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Comparison of Excimer Laser Versus Femtosecond Laser Assisted Trephination in Penetrating Keratoplasty: A Retrospective Study
摘要： Introduction: To compare the impact of non-mechanical excimer-assisted (EXCIMER) and femtosecond laser-assisted (FEMTO) trephination on outcomes after penetrating keratoplasty (PK). Methods: In this retrospective study, 68 eyes from 23 females and 45 males (mean age at time of surgery, 53.3 ± 19.8 years) were included. Inclusion criteria were one surgeon (BS), primary central PK, Fuchs’ dystrophy (FUCHS) or keratoconus (KC), no previous intraocular surgery, graft oversize 0.1 mm and 16-bite double running suture. Trephination was performed using a manually guided 193-nm Zeiss Meditec (EXCIMER group: 18 MEL70 excimer laser in the FUCHS, 17 KC) or 60-kHz IntraLaseTM femtosecond laser (FEMTO group: 16 FUCHS, 17 KC). Subjective refractometry (trial glasses) and topography analysis (Pentacam HR; corneal Casia SS-1000 AS-OCT; TMS-5) were performed preoperatively, before removal of the first suture (11.4 ± 1.9 months) and after removal of the second suture (22.6 ± 3.8 months). Results: Before suture removal, mean refractive/AS-OCT topographic astigmatism did not differ significantly between EXCIMER and FEMTO. After suture removal, mean refractive/astigmatism Pentacam/AS-OCT topographic was significantly higher (6.2 ± 2.9 D/7.1 ± 3.2 D/7.4 ± 3.3 D) than in the EXCIMER patients (4.3 ± 3.0 D/4.4 ± 3.1 D/4.0 ± 2.9 D) (p B 0.005). Mean corrected distance visual acuity increased from 0.22 and 0.23 preoperatively to 0.55 and 0.53 before or 0.7 and 0.6 after suture removal in the EXCIMER and FEMTO groups, respectively. Differences between EXCIMER and FEMTO were only pronounced in the KC subgroup. Conclusion: Non-mechanical EXCIMER trephination seems to have advantages regarding postoperative corneal astigmatism and visual acuity compared with FEMTO trephination, especially in KC. A bigger sample size and longer follow-up are needed to evaluate the long-term impact of EXCIMER and FEMTO trephination on postoperative topographic and visual outcomes.
关键词： Excimer,Visual acuity,Femtosecond,Laser,Penetrating keratoplasty,Ophthalmology,Astigmatism
更新于2025-09-19 17:13:59
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Automated Optical Flow Based Registration For Adaptive Optics Scanning Laser Ophthalmoscope
摘要： This study presents an automated registration method based on optical flow for an adaptive optics scanning laser ophthalmoscope. The method was designed to align and average images to obtain a higher signal-to-noise ratio image. A correlation based optical flow image registration method, which has large registration degrees of freedom, is adopted as a local registration method. By comparing the images before and after image registration, we show the effectiveness of our method. Furthermore, the advantage of our method, which is the containment of large registration degrees of freedom, is confirmed.
关键词： Retinal images,Image processing,Imaging systems,Optical flow,Active or adaptive optics,Ophthalmology
更新于2025-09-16 10:30:52
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Towards Automatically Controlled Dosing for Selective Laser Trabeculoplasty
摘要： Purpose: Selective laser trabeculoplasty (SLT) is a treatment option for open-angle glaucoma; however, it lacks an instant evidence for successful irradiation. So far ophthalmologists use the visible appearance of permanent champagnelike bubbles (macro bubbles) as an indicator for appropriate pulse energy. We hypothesize that micro bubbles, which start energetically far below the appearance of macro bubbles, already trigger the therapeutic benefit. Here we present two methods to capture the onset of these micro bubbles. Methods: The trabecular meshwork of freshly enucleated porcine eye globes was irradiated with a series of 15 pulses with a pulse duration of 1.7 ls and with increasing energy at a repetition rate of 100 Hz per each spot of 200 lm in diameter. An optical and an optoacoustic method have been developed and appropriate algorithms investigated towards the real-time detection of the onset of micro bubbles. Results: Both observation methods are capable of detecting micro bubble nucleation. Threshold radiant exposures were found at 310 6 137 mJ/cm2. By combination of both methods a sensitivity and specificity of 0.96 was reached. Conclusions: In case that the therapeutically demanded pressure reduction is already achieved with these micro bubbles, which needs to be proven clinically, then the methods presented here can be used in an automatic feedback loop controlling the laser irradiation. This will unburden the clinicians from any dosing during SLT. Translational Relevance: Automatic real-time pulse energy dosing based on the formation of micro bubbles in SLT significantly improves and facilitates the treatment for the physician.
关键词： dosimetry,selective laser trabeculoplasty,ophthalmology,micro bubble detection,ophthalmic optics and device
更新于2025-09-12 10:27:22
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Femtosecond Laser Surgery in Ophthalmology
摘要： This comprehensive, well-organized text encompasses the numerous applications of femtosecond lasers to anterior segment surgery. From the use of laser-assisted in situ keratomileusis flap creation, cataract surgery, and even femtosecond-assisted keratopigmentation, this text thoroughly reviews all aspects of technology, leaving no application uncovered, highlighting the great versatility and potential of this technology. Each of the chapters is written by 1 to 3 experienced ophthalmic surgeons, and the text is well edited to assure completeness and prevent redundancy.
关键词： anterior segment surgery,femtosecond laser,laser-assisted in situ keratomileusis,ophthalmology,cataract surgery
更新于2025-09-12 10:27:22
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The eye in AI: artificial intelligence in ophthalmology
摘要： The convergence of major developments in artificial intelligence (AI) for image analysis with advances in clinical imaging technologies has major implications for the practice of medicine. Gains in AI system performance have been the product of improvements in computing hardware and progress in algorithm design, such that large volumes of data can now be processed with great accuracy at extraordinary speeds. As Hogarty et al. illustrate in this edition of the Journal, the discipline of ophthalmology is at the forefront of the AI revolution, with a growing body of research indicating that AI systems can be applied to a wide range of ophthalmic imaging methods across a broad range of disease categories with remarkable performance.
关键词： image analysis,clinical imaging,artificial intelligence,deep learning,ophthalmology
更新于2025-09-11 14:15:04
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Screening for retinopathy of prematurity by telemedicine in a tertiary level neonatal intensive care unit in France: Review of a six-year period
摘要： To analyze the prevalence and risk factors for retinopathy of prematurity (ROP) and severe (treatment-requiring) ROP. A retrospective study was conducted in a level III neonatal unit in Bordeaux, France, from 2009 to 2015. Four hundred and nineteen preterm infants who were screened for ROP exclusively by RetCam were included. ROP of any degree was diagnosed in 27.68% of infants. Stages 1, 2, 3 and 4 ROP was found in 44%, 46%, 9% and 1% of subjects, respectively. No stage 5 ROP was observed. 28/419 infants (6.6%) were treated exclusively with laser photocoagulation. No intravitreal anti-VEGF injections or surgical treatments were performed. No infants born at > 31 weeks or with BW > 1110 g required ROP treatment. On multivariate analysis, risk factors for ROP development were low birth weight, low gestational age at birth, high duration of invasive mechanical ventilation, shock or use of vasopressors. On multivariate analysis, risk factors for severe, treatment-requiring ROP were male gender, gestational age ≤ 27 weeks and Apgar score at 5 minutes ≤ 7. In our 6-year series, ROP was successfully identified on screening exclusively by telemedicine, and no surgical treatment was required. This study identifies known ROP risk factors, but the Apgar score at 5 minutes as a risk factor for severe ROP requires further studies in order to be confirmed.
关键词： Risk analysis,Retinopathy of prematurity,Pediatric ophthalmology,Retina,Risk factor
更新于2025-09-09 09:28:46
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Horizontal Extraocular Muscle and Scleral Anatomy in Children: A Swept-Source Anterior Segment Optical Coherence Tomography Study
摘要： Purpose: To evaluate the efficacy of anterior segment swept-source optical coherence tomography (SS-OCT) for examining horizontal extraocular muscle thickness, distance from the corneal limbus to the insertion of the horizontal extraocular muscle (limbus to insertion distance), and scleral thickness in Korean pediatric strabismus patients. Methods: This study included pediatric strabismus patients between 5 and 10 years of age. Children with any ocular disease other than strabismus or a history of ocular surgery were excluded. SS-OCT was used to measure horizontal extraocular muscle thickness, limbus to insertion distance, and scleral thickness. Eyes were classified into subgroups by sex, spherical equivalent of the refractive error (measured with cycloplegic refraction), and fixating/deviating eye. Results: One patient initially included in this study was excluded due to poor cooperation. Of the remaining 35 eyes of 20 patients, 19 eyes (54.3%) were from male patients and 16 eyes (45.7%) were from female patients. The mean patient age was 7.86 ± 1.38 years. Lateral scleral thickness was greater in male eyes than in female eyes (p = 0.048). No other differences were noted between male and female children. Additionally, there were no statistically significant differences between fixating and deviating eyes or among spherical equivalent groups for any parameter examined. Conclusions: Anterior segment SS-OCT can successfully and comfortably measure horizontal extraocular muscle and scleral anatomy in children. These measurements may be helpful for treatment and follow-up of pediatric strabismus patients.
关键词： Oculomotor muscle,Optical coherence tomography,Strabismus,Sclera,Pediatric ophthalmology
更新于2025-09-09 09:28:46
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A teleophthalmology system for the diagnosis of ocular urgency in remote areas of Brazil
摘要： Purposes: To validate a teleophthalmology mobile system aimed at improving and providing eye urgency screenings in remote and poor area settings in Brazil. The system enables one or more ophthalmologists to remotely examine a patient’s condition and submit a decision describing the gravity of the case. If necessary, the patient can be forwarded to a hospital for further consultation. Methods: A cellphone (Nexus One model, with a 5 megapixel camera) was used to collect data and pictures from 100 randomly selected patients at the Ophthalmology Emergency Room located at the General Hospital of the Federal University of S?o Paulo (UNIFESP). Data was then sent remotely to an online recording system to be reviewed by an ophthalmologist who provided feedback regarding the state of ocular urgency. Results were then compared to the gold standard diagnosis provided at the hospital. Results: The diagnosis of urgency was given by two ophthalmologists: one in the hospital (gold standard) and one remotely. When we compared both diagnoses we obtained results of 81.94% specificity, 92.85% sensitivity, and 85% accuracy, with a negative predictive value of 96.72%. This work also included a processing time analysis, resulting in an average time of 8.6 min per patient for remote consultations. Conclusions: This study is the first that has used only a cellphone for diagnosing the urgency of ocular cases. Based on our results, the system can provide a reliable distinction between urgent and non-urgent situations and can offer a viable alternative for the servicing of underprivileged areas. In screening techniques, the most important outcome is to identify urgent cases with a high level of sensitivity and predictive negative value. Thus, our results demonstrate that this tool is robust and we suggest that a major study aimed to verify its efficiency in resource-poor areas should be initiated.
关键词： Diffusion of innovation,Telemedicine,Remote consultation,Ophthalmology,Eye diseases/diagnosis,Triage
更新于2025-09-04 15:30:14
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3D Printing and Ophthalmology for the Community
摘要： People may have heard of three dimensional (3D) printed firearms, which carries bad publicity for 3D printing, yet amazing things have been achieved with simple desktop 3D printers within the medical field. 3D printing was almost unheard of until the last 5 years; as key additive-manufacturing patents expire, affordable desktop 3D printers mushroomed globally. The technology of 3D printing is not new. Actually, the idea can be traced back to as early as the 1890s when Blanther suggested a layered method for making a mould for topographical relief maps. However, it was not until 1987 when the first additive manufacturing machine emerged. In simpler terms, 3D printing is in fact 2D printing but over and over again, layered together. As patents expire, innovation took over the stage and people started building affordable, user-friendly 3D printers that are now widely available. Fused deposition modelling (FDM) printers are the most common consumer oriented printers and brands such as MakerBot and Ultimaker currently dominate the consumer market. These are low end 3D printers that have made the biggest impacts and allowed innovative leaps in the medical field. Recently, an interventional radiologist managed to save a patient’s spleen with 3D printing technology. The patient was diagnosed with a number of complicated tortuous splenic aneurysms and conventionally, she would have been treated with splenectomy. However, the interventional radiologist managed to spare her spleen by coiling the aneurysms instead. The success was not by luck or co-incidence; it was through countless practices on a 3D printed replica of the patient’s splenic aneurysms. 3D printing in ophthalmology is an exciting field. There are a variety of uses ranging from optics industry printing spectacles to scientist printing ocular tissues such as sclera and cornea. 3D printing has the advantage of low-cost yet high-level customization, making it cost-effective for making one of a kind devices or prostheses. Combined with 3D scanning technology, a patient could have his or her customized prosthetic eye 3D printed in a matter of days instead of weeks.
关键词： Smartphone retinal camera,Smartphone slit lamp microscope,3D printing in ophthalmology,Smartphone in teleophthalmology
更新于2025-09-04 15:30:14