Real-world data regarding the efficacy and safety of coronary intravascular lithotripsy (IVL) are lacking. We conducted a study of 50 consecutive patients (64 lesions) who underwent IVL. 3 patients suffered in-hospital mortality unrelated to the IVL; there was no other occurrence of MACE up to 30 days. Angiographic success was nearly universal (98% of patients with residual stenosis <50%, 96% of patients with TIMI 3 flow) and complication was rare, including among patients undergoing IVL for in-stent restenosis or left main coronary artery lesions. In a high-risk real-world cohort, IVL was a safe and effective treatment for highly-calcified coronary lesions.
Purpose: To investigate the relationship between corneal collagen cross-linking (CXL) and the number of corneal transplants required for the treatment of keratoconus (KCN) in 2 major Canadian provinces. Methods: This is a retrospective review of all corneal transplantation performed in Ontario and British Columbia over an 18-year period (1998–2016). Data were collected at the Eye Bank of Canada—Ontario/British Columbia Divisions. The primary outcome was to determine the change in proportion and absolute number of corneal transplants required for treatment of KCN since the introduction of CXL in Canada in 2008. Results: A total of 31,943 grafts were included. Overall, the mean age of participants was 39.3 ± 2.2 years, with our cohort being composed of 28% of women and 72% of men. The results showed a significant decrease in the proportion of total transplants required for KCN between 1998 and 2016 [1998–2008 (pre-CXL), range: 14.77%–12.63%; 2009–2016 (post-CXL), range: 12.98%–5.50%, P < 0.001]. However, there was no change in the absolute number of grafts performed for KCN over this time (pre-CXL: 179 ± 26 grafts; post-CXL: 198 ± 27 grafts; P = 0.5), whereas the total number of grafts (pre-CXL: 1318 ± 183 grafts; post-CXL: 2181 ± 404; P < 0.001) and endothelial keratoplasties (pre-CXL: 59 ± 108; post-CXL: 966 ± 431 grafts; P < 0.001) increased significantly. In addition, there were no changes in penetrating keratoplasty/deep anterior lamellar keratoplasty (DALK) performed for indications other than KCN (pre-CXL: 1080 ± 157; post-CXL: 1017 ± 92; P > 0.5). Conclusions: Although there has been a significant decrease in the proportion of corneal graft rates for KCN since the introduction of CXL as a factor of all transplants performed for all indications, this result is most likely because of an increase in endothelial keratoplasties rather than decreased transplants performed for definitive treatment.
It has been proposed that after activation by blue light, activated melanopsin is converted back to its resting state by long wavelength red light exposure, a putative mechanism of melanopsin chromophore recovery in vivo. We tested this hypothesis by investigating whether red light attenuates the ongoing post-illumination pupil response (PIPR) induced by melanopsin-activating blue light. Pupillary light responses were tested using "Blue+Red" double flashes and "Blue Only" single flash stimuli in 10 visually normal subjects. For "Blue+Red" conditions, PIPR was induced with an intense blue flash, followed by experimental red light exposure of variable intensity and duration (Experiment 1) immediately or 9s after the offset of the blue flash (Experiment 2). For "Blue Only" conditions, only the PIPR-inducing blue stimuli were presented (reference condition). PIPR was defined as the mean pupil size from 10 to 30s (Experiment 1) and from 25 to 60s (Experiment 2) after the offset of blue light stimuli. The results showed that PIPR from "Blue+Red" conditions did not differ significantly from those of "Blue Only" conditions (p=0.55) in Experiment 1. The two stimulation conditions also did not differ in Experiment 2 (p=0.38). We therefore conclude that red light exposure does not alter the time course of PIPR induced by blue light. This finding does not support the hypothesis that long wavelength red light reverses activated melanopsin; rather it lends support to the hypothesis that the wavelengths of stimuli driving both the forward and backward reactions of melanopsin may be similar.
We collected and analyzed pupil diameter data from of 7 visually normal participants to compare the maximum pupil constriction (MPC) induced by “Red Only” vs. “Blue+Red” visual stimulation conditions.The “Red Only” condition consisted of red light (640±10 nm) stimuli of variable intensity and duration presented to dark-adapted eyes with pupils at resting state. This condition stimulates the cone-driven activity of the intrinsically photosensitive retinal ganglion cells (ipRGC). The “Blue+Red” condition consisted of the same red light stimulus presented during ongoing blue (470±17 nm) light-induced post-illumination pupil response (PIPR), representing the cone-driven ipRGC activity superimposed on the melanopsin-driven intrinsic activity of the ipRGCs (“The Absence of Attenuating Effect of Red light Exposure on Pre-existing Melanopsin-Driven Post-illumination Pupil Response” Lei et al. (2016) [1]).MPC induced by the “Red Only” condition was compared with the MPC induced by the “Blue+Red” condition by multiple paired sample t-tests with Bonferroni correction.
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