Search Results (28)

Decisions made by pilots and drivers suffering from depression can endanger the lives of hundreds of people, as demonstrated by the tragedies of Germanwings flight 9525 and Air India flight 171. Since the detection of depression is currently based largely on subjective self-reporting, there is an urgent need for fast, objective, and reliable detection methods. In our study, we present an artificial intelligence-based system that combines iris-based identification with the analysis of pupillometric and eye movement biomarkers, enabling the real-time detection of physiological signs of depression before driving or flying. The two-module model was evaluated based on data from 242 participants: the iris identification module operated with an Equal Error Rate of less than 0.5%, while the depression-detecting CNN-LSTM network achieved 89% accuracy and an AUC value of 0.94. Compared to the neutral state, depressed individuals responded to negative news with significantly greater pupil dilation (+27.9% vs. +18.4%), while showing a reduced or minimal response to positive stimuli (−1.3% vs. +6.2%). This was complemented by slower saccadic movement and longer fixation time, which is consistent with the cognitive distortions characteristic of depression. Our results indicate that pupillometric deviations relative to individual baselines can be reliably detected and used with high accuracy for depression screening. The presented system offers a preventive safety solution that could reduce the number of accidents caused by human error related to depression in road and air traffic in the future. Full article

Eye-tracking technology has gained traction in the field of medical rehabilitation due to its non-invasive and intuitive nature. However, current eye-tracking methods based on object detection technology suffer from insufficient accuracy in detecting the eye socket and iris, as well as inaccuracies in determining eye movement direction. To address this, this study improved the YOLOv11 model using the EFFM and ORC modules, resulting in a 1.7% and 9.9% increase in recognition accuracy for the eye socket and iris, respectively, and a 5.5% and 44% increase in recall rate, respectively. A method combining frame voting mechanisms with eye movement area discrimination was proposed for eye movement direction discrimination, achieving average accuracy rates of 95.3%, 92.8%, and 94.8% for iris fixation, left, and right directions, respectively. The discrimination results of multiple eye movement images were mapped to a binary value, and eye movement encoding was used to obtain control commands that align with the robotic arm. The average matching degree of eye movement encoding ranged from 93.4% to 96.8%. An experimental platform was established, and the average completion rates for three object-grabbing tasks controlled by eye movements were 98%, 78%, and 96%, respectively. Full article

Anterior segment optical coherence tomography (AS-OCT) has emerged as a crucial imaging technique in ophthalmology, particularly for evaluating intraocular structures and the behavior of phakic and secondary intraocular lenses (IOLs). This narrative review summarizes the latest findings and clinical applications of OCT regarding phakic and secondary IOLs, focusing on their effectiveness, safety, and factors influencing performance. Through a comprehensive analysis of current literature, we explore how OCT facilitates the assessment of IOLs on key anatomical parameters—such as vault, angle configuration, lens centration, tilt, and haptic positioning—essential for optimizing surgical outcomes and minimizing postoperative complications. In phakic IOLs, including posterior chamber lenses such as the Implantable Collamer Lens (ICL, STAAR Surgical, Monrovia, CA, USA) and iris-fixated lenses, such as Artiflex (Ophtec BV, Groningen, The Netherlands), OCT enables precise evaluation of the anterior segment, aiding both candidate selection and long-term monitoring. In secondary implants for aphakia—especially iris-fixated lenses like Artisan (Ophtec BV, Groningen, The Netherlands) and sutureless scleral-fixated lenses such as the Carlevale IOL (Soleko, Rome, Italy)—or those implanted via the Yamane technique, OCT provides high-resolution visualization of haptic fixation, IOL stability, and potential complications, including tilt or decentration. This review also highlights comparative insights between fixation techniques, underscores the need for standardized OCT protocols, and discusses the integration of artificial intelligence tools. In summary, the routine use of OCT in the preoperative and postoperative management of phakic and secondary IOLs has been increasingly incorporated into clinical practice, as it enhances clinical decision-making and improves patient outcomes. Full article

Cereal/legume intercropping enhances legume nodulation and improves nitrogen use efficiency (NUE) in cereal crops. This facilitation of symbiotic nitrogen fixation (SNF) in intercropped legumes involves a complex eco-physiological mechanism driven by multiple factors. Among them, interspecific root interactions (IRIs) are a key factor influencing SNF in intercropped legumes. Currently, it remains unclear whether and how IRIs modulate SNF to affect NUE and yield formation in legume species. In this study, maize/pea intercropping with different types of root separation [no barrier (NB) and plastic barrier (PB)] and pea monocropping (IP) were simulated in a nitrogen (N)-free nutrient matrix in pots, and the SNF, N metabolism, and N partitioning were investigated. We demonstrated that IRIs optimize SNF performance. N assimilation is positively regulated following increases in enzyme activity and gene expression in intercropped roots and nodules. Furthermore, IRIs facilitate amino acid (AA) export from nodules to roots and shoots, which is followed by an increase in AA levels in leaves (source) and leaf exudates (sink). Overall, intensive SNF drives N metabolism and alters source-to-sink N partitioning, thereby increasing NUE (by 23%) and yield (by 15%) in intercropped pea. This study reveals the positive roles of IRIs to the NUE and yield and provides useful reference material for increasing N contents derived from SNF to maximize NUE and crop yields in intercropped legumes. Full article

Background/Objectives: Different surgical techniques are available in cases of missing or insufficient capsular bag support. Next to the anterior chamber or iris-fixated intraocular lenses (IOL), the implantation of the Carlevale IOL provides a sutureless and scleral fixated treatment method. Methods: In a retrospective single-center study, the perioperative data of 100 patients who consecutively received a scleral fixated Carlevale IOL combined with a 25 gauge (G) pars plana vitrectomy between September 2021 and June 2024 were investigated. The intraoperative and postoperative results were analyzed in terms of complication rates and refractive outcomes. Results: IOL dislocation was the most common surgical indication (50%) for sutureless Carlevale IOL implantation, followed by postoperative aphakia in 35 patients (35%). Nearly every fourth patient (24%) had a preoperative traumatic event, and 21% had pseudoexfoliation (PEX) syndrome. The average surgery time was 60.2 (±20.1) min. Intraoperative intraocular hemorrhage occurred in seven cases, and IOL haptic breakage in two patients. Temporary intraocular pressure fluctuations represented the most common postoperative complications (28%). Severe complications such as endophthalmitis or retinal detachment were not observed in our cohort. The mean refractive prediction error was determined in 67 patients and amounted to an average of −0.7 ± 2.0 diopters. The best corrected visual acuity (BCVA) at the last postoperative follow-up showed an improvement of 0.2 ± 0.5 logMAR (n = 76) compared to the preoperative BCVA (p = 0.0002). The postoperative examination was performed in 72% of the patients, and the mean follow-up period amounted to 7.2 ± 6.4 months. Conclusions: Overall, sutureless and scleral fixated implantation of the Carlevale IOL represents a valuable therapeutic option in the treatment of aphakia and lens as well as IOL dislocation in the absence of capsular bag support with minor postoperative complications and positive refractive outcomes. Full article

Background: Artificial iris (AI) implantation is an innovative and increasingly utilized surgical procedure for injured eyes with iris trauma. Methods: A 76-year-old female and a 34-year-old male presented at the emergency department with a traumatic corneo-scleral laceration and perforated corneal ulcer, respectively. Emergency surgeries were performed to restore ocular integrity. In both cases, a modified surgical technique involving the implantation of an AI was performed; however, two different models of AI were used. Results: The AIs were sutured with four stitches directly to the scleral-fixated (SF) intra ocular lens (IOL), and the AI-IOL complexes were implanted, as a single unit, and fixated to the sclera using the lens haptics. Before and after the surgery, patients underwent a comprehensive eye examination, including a visual acuity test. The AI-SF IOL complexes remained well positioned, with no intraocular or extraocular complications observed during the follow-up evaluations of both patients. Conclusions: We reported a straightforward and repeatable modified surgical technique for two patients with two models of AI, both sutured to the SF IOL and fixated to the sclera, as a single unit. This approach may serve as an excellent alternative for managing aphakic eyes with extensive iridodialysis or partial aniridia. Full article

Background: This study compared the visual and morphological outcomes between iris fixation and anterior chamber intraocular lens (ACIOL) implantation for late spontaneously dislocated intraocular lens (IOL)–capsular bag complexes in a tertiary reference center in Lithuania. Methods: A prospective observational study was conducted between 2017 and 2019 involving 80 patients (83 eyes) with late spontaneous IOL–capsular bag dislocation. Patients underwent repositioning and fixation of the dislocated IOL to the iris (IF group) or IOL exchange with an ACIOL implant (ACIOL group). Pre- and postoperative assessments included best-corrected distance visual acuity (BCDVA), intraocular pressure (IOP), corneal endothelial cell density (ECD) and macular thickness (evaluating whether cystoid macular edema (CME) had occurred). Results: Both groups showed a significant improvement in BCDVA, with a more remarkable improvement in the IF group (median: 0.1 logMAR) than in the ACIOL group (median: 0.3 logMAR), p = 0.001. Corneal astigmatism increased significantly in the ACIOL group (p < 0.001) but remained stable in the IF group. IOP management outcomes were better in the IF group as fewer eyes required additional glaucoma treatment. ECD decreased in both groups, but the decrease was significantly greater in the ACIOL group (p < 0.001). Postoperative CME occurred in 4.4% of IF eyes and 39% of ACIOL eyes (p = 0.01). Conclusions: The iris fixation of late dislocated IOL–capsular bag complexes is a safe and minimally invasive technique that offers better visual outcomes, less astigmatism and fewer complications than ACIOL exchange. Full article

Gaze tracking and estimation are essential for understanding human behavior and enhancing human–computer interactions. This study introduces an innovative, cost-effective solution for real-time gaze tracking using a standard webcam, providing a practical alternative to conventional methods that rely on expensive infrared (IR) cameras. Traditional approaches, such as Pupil Center Corneal Reflection (PCCR), require IR cameras to capture corneal reflections and iris glints, demanding high-resolution images and controlled environments. In contrast, the proposed method utilizes a convolutional neural network (CNN) trained on webcam-captured images to achieve precise gaze estimation. The developed deep learning model achieves a mean squared error (MSE) of 0.0112 and an accuracy of 90.98% through a novel trajectory-based accuracy evaluation system. This system involves an animation of a ball moving across the screen, with the user’s gaze following the ball’s motion. Accuracy is determined by calculating the proportion of gaze points falling within a predefined threshold based on the ball’s radius, ensuring a comprehensive evaluation of the system’s performance across all screen regions. Data collection is both simplified and effective, capturing images of the user’s right eye while they focus on the screen. Additionally, the system includes advanced gaze analysis tools, such as heat maps, gaze fixation tracking, and blink rate monitoring, which are all integrated into an intuitive user interface. The robustness of this approach is further enhanced by incorporating Google’s Mediapipe model for facial landmark detection, improving accuracy and reliability. The evaluation results demonstrate that the proposed method delivers high-accuracy gaze prediction without the need for expensive equipment, making it a practical and accessible solution for diverse applications in human–computer interactions and behavioral research. Full article

Marfan syndrome (MFS) is a genetic disorder that affects the connective tissue in several systems, with ocular, cardiovascular, and skeletal system manifestations. Its ocular manifestations include ectopia lentis (EL), myopia, astigmatism, and corneal abnormalities. This review examines refractive alterations related to MFS such as EL, microspherophakia, lens coloboma, altered corneal biomechanics (flattening, thinning, and astigmatism), and myopia and their impact on visual acuity. The pathogenesis of these manifestations stems from mutations in the FBN1 gene (encoding fibrillin-1). Moreover, the current medical and surgical management strategies for MFS-related refractive errors, including optical correction (eyeglasses, contact lenses, etc.), and surgical interventions like lensectomy, intraocular lens (IOL) implantation (anterior chamber, posterior chamber, scleral-fixated, iris-fixated), and the use of capsular tension rings/segments are further discussed. Considering the likelihood of underdiagnosing and underestimating ocular involvement in MFS, this updated review highlights the critical need to identify and address these refractive issues to enhance the visual outcomes for those affected. Full article

Background: The aim of this retrospective study was to compare the surgical and refractive outcomes using the Carlevale IOL (FIL SSF; SOLEKO) with those of the retropupillary-fixated Artisan IOL (Aphakia Model 205; OPHTEC), implanted through a 6 mm sclerocorneal tunnel incision in both groups. Methods: This study included 51 consecutive eyes (25 Carlevale and 26 Artisan IOLs). Due to complex preoperative conditions (e.g., dislocated polymethylmethacrylat IOL, luxated Cataracta rubra), all patients underwent lens explantation using a standardized 6 mm sclerocorneal tunnel incision and a 23 G or 25 G pars plana vitrectomy. Visual acuity (VA), spherical equivalent, refractive prediction error (PE), incision-suture time, and complication rates were recorded preoperatively and during the follow-up period. Results: The average follow-up period was 40.9 ± 5.7 days. VA improved by 0.28 ± 0.39 logMAR (p < 0.0001) in the Carlevale group and by 0.36 ± 0.47 logMAR (p < 0.0001) in the Artisan group. The improvement was comparable between both groups (p = 0.921). The deviation of the PE was −0.67 ± 0.56 in the Carlevale group and 0.34 ± 0.71 in the Artisan group (p < 0.0001). The mean incision-suture time was 42.5 ± 5.8 min in the Carlevale group and 28.2 ± 6.4 min in the Artisan group. Anterior chamber and vitreous hemorrhages were the most common complications, occurring in 12% in the Carlevale group and 17.2% in the Artisan group. Conclusions: The use of the Carlevale IOL, implanted using a sclerocorneal tunnel technique, presents a valid option for treating complex lens dislocations. The scleral fixation of the Carlevale IOL minimizes risks associated with iris fixation, such as chronic inflammation and pupil distortion, making it particularly suitable for patients with damaged irises. Full article

Objectives: This study aimed to describe the outcomes of a staged procedure combining Descemet membrane endothelial keratoplasty (DMEK) and sutureless scleral fixation (SSF) of a one-piece intraocular lens (IOL) in a case series. Co-performing endothelial keratoplasty (EK) and SSF is associated with intraoperative and postoperative complications such as graft deployment difficulties, air migration, graft detachment, and IOL opacification or tilt, all of which are evaluated in this study. Methods: This is a retrospective observational case series. Clinical data were collected from eight eyes of eight patients who underwent DMEK for endothelial failure and had previously received an SSF with one-piece IOL following complete vitrectomy. During DMEK surgery, an air leak test was conducted to check for air migration into the posterior chamber. If instability was detected, pupilloplasty was performed. Intraoperative and postoperative data, including DMEK graft unfolding time, were collected. Corrected Distance Visual Acuity (CDVA), refraction, endothelial cell density (ECD), central corneal thickness (CCT), intraocular pressure (IOP), and complications were recorded over a 12-month follow-up period. Results: We performed pupilloplasty in four patients (50%). The median CDVA improved from preoperative 0.85 logMAR (range: 0.60 to 1.00) at baseline to 0.18 logMAR (range: 0.10 to 0.70, p = 0.012) at 12 months. The median refraction value changed significantly from −1.00 to −0.50 at 12 months. The median percentage reduction in ECD after 12 months was 33.4% (range 30 to 40). The median baseline CCT was 689 μm (range: 651 to 701) at baseline visit and 541.5 μm (range: 525 to 591, p = 0.008) at 12 months. The median IOP was reduced significantly during follow-up. The median graft unfolding time was 6 min (5 to 9). One patient required rebubbling for partial detachment on postoperative day one. No complications occurred within 12 months. Conclusions: The effective compartmentalization of the anterior and posterior chambers in vitrectomized eyes with an SSF one-piece IOL and pupilloplasty can facilitate critical steps of DMEK surgery in complex eyes. Additionally, the air leak test could prove useful in identifying the need for iris-lens diaphragm reconstruction. Full article

Background/Objectives: To compare the clinical outcome of suture and sutureless iris fixation techniques for dislocated intraocular lenses (IOLs). Methods: Retrospective cohort study including patients who underwent surgery for late IOL dislocation over a 10-year period. IOL repositioning was achieved either by suturing the original IOL to the iris using the Siepser slipknot technique or by replacing it with a retropupillary sutureless iris claw IOL. Data collected during surgery included the type of dislocation, the need for anterior or posterior vitrectomy, duration of surgery, and intraoperative complications. Six months after surgery we assessed the eye and iris anatomy; refraction, astigmatism, and visual acuity; endothelial cell damage; and rate of postoperative complications. Results: Included in the study were 60 patients: 32 underwent IOL relocation and 28 underwent IOL exchange. Pseudoexfoliation (43.7% and 39.3%) and retinal surgery (34.4% and 28.6%) were identified as the main possible causes for IOL dislocation. The mean duration of the surgery was 62.9 ± 14.9 min for the Relocation group, and was 42.7 ± 11.4 min for the Exchange group (p < 0.001), with similar low intraoperative complication rates (6.25% and 7.14%, respectively). The studied parameters showed no differences between the two groups postoperatively, except for corneal astigmatism which was 1.31 ± 0.45 D in the Relocation group and was 1.89 ± 0.86 D in the Exchange group (p < 0.001). Conclusions: Both suture and sutureless iris fixation techniques for dislocated IOLs yielded similarly favorable outcomes in this study. IOL relocation resulted in less postoperative astigmatism, while IOL exchange offered the advantage of shorter surgical time. Full article

Background/Objectives: This study aimed to evaluate the visual outcomes and prognosis after cataract surgery in patients with prior history of Verisyse phakic intraocular lens (pIOL) implantation. Methods: A retrospective cohort study involving 215 Verisyse pIOL implantations and 17 explantations was conducted. The Verisyse pIOL was disenclaved and removed through a superior scleral tunnel incision. Cataract extraction with phacoemulsification was then performed through a temporal clear corneal incision. Results: An occurrence rate of 7.9% of eyes with cataract formation was found. Both uncorrected (UDVA) and corrected visual acuity (CDVA) three months after cataract surgery were significantly improved (0.24 ± 0.30 vs. 0.73 ± 0.48; p < 0.001 and 0.10 ± 0.14 vs. 0.30 ± 0.31; p = 0.004, respectively). The UDVA was 20/20 or better in 41% of eyes and 20/40 or better in 65% of eyes. The CDVA was 20/20 or better in 53% of eyes and 20/40 or better in 88% of eyes. The safety and efficacy indices were 1.96 ± 1.68 and 1.60 ± 1.36, respectively. Conclusions: Various complications including cataracts may develop in these patients. Verisyse pIOLs have a lower incidence of cataract formation and are more likely to lead to age-related cataracts rather than the anterior subcapsular cataracts commonly seen in implantable collamer lens (ICL) patients. Patients with a prior history of Verisyse pIOL can expect to have a good visual prognosis after cataract extraction. Full article

Different techniques for artificial iris implantation with or without an intraocular lens, depending on lens status, are described in the literature. We describe a surgical technique for a custom-made artificial iris and toric-intraocular lens intrascleral flange fixation. We modified the “Backpack” artificial iris implantation surgical technique to facilitate an accurate alignment of the toric-intraocular lens in a patient with aphakia, aniridia, and high asymmetric astigmatism secondary to blunt trauma. Two months after the surgery, uncorrected visual acuity was 20/30, corrected to 20/25 with a refraction of −2.00 in the diopter sphere with no residual astigmatism. The artificial iris implant and toric-intraocular lens were well-centered. The patient was satisfied with the visual and cosmetic outcomes. This procedure, however, is not complication-free as our patient developed uveitis and increased intraocular pressure during the postoperative period, which was treated successfully. Full article

Periprosthetic joint infections (PJIs) in arthroplasty and osteosynthesis-associated infections (OAIs) in reconstructive surgery still represent a challenging complication in orthopaedics and traumatology causing a burden worsening the patient’s quality of life, for caregiver and treating physicians, and for healthcare systems. PJIs and OAIs are the result of bacterial adhesion over an implant surface with subsequent biofilm formation. Therefore, the clinical pathological outcome is a difficult-to-eradicate persistent infection. Strategies to treat PJIs and OAIs involve debridement, the replacement of internal fixators or articular prostheses, and intravenous antibiotics. However, long treatments and surgical revision cause discomfort for patients; hence, the prevention of PJIs and OAIs represents a higher priority than treatment. Local antibiotic treatments through coating-release systems are becoming a smart approach to prevent this complication. Hydrophilic coatings, loaded with antibiotics, simultaneously provide a barrier effect against bacterial adhesion and allow for the local delivery of an antibiotic. The intraoperative use of a hyaluronan (HY)-derivative coating in the form of a gel, loaded with antibiotics to prevent PJI, has recently raised interest in orthopaedics. Current evidence supports the use of this coating in the prophylaxis of PJI and IRIs in terms of clinical outcomes and infection reduction. Thus, the purpose of this narrative review is to assess the use of a commercially available HY derivative in the form of a gel, highlighting the characteristics of this biomaterial, which makes it attractive for the management of PJIs and IRIs in orthopaedics and traumatology. Full article