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Gabric I, Bohac M, Gabric K, Arba Mosquera S. First European results of a new refractive lenticular extraction procedure-SmartSight by SCHWIND eye-tech-solutions. Eye (Lond) 2023; 37:3768-3775. [PMID: 37277614 PMCID: PMC10698070 DOI: 10.1038/s41433-023-02601-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/05/2023] [Accepted: 05/19/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND To evaluate vision 3 months after SmartSight lenticule extraction treatments. DESIGN Case series. METHODS This case series of patients were treated at Specialty Eye Hospital Svjetlost in Zagreb, Croatia. Sixty eyes of 31 patients consecutively treated with SmartSight lenticule extraction were assessed. The mean age of the patients was 33 ± 6 years (range 23-45 years) at the time of treatment with a mean spherical equivalent refraction of -5.10 ± 1.35 D and mean astigmatism of 0.46 ± 0.36 D. Monocular corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA) were assessed pre- and post-operatively. Ocular and corneal wavefront aberrations have been postoperatively compared to the preoperative baseline values. Changes in ocular wavefront refraction, as well as changes in keratometric readings are reported. RESULTS At 3 months post-operatively, mean UDVA was 20/20 ± 2. Spherical equivalent showed a low myopic residual refraction of -0.37 ± 0.58 D with refractive astigmatism of 0.46 ± 0.26 D postoperatively. There was a slight improvement of 0.1 Snellen lines at 3-months follow-up. Compared to the preoperative status, ocular aberrations (at 6 mm diameter) did not change at 3 months follow-up; whereas corneal aberrations increased (+0.22 ± 0.21 µm for coma; +0.17 ± 0.19 µm for spherical aberration; and +0.32 ± 0.26 µm for HOA-RMS). The same correction was determined using changes in ocular wavefront refraction, as well as changes in keratometric readings. CONCLUSION Lenticule extraction after SmartSight is safe and efficacious in the first 3 months postoperatively. The post-operative outcomes indicate improvements in vision.
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Affiliation(s)
- Ivan Gabric
- Specialty Eye Hospital Svjetlost, School of Medicine University of Rijeka, Zagreb, Croatia
| | - Maja Bohac
- Specialty Eye Hospital Svjetlost, School of Medicine University of Rijeka, Zagreb, Croatia.
| | - Kresimir Gabric
- Specialty Eye Hospital Svjetlost, School of Medicine University of Rijeka, Zagreb, Croatia
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Bohač M, Gabrić I, Gabrić K, Jagić M, Arba Mosquera S. Predictability of the Achieved Lenticule Thickness in Keratorefractive Lenticule Extraction for Myopia Correction. J Refract Surg 2023; 39:728-735. [PMID: 37937760 DOI: 10.3928/1081597x-20230925-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
PURPOSE To assess the predictability between the SCHWIND ATOS femtosecond laser (SCHWIND eye-tech-solutions) read-out and achieved lenticule thickness measured using MS-39 anterior segment optical coherence tomography (ASOCT; CSO) at the corneal vertex at postoperative 1 day and 1 and 3 months of follow-up. METHODS This retrospective case series included 130 eyes of 65 consecutive patients who were treated with SmartSight (SCHWIND eye-tech-solutions) lenticule extraction. Sixty-four percent of patients were women with a mean spherical refraction of -4.98 ± 1.19 diopters (D) and mean astigmatism of 0.53 ± 0.64 D. The measurements were performed using AS-OCT with the Phoenix Software v 4.1.1.5. Lenticule thickness was obtained by the subtraction method between preoperative and postoperative total corneal thickness. RESULTS A lower reduction in central corneal thickness (CCT) compared to the laser read-out for all three follow-up visits can be observed. Essentially, the reduction in CCT was identical at 3 months versus 1 month. The reduction in CCT was lowest at postoperative 1 day. Examining the 1- and 3-month data (essentially equivalent), one can see a best fit of y = 0.94 x -7 µm. CONCLUSIONS The reduction in CCT was stable from 1 month of follow-up. The stable reduction in CCT was -6% (-1.5% after accounting for design decisions) and -7 µm lower than the respective laser read-out. The findings are predictable, showing a certain level of the lenticules becoming slightly thinner than their respective laser read-outs. [J Refract Surg. 2023;39(11):728-735.].
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Pradhan KR, Arba Mosquera S. Comparing high and low energy outcomes on day one for SmartSight myopic-astigmatism treatments with the SCHWIND ATOS: a retrospective case series. BMC Ophthalmol 2023; 23:328. [PMID: 37464345 DOI: 10.1186/s12886-023-03076-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/12/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Impact of low energy asymmetric spacings vs. high energy symmetric spacings on the immediate/early (postoperative day 1 (POD1)) outcomes of SmartSight lenticule extraction for myopic astigmatism with a new femtosecond laser system. METHODS The first 112 eyes of 56 patients consecutively treated using low energy asymmetric spacings (Group A; Study group) were compared at POD1 to the last 112 eyes of 56 patients consecutively treated using high energy symmetric spacings (Group S; Controls). Mean age of the patients was 28 ± 5 years with a mean spherical equivalent of -4.41 ± 1.76 diopters (D) and a mean magnitude of refractive astigmatism of 0.89 ± 0.82 D. RESULTS Laser Energy was -25 ± 1nJ lower for asymmetric treatments (p < .0001); Spot and Track distances were + 0.7 ± 0.1 µm larger and -0.8 ± 0.1 µm tighter for asymmetric treatments, respectively (p < .0001 for both). At POD1, astigmatism was -0.08 ± 0.02D lower for asymmetric treatments (p < .0003); uncorrected and corrected visual acuities (UDVA and CDVA, respectively) were -0.03 ± 0.01logMAR better for asymmetric treatments (p < .0007); differences between postop UDVA and preop CDVA along with change in CDVA were + 0.3 ± 0.1lines better for asymmetric treatments (p < .0003). CONCLUSIONS Lenticule extraction treatment using SmartSight is safe and efficacious already at POD1. Findings suggest that low energy asymmetric spacings may further improve the immediate and short-term outcomes of SmartSight lenticule extraction in the treatment of myopic astigmatism compared to conventional settings (high energy symmetric spacings).
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Affiliation(s)
- Kishore Raj Pradhan
- Matrika Eye Center, Dhunge Dhara Marg, Ward number 9, Kathmandu, 44600, Nepal
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Pradhan KR, Arba Mosquera S. Twelve-month outcomes of a new refractive lenticular extraction procedure. JOURNAL OF OPTOMETRY 2023; 16:30-41. [PMID: 34949535 PMCID: PMC9811368 DOI: 10.1016/j.optom.2021.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/02/2021] [Accepted: 11/11/2021] [Indexed: 06/07/2023]
Abstract
BACKGROUND To evaluate the 12-month refractive and visual outcomes of Small Incision Guided Human-cornea Treatment (SmartSight®, SCHWIND eye-tech-solutions, Kleinostheim, Germany) in the treatment of myopia corrections with low to moderate astigmatism with the use of a new femtosecond laser system. METHODS 221 eyes of 114 patients consecutively treated with SmartSight lenticule extraction were assessed. The mean age of the patients was 28±6 years at the time of treatment with a mean spherical equivalent refraction of -6.26±2.17D and mean astigmatism of 0.92±0.68D. Monocular corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA) were assessed pre- and post-operatively. Refractive changes have been determined in terms of changes in refraction, as well as changes in keratometric readings. The changes in central epithelial thickness have been determined. RESULTS At twelve months post-operatively, mean UDVA was 20/21±2. Spherical equivalent showed a residual refraction of +0.48±0.31D with refractive astigmatism of 0.13±0.18D postoperatively. There was a slight decrease of -0.1 Snellen lines at 12-months follow-up. The same correction was determined using changes in refraction, as well as changes in keratometric readings. The central epithelial thickness increased by +3±2µm. Spherical equivalent correction within ±0.50D was achieved in 199 eyes (90%), and cylindrical correction in 221 (100%). Preoperative corrected distance visual acuity (CDVA) was 20/20 or better in 213 eyes (96%), and postoperative uncorrected (UDVA) was 20/20 or better in 205 eyes (93%). No eye had lost two or more Snellen lines of CDVA. CONCLUSIONS Myopic astigmatism correction with SmartSight provided good results for efficacy, safety, predictability, and visual outcomes at the twelve months of follow up. The central epithelial thickness barely increased by 3±2µm.
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Affiliation(s)
- Kishore Raj Pradhan
- Matrika Eye Center, Dhunge Dhara Marg, Ward number 9, Kathmandu 44600, Nepal.
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Wang YJ, Chang CC, Lu ME, Wu YH, Shen JW, Chiang HM, Lin BS. Photoaging and Sequential Function Reversal with Cellular-Resolution Optical Coherence Tomography in a Nude Mice Model. Int J Mol Sci 2022; 23:ijms23137009. [PMID: 35806013 PMCID: PMC9266384 DOI: 10.3390/ijms23137009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/18/2022] [Accepted: 06/20/2022] [Indexed: 12/11/2022] Open
Abstract
Although nude mice are an ideal photoaging research model, skin biopsies result in inflammation and are rarely performed at baseline. Meanwhile, studies on antiphotoaging antioxidants or rejuvenation techniques often neglect the spontaneous reversal capacity. Full-field optical coherence tomography (FFOCT) can acquire cellular details noninvasively. This study aimed to establish a photoaging and sequential function reversal nude mice model assisted by an in vivo cellular resolution FFOCT system. We investigated whether a picosecond alexandrite laser (PAL) with a diffractive lens array (DLA) accelerated the reversal. In the sequential noninvasive assessment using FFOCT, a spectrophotometer, and DermaLab Combo®, the photodamage percentage recovery plot demonstrated the spontaneous recovery capacity of the affected skin by UVB-induced transepidermal water loss and UVA-induced epidermis thickening. A PAL with DLA not only accelerated skin barrier regeneration with epidermal polarity, but also increased dermal neocollagenesis, whereas the nonlasered group still had >60% collagen intensity loss and 40% erythema from photodamage. Our study demonstrated that FFOCT images accurately resemble the living tissue. The photoaging and sequential function reversal model provides a reference to assess the spontaneous recovery capacity of nude mice from photodamage. This model can be utilized to evaluate the sequential noninvasive photodamage and reversal effects after other interventions.
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Affiliation(s)
- Yen-Jen Wang
- Department of Dermatology, MacKay Memorial Hospital, Taipei 10449, Taiwan; (Y.-J.W.); (Y.-H.W.)
- Department of Cosmetic Applications and Management, MacKay Junior College of Medicine, Nursing, and Management, New Taipei City 25245, Taiwan
| | - Chang-Cheng Chang
- Department of Cosmeceutics, China Medical University, Taichung 40433, Taiwan; (M.-E.L.); (J.-W.S.); (H.-M.C.)
- Institute of Imaging and Biomedical Photonics, National Yang Ming Chiao Tung University, Tainan 71150, Taiwan;
- School of Medicine, College of Medicine, China Medical University Hospital, China Medical University, Taichung 404332, Taiwan
- Aesthetic Medical Center, China Medical University Hospital, Taichung 40402, Taiwan
- Correspondence: ; Tel.: +886-04-22052121 (ext. 2020 or 2021) or +886-975365540; Fax: +886-04-22031270
| | - Meng-En Lu
- Department of Cosmeceutics, China Medical University, Taichung 40433, Taiwan; (M.-E.L.); (J.-W.S.); (H.-M.C.)
| | - Yu-Hung Wu
- Department of Dermatology, MacKay Memorial Hospital, Taipei 10449, Taiwan; (Y.-J.W.); (Y.-H.W.)
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan
| | - Jia-Wei Shen
- Department of Cosmeceutics, China Medical University, Taichung 40433, Taiwan; (M.-E.L.); (J.-W.S.); (H.-M.C.)
| | - Hsiu-Mei Chiang
- Department of Cosmeceutics, China Medical University, Taichung 40433, Taiwan; (M.-E.L.); (J.-W.S.); (H.-M.C.)
| | - Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Yang Ming Chiao Tung University, Tainan 71150, Taiwan;
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Arba-Mosquera S, Naubereit P, Sobutas S, Verma S. Analytical optimization of the cutting efficiency for generic cavitation bubbles. BIOMEDICAL OPTICS EXPRESS 2021; 12:3819-3835. [PMID: 34457382 PMCID: PMC8367260 DOI: 10.1364/boe.425895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 06/07/2023]
Abstract
A theoretical method to determine the optimum laser parameters for maximizing the cutting efficiency for different materials (in particular human cornea) is proposed. The model is simple and reduced to laser beam characteristics and cavitation properties. The model further provides a method to convert energy fluctuations during the cutting process to equivalent deviations in the cavitation bubbles. The proposed model can be used for calibration, verification and validation purposes of laser systems used for cutting processes at relatively low cost and may improve the quality of the results.
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Affiliation(s)
| | | | | | - Shwetabh Verma
- SCHWIND eye-tech-solutions, Kleinostheim, D- 63801, Germany
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Paradis G, Chevance FFV, Liou W, Renault TT, Hughes KT, Rainville S, Erhardt M. Variability in bacterial flagella re-growth patterns after breakage. Sci Rep 2017; 7:1282. [PMID: 28455518 PMCID: PMC5430758 DOI: 10.1038/s41598-017-01302-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 03/29/2017] [Indexed: 11/09/2022] Open
Abstract
Many bacteria swim through liquids or crawl on surfaces by rotating long appendages called flagella. Flagellar filaments are assembled from thousands of subunits that are exported through a narrow secretion channel and polymerize beneath a capping scaffold at the tip of the growing filament. The assembly of a flagellum uses a significant proportion of the biosynthetic capacities of the cell with each filament constituting ~1% of the total cell protein. Here, we addressed a significant question whether a flagellar filament can form a new cap and resume growth after breakage. Re-growth of broken filaments was visualized using sequential 3-color fluorescent labeling of filaments after mechanical shearing. Differential electron microscopy revealed the formation of new cap structures on broken filaments that re-grew. Flagellar filaments are therefore able to re-grow if broken by mechanical shearing forces, which are expected to occur frequently in nature. In contrast, no re-growth was observed on filaments that had been broken using ultrashort laser pulses, a technique allowing for very local damage to individual filaments. We thus conclude that assembly of a new cap at the tip of a broken filament depends on how the filament was broken.
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Affiliation(s)
- Guillaume Paradis
- Department of Physics, Engineering Physics and Optics and Centre of Optics, Photonics and Lasers, Laval University, Quebec City, Quebec, Canada
| | | | - Willisa Liou
- Department of Biology, University of Utah, Salt Lake City, Utah, 84112, USA
| | - Thibaud T Renault
- Helmholtz Centre for Infection Research, 38124, Braunschweig, Germany
| | - Kelly T Hughes
- Department of Biology, University of Utah, Salt Lake City, Utah, 84112, USA
| | - Simon Rainville
- Department of Physics, Engineering Physics and Optics and Centre of Optics, Photonics and Lasers, Laval University, Quebec City, Quebec, Canada.
| | - Marc Erhardt
- Helmholtz Centre for Infection Research, 38124, Braunschweig, Germany.
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Subramanian K, Gabay I, Ferhanoğlu O, Shadfan A, Pawlowski M, Wang Y, Tkaczyk T, Ben-Yakar A. Kagome fiber based ultrafast laser microsurgery probe delivering micro-Joule pulse energies. BIOMEDICAL OPTICS EXPRESS 2016; 7:4639-4653. [PMID: 27896003 PMCID: PMC5119603 DOI: 10.1364/boe.7.004639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/12/2016] [Accepted: 10/13/2016] [Indexed: 05/22/2023]
Abstract
We present the development of a 5 mm, piezo-actuated, ultrafast laser scalpel for fast tissue microsurgery. Delivery of micro-Joules level energies to the tissue was made possible by a large, 31 μm, air-cored inhibited-coupling Kagome fiber. We overcome the fiber's low NA by using lenses made of high refractive index ZnS, which produced an optimal focusing condition with 0.23 NA objective. The optical design achieved a focused laser spot size of 4.5 μm diameter covering a 75 × 75 μm2 scan area in a miniaturized setting. The probe could deliver the maximum available laser power, achieving an average fluence of 7.8 J/cm2 on the tissue surface at 62% transmission efficiency. Such fluences could produce uninterrupted, 40 μm deep cuts at translational speeds of up to 5 mm/s along the tissue. We predicted that the best combination of speed and coverage exists at 8 mm/s for our conditions. The onset of nonlinear absorption in ZnS, however, limited the probe's energy delivery capabilities to 1.4 μJ for linear operation at 1.5 picosecond pulse-widths of our fiber laser. Alternatives like broadband CaF2 crystals should mitigate such nonlinear limiting behavior. Improved opto-mechanical design and appropriate material selection should allow substantially higher fluence delivery and propel such Kagome fiber-based scalpels towards clinical translation.
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Affiliation(s)
- Kaushik Subramanian
- Department of Mechanical Engineering, The University of Texas at Austin, Texas 78712, USA
- These authors contributed equally to this work
| | - Ilan Gabay
- Department of Mechanical Engineering, The University of Texas at Austin, Texas 78712, USA
- These authors contributed equally to this work
| | - Onur Ferhanoğlu
- Department of Mechanical Engineering, The University of Texas at Austin, Texas 78712, USA
| | - Adam Shadfan
- Department of Bioengineering, Rice University, Houston 77005, USA
| | - Michal Pawlowski
- Department of Bioengineering, Rice University, Houston 77005, USA
| | - Ye Wang
- Department of Bioengineering, Rice University, Houston 77005, USA
| | - Tomasz Tkaczyk
- Department of Bioengineering, Rice University, Houston 77005, USA
| | - Adela Ben-Yakar
- Department of Mechanical Engineering, The University of Texas at Austin, Texas 78712, USA
- Department of Biomedical Engineering, The University of Texas at Austin, Texas 78712, USA
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