Background:Keratoconus is a contraindication for photorefractive keratectomy (PRK). In the recent decade, some efforts have been made to perform PRK in patients with keratoconus whose corneas are stable naturally or by doing corneal collagen crosslinking. These studies have suggested residual central corneal thickness (CCT) ≥450 μm.Aims:The aim was to evaluate the long-term outcomes of PRK in patients with mild to moderate keratoconus in patients older than 40 with residual CCT ≥ 400 μm.Settings and Design:This prospective study was conducted in our Cornea Research Center, Mashhad, Iran.Materials and Methods:Patients over 40 years old, with a grade I/II keratoconus without progression in the last 2 years were recruited. Patients with a predicted postoperative CCT < 400 μm were excluded. PRK with tissue saving protocol was performed with Tecnolas 217 Z. Mitomycin-C was applied after ablation. The final endpoints were refraction parameters the last follow-up visit (mean: 35 months). Paired t-test and Chi-square were used for analysis.Results:A total of 38 eyes of 21 patients were studied; 20 eyes (52.6%) with a grade I and 18 eyes (47.4%) with grade II keratoconus. The mean uncorrected visual acuity, best corrected visual acuity (BCVA), spherical equivalent, cylindrical power and keratometric readings were significantly improved at the final endpoint compared to preoperation measurements (P < 0.001). Two eyes (5%) lost two lines of BCVA at the final visit. No case of ectasia occurred during the follow-up course.Conclusions:PRK did not induce keratoconus progression in patients older than 40 with a grade I/II keratoconus. Residual CCT ≥ 450 μm seems to be sufficient to prevent the ectasia.

BackgroundUltrasound elastography, is a pioneer sonographic modality that is conducted during endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) in order to increase the accuracy of sampling location. The current study aims to evaluate the usefulness of elastography during EBUS‐TBNA in a population with a high prevalence of anthracosis.MethodsThis prospective single‐blinded study was performed on 69 lymph nodes (LNs) of patients with mediastinal lymphadenopathy undergoing EBUS‐TBNA and EBUS‐elastography from October 2017 to July 2018. The stiffness level of the tissue was translated into a color to demonstrate the hardness of tissue. Blue and total areas of each section were measured to calculate the hardness of each LN.ResultsSixty‐nine LNs were evaluated by elastography. Twenty percent of LNs were malignant. There was a statistical difference between malignant and non‐malignant nodes based on color dominancy (P = 0.032). However, with the exclusion of anthracosis nodes from the analysis, the difference was more significant (P < 0.001). Moreover, when the blue dominancy was used as the predictor of malignancy or anthracosis, the results showed a significant correlation (P < 001).ConclusionThe usefulness of elastography in selecting the hardest area of tissue that is appropriate for diagnosing diseases has been proven previously. Since in countries with a high prevalence of anthracosis, blue color achieved using elastography predicts either malignancy or anthracosis so, cases with blue dominancy of LNs in elastography and the white color in the EBUS‐TBNA indicate anthracosis‐caused calcification should be reconsidered.

The study revealed sufficiency of WLL as the PAP patients' treatment. Also hemoptysis was found to be the independent factor that can predict treatment failure.