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Mastropasqua L, Salgari N, D'Ugo E, Lanzini M, Alió Del Barrio JL, Alió JL, Cochener B, Nubile M. In Vivo Confocal Microscopy of Stromal Lenticule Addition Keratoplasty for Advanced Keratoconus. J Refract Surg 2021; 36:544-550. [PMID: 32785728 DOI: 10.3928/1081597x-20200527-01] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 05/27/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE To investigate the in vivo corneal microscopic changes after femtosecond laser-assisted stromal lenticule addition keratoplasty in keratoconus by means of in vivo confocal microscopy. METHODS Patients affected by advanced keratoconus were included in the study. Negative meniscus-shaped stromal lenticules, produced with a femtosecond laser (VisuMax; Carl Zeiss Meditec) from eye bank corneas were transplanted into a stromal pocket dissected in the recipient cornea at a depth of 120 µm. In vivo confocal microscopy was performed during the 12-month follow-up to investigate changes of the corneal and lenticule structure. RESULTS Ten patients were enrolled in the study. No changes of the dendritic cell population were documented during the follow-up period. Mild edema and stromal keratocyte activation gradually decreased during the first month. Subbasal nerve density returned to preoperative values after 6 months. Donor-recipient interfaces appeared hyperreflective but gradually improved over time with significantly reduced reflectivity after 3 months. No evidence of stromal inflammatory cell migration or matrix opacification was observed. Endothelial and keratocyte density remained stable over time. A variable degree of stromal radially distributed folds, not visible on biomicroscopy, was observed in the lenticule and in the posterior recipient stroma. CONCLUSIONS Stromal lenticule addition keratoplasty produces transitory nerve plexus density reduction and minor inflammatory reaction that rapidly decreases during the first month. Donor-recipient interface reflectivity is comparable to a femtosecond laser refractive procedure with no sign of stromal opacification or stromal rejection in 1 year of follow-up. [J Refract Surg. 2020;36(8):544-550.].
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Yin Y, Hu T, Xiang A, Fu Y, Zhao Y, Wu X, Wu X, Wen D. A microscopic study of the corneal stromal lenticules extracted during femtosecond laser-assisted small incision lenticule extraction. Exp Ther Med 2021; 22:681. [PMID: 33986846 DOI: 10.3892/etm.2021.10113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 11/20/2020] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to investigate the histological and morphological characteristics of corneal stromal lenticules extracted during femtosecond laser-assisted small incision lenticule extraction (SMILE) surgery by light and electron microscopy. A total of 20 human corneal stromal lenticules extracted during SMILE surgery were sent for microscopic examination immediately after surgery. Of these, six were observed under a light microscope and 14 were observed under an electron microscope. The smoothness of the front and rear surface of the lenticules observed under an electron microscope was rated on a scale of 0 to 4 according to unified evaluation criteria and the scores were statistically compared. Under the light microscope, the edge of the cross section of the corneal stromal lenticules was deeply stained and certain burrs and broken collagen fibers were observed. The swollen corneal stromal fibers were distributed irregularly, with a few bubbles of different sizes. Under the electron microscope, the surface of the lenticules ablated using a femtosecond laser was not perfectly smooth and the front surface was smoother than the rear surface. The side edge of the lenticules ablated using a femtosecond laser was not as regular as the edge cut using microscissors. Necrosis and dissolution of collagen fibers were observed near the surface of the lenticules. In conclusion, the surface quality of corneal stromal lenticules ablated using a femtosecond laser was not optimal when observed under a microscope. Increased attention should be paid to the histology and morphology of the corneal surface following laser ablation.
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Affiliation(s)
- Yewei Yin
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China.,Hunan Key Laboratory of Ophthalmology, College of Basic Medicine, Central South University, Changsha, Hunan 410008, P.R. China
| | - Tu Hu
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China.,Hunan Key Laboratory of Ophthalmology, College of Basic Medicine, Central South University, Changsha, Hunan 410008, P.R. China
| | - Aiqun Xiang
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Yanyan Fu
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Yang Zhao
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Xiaoying Wu
- Department of Pathology, College of Basic Medicine, Central South University, Changsha, Hunan 410008, P.R. China
| | - Xiaoying Wu
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China.,Hunan Key Laboratory of Ophthalmology, College of Basic Medicine, Central South University, Changsha, Hunan 410008, P.R. China
| | - Dan Wen
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China.,Hunan Key Laboratory of Ophthalmology, College of Basic Medicine, Central South University, Changsha, Hunan 410008, P.R. China
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Zhao J, Liu R, Shen Y, Zhang X, Zhao Y, Xu H, Xu Y, Zhou X. Two-year observation of morphologic and histopathologic changes in the monkey cornea following small incision allogenic lenticule implantation. Exp Eye Res 2020; 192:107935. [DOI: 10.1016/j.exer.2020.107935] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/28/2019] [Accepted: 01/14/2020] [Indexed: 10/25/2022]
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Damgaard IB, Riau AK, Liu YC, Tey ML, Yam GHF, Mehta JS. Reshaping and Customization of SMILE-Derived Biological Lenticules for Intrastromal Implantation. Invest Ophthalmol Vis Sci 2019; 59:2555-2563. [PMID: 29847663 DOI: 10.1167/iovs.17-23427] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the feasibility of excimer laser reshaping of biological lenticules available after small incision lenticule extraction (SMILE). Methods Fresh and cryopreserved SMILE-derived human lenticules underwent excimer laser ablation for stromal reshaping. The treatment effects in the lasered group were compared with the nonlasered group with respect to changes in surface functional groups (by Fourier transform infrared spectroscopy [FTIR]) and surface morphology (by scanning electron microscopy [SEM] and atomic force microscopy [AFM]). Ten SMILE-derived porcine lenticules, five nonlasered (107-μm thick, -6 diopter [D] spherical power) and five excimer lasered (50% thickness reduction), were implanted into a 120-μm stromal pocket of 10 porcine eyes. Corneal thickness and topography were assessed before and after implantation. Results FTIR illustrated prominent changes in the lipid profile. The collagen structure was also affected by the laser treatment but to a lesser extent. SEM exhibited a more regular surface for the lasered lenticules, confirmed by the lower mean Rz value (290.1 ± 96.1 nm vs. 380.9 ± 92.6 nm, P = 0.045) on AFM. The lasered porcine lenticules were thinner than the nonlasered controls during overhydration (132 ± 26 μm vs. 233 ± 23 μm, P < 0.001) and after 5 hours in a moist chamber (46 ± 3 μm vs. 57 ± 3 μm, P < 0.001). After implantation, the nonlasered group showed a tendency toward a greater increase in axial keratometry (6.63 ± 2.17 D vs. 5.60 ± 3.79 D, P = 0.613) and elevation (18.6 ± 15.4 vs. 15.2 ± 5.5, P = 0.656) than the lasered group. Conclusions Excimer laser ablation may be feasible for thinning and reshaping of SMILE-derived lenticules before reimplantation or allogenic transplantation. However, controlled lenticule dehydration before ablation is necessary in order to allow stromal thinning.
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Affiliation(s)
- Iben Bach Damgaard
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark.,Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
| | - Andri Kartasasmita Riau
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,School of Materials Science and Engineering, Nanyang Technological University, Singapore
| | - Yu-Chi Liu
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore
| | - Min Li Tey
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gary Hin-Fai Yam
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore
| | - Jodhbir Singh Mehta
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,School of Materials Science and Engineering, Nanyang Technological University, Singapore.,Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore
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Kim WK, Ryu IH, Kim JS, Jeon GH, Lee IS, Kim HS, Kim JK. Clinical Outcomes of One Day Small-incision Lenticule Extraction Compared with Scheduled Methods for Myopic Patients. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.3.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Damgaard IB, Ang M, Farook M, Htoon HM, Mehta JS. Intraoperative Patient Experience and Postoperative Visual Quality After SMILE and LASIK in a Randomized, Paired-Eye, Controlled Study. J Refract Surg 2018; 34:92-99. [PMID: 29425387 DOI: 10.3928/1081597x-20171218-01] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 12/08/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare intraoperative and postoperative subjective patient experience after small incision lenticule extraction (SMILE) and femtosecond laser-assisted LASIK. METHODS In a prospective, randomized, paired-eye, single-masked clinical trial at Singapore National Eye Centre, 70 patients were randomly treated with SMILE and LASIK in each eye. The intraoperative questionnaire was completed immediately after surgery and included light perception and levels of anxiety, fear, and discomfort. The postoperative 1- and 3-month questionnaires evaluated severity of light sensitivity, eye discomfort, eye dryness, excessive tearing, gritty sensation, glare, halos, blurring, and fluctuations in vision. RESULTS Average discomfort scores were higher during tissue manipulation in SMILE (1.9 ± 0.9) than flap lifting in LASIK (1.59 ± 0.8) (P = .020) but comparable during docking and laser application (P > .249). Fear scores were lower in SMILE than LASIK during docking (2.6 ± 1.6 vs 3.4 ± 1.9, P = .024) but similar during occasional blackout, laser application, and lenticule/flap manipulation (P > .364). Fear scores were generally higher in patients with intraoperative suction loss (n = 3). For SMILE, light sensitivity, eye discomfort, blurring, and fluctuations in vision improved from 1 to 3 months (P < .039). For LASIK, improvements were reported for light sensitivity, eye discomfort, eye dryness, gritty sensation, and fluctuations in vision from 1 to 3 months (P < .046). At 1 month, patients experienced more blurring after SMILE than LASIK (2.1 ± 0.8 vs 1.8 ± 0.7, P = .025), but with no differences in any of the visual symptoms at 3 months. CONCLUSIONS Tissue manipulation may be more uncomfortable during SMILE than LASIK, but not more frightening. Subjective visual symptoms were comparable after 3 months. [J Refract Surg. 2018;34(2):92-99.].
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Ang M, Ho H, Fenwick E, Lamoureux E, Htoon HM, Koh J, Tan D, Mehta JS. Vision-related quality of life and visual outcomes after small-incision lenticule extraction and laser in situ keratomileusis. J Cataract Refract Surg 2016; 41:2136-44. [PMID: 26703289 DOI: 10.1016/j.jcrs.2015.10.049] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 02/20/2015] [Accepted: 02/22/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare vision-related quality of life (VRQoL) scores and clinical outcomes between small-incision lenticule extraction and laser in situ keratomileusis (LASIK). SETTING Singapore National Eye Centre, Singapore. DESIGN Prospective study. METHODS Patients had small-incision lenticule extraction using the Visumax 500 kHz femtosecond laser; or LASIK excimer ablation with the Wavelight Allegretto 400 Hz laser. Primary outcomes were 3-month predictability, efficacy, and safety. Secondary outcomes were intraoperative experience, visual symptoms, and VRQoL (validated Quality of Life Impact of Refractive Correction [QIRC] questionnaire) in 25 a subgroup of patients in each group. Following Rasch analysis, "Functional" and "Emotional," QIRC dimensions were analysed separately. RESULTS At 3 months, predictability (82.5% versus 85.3%, ±0.5 diopters attempted correction, P =.453), safety index (1.13 ± 0.19 [SD] versus 1.07 ± 0.16, P = .158), and efficacy index (0.91 ± 0.21 versus 0.97 ± 0.19; P = .002) were found when comparing small-incision lenticule extraction (172 eyes) and LASIK (matched 688 eyes). Intraoperative experience between groups was not statistically different; visual fluctuations (P = .020) and episodes of visual blurring (P = .008) were greater after small-incision lenticule extraction than after LASIK at 1 month but not at 3 months. There was no difference in "functional" (66.7 ± 15.7 versus 55.3 ± 22.2, P = .064) and "emotional" (42.7 ± 23.2 versus 37.9 ± 23.8, P = .394) QIRC dimensions between the 2 groups (25 patients in each group) at 3 months. CONCLUSION The study, 3-month predictability, safety, and VRQL scores were not statistically different between small-incision lenticule extraction and LASIK. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Marcus Ang
- From the Singapore National Eye Centre (Ang, Ho, Koh, Tan, Mehta), the Singapore Eye Research Institute (Ang, Ho, Lamoureux, Htoon, Tan, Mehta), Duke-NUS Graduate Medical School (Lamoureux, Htoon, Tan, Mehta), and the National University Health System (Tan), Singapore; the Centre for Eye Research Australia (Fenwick, Lamoureux), University of Melbourne, Melbourne, Australia
| | - Henrietta Ho
- From the Singapore National Eye Centre (Ang, Ho, Koh, Tan, Mehta), the Singapore Eye Research Institute (Ang, Ho, Lamoureux, Htoon, Tan, Mehta), Duke-NUS Graduate Medical School (Lamoureux, Htoon, Tan, Mehta), and the National University Health System (Tan), Singapore; the Centre for Eye Research Australia (Fenwick, Lamoureux), University of Melbourne, Melbourne, Australia
| | - Eva Fenwick
- From the Singapore National Eye Centre (Ang, Ho, Koh, Tan, Mehta), the Singapore Eye Research Institute (Ang, Ho, Lamoureux, Htoon, Tan, Mehta), Duke-NUS Graduate Medical School (Lamoureux, Htoon, Tan, Mehta), and the National University Health System (Tan), Singapore; the Centre for Eye Research Australia (Fenwick, Lamoureux), University of Melbourne, Melbourne, Australia
| | - Ecosse Lamoureux
- From the Singapore National Eye Centre (Ang, Ho, Koh, Tan, Mehta), the Singapore Eye Research Institute (Ang, Ho, Lamoureux, Htoon, Tan, Mehta), Duke-NUS Graduate Medical School (Lamoureux, Htoon, Tan, Mehta), and the National University Health System (Tan), Singapore; the Centre for Eye Research Australia (Fenwick, Lamoureux), University of Melbourne, Melbourne, Australia
| | - Hla M Htoon
- From the Singapore National Eye Centre (Ang, Ho, Koh, Tan, Mehta), the Singapore Eye Research Institute (Ang, Ho, Lamoureux, Htoon, Tan, Mehta), Duke-NUS Graduate Medical School (Lamoureux, Htoon, Tan, Mehta), and the National University Health System (Tan), Singapore; the Centre for Eye Research Australia (Fenwick, Lamoureux), University of Melbourne, Melbourne, Australia
| | - Jane Koh
- From the Singapore National Eye Centre (Ang, Ho, Koh, Tan, Mehta), the Singapore Eye Research Institute (Ang, Ho, Lamoureux, Htoon, Tan, Mehta), Duke-NUS Graduate Medical School (Lamoureux, Htoon, Tan, Mehta), and the National University Health System (Tan), Singapore; the Centre for Eye Research Australia (Fenwick, Lamoureux), University of Melbourne, Melbourne, Australia
| | - Donald Tan
- From the Singapore National Eye Centre (Ang, Ho, Koh, Tan, Mehta), the Singapore Eye Research Institute (Ang, Ho, Lamoureux, Htoon, Tan, Mehta), Duke-NUS Graduate Medical School (Lamoureux, Htoon, Tan, Mehta), and the National University Health System (Tan), Singapore; the Centre for Eye Research Australia (Fenwick, Lamoureux), University of Melbourne, Melbourne, Australia
| | - Jodhbir S Mehta
- From the Singapore National Eye Centre (Ang, Ho, Koh, Tan, Mehta), the Singapore Eye Research Institute (Ang, Ho, Lamoureux, Htoon, Tan, Mehta), Duke-NUS Graduate Medical School (Lamoureux, Htoon, Tan, Mehta), and the National University Health System (Tan), Singapore; the Centre for Eye Research Australia (Fenwick, Lamoureux), University of Melbourne, Melbourne, Australia.
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Liu YC, Ang HP, Teo EPW, Lwin NC, Yam GHF, Mehta JS. Wound healing profiles of hyperopic-small incision lenticule extraction (SMILE). Sci Rep 2016; 6:29802. [PMID: 27418330 PMCID: PMC4945911 DOI: 10.1038/srep29802] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/20/2016] [Indexed: 12/14/2022] Open
Abstract
Refractive surgical treatment of hyperopia still remains a challenge for refractive surgeons. A new nomogram of small incision lenticule extraction (SMILE) procedure has recently been developed for the treatment of hyperopia. In the present study, we aimed to evaluate the wound healing and inflammatory responses of this new nomogram (hyperopic-SMILE), and compared them to those of hyperopic-laser-assisted in situ keratomileusis (LASIK), using a rabbit model. A total of 26 rabbits were used, and slit lamp biomicroscopy, autorefractor/keratometer, intraocular pressure measurement, anterior segment optical coherence tomography, corneal topography, and in vivo confocal microscopy examinations were performed during the study period of 4 weeks. The corneas were then harvested and subject to immunofluorescence of markers for inflammation (CD11b), wound healing (fibronectin) and keratocyte response (HSP47). The lenticule ultrastructual changes were also analyzed by transmission electron microscopy. Out results showed that hyperopic-SMILE effectively steepened the cornea. Compared to hyperopic-LASIK, hyperopic-SMILE had less postoperative wound healing response and stromal interface reaction, especially in higher refractive correction. However, compared to myopic-SMILE, hyperopic-SMILE resulted in more central deranged collagen fibrils. These results provide more perspective into this new treatment option for hyperopia, and evidence for future laser nomogram modification.
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Affiliation(s)
- Yu-Chi Liu
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,Singapore National Eye Centre, 11 Third Hospital Ave, Singapore
| | - Heng Pei Ang
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
| | - Ericia Pei Wen Teo
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
| | - Nyein Chan Lwin
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
| | - Gary Hin Fai Yam
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
| | - Jodhbir S Mehta
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,Singapore National Eye Centre, 11 Third Hospital Ave, Singapore.,Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore.,School of Material Science &Engineering and School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Ave, n3, 639798, Singapore
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Zhang T, Sun Y, Liu M, Zhou Y, Wang D, Chen Y, Liu Q. Femtosecond Laser-assisted Endokeratophakia Using Allogeneic Corneal Lenticule in a Rabbit Model. J Refract Surg 2016; 31:775-82. [PMID: 26544566 DOI: 10.3928/1081597x-20151021-07] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/10/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the feasibility of allogeneic corneal lenticule implantation using the femtosecond laser as a method for cornea remodeling. METHODS Small incision lenticule extraction was performed on the right eyes of 15 New Zealand white rabbits. Corneal intrastromal pockets were created with a femtosecond laser on the left eyes. Allogeneic corneal lenticule implantation was performed on the left eye immediately after the lenticule was extracted from the right eye. All animals had preoperative and postoperative slit-lamp photography, ultrasonic pachymetry, corneal endothelial cell count, anterior segment optical coherence tomography, in vivo confocal microscopy, and retinoscopy refraction during the observation period of 8 weeks. The rabbits were killed 8 weeks after surgery. Corneal wound healing response was analyzed by transmission electron microscopy, hematoxylin-eosin staining, TUNEL assay, and immunofluorescent staining. RESULTS Mild corneal edema and decreased clarity were noted the first few days after implantation, improving to normal 8 weeks after surgery. The corneal thickness and retinoscopy refraction were stable during the observation period. Viable keratocytes could be detected within the lenticule lamellae by ultrastructural analysis 8 weeks after surgery. The anterior and posterior border of the lenticule showed acellular layers with highly irregular collagen arrangement on transmission electron microscope images. Proliferating Ki-67 positive cells were present only in the epithelium layer. CONCLUSION Femtosecond laser-assisted endokeratophakia using allogeneic corneal lenticule may be feasible for reshaping cornea, providing a new possibility in refractive surgery and keratoconus treatment.
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Liu YC, Teo EPW, Lwin NC, Yam GHF, Mehta JS. Early Corneal Wound Healing and Inflammatory Responses After SMILE: Comparison of the Effects of Different Refractive Corrections and Surgical Experiences. J Refract Surg 2016; 32:346-53. [DOI: 10.3928/1081597x-20160217-05] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 01/06/2016] [Indexed: 11/20/2022]
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Tan DKL, Tay WT, Chan C, Tan DTH, Mehta JS. Postoperative ocular higher-order aberrations and contrast sensitivity: femtosecond lenticule extraction versus pseudo small-incision lenticule extraction. J Cataract Refract Surg 2015; 41:623-34. [PMID: 25804583 DOI: 10.1016/j.jcrs.2014.07.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 06/29/2014] [Accepted: 07/10/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate and compare changes in contrast sensitivity and ocular higher-order aberrations (HOAs) after femtosecond lenticule extraction (FLEx) and pseudo small-incision lenticule extraction (SMILE). SETTING Singapore National Eye Centre, Singapore. DESIGN Retrospective case series. METHOD Patients had femtosecond lenticule extraction (Group 1) or pseudo small-incision lenticule extraction (Group 2) between March 2010 and December 2011. The main outcome measures were manifest refraction, HOAs, and contrast sensitivity 1, 3, 6, and 12 months postoperatively. RESULTS Fifty-two consecutive patients (102 eyes) were recruited, 21 patients (42 eyes) in Group 1 and the 31 patients (60 eyes) in Group 2. The uncorrected and corrected distance visual acuities were significantly better in Group 2 than in Group 1 at 12 months (P = .032). There was no significant increase in 3rd- or 4th-order aberrations at 1 year and no significant difference between the 2 groups preoperatively or postoperatively. At 1 year, there was a significant increase in mesopic contrast sensitivity in Group 2 at 1.5 cycles per degree (cpd) (P = .008) that was not found in Group 1, and photopic contrast sensitivity at 6.0 cpd was higher in Group 2 (P = .027). CONCLUSIONS These results indicate that refractive lenticule extraction is safe and effective with no significant induction of HOAs or deterioration in contrast sensitivity at 1 year. Induction of HOAs was not significantly different between both variants of refractive lenticule extraction. However, there was significant improvement in photopic contrast sensitivity after pseudo small-incision lenticule extraction, which persisted through 1 year. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Deborah K L Tan
- From the Singapore Eye Research Institute (D.K.L. Tan, Tay, Chan, D.T.H. Tan, Mehta), the Department of Ophthalmology (D.T.H. Tan), Yong Loo Lin School of Medicine, National University of Singapore, the Singapore National Eye Center (D.K.L. Tan, Chan, D.T.H. Tan), the Department of Clinical Sciences (Mehta), Duke-NUS Graduate Medical School, and the Lee Kong Chian School of Medicine (D.T.H. Tan), Nanyang Technological University, Singapore
| | - Wan Ting Tay
- From the Singapore Eye Research Institute (D.K.L. Tan, Tay, Chan, D.T.H. Tan, Mehta), the Department of Ophthalmology (D.T.H. Tan), Yong Loo Lin School of Medicine, National University of Singapore, the Singapore National Eye Center (D.K.L. Tan, Chan, D.T.H. Tan), the Department of Clinical Sciences (Mehta), Duke-NUS Graduate Medical School, and the Lee Kong Chian School of Medicine (D.T.H. Tan), Nanyang Technological University, Singapore
| | - Cordelia Chan
- From the Singapore Eye Research Institute (D.K.L. Tan, Tay, Chan, D.T.H. Tan, Mehta), the Department of Ophthalmology (D.T.H. Tan), Yong Loo Lin School of Medicine, National University of Singapore, the Singapore National Eye Center (D.K.L. Tan, Chan, D.T.H. Tan), the Department of Clinical Sciences (Mehta), Duke-NUS Graduate Medical School, and the Lee Kong Chian School of Medicine (D.T.H. Tan), Nanyang Technological University, Singapore
| | - Donald T H Tan
- From the Singapore Eye Research Institute (D.K.L. Tan, Tay, Chan, D.T.H. Tan, Mehta), the Department of Ophthalmology (D.T.H. Tan), Yong Loo Lin School of Medicine, National University of Singapore, the Singapore National Eye Center (D.K.L. Tan, Chan, D.T.H. Tan), the Department of Clinical Sciences (Mehta), Duke-NUS Graduate Medical School, and the Lee Kong Chian School of Medicine (D.T.H. Tan), Nanyang Technological University, Singapore
| | - Jodhbir S Mehta
- From the Singapore Eye Research Institute (D.K.L. Tan, Tay, Chan, D.T.H. Tan, Mehta), the Department of Ophthalmology (D.T.H. Tan), Yong Loo Lin School of Medicine, National University of Singapore, the Singapore National Eye Center (D.K.L. Tan, Chan, D.T.H. Tan), the Department of Clinical Sciences (Mehta), Duke-NUS Graduate Medical School, and the Lee Kong Chian School of Medicine (D.T.H. Tan), Nanyang Technological University, Singapore.
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Ang M, Mehta JS, Chan C, Htoon HM, Koh JCW, Tan DT. Refractive lenticule extraction: transition and comparison of 3 surgical techniques. J Cataract Refract Surg 2015; 40:1415-24. [PMID: 25135532 DOI: 10.1016/j.jcrs.2013.12.026] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 12/09/2013] [Accepted: 12/17/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE To describe the transition and outcomes of 3 refractive lenticule extraction (ReLEx) techniques: femtosecond lenticule extraction (FLEx), small-incision lenticule extraction (SMILE), and pseudo small-incision lenticule extraction. SETTING Singapore National Eye Center, Singapore. DESIGN Prospective comparative case series. METHODS Refractive lenticule extraction was performed between March 1, 2010, and November 1, 2012, using the Visumax 500 kHz femtosecond laser system. The main outcome measures were the refractive efficacy, predictability, and safety over 12 months. RESULTS The study enrolled 88 eyes. All 3 refractive lenticule extraction techniques yielded good refractive outcomes and stability over 12 months. Three months postoperatively, the mean overall efficacy index of refractive lenticule extraction was 0.89±0.22 (SD), with 95.5% of eyes attaining an uncorrected distance visual acuity (UDVA) of better than 20/40 and 60.2% of better than 20/20. Of all eyes, 95.5% were within ±1.00 diopter (D) and 78.4% within ±0.50 D of the attempted correction. The mean overall safety index was 1.06±0.17. At 3 months, all small-incision lenticule extraction eyes and 96.7% of pseudo small-incision lenticule extraction eyes had a UDVA of 20/40 or better, while femtosecond lenticule extraction eyes had a lower efficacy index (87.0%). However, efficacy was comparable in all 3 groups by 12 months (mean 0.87±0.04 [standard error of the mean]; P=1.00). CONCLUSION The efficacy, safety, and predictability profiles of the 3 refractive lenticule extraction techniques were good over a 12-month follow-up. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Marcus Ang
- From the Singapore National Eye Centre (Ang, Mehta, Chan, Koh, Tan), the Singapore Eye Research Institute (Ang, Mehta, Htoon, Tan), Duke-NUS Graduate Medical School (Mehta, Htoon), and the National University Health System (Tan), Singapore
| | - Jodhbir S Mehta
- From the Singapore National Eye Centre (Ang, Mehta, Chan, Koh, Tan), the Singapore Eye Research Institute (Ang, Mehta, Htoon, Tan), Duke-NUS Graduate Medical School (Mehta, Htoon), and the National University Health System (Tan), Singapore
| | - Cordelia Chan
- From the Singapore National Eye Centre (Ang, Mehta, Chan, Koh, Tan), the Singapore Eye Research Institute (Ang, Mehta, Htoon, Tan), Duke-NUS Graduate Medical School (Mehta, Htoon), and the National University Health System (Tan), Singapore
| | - Hla M Htoon
- From the Singapore National Eye Centre (Ang, Mehta, Chan, Koh, Tan), the Singapore Eye Research Institute (Ang, Mehta, Htoon, Tan), Duke-NUS Graduate Medical School (Mehta, Htoon), and the National University Health System (Tan), Singapore
| | - Jane C W Koh
- From the Singapore National Eye Centre (Ang, Mehta, Chan, Koh, Tan), the Singapore Eye Research Institute (Ang, Mehta, Htoon, Tan), Duke-NUS Graduate Medical School (Mehta, Htoon), and the National University Health System (Tan), Singapore
| | - Donald T Tan
- From the Singapore National Eye Centre (Ang, Mehta, Chan, Koh, Tan), the Singapore Eye Research Institute (Ang, Mehta, Htoon, Tan), Duke-NUS Graduate Medical School (Mehta, Htoon), and the National University Health System (Tan), Singapore.
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Abstract
Corneal photorefractive surgery is currently performed by ablation of corneal stroma under the stromal flap. A stromal flap is created using a femtosecond (FS) laser or mechanical microkeratome, although the FS laser procedure is considered safer and more accurate. This review assesses and compares the use of FS laser versus mechanical microkeratome ablation for corneal stromal characteristics mainly examined by histology and cellular biological responses. Supporting data from our studies, using corneas of enucleated porcine eye globes, are included in this review. Histological analysis and experimental studies of cellular/tissue responses to FS laser irradiation should be further investigated, and the equipment used to perform these techniques should be improved.
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Lim CHL, Riau AK, Lwin NC, Chaurasia SS, Tan DT, Mehta JS. LASIK following small incision lenticule extraction (SMILE) lenticule re-implantation: a feasibility study of a novel method for treatment of presbyopia. PLoS One 2013; 8:e83046. [PMID: 24349429 PMCID: PMC3859649 DOI: 10.1371/journal.pone.0083046] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 11/07/2013] [Indexed: 11/25/2022] Open
Abstract
Presbyopia remains a major visual impairment for patients, who have previously undergone laser refractive correction and enjoyed unaided distance vision prior to the onset of presbyopia. Corneal stromal volume restoration through small incision lenticule extraction (SMILE) lenticule re-implantation presents an opportunity for restoring the patients’ non-dominant eye to previous low myopia to achieve a monovision. In this study, we investigated the feasibility of performing LASIK after lenticule re-implantation as a method to create presbyopic monovision. A -6.00D SMILE correction was performed in 9 rabbit eyes. The lenticules were cryopreserved for 14 days and re-implanted. Five weeks later, 3 of these eyes underwent LASIK for -5.00D correction (RL group); 3 underwent LASIK flap creation, which was not lifted (RN); and no further procedures were performed on the remaining 3 eyes. These groups were compared with 3 eyes that underwent standard LASIK for a -5.00D correction (LO); 3 that underwent creation of non-lifted flap (LN); and 3 non-operated eyes. Rabbits were euthanized 1 day post-surgery. Tissue responses were analyzed by immunohistochemistry, slit lamp and in vivo confocal microscopy (IVCM). Intrastromal irregularities and elevated reflectivity levels of the excimer-ablated plane were observed on slit lamp and IVCM, respectively in the RL group. The results were comparable (P = 0.310) to IVCM findings in the LO group. RL and LO groups showed similar fibronectin expression levels, number of CD11b-positive cells (P = 0.304) and apoptotic cells (P = 0.198). There was no difference between the RN and LN groups in reflectivity levels (P = 0.627), fibronectin expression levels, CD11b-positive cells (P = 0.135) and apoptotic cells (P = 0.128). LASIK can be performed following lenticule re-implantation to create presbyopic monovision. The tissue responses elicited after performing LASIK on corneas that have undergone SMILE and subsequent lenticule re-implantation are similar to primary procedure.
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Affiliation(s)
- Chris H. L. Lim
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore
- Singapore National Eye Centre, Singapore, Singapore
| | - Andri K. Riau
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Nyein C. Lwin
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Shyam S. Chaurasia
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- SRP Neuroscience and Behavioral Disorders, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Donald T. Tan
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore
- Singapore National Eye Centre, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jodhbir S. Mehta
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore
- Singapore National Eye Centre, Singapore, Singapore
- Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore
- * E-mail:
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15
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Riau AK, Angunawela RI, Chaurasia SS, Lee WS, Tan DT, Mehta JS. Reversible femtosecond laser-assisted myopia correction: a non-human primate study of lenticule re-implantation after refractive lenticule extraction. PLoS One 2013; 8:e67058. [PMID: 23826194 PMCID: PMC3691223 DOI: 10.1371/journal.pone.0067058] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 05/14/2013] [Indexed: 11/24/2022] Open
Abstract
LASIK (laser-assisted in situ keratomileusis) is a common laser refractive procedure for myopia and astigmatism, involving permanent removal of anterior corneal stromal tissue by excimer ablation beneath a hinged flap. Correction of refractive error is achieved by the resulting change in the curvature of the cornea and is limited by central corneal thickness, as a thin residual stromal bed may result in biomechanical instability of the cornea. A recently developed alternative to LASIK called Refractive Lenticule Extraction (ReLEx) utilizes solely a femtosecond laser (FSL) to incise an intrastromal refractive lenticule (RL), which results in reshaping the corneal curvature and correcting the myopia and/or astigmatism. As the RL is extracted intact in the ReLEx, we hypothesized that it could be cryopreserved and re-implanted at a later date to restore corneal stromal volume, in the event of keratectasia, making ReLEx a potentially reversible procedure, unlike LASIK. In this study, we re-implanted cryopreserved RLs in a non-human primate model of ReLEx. Mild intrastromal haze, noted during the first 2 weeks after re-implantation, subsided after 8 weeks. Refractive parameters including corneal thickness, anterior curvature and refractive error indices were restored to near pre-operative values after the re-implantation. Immunohistochemistry revealed no myofibroblast formation or abnormal collagen type I expression after 8 weeks, and a significant attenuation of fibronectin and tenascin expression from week 8 to 16 after re-implantation. In addition, keratocyte re-population could be found along the implanted RL interfaces. Our findings suggest that RL cryopreservation and re-implantation after ReLEx appears feasible, suggesting the possibility of potential reversibility of the procedure, and possible future uses of RLs in treating other corneal disorders and refractive errors.
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Affiliation(s)
- Andri K. Riau
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore
- * E-mail: (JSM); (AKR)
| | - Romesh I. Angunawela
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore
- Singapore National Eye Centre, Singapore, Singapore
| | - Shyam S. Chaurasia
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore
- SRP Neuroscience and Behavioral Disorder Program, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wing S. Lee
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Donald T. Tan
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore
- Singapore National Eye Centre, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore
- Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Jodhbir S. Mehta
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore
- Singapore National Eye Centre, Singapore, Singapore
- Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore
- Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore, Singapore
- * E-mail: (JSM); (AKR)
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Riau AK, Ang HP, Lwin NC, Chaurasia SS, Tan DT, Mehta JS. Comparison of Four Different VisuMax Circle Patterns for Flap Creation After Small Incision Lenticule Extraction. J Refract Surg 2013; 29:236-44. [DOI: 10.3928/1081597x-20130318-02] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Accepted: 02/06/2013] [Indexed: 11/20/2022]
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18
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Kymionis GD, Kankariya VP, Plaka AD, Reinstein DZ. Femtosecond laser technology in corneal refractive surgery: a review. J Refract Surg 2013; 28:912-20. [PMID: 23231742 DOI: 10.3928/1081597x-20121116-01] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 10/18/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE To discuss current applications and advantages of femtosecond laser technology over traditional manual techniques and related unique complications in corneal refractive surgical procedures, including LASIK flap creation, intracorneal ring segment implantation, astigmatic keratotomy, presbyopic treatments, and intrastromal lenticule procedures. METHODS Literature review. RESULTS From its first clinical use in 2001 for LASIK flap creation, femtosecond lasers have steadily made a place as the dominant flap-making technology worldwide. Newer applications are being evaluated and are increasing in their frequency of use. CONCLUSIONS Femtosecond laser technology is rapidly becoming a heavily utilized tool in corneal refractive surgical procedures due to its reproducibility, safety, precision, and versatility.
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Affiliation(s)
- George D Kymionis
- Department of Ophthalmology, University of Crete, Medical School, Heraklion, Greece.
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19
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Ackermann R, Kammel R, Merker M, Kamm A, Tünnermann A, Nolte S. Optical side-effects of fs-laser treatment in refractive surgery investigated by means of a model eye. BIOMEDICAL OPTICS EXPRESS 2013; 4:220-9. [PMID: 23413236 PMCID: PMC3567709 DOI: 10.1364/boe.4.000220] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 11/29/2012] [Accepted: 11/30/2012] [Indexed: 05/25/2023]
Abstract
Optical side-effects of fs-laser treatment in refractive surgery are investigated by means of a model eye. We show that rainbow glare is the predominant perturbation, which can be avoided by randomly distributing laser spots within the lens. For corneal applications such as fs-LASIK, even a regular grid with spot-to-spot distances of ~3 µm is sufficient to minimize rainbow glare perception. Contrast sensitivity is affected, when the lens is treated with large 3D-patterns.
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Affiliation(s)
- Roland Ackermann
- Institute of Applied Physics, Abbe Center of Photonics,
Friedrich-Schiller-Universität Jena, Max-Wien-Platz 1, 07743 Jena,
Germany
| | - Robert Kammel
- Institute of Applied Physics, Abbe Center of Photonics,
Friedrich-Schiller-Universität Jena, Max-Wien-Platz 1, 07743 Jena,
Germany
| | - Marina Merker
- Institute of Applied Physics, Abbe Center of Photonics,
Friedrich-Schiller-Universität Jena, Max-Wien-Platz 1, 07743 Jena,
Germany
| | - Andreas Kamm
- Fraunhofer Institute for Applied Optics and Precision Engineering
(IOF), Albert-Einstein-Straße 7, 07745 Jena, Germany
| | - Andreas Tünnermann
- Institute of Applied Physics, Abbe Center of Photonics,
Friedrich-Schiller-Universität Jena, Max-Wien-Platz 1, 07743 Jena,
Germany
- Fraunhofer Institute for Applied Optics and Precision Engineering
(IOF), Albert-Einstein-Straße 7, 07745 Jena, Germany
| | - Stefan Nolte
- Institute of Applied Physics, Abbe Center of Photonics,
Friedrich-Schiller-Universität Jena, Max-Wien-Platz 1, 07743 Jena,
Germany
- Fraunhofer Institute for Applied Optics and Precision Engineering
(IOF), Albert-Einstein-Straße 7, 07745 Jena, Germany
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