004). Patients with low BCVA had greater incidence of UM-related mortality in competing risk analysis (p = 0.0019) and shorter overall survival (p < 0.0001). Low BCVA was also associated with increased hazard ratio (HR) for UM-related mortality in univariate analysis (HR 1.5, 95% confidence interval 1.2 to 1.9), but not in multivariate analysis with tumour size and location as covariates.ConclusionsUM patients with low BCVA before primary tumour treatment have a worse prognosis, likely related to increased tumour dimensions. Future studies should examine the prognostic significance of BCVA in relation to macula-involving retinal detachment and genetic factors.

Long-Term Outcome of Corneal Collagen Crosslinking with Riboflavin and UV-A Irradiation for Keratoconus*

Purpose To evaluate long-term outcomes of corneal collagen crosslinking (CXL) using riboflavin and UV-A irradiation and to determine when to repeat CXL. Methods In this retrospective consecutive interventional case series 131 eyes of 131 patients (95 male, 36 female, mean age 29.7 ± 11.4 years) between 2006 and 2016 received standard CXL (Dresden protocol, epithelium-off) for progressive keratoconus. Corrected distance visual acuity (CDVA) and corneal tomography (K1, K2, K max) were repeatedly recorded 1 year (n = 103 eyes) to 10 years (n = 44) postoperatively. Only one eye per patient was included. Paired t-test or Wilcoxon matched-pairs signed rank test was used for parametric and nonparametric data, respectively. Results 1–3 years preoperatively, median K2 significantly increased by 1.1 D (p < 0.001). Postoperatively, median K2 increased by 0.1 D after 1 year, then decreased over the remaining postoperative period by 0.85 D (p = 0.021). K max fluctuated without significant change. Median apical corneal thickness decreased by 16 µm (p = 0.012) after 5 years and then returned to preoperative values. Mean CDVA showed a significant improvement (decrease in logMAR 0.08 after 10 years, p = 0.010). CXL non-responders, defined by a postoperative increase in K max>2 D, increased from 16% after 5 to 33% after 10 years. Risk factors for non-response were young age, high astigmatism (>4.3 D), thin cornea (<480 µm), poor initial visual acuity (CDVA ≥0.3 D), and atopic dermatitis. 4 eyes were re-treated 3–4 years after first CXL without complications and keratoconus stabilized thereafter. Conclusions CXL can slow or stop keratoconus progression. However, as the number of responders declines after 5 years, especially patients with risk factors may require re-treatment.

A prognostic classification system for uveal melanoma based on a combination of patient age and sex, the American Joint Committee on Cancer and the Cancer Genome Atlas models.

To revisitthe independent importance of ciliary body involvement (CBI), monosomy 3 (M3), tumour size, histological and clinical factors in uveal melanoma (UM) and to devise a new prognostic classification based on a combination of the American Joint Committee on Cancer (AJCC) and the Cancer Genome Atlas (TCGA) models. Two cohorts with a total of 1796 patients were included. Clinicopathological factors were compared between patients with and without CBI and M3. Development of the prognostic classification was performed in a training cohort and was then tested in two independent validation cohorts. Tumours with CBI were more common in women, had greater apical thickness, greater basal tumour diameter, greater rates of vasculogenic mimicry and greater rates of M3, were more often asymptomatic at diagnosis and had poorer 5- and 10-year globe conservation rates (p < 0.023). In multivariate logistic regression, patient age at diagnosis, tumour diameter and CBI were independent predictors of M3 (p < 0.001). In multivariate Cox regression, male sex, age at diagnosis, tumour diameter, M3 and CBI were independent predictors of metastasis. The proposed prognostic classification combined patient age, sex, CBI, extraocular extension, M3, 8q (optional) and tumour size, and demonstrated greater prognostic acumen than both AJCC 4 T categories and TCGA groups A to D in validation cohorts. Tumour size does not confound the prognostic implication of CBI, M3, male sex and age at diagnosis in UM. These factors were included in a new prognostic classification that outperforms AJCC T category and TCGA groups.

Comparative evaluation of mineral trioxide aggregate and biodentine apical plug thickness on fracture resistance of immature teeth: An In vitro study.

This study aims to compare the fracture resistance of simulated immature teeth after using different thicknesses of Mineral Trioxide Aggregate (MTA) and Biodentine apical plug. Forty human maxillary anterior teeth were selected. Teeth were randomly divided into eight groups of five teeth in each group. Positive control group = 5 teeth; prepared without access cavity preparation. Access cavities of the remaining 35 teeth were prepared, and instrumented with Peeso reamers. Negative control = 5 teeth; filled with calcium hydroxide. Thirty teeth divided into Groups 1 and 2 of MTA (MTA-Angelus, Londrina, Brazil) and Biodentine (Septodant, Saint Maur des Fosses, France) and each group divided into three subgroups: subgroup A - 3 mm apical plug; subgroup B - 6 mm apical plug; and subgroup C: full canal length. The rest of the canals in subgroups A and B were filled with gutta-percha and AH Plus sealer. After the required storage period, all the samples were subjected to fracture testing under universal testing machine and fracture strength was recorded. Data were analyzed using 1-way analysis of variance with the Tukey post hoc test for multiple comparisons. The negative control group showed the lowest fracture resistance compared with the other groups (P < 0.0001). The 6-mm apical plug subgroup of biodentine showed the highest fracture resistance. Within the limitations of this study, MTA and Biodentine can be used as an apical plug instead of root canal filling material to increase the fracture resistance of immature teeth.