Ectasia In Patients Research Articles

The Association between Visfatin as A Marker of Isolated Coronary Ectasia and Its Severity: A Cross-Sectional study

Abstract Aim and objectives to assess the association between Visfatin level-as an independent marker -and the presence of coronary artery ectasia in patients undergoing diagnostic coronary angiography. Patients and Methods A total of 90 participants were recruited from candidates undergoing diagnostic coronary angiography in the Cath lab of Cardiology Department at Ain Shams University. They were then divided into three groups. The first group included individuals with normal coronaries, the second patients with coronary artery disease (CAD) without ectasia, and the third is patients with isolated coronary artery ectasia (CAE). After history taking, they all underwent biochemical tests for serum Visfatin, HBA1C%, serum creatinine and CRP. Univariate and correlation analysis was done. Results regarding demographic and clinical characteristics of our study population, we found that only higher age and being a smoker was significantly associated with the presence of ectasia. High level of serum Visfatin was strongly significantly associated with the presence of ectasia. Serum creatinine and CRP displayed a similar pattern. Moreover, we found that the mean level of serum Visfatin increases with the severity of ectasia according to Markis classification. Finally, Roc showed that a cut- off value of > 34 ng/ml demonstrated a sensitivity of 89% and a specificity of 87% of predicting CAE. Conclusion high serum Visfatin level is significantly associated with the presence of coronary artery ectasia. Also, it is positively correlated with its severity according to Markis classification. Hence, it can be a valuable predictor of CAE.

Prognostic role of coronary artery ectasia in patients with nonobstructive coronary artery disease.

Coronary artery ectasia (CAE) has been linked to the occurrence of adverse events in patients with ischemia/angina and no obstructive coronary arteries (INOCA/ANOCA), while the relationship between CAE and myocardial infarction with nonobstructive coronary arteries (MINOCA) has been poorly investigated. In our study we aimed at assessing differences in clinical, angiographic and prognostic features among patients with CAE and MINOCA vs. INOCA/ANOCA presentation. Patients with angiographic evidence of CAE were enrolled at the University Hospital of Parma and divided into MINOCA vs. INOCA/ANOCA presentation. Clinical and quantitative angiographic information was recorded and the incidence of major adverse cardiovascular events (MACE) was assessed at follow-up. We enrolled a total of 97 patients: 49 (50.5%) with MINOCA and 48 (49.5%) with INOCA/ANOCA presentation. The presentation with MINOCA was associated with a higher frequency of inflammatory diseases ( P = 0.041), multivessel CAE ( P = 0.030) and thrombolysis in myocardial infarction (TIMI) flow < 3 ( P = 0.013). At a median follow-up of 38 months, patients with MINOCA had a significantly higher incidence of MACE compared with those with INOCA/ANOCA [8 (16.3%) vs. 2 (4.2%), P = 0.045], mainly driven by a higher rate of nonfatal MI [5 (10.2%) vs. 0 (0.0%), P = 0.023]. At multivariate Cox regression analysis, the presentation with MINOCA ( P = 0.039) and the presence of TIMI flow <3 ( P = 0.037) were independent predictors of MACE at follow-up. Among a cohort of patients with CAE and nonobstructive coronary artery disease, the presentation with MINOCA predicted a worse outcome.

Investigating the Prevalence of Ectasia in Angiographic Patients with Acute Coronary Syndrome

Coronary artery ectasia is dilatation of a segment of the coronary arteries leading to intense cardiac conditions. Among the patients undergoing angiography, it has a rare prevalence of 0.3 – 5.3%. It has been strongly associated with atherosclerosis as an evident cause of the dilation of coronary lumen. Objective: To determine the frequency of ectasia in patients of acute coronary syndrome undergoing coronary angiography. Methods: It is a cross sectional study conducted over six months. 160 patients from the Department of Cardiology, Mayo Hospital, Lahore were enrolled that fulfilled the study criteria of 30-70 years of age, presenting acute coronary syndrome, and undergoing angiography. The Angiography was done by an expert surgeon, simultaneously observed by one of the researchers. Ectasia was diagnosed in all the 160 based on its operational definition. Socio-demographic information including name, age, sex, diabetes (BSR&gt;200mg/dl), hypertension (BP≥140/90mmHg), smoking, and type of acute coronary syndrome was collected with informed consent. Statistical analysis was performed using SPSS version 21. The chi-square test was practiced comparing ectasia in stratified groups of socio-demographic characters and type of acute coronary syndrome. Results: Ectasia was diagnosed in 54 (33.8%) patients. No significant association was seen between the age of patients and ectasia. However, frequency of ectasia was higher in patients in the age group 30-50 years. Frequency of ectasia was higher among male patients, but it was not statistically significant when compared with frequency of ectasia among female patients. No significant association was seen between ectasia and diabetes (p-value &gt; 0.999), hypertension (p-value = 0.439) and smoking status (p-value = 0.140) of patients. Conclusions: Ectasia is a well-established condition of coronary artery but is an unconventional diagnostic finding of coronary angiography in patients affected with acute coronary syndromes.

Influence of corneal diameter on the accuracy of corneal tomography in patients with forme fruste keratoconus or thin corneas

ABSTRACT Clinical relevance The detection of subclinical ectasia is important in preoperative screening for laser-refractive surgery. Previous studies have confirmed the impact of corneal diameter on the diagnostic accuracy of several ectasia indices in tomographically normal eyes. Background This study aimed to investigate the influence of corneal diameter on the diagnostic accuracy of Pentacam tomographic indices in eyes with forme fruste keratoconus (FFKC) and thin corneas. Methods One hundred and one eyes of 101 patients with FFKC (FFKC group), 104 eyes of 104 patients with a corneal thickness <490 μm (thin cornea group), and 200 eyes of 200 normal subjects (normal group) were analysed in the study. Pentacam ectasia indices were compared between the groups. Results The results of multiple linear regression analysis showed that the standardised coefficients for corneal diameter and overall deviation of normality (BAD-D) were −0.386, −0.552, and −0.552 for the FFKC, thin cornea, and normal groups, respectively (p < 0.001). Comparing for the classifications (normal versus abnormal) of the individual indices demonstrated that for corneal diameters ≤11.9 mm, the rates of abnormal cases were significantly higher in the FFKC group than in the normal group for seven indices and in the thin cornea group than normal group for nine indices. For corneal diameters >11.9 mm, the rates of abnormal cases were higher in the FFKC than normal group for three indices and higher in the thin cornea group than normal group for seven indices. Conclusion Belin/Ambrosio Enhanced Ectasia display indices may underestimate the risk of ectasia in patients with large corneas, especially those with FFKC.

Tomographic Predictors of Ectasia Development After Keratorefractive Surgery.

The aim of this study was to identify the risk factors for postkeratorefractive surgery ectasia in unsuspicious tomographies and to report a new index coined diameter of peak locations (DPLs). All patients who underwent keratorefractive surgery between 2011 and 2018 at Care-Vision Laser Centers, Israel, and later developed ectasia were included. For each ectasia case, 3 matched controls were selected. Demographic and preoperative, intraoperative, and postoperative data were collected. Multivariate analysis was performed to evaluate the interdependence of the variables. The retrospective study included 19 ectasia and 58 control eyes. There were no significant differences between the groups in ablation depth ( P = 0.73), preoperative spherical equivalent ( P = 0.12), percent tissue altered ( P = 0.71), residual stromal bed ( P = 0.73), and Ectasia Risk Score System ( P = 0.60). The anterior and the posterior symmetry index were significantly higher ( P < 0.001), and DPL was significantly tighter in the ectasia group ( P = 0.01). Binary multiple logistic regression found the symmetry index of the posterior cornea and DPL to be better predictors than age, percent tissue altered, Ectasia Risk Score System, residual stromal bed, and ablation depth. A higher posterior symmetry index and a tighter DPL are predictors of ectasia in patients with otherwise normal tomographies. A tight DPL implies a weak area in the cornea, which is thin and slightly bulging, increasing the risk of this area becoming ectatic.

Chronic exposure to high altitude and the presence of coronary ectasia in patients with ST elevation myocardial infarction.

To evaluate the association between chronic exposure to high altitude and the presence of coronary ectasia (CE) in patients with ST-segment elevation myocardial infarction (STEMI) treated in a highly specialized cardiovascular reference hospital in Peru. Retrospective matched case-control study. The cases were patients with CE and controls without CE. The relationship between CE and chronic exposure to high altitude was evaluated considering intervening variables such as arterial hypertension, diabetes mellitus, dyslipidemia, smoking, and hematocrit values. Patients with chronic inflammatory pathologies, chronic obstructive pulmonary disease, and previous revascularization were excluded. Multivariate logistic regression was applied to obtain the OR value and their respective confidence intervals. Eighteen cases and 18 controls were studied, most of them were men with an average age of 65 years. Thirty-six percent of the population came from high altitude; in this group 76.9% had coronary ectasia of the infarct-related artery. The mean hematocrit value was slightly higher in the high-altitude native (46 ± 7% versus 42 ± 5%, p=0.094). Multivariate conditional logistic regression did not find a significant relationship between exposure to high altitude and the risk of presenting CE (OR:6.03, IC95%: 0.30-118, p=0.236). In patients with STEMI, we found no association between chronic exposure to high altitude and coronary ectasia.

Clinical and laboratory predictors of isolated coronary artery ectasia in patients with chronic coronary syndromes

Clinical and laboratory predictors of isolated coronary artery ectasia in patients with chronic coronary syndromes

Nintedanib-Induced Gastric Antral Vascular Ectasia in Patients With Idiopathic Pulmonary Fibrosis

ABSTRACT Gastric antral vascular ectasia (GAVE) is a rare cause of gastrointestinal bleeding. However, its association with nintedanib use, antifibrotic therapy for idiopathic pulmonary fibrosis (IPF), has not been reported. We present 2 cases of GAVE that were presumed to be secondary to nintedanib use in patients with IPF. Both patients experienced anemia, one of which had hematemesis. GAVE diagnosis was confirmed by upper gastrointestinal endoscopy. Moreover, successful treatment was achieved with endoscopic argon plasma coagulation. These cases highlight the importance of considering GAVE as a potential cause of anemia and upper gastrointestinal bleeding in patients with IPF receiving nintedanib.

ST-elevation myocardial infarction complicated by ventricular tachycardia revealing coronary artery ectasia: a case report

BackgroundCoronary artery ectasia is a rare angiographic finding and results from a disease process that compromises the integrity of the vessel wall. Its prevalence ranges between 0.3% and 5% of patients undergoing coronary angiography (Swaye et al. in Circulation 67:134–138, 1983). Coronary artery ectasia in patients with ST-elevation myocardial infarction is associated with an increased risk of cardiovascular events and death after percutaneous coronary intervention.Case presentationWe report the case of a 50-year-old male Caucasian patient, admitted for ventricular tachycardia at 200 beats per minute hemodynamically not tolerated that was reduced by external electric shock. Electrocardiogram after cardioversion showed a sinus rhythm with anterior ST-elevation myocardial infarction. Thrombolytic therapy was chosen after exposure to dual antiplatelet therapy and heparin since the expected time to percutaneous coronary intervention was greater than 120 minutes from first medical contact and the patient presented within 12 hours of onset of ischemic symptoms. The electrocardiogram after thrombolysis showed the resolution of the ST segment. The echocardiogram showed a dilated left ventricle with severe dysfunction with left ventricle ejection fraction at 30%. Coronary angiography revealed non-obstructive giant ecstatic coronaries without any thrombus. A check-up to look for possible etiologies for coronary artery ectasia was carried out and returned normal. Since no etiology for coronary artery ectasia was found at the limit of available exams in our center, the patient was discharged with antiplatelet therapy (aspirin 100 mg once a day) and heart failure treatment with an indication for an implantable cardiac defibrillator.ConclusionsCoronary artery ectasia in the context of acute myocardial infarction is a rare condition that may have dangerous complications, especially when an optimal treatment for ecstatic culprit vessels is still controversial.

Cardiovascular risk factors associated with coronary ectasia and acute myocardial infarction.

Coronary ectasia has a low prevalence in the general population. Its risk factors may differ from those of coronary artery disease. To identify the prevalence of coronary ectasia in patients with acute myocardial infarction (AMI) and cardiovascular risk factors (CVRFs). Retrospective, cross-sectional study. Out of 3,254 cardiac catheterizations for AMI during one year, 2,975 had no coronary ectasia. We included 558 patients with coronary ectasia on coronary angiography and, as controls, subjects with similar characteristics except for coronary ectasia, and CVRFs were recorded. Descriptive statistics, bivariate and multivariate analysis were used; odds ratio (OR) was calculated. 279 patients with and without coronary ectasia were studied. The prevalence of coronary ectasia was 8.5 %. The platelet/lymphocyte ratio (PLR) was higher in patients with ectasia than in those without ectasia (p = 0.003). In the bivariate analysis, associated CVRFs were overweight, obesity and diabetes, and in the multivariate analysis, hypercholesterolemia (OR: 3.90; p = 0.0001) and exposure to herbicides (OR: 6.82; p = 0.020). A high prevalence of coronary ectasia was found, with the main risk factors being a history of herbicide use and hypercholesterolemia. PLR was found to be elevated in these patients. Early detection is important due to its association with acute coronary events.

Bowman Layer Transplantation for Treating Keratoconus-Preliminary Findings.

(1) Background: Mid-stromal isolated Bowman layer transplantation aims to reduce and stabilize corneal ectasia in patients with advanced, progressive keratoconus. The purpose of this review is to evaluate the effectiveness and safety of this new surgical technique. (2) Methods: Following the PRISMA statement and checklist, we searched Medline, the Cochrane Controlled Trials Register, and Embase and used a broad systematic search strategy according to the Cochrane Collaboration. (3) Results: Eight studies with a total number of 120 eyes of 106 patients met our inclusion criteria. One month after Bowman layer transplantation, patients with keratoconus showed a significant decrease in the measured simulated keratometry (-4.74 D [95% CI -6.79 to -2.69]) and the maximum keratometry (-7.41 D [95% CI -9.64 to -5.19]), which remained significant one year postoperatively (-2.91 D [95% CI -5.29 to -0.53] and -5.80 D [-8.49 to -3.12]). Intra- and postoperative complications were observed in 3% and 9% of the patients, respectively. An estimated success rate of 75% to 85% was achieved by experienced surgeons at 5 to 8 years postoperatively. (4) Conclusions: Bowman layer transplantation may be an effective and safe treatment option in patients with advanced, progressive keratoconus. Additional multicenter prospective interventional studies are needed to confirm these preliminary findings.

Frequency of coronary artery ectasia in patients with myocardial infarction.

Objective: To determine the frequency of coronary artery ectasia in patients with MI in our population. Study Design: Descriptive, Cross Sectional study. Setting: Cardiac Catheterization Department of Ch. Pervaiz Elahi Institute of Cardiology, Multan. Period: 1st October 2019 to 31st March 2020. Material &amp; Methods: A total of 191 patients with myocardial infarction of age 18-60 years of either gender undergoing coronary angiography were included. Patients with vulvular heart disease, cardiomyopthies, heart failure and CKD were excluded. Full demographic informations including name, age, gender and risk factors like diabetes mellitus (DM), hypertension (HTN) and smoking were noted. The coronary angiographic films were reviewed and looked for presence or absence of coronary artery ectasia. Results: Mean age was 49.28 ± 9.64 years in our study. Out of the 191 patients, 85.86% were male and 14.14% were females with ratio of 6:1. The %age of vessel involvement in descending order was right coronary artery in 56.02%, left anterior descending artery in 25.13%, left circumflex artery in 13.10% and left main stem in 5.76% patients. Coronary artery ectasia was found in 62.83% patients. Conclusion: This study concluded that there is a high frequency of coronary artery ectasia (CAE) in myocardial infarction patients with positive association with older age, male gender, hypertension, diabetes mellitus and smoking.

A New Predictor of Obstructive Coronary Artery Ectasia in Patients with Non-ST-Elevation Acute Coronary Syndrome: The Atherogenic Index of Plasma

Introduction: Coronary artery ectasia (CAE) is one of the uncommon cardiovascular disorders with a clinical spectrum ranging from asymptomatic cases to myocardial infarction. Atherosclerosis plays a pivotal role in the pathogenesis of CAE. Recently, it has been determined that the atherogenic index of plasma (AIP) is a strong predictive marker for atherosclerosis. The aim of this study was to investigate whether there is a relationship between obstructive CAE and AIP in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS). Materials and methods: In this retrospective study, hospital electronic patient records were retrospectively examined. A total of 213 NSTE-ACS patients were included in the study. Patients were divided into two groups according to non-obstructive and obstructive CAE. The AIP value was compared between groups and regression analysis evaluated whether it is an indicator to predict the risk of obstructive CAE. Results: The AIP value was found to be numerically and statistically significant in the obstructive CAE group compared to the non-obstructive CAE group. The multivariate logistic regression analysis identified AIP as a predictor of obstructive CAE in NSTE-ACS patients in the receiver operating curve analysis, AIP values above 0.33 had 90% sensitivity and 68% specificity to predict obstructive CAE in NSTE-ACS patients. Conclusions: AIP values were increased in the presence of obstructive CAE in NSTE-ACS patients. Our findings suggest that AIP may be involved in the pathogenesis of obstructive CAE.

Coronary Artery Ectasia in Patients with and Without Diabetes: A Study from Northern Pakistan

Objectives: To determine the association of coronary artery ectasia in terms of its severity and vessels involved in diabetes patients and non-diabetes patients.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Cardiology, PAEC General Hospital, Islamabad Pakistan from Jun 2018 to Jun 2020.&#x0D; Methodology: All patients who underwent coronary angiography were included in this study. Two hundred patients (100 patients having diabetes and 100 patients not having diabetes) who presented with chest pain and chest heaviness were diagnosed with coronary artery ectasia on coronary angiography included in this study.&#x0D; Results: Two hundred patients, 100 patients had diabetes, and 100 patients had no diabetes. 71 (35.5%) of the patients were males, and 29 (14.5%) were females. The left anterior descending artery alone was responsible for 23% of Coronary Artery Ectasia, followed by the right coronary artery (16%) in diabetic patients. In patients with diabetes with multiple vessels, the left anterior descending artery and left circumflex artery were most frequently (21%) involved vessels, while left anterior descending and right coronary artery were observed to have Coronary artery ectasia in 16% of diabetes patients.&#x0D; Conclusion: No significant difference in the severity of coronary artery ectasia was noted among diabetes and non-diabetes patients. Left anterior descending was most frequently involved vessels in diabetes patients and right coronary artery in nondiabetes patients. Left anterior descending and left circumflex artery both had coronary artery ectasia in most of the diabetes patients and non-diabetes patients.

Frequency of various coronary risk factors in patients with acute coronary syndrome having coronary ectasia

BACKGROUND: Coronary artery ectasia (CAE) is the aneurysmal dilatation of coronary arteries, which can be local or generalized. It is deliberated as the variant of coronary atherosclerosis. CAE occurs due to several risk factors of cardiovascular diseases. AIMS AND OBJECTIVE: To assess the frequency of various coronary risk factors in patients with acute coronary syndrome having coronary ectasia. MATERIAL AND METHODS: This cross sectional study was carried out at the department of cardiology, Mayo hospital, Lahore over the duration of 6 months from 01-11-2017 to 30-04-2018. Total 135 patients fulfilling the selection criteria were recruited. History of patient regarding coronary risk factors was obtained including DM, smoking, hypertension and hyperlipidemia. RESULTS: The mean age of patients was 59.70±11.29years. There were 75 (55.6%) males and 60 (44.4%) females. The mean BMI of patients was 27.43±4.77kg/m2. In this study, 39 (28.9%) had STEMI, 45 (33.3%) had NSTEMI while 51 (37.8%) had UA. In this study, 93 (68.9%) patients had hypertension, 41 (30.4%) patients had diabetes, 43 (31.9%) patients were smokers and66 (48.9%) patients had hyperlipidemia. CONCLUSION: Frequency of certain risk factors causing coronary artery ectasia in patients having ACS is high in local population. KEY WORDS: Coronary factors, acute coronary syndrome, coronary ectasia, hypertension, diabetes, hyperlipidemia, smoking.

Prevalence, Predictors, and Impact of Coronary Artery Ectasia in Patients With Atherosclerotic Heart Disease.

The clinical relevance of coronary artery ectasia (CAE) is poorly understood. We investigated the prevalence, potential predictors, and prognostic significance of CAE in patients with atherosclerotic coronary artery disease. Consecutive patients undergoing percutaneous coronary intervention (PCI) from January 2016 to December 2018 were included and followed up for 1year. CAE was diagnosed as an abnormal dilation >1.5-fold the diameter of adjacent normal segments on angiography. A total of 590 patients with CAE were identified from 36790 patients undergoing PCI (overall rate of CAE: 1.6%). In multivariate analysis, variables including body mass index >30kg/m2 (risk ratio, RR: 2.413, P = .018), ever-smoking (RR: 1.669, P < .001), hypertension (RR: 1.221, P = .025), acute myocardial infarction at admission (RR: 1.343, P = .004), no diabetes (RR: .810, P = .023), previous myocardial infarction (RR: 1.545, P < .001), no left main disease (RR: .632, P = .008) and multiple-vessel disease (RR: 1.326, P = .001), increased C-reactive protein (RR: 1.006, P = .012) were predictors of CAE. The incidence of adverse cardiovascular outcomes did not differ significantly between patients with or without CAE (P = .203). CAE is not uncommon among patients undergoing PCI in this cohort study. The presence of CAE vs its absence had no significant impact on 1-year clinical outcomes after PCI.

Long-term durability of a reimplantationvalve-sparing aortic root replacement can be expected in both Marfan syndrome and Loeys-Dietz syndrome.

The goal of this study was to evaluate the surgical outcomes of a valve-sparing root replacement using the reimplantation technique for annuloaortic ectasia in patients with Marfan syndrome (MFS) and in those with Loeys-Dietz syndrome (LDS). We reviewed 103 patients with MSF with mutations in the fibrillin-1 gene and 28 patients with LDS with mutations in the transforming growth factor-beta receptor and 2, SMAD3 and transforming growth factor beta-2 from 1988 to 2020. Forty-four (42.7%) patients with MFS [26 men, 31 (7.6) years] and 10 (35.7%) patients with Loeys-Dietz syndrome (LDS) [7 men, 22 (standard deviation: 8.6) years] who had no aortic dissection and underwent valve-sparing root replacement were included. The preoperative sinus diameter [46 (45-50.5) mm in those with MFS vs 48 (47-50) mm in those with LDS, p = 0.420] and the percentage of aortic insufficiency > grade 2+ [31.8% (10/44) in patients with MFS vs 10.0% (1/10) in those with LDS, p = 0.667] revealed no significant differences between the 2 groups. The cumulative incidences of aortic insufficiency greater than grade 1 (p = 0.588) and aortic valve reoperation (p = 0.310) were comparable between the 2 groups. Patients with LDS had a higher tendency towards aortic dissection after the initial operation (p = 0.061) and a significantly higher cumulative incidence of aortic reoperation (p = 0.003) versus those with MFS. Patients with MFS and those with LDS showed similar cumulative incidences of recurrent aortic valve insufficiency and aortic valve reoperation. Those with LDS revealed a higher cumulative incidence of aortic reoperation and a greater tendency towards aortic dissection after the initial operation compared with those with MFS.

Management of lateral meningocele syndrome in a child without neurological symptoms and literature review.

Lateral meningocele syndrome (LMS) is a rare genetic connective tissue disorder which is associated with meningocele-related neurologic dysfunction. Several patients with LMS have been reported. But, guidelines for screening and treatment of LMS have not been established. We review the current knowledge of LMS in the article. Then, we describe a boy for whom a genomic analysis which allowed us to make a diagnosis of LMS and to begin monitoring of his condition for possible neurological complications. It would be difficult to make a diagnosis of LMS on the basis of clinical manifestations alone. The natural history of dural ectasia in patients with LMS needs to be better defined to establish surgical indications. Based upon the current literature, ventriculoperitoneal shunting (V-Ps) has been recommended as the first-line surgical treatment option for patients with symptomatic thoracolumbar meningoceles.

Infectious keratitis after corneal crosslinking: systematic review.

Corneal crosslinking is a U.S. Food and Drug Administration--approved therapy to stiffen the cornea and prevent progression of corneal ectasia in patients with keratoconus. The standard procedure involves removal of the corneal epithelium (epithelial-off) prior to treatment. Variations to the standard procedure include accelerated crosslinking and transepithelial procedures. This study reviewed what is known regarding the risk for infection after epithelial-off crosslinking, the spectrum of pathogens, and clinical outcomes. 26 publications were identified. All eyes were fit with a bandage contact lens postoperatively. Available data indicate that the overall frequency of infectious keratitis after epithelium-off crosslinking is low. Bacterial infections are the most common, with a mean time of presentation of 4.8 days postoperatively. The use of steroids and bandage contact lenses in the immediate postoperative period and/or a history of atopic or herpetic disease were associated with infection. These patients require intense postoperative care with prophylactic antiviral therapy when appropriate.

Posterior Chamber Phakic Intraocular Lens Implantation for Refractive Correction in Corneal Ectatic Disorders: A Review.

To summarize the indications and outcomes of posterior chamber phakic intraocular lens (PIOL) implantation in corneal ectasias including keratoconus, pellucid marginal degeneration (PMD), post-refractive surgery, and post-keratoplasty ectasias. A review of the literature was conducted using the relevant keywords from various databases up to August 15, 2020. All pertinent studies were reviewed, and the relevant articles were studied in detail for efficacy, stability, predictability, and safety outcomes. In addition, visual quality, corneal biomechanical outcomes, complications, the role of posterior chamber PIOL in combination treatment, and comparison of posterior chamber PIOL with other PIOLs for ectasias were also evaluated. A total of 30 relevant studies (13 prospective, 13 retrospective, 4 case reports) on the subject were studied and summarized. All studies showed a favorable refractive outcome. Quality of vision remained unaffected and no significant complications were reported in any of the studies. Posterior chamber PIOLs represent a viable option in the treatment of mild to moderate and stable corneal ectasia in patients with contact lens intolerance who have low irregular astigmatism, a clear central cornea, and good preoperative corrected distance visual acuity. [J Refract Surg. 2021;37(5):351-359.].