Corneal collagen cross-linking (CXL) is a therapeutic intervention that utilizes riboflavin photochemical activation with ultraviolet-A (UV-A) light to induce covalent cross-links within the stromal corneal fibers, effectively increasing corneal biomechanical stability and halting the progressive ectasia. The method was introduced in the late 1990s in Germany at the University of Dresden. The cross-linking method using the Avedro system (Waltham, MA, USA) was approved by the US Food and Drug Administration (FDA) on 18 April 2016, based on three prospective, multicenter, randomized clinical trials for keratoconus and other corneal ectasias. Recent innovations in CXL include a range of new treatment protocols and methods, which have been introduced to further enhance the clinical effectiveness, efficiency, and safety of CXL. These modifications encompass approaches like transepithelial or epithelium-on CXL (TE-CXL or epi-on CXL), accelerated CXL (ACXL), pulsed CXL (PL-CXL), transepithelial iontophoresis-assisted crosslinking (I-CXL), diluted alcohol and iontophoresis-assisted corneal cross-linking (DAI-CXL), slit-lamp CXL, and CXL plus (combined) methods. This review synthesizes findings on currently used modifications of the cross-linking method, the effectiveness, and directions of development of this currently dominant surgical method of treating corneal ectasia. This review concentrates on the long-term follow-up data, based on publications ranging from 1998 up to 2023.

Data on the clinical outcomes comparing synthetic fluorocarbon polymer polytetrafluoroethylene- (PTFE, GraftMaster) and polyurethane- (Papyrus) covered stents (CSs) to seal coronary artery perforations (CAPs) are limited. We aimed to evaluate 30-day and 1-year clinical outcomes after PCI complicated by CAP and treated with CS. We assessed 106 consecutive patients with successful CAP sealing (122 CSs): GraftMaster (51 patients, 57 CSs) or Papyrus CS (55 patients, 65 CSs). The primary endpoint was the occurrence of major adverse cardiac events (MACE), defined as the composite of cardiac death, target lesion revascularisation (TLR), and myocardial infarction (MI). The mean age of subjects was 69 ± 9.6 years (53.8% males). No significant differences were identified between the GraftMaster and Papyrus groups at the 30-day follow-up for MACE, cardiac death, MI and stent thrombosis (ST), while significantly lower rate of TLR and TVR (p = 0.02) were confirmed in the Papyrus group. At one year, differences remained similar between stents for MACE, a trend towards a lower rate of TLR (p = 0.07), MI (p = 0.08), and ST (p = 0.08), and higher for cardiac death (p = 0.07) was observed in the Papyrus group. This real-life registry of CAP illustrated that the use of Papyrus CS is associated with lower rates of TLR and TVR at 30-day follow-up in comparison to the GraftMaster CSs and no significant differences between both assessed CS at one year of follow-up.

Rotational atherectomy (RA) used in elderly patients treated with percutaneous coronary interventions (PCI) could enable revascularization or the omission of cardiac surgery. Knowledge about factors affecting the prognosis may improve the results of treatment. We aimed to assess the relationship of gender and age with long-term clinical outcomes expressed as major adverse cardiac and cerebrovascular events (MACCEs). The study included 97 consecutive patients treated with PCI and RA at the mean age of 71. The study group contained 73.2% men and 26.8% women, 36.1% of patients older than 75 and 63.9% younger than 75. The mean time of follow-up was 695.3 ±560.9 days. The rate of MACCEs (deaths, myocardial infarctions (MIs), reinterventions, coronary artery by-pass surgeries, or cerebral strokes (CSs)/transient ischemic attacks (TIAs)) in the overall group of patients was calculated at 33.7%. The comparison of Kaplan-Meier survival curves did not depict significant differences in the frequency of MACCEs for age (p = 0.36) and gender (p = 0.07). We noticed that the death rate was higher in females than in males and in patients older than 75 compared to those younger, and was statistically significant for age (p = 0.04). The rate of periprocedural complications was significantly higher among women than among men (p = 0.005) and in patients older than 75 compared to the younger ones (p = 0.003). Age and gender are not significantly associated with an increased rate of MACCEs during follow-up in elderly patients treated with PCI and RA.

Aims: To summarize current evidence on lifestyle interventions, metabolic stabilization and screening strategies relevant to diabetic retinopathy during pregnancy. Material and methods: A narrative review of clinical studies, systematic reviews, meta-analyses and guideline documents was performed using PubMed/MEDLINE, Scopus and Google Scholar. Results: Baseline retinal status in early pregnancy is the strongest predictor of progression. Additional risk is associated with longer diabetes duration, elevated glycated hemoglobin, glycemic variability, nephropathy and hypertensive disorders, including preeclampsia. Women without retinopathy in early pregnancy generally have a low risk of sight-threatening disease during the same gestation, whereas women with pre-existing retinopathy require close surveillance. Lifestyle interventions do not directly treat retinal lesions, but they improve glycemic control, support appropriate gestational weight gain and reduce vascular burden. Evidence also suggests that continuous glucose monitoring and automated insulin delivery may indirectly support retinal protection by improving metabolic stability. Conclusions: In pregnant women with diabetes, ophthalmic screening remains the main clinical priority. However, lifestyle-based metabolic support is a meaningful complementary strategy and should be integrated into antenatal care alongside risk-stratified retinal follow-up.

Wprowadzenie: W ostatnich latach stożek rogówki stał się często diagnozowanym schorzeniem okulistycznym, charakteryzującym się postępującym ścieńczeniem obszaru centralnego lub paracentralnego rogówki. Standardową metodą terapeutyczną jest cross-linking rogówki (CXL), który oferuje różnorodne techniki leczenia dostosowane do zaawansowania choroby. Celem niniejszego przeglądu jest zebranie i omówienie najczęściej stosowanych metod CXL w sposób, który ułatwi lekarzom dobór najbardziej odpowiedniego planu terapeutycznego, uwzględniającego indywidualne potrzeby pacjenta.Metody przeglądu: Niniejszy przegląd opiera się na 42 artykułach starannie wybranych z ogólnodostępnych źródeł, z wykorzystaniem baz danych PubMed i Google Scholar. Wyszukiwanie obejmowało postępowanie terapeutyczne w CXL zarówno u dorosłych, jak i u dzieci. Przegląd literatury obejmuje publikacje z lat 2003–2024.Stan wiedzy: CXL jest uważany za podstawową strategię terapeutyczną w leczeniu stożka rogówki. Liczne badania wskazują, że metoda ta jest bardzo skuteczna u pacjentów cierpiących na to schorzenie.Wnioski: Przegląd ocenia różne metody CXL. W metodzie przeznabłonkowego CXL (transepithelial cross-linking – TE-CXL) zachowuje się warstwę nabłonka, co zmniejsza ryzyko powikłań pooperacyjnych i umożliwia leczenie cieńszych rogówek oraz zaawansowanego stożka rogówki. Chociaż wspomniana metoda jest bezpieczniejsza, mniej bolesna i sprzyja szybszemu powrotowi do zdrowia, jej skuteczność może być ograniczona przez niewystarczającą penetrację ryboflawiny. Z kolei CXL z usunięciem nabłonka (epithelium-off – epi-off), zwłaszcza protokół drezdeński, pozostaje złotym standardem, choć niesie za sobą ryzyko powikłań, takich jak ból. Praca podkreśla potrzebę równoważenia bezpieczeństwa i skuteczności przy wyborze metod CXL, przy jednoczesnym uznaniu, że wszystkie metody są skuteczne w hamowaniu postępu stożka rogówki.