Search Results (16)

Background/Objectives: Ocular wavefront aberrations are clinically relevant for optimizing vision correction and predicting surgical outcomes. This study aimed to establish normative reference ranges for a Korean population by quantifying wavefront aberrations using a Hartmann–Shack wavefront sensor and Zernike coefficients, and to assess correlations with age, sex, and spherical equivalent (SE). Methods: Wavefront aberrations were measured in 98 Koreans (196 eyes) using a Hartmann–Shack aberrometer without cycloplegia. Five repeated measurements per eye at a 6 mm pupil size were averaged. Parameters included Zernike coefficients (Z3–Z20), higher-order aberration (HOA) root mean square (RMS, Z6–Z20), and total RMS (Z3–Z20). Associations with age, sex, and SE were assessed using univariable and multivariable linear mixed-effects models. Second-order polynomial regression assessed nonlinear relationships. Interocular symmetry was evaluated using mirror-symmetry-adjusted Spearman’s correlation and intraclass correlation coefficients (ICCs). Results: Vertical coma (Z7, 0.208 ± 0.174 μm) and spherical aberration (Z12, 0.200 ± 0.161 μm) were the largest contributors to HOA RMS. Mean HOA RMS and total RMS were 0.51 ± 0.21 μm and 3.03 ± 2.51 μm, respectively. HOA RMS increased with age (β = 0.003 μm/year, p = 0.010), whereas total RMS decreased with SE (β = −0.678 μm/D, p < 0.001). Most Zernike coefficients showed positive interocular correlations, with ICCs of 0.75 for total RMS and 0.64 for HOA RMS. Conclusions: In normal Korean eyes, HOAs increased with age and exhibited significant interocular symmetry. Vertical coma and spherical aberration were predominant components. While the pattern was similar to that in Western populations, the absolute values were greater. These normative values may aid future wavefront-guided refractive surgery and presbyopia correction procedures. Full article

Harmful gases produced by diesel locomotives tend to accumulate within tunnels, posing risks such as dizziness, vomiting, coma, and even death to the working staff, particularly in long tunnels with high traffic density. As the number of such structures increases, ventilation in extra-long tunnels represents a critical challenge within the engineering area. In this study, the ventilation of an extra-long single-bore double-track tunnel operating with diesel locomotives is investigated. Through scale model tests and based on the inspection sensor data, the natural diffusion patterns of harmful gases under various operating conditions were elucidated. Based on the local resistance coefficient optimization theory and numerical simulations, the ventilation shafts of the tunnel were optimally designed, and an overall ventilation scheme was developed. The ventilation effect of the tunnel was verified through improved scale model tests. The results show that harmful gases primarily diffuse towards the higher elevation tunnel entrance, with only gases near the lower entrance escaping from it. Under the same operating conditions, NO₂ diffuses more slowly than CO, making it harder to discharge. Applying the local resistance coefficient optimization theory, the inclined and vertical shafts of the tunnel can be effectively optimized. The optimized ventilation shafts, coupled with jet fans, can reduce harmful gas concentrations below safety limits within one minute. The methodologies and findings presented here can offer valuable guidance for the ventilation design of similar infrastructures. Full article

Background: To assess the outcome of Keraring (Mediphacos, Brazil) implantation according to a topographic pattern-based nomogram in eyes with mild to moderate keratoconus. Materials and Methods: A topographic pattern-based nomogram was used to guide Keraring selection in 47 consecutive eyes with stage I-II keratoconus (Amsler-Krumeich staging), which underwent femtosecond laser-assisted implantation at a single center. Electronic data of LogMar uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) manifest refraction and tomographic analysis (Pentacam HR, Oculus, Germany) measured preoperatively and at the last postoperative examination were retrospectively analyzed. Results: Mean follow-up was 18.8 months. (range 3–35). Mean UDVA improved (p < 0.001) from 0.87 ± 0.27 to 0.35 ± 0.21. UDVA increased on average by 5.13 lines. Mean CDVA improved from 0.21 ± 0.10 to 0.09. ± 0.07, and the proportion of eyes with CDVA ≥ 20/25 increased from 29.8% to 85.1% after surgery. No eyes lost lines of CDVA. The Alpins correction index of astigmatism was 0.77 and the mean refractive cylinder decreased from 4.99 ± 1.89 to −2.31 ± 1.47 D (p < 0.001). Mean and maximal keratometry was reduced on average by −2.10 ± 1.42 D and −3.02 ± 3.68 D, respectively (p < 0.001). The RMS of corneal high-order aberrations dropped from 3.296 ± 1.180 µm to 2.192 ± 0.919 µm, and that of vertical coma from −2.656 ± 1.189 µm to −1.427 ± 1.024 µm (p < 0.001). All topometric indices improved after surgery. Conclusions: Planning Keraring implantation using the topographic pattern-based nomogram is very effective and safe in eyes with mild to moderate keratoconus. Using that nomogram of UDVA and CDVA are clinically significant. Full article

Purpose: To assess the possible impact of minor changes in fixation on wavefront measurements as a potential constraint in detecting subtle temporal variations in ocular wavefront error. Methods: Twelve healthy subjects with an average age of 36.3 ± 8.8 were instructed to put their heads in the aberrometer’s chin-rest and look at a fixation target that was embedded in the device. The fixation targets were readily observable to the participants without accommodation, thanks to the aberrometer’s Badal system. When each eye was staring at the target, its wavefront aberration was recorded three times and then averaged for further analysis. The averaged Zernike coefficients were rescaled to the smallest value of the maximum round pupil found among all eyes (4.41 mm), and this procedure was repeated for each target. Results: Alteration of the fixation targets caused changes to the Zernike coefficients of defocus (C(2,0)), vertical trefoil (C(3,–3)), vertical coma (C(3,–1)), horizontal coma (C(3,1)), oblique trefoil (C(3,3)), primary spherical aberration (C(4,0)), and secondary spherical aberration (C(6,0)), but the changes were not statistically significant. Nevertheless, an alteration in the target’s size and shape exhibited a significant correlation across all of the aforementioned coefficients in both eyes (p < 0.05). The total RMS of aberrations and the RMS of the spherical-like aberrations were both lowest while choosing the larger Maltese cross, and the bigger E-letter minimized the RMS of HOA and comatic aberrations. Conclusion: The aberrometric changes occur as a consequence of altering the fixational gaze and are within the range of the changes found after performing a near-vision task, so they might potentially act as a confounding factor when attempting to identify such small variations in the ocular wavefront. Using a smaller E-letter (5 arcmin) as an internal fixation target resulted in the least standard deviation of measurements, fixational stability, and higher accuracy in ocular wavefront measurements. Full article

This study compares a standard monofocal intraocular lens (IOL) with two rotationally asymmetric refractive multifocal IOLs, analyzing power profiles and wavefront data across three nominal powers. Tested IOLs included monofocal Acunex AN6 and multifocal AN6V (addition +1.50 D) and AN6VM (addition +3.00 D) by Teleon Surgical, at powers +10.00 D, +20.00 D, and +30.00 D. Using NIMO TR1504, power profiles, spherical aberration, and coma were analyzed. Multifocal lenses displayed an asymmetrical design, with zones for far and near vision and a central notch for far power. The multifocal AN6V and AN6VM showed neutral spherical aberration in the center, increasing to positive values, and finally achieving negative values towards the periphery. The vertical coma coefficient [Z(3:−1)] remains almost stable for the monofocal IOLs. The lower-addition multifocal IOLs induce primary vertical coma of +0.11 microns at 3 mm away from the lens center compared to +0.21 microns obtained with the high-addition lens. We can conclude that the multifocal AN6V and AN6VM lenses display an asymmetrical design. The final addition provided by these lenses depends on its nominal power. The variation of SA with optic size is more pronounced for the monofocal model, and it is dependent on the nominal power. Full article

The objective of this study was to assess the effect of sustained reading on the temporal changes in the wavefront error in the presbyopic eye. The wavefront aberration of the eyes was measured using an IRX3 Shack–Hartmann aberrometer before and after (immediately, 5 min, and 10 min after) a reading task. Temporal changes in ${\mathrm{C}}_2^0$, ${\mathrm{C}}_4^0$, and ${\mathrm{C}}_3^{-1}$ coefficient values of the eyes were plotted, showing a predominant number of V-shaped patterns (for ${\mathrm{C}}_4^0$ and ${\mathrm{C}}_3^{-1}$) and inverse V-shaped patterns (for ${\mathrm{C}}_2^0$) among the study group, and the percentages (between 27 and 73%) were reported. The median of the total RMS of aberrations and the RMS of HOA (higher-order aberrations), which included comatic (3rd order) and spherical-like aberrations (4th and 6th order), increased immediately after finishing the near-vision reading task and then decreased. The median of RMS of comatic aberrations had a similar pattern of variations, while the median of RMS of spherical-like aberrations displayed an opposite pattern. Simulating the aberration changes due to lens decentration caused by relaxed zonules during 4 D accommodation in an eye model demonstrated that the expected range of changes for the vertical coma and spherical aberrations are in the order of 0.001 and 0.01 μm, respectively, which could justify why the observed changes were not statistically significant. The observed dynamic changes in HOA might be linked to the biomechanical characteristics and alterations in the displacement of the crystalline lens following prolonged near-vision tasks in presbyopic people. Although some predominant patterns under some conditions were shown, they exhibit considerable inter-subject and inter-ocular variability. This might be due to slight misalignments while fixating on the internal extended object in the aberrometer. Full article

Background: This retrospective chart review compared the higher-order aberrations (HOAs) among photorefractive keratectomy (PRK), laser-assisted in situ keratomileusis (LASIK), and small incision lenticule extraction (SMILE) alongside changes in spherical equivalent (SEQ) and corneal shape (Q-value). Methods: Analyzing 371 myopic eyes, including 154 LASIK, 173 PRK, and 44 SMILE cases, Pentacam imaging was utilized pre-operatively and at one-year post-operative visits. Results: All procedures resulted in 100% of patients achieving an uncorrected distance visual acuity (UDVA) of 20/40 or better, with 87% of LASIK and PRK, and 91% of SMILE patients having 20/20 or better. Significant increases in HOAs were observed across all procedures (p < 0.05), correlating positively with SEQ and Q-value changes (LASIK (0.686, p < 0.05), followed by PRK (0.4503, p < 0.05), and SMILE (0.386, p < 0.05)). Vertical coma and spherical aberration (SA) were the primary factors for heightened aberration magnitude among the procedures (p < 0.05), with the largest contribution in SMILE, which is likely attributed to the centration at the corneal apex. Notably, PRK showed insignificant changes in vertical coma (−0.197 µm ± 0.0168 to −0.192 µm ± 0.0198, p = 0.78), with an increase in oblique trefoil (p < 0.05). Conclusions: These findings underscore differences in HOAs among PRK, LASIK, and SMILE, helping to guide clinicians. Full article

To build a representative 3D finite element model (FEM) for intracorneal ring segment (ICRS) implantation and to investigate localized optical changes induced by different ICRS geometries, a hyperelastic shell FEM was developed to compare the effect of symmetric and progressive asymmetric ICRS designs in a generic healthy and asymmetric keratoconic (KC) cornea. The resulting deformed geometry was assessed in terms of average curvature via a biconic fit, sagittal curvature (K), and optical aberrations via Zernike polynomials. The sagittal curvature map showed a locally restricted flattening interior to the ring (Kmax −11 to −25 dpt) and, in the KC cornea, an additional local steepening on the opposite half of the cornea (Kmax up to +1.9 dpt). Considering the optical aberrations present in the model of the KC cornea, the progressive ICRS corrected vertical coma (−3.42 vs. −3.13 µm); horizontal coma (−0.67 vs. 0.36 µm); and defocus (2.90 vs. 2.75 µm), oblique trefoil (−0.54 vs. −0.08 µm), and oblique secondary astigmatism (0.48 vs. −0.09 µm) aberrations stronger than the symmetric ICRS. Customized ICRS designs inspired by the underlying KC phenotype have the potential to achieve more tailored refractive corrections, particularly in asymmetric keratoconus patterns. Full article

Intrastromal corneal ring segments (ICRS) improve corneal topographic symmetry and reduce corneal aberrations through regularization of the corneal surface, thereby functioning as a viable surgical intervention for patients with keratoconus. This study aims to evaluate changes in lower- (LOAs) and higher-order aberrations (HOAs) amongst varying pupil sizes pre- and post- ICRS implantation in keratoconus patients. We specifically investigate the impact of pupil size on total corneal HOAs up to the 6th order. Twenty-one eyes that underwent ICRS implantation were included in this prospective interventional study. LOAs and HOAs measurements at the 6 mm, 4 mm, and 2 mm pupil diameters were collected preoperatively and at 6 months postoperatively using the Zernicke analysis function on a Scheimpflug device. ICRS implantation demonstrated a statistically significant effect in vertical coma with a −0.23 reduction (p = 0.015) for a 4 mm pupil size and a −1.384 reduction (p < 0.001) for 6 mm, with no significant effect at 2 mm. Horizontal coma, astigmatism 0°, astigmatism 45°, trefoil 5th order 30°, and RMS HOA demonstrated significant reductions at 4 mm or 6 mm pupil sizes but not at 2 mm. Our analysis demonstrates a favorable effect of ICRS implantation on larger pupil sizes, suggesting the importance of pupil size as it correlates with HOAs reduction. Full article

We present a retrospective, single-center report of one-year visual outcomes for Small Incision Lenticule Extraction (SMILE) to treat myopia and myopic astigmatism, as well as to compare outcomes with other published literature, including results from the United States Food and Drug Administration (US FDA). A total of 405 eyes with a mean preoperative spherical equivalent of −5.54 diopters (D) underwent SMILE between April 2017 and April 2022. The outcomes measured included visual acuity, manifest refraction, vector analysis, and wavefront aberrometry at various time points, specifically pre-operative and twelve months post-operatively. Results were compared to other similar published studies of SMILE outcomes between 2012 and 2021. A total of 308 and 213 eyes were evaluated at three and twelve months, respectively. At twelve months, 79% of eyes achieved UDVA ≥ 20/20, and 99% had ≥20/40, with no patients losing ≥2 lines of vision. For accuracy, 84% of eyes were within 0.5 D of target SEQ, and 97% were within 1 D. Total corneal higher order aberrations (HOA) increased from 0.33 to 0.61 um. Significant change was found in vertical coma and spherical aberration at twelve months. SMILE remains a safe and effective treatment for myopia and myopic astigmatism. Clinical outcomes are likely to improve with increased surgeon experience and refinement of technology and nomograms. Full article

Background: Music stimulation is considered a valuable form of intervention in disorders of consciousness (DoC); for instance, verticalization may improve motor and cognitive recovery. Our purpose is to investigate the effects of a novel rehabilitative approach combining robotic verticalization training (RVT) with personalized music stimulation in people with DoC. Methods: Sixteen subjects affected by minimally conscious state due to traumatic brain lesions who attended our Intensive Neuro-Rehabilitation Unit were enrolled in this randomized trial. They received either music robotic verticalization (MRV) using the Erigo device plus a personalized music playlist or only RVT without music stimuli. Each treatment was performed 2 times a week for 8 consecutive weeks in addition to standard neurorehabilitation. Results: We found significant improvements in all patients’ outcomes in the experimental group (who received MRV): Coma Recovery Scale-Revised (CRS-R) (p < 0.01), Level of Cognitive Functioning (LCF) (p < 0.02), Functional Independence Measure (FIM) (p < 0.03), Functional Communication Scale (FCS) (p < 0.007), Trunk Control Test (TCT) (p = 0.05). Significant differences between the two groups were also found in the main outcome measure CRS-R (p < 0.01) but not for TCT and FIM. Conclusions: Our study supports the safety and effectiveness of RVT with the Erigo device in chronic MCS, and the achievement of better outcomes when RVT is combined with music stimulation. Full article

This study aimed to assess the anterior corneal wavefront aberrations, keratometry, astigmatism vectors and pupil size between Pentacam HR^® (Oculus Optikgeraete GmbH, Wetzlar, Germany) and iTrace^® (Tracey Technologies Corp., Houston, TX, USA). In this observational study, 100 eyes (50 healthy volunteers) were scanned in mesopic light condition with a Pentacam HR^® and iTrace^®. Anterior corneal aberrations (spherical aberration (Z40), vertical coma (Z3 − 1), horizontal coma (Z3 + 1)), keratometry in the flattest (K1) and steepest meridian (K2), mean astigmatism, astigmatic vectors (J0 and J45), and pupil size were measured. We found a significant difference in Z40 (Pentacam^®: +0.30 ± 0.11 µm and iTrace^®: −0.03 µm ± 0.05 µm; p < 0.01) with no correlation between the devices (r = −0.12, p = 0.22). The devices were in complete agreement for Z3 − 1 (p = 0.78) and Z3 + 1 (p = 0.39), with significant correlation between the machines (r = −0.38, p < 0.01 and r = −0.6, p < 0.01). There was no difference in K1, K2 and mean astigmatism. J0 was negative with both devices (against-the-rule astigmatism), but there was no correlation. J45 was negative with the Pentacam HR^® (more myopic oblique astigmatism) but significantly correlated between the devices. Pupil size was smaller with Pentacam HR^® (p < 0.01). In summary, these devices cannot be used interchangeably. Corneal Z40 was significantly different with more negative Z40 with iTrace^® compared to Pentacam HR^®. iTrace^® operates with lower illumination, giving larger pupil size than Pentacam HR^®, which uses intense blue light during measurement. No correlation was found for J0. Pentacam HR^® had a trend to record more negative J45 (myopic oblique astigmatism). Full article

(1) Background: The goal of this study was to determine the incidence of in-hospital mortality and to investigate its predictors in patients with a primary intracranial hemorrhage (ICH) undergoing endotracheal intubation. (2) Methods: This retrospective study, between July 2018 to July 2019, recruited patients who were diagnosed with a primary ICH and who were intubated during treatment in our institution. The outcome variable was in-hospital mortality, known as 30-day mortality, in patients with ICH undergoing endotracheal intubation. Multivariable analyses were performed to identify the prediction of in-hospital mortality. (3) Results: A total of 180 patients with ICH undergoing endotracheal intubation were included, with a mean (SD) age of 62.64 (13.82) years. A total of 73.33% were female, and 71.11% of the patients were indicated for intubation due to neurological reasons. The in-hospital mortality rate, following endotracheal intubation, was 58.33%. In a reduced model using a stepwise backward selection strategy with p values < 0.2, independent predictors of in-hospital mortality were brain herniations on cranial CT scans (OR: 10.268, 95% CI: 2.749–38.344), lower Glasgow coma scale (CGS) scores before intubation (OR: 0.614, 95% CI: 0.482–0.782), and the loss of the vertical oculocephalic reflex before intubation (OR: 6.288, 95% CI: 2.473–15.985). Conclusions: The in-hospital mortality rate was comparable to that in the early evidence, but was significantly higher compared to recent reports. We infer that brain herniations on cranial CT imaging, lower CGS scores before intubation, and the loss of the vertical oculocephalic reflex before intubation could be used to approximately predict in-hospital mortality in patients with primary ICH undergoing endotracheal intubation. These considerations can help guide clinical decisions and community stroke discussions. Full article

We aim to evaluate magnitudes of higher order aberrations (HOAs) from 3rd–6th order after scleral buckling (SB) for rhegmatogenous retinal detachment (RRD). A retrospective cross-sectional study of 19 patients with RRD who received SB (six receiving encircling SB, thirteen receiving segmental SB) was conducted. A wavefront analysis for surveying HOAs and other ophthalmic parameters were collected. Data between operated and fellow eyes, and a subgroup analysis of operated eyes, were analyzed by the Mann–Whitney U test, while a generalized linear model was applied to evaluate the correlation of HOAs to best-corrected visual acuity (BCVA) and optical symptoms. BCVA in the operated eyes was significantly worse (LogMAR: 0.18 ± 0.23 versus 0.05 ± 0.07, p = 0.001). Tilt (0.32 ± 0.14 versus 0.13 ± 0.08, p = 0.004), defocus (1.78 ± 0.47 versus 1.05 ± 0.17, p = 0.019) and coma (0.43 ± 0.11 versus 0.27 ± 0.09, p = 0.016) were significantly increased after SB. All root mean square (RMS), including RMS-3, RMS-4 and total RMS, were higher in operated eyes (all p < 0.05). Regarding Zernike terms, a significant elevation of vertical coma in the operated eyes was found (p = 0.038). In addition, tilt (0.41 ± 0.10 versus 0.17 ± 0.12, p = 0.007), defocus (2.27 ± 0.58 versus 0.82 ± 0.39, p = 0.001) and coma (0.59 ± 0.17 versus 0.11 ± 0.10, p = 0.015) were higher in the segmental subgroup, whereas spherical aberration (SA) was higher in the encircling subgroup (0.22 ± 0.04 versus 0.40 ± 0.15, p = 0.024) and RMS-4 and total RMS were increased in the segmental subgroup (both p < 0.05). Besides, tilt was correlated to worse BCVA (p = 0.036), whereas all four HOAs were correlated to the presence of optical symptoms (all p < 0.05). In conclusion, SB may increase HOAs, which could be associated with unfavorable postoperative visual outcomes and subject symptoms. Full article

The short-term safety and efficacy of intracorneal ring segment (ICRS) implantation in keratoconus eyes of children are investigated in this study. A retrospective interventional case series study including a total of 33 keratoconus eyes (age 8 to 17 years) that had undergone ICRS (Keraring segments, Mediphacos) implantation was conducted. Information about visual, refractive, pachymetric, corneal topographic and aberrometric, and corneal endothelial changes during a 3-month follow-up were extracted and analysed. A significant improvement was observed in logMAR corrected distance visual acuity (p = 0.005), combined with a statistically significant reduction in keratometric readings (p < 0.001). A reduction in the magnitude of corneal astigmatism of ≥1 D was observed in 52.8% of eyes. No significant changes were observed in corneal endothelial density (p = 0.317). Significant changes were found in the anterior vertical coma component (p = 0.002) as well as in the spherical aberration of the posterior corneal surface (p = 0.004). Only two relevant complications were described: one corneal microperforation with penetration of the ring segment into the anterior chamber (1 eye, 2.8%), and a case of ring extrusion (1 eye, 2.8%). ICRS implantation in children keratoconus eyes allows a reduction of corneal astigmatism, irregularity, and aberrations, leading to a significant visual improvement. Full article