Clinical efficacy of femtosecond laser-assisted phacoemulsification in diabetic cataract patients

BACKGROUND Diabetic patients with cataracts encounter specific difficulties during cataract surgery due to alterations in microcirculation,blood supply,metabolism,and the microenvironment.Traditional phacoemulsification may not fully tackle these issues,especially in instances with substantial preoperative astigmatism.The utilization of femtosecond laser-assisted phacoemulsification,in conjunction with Toric intraocular lens(IOL)implantation,offers a potentially more efficient strategy.This research seeks to evaluate the efficacy and possible complications of this approach in diabetic cataract patients.AIM To investigate the clinical efficacy and complications of femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation in diabetic cataract patients,comparing it with traditional phacoemulsification methods.METHODS This retrospective study enrolled 120 patients with diabetes cataract from May 2019 to May 2021.The patients were divided into two groups:the control group underwent traditional phacoemulsification and Toric IOL implantation,while the treatment group received Len Sx femtosecond laser-assisted treatment.Outcome measures included naked eye vision,astigmatism,high-level ocular phase difference detection,clinical efficacy,and complication.RESULTS There were no significant preoperative differences in astigmatism or naked eyesight between the two groups.However,postoperative improvements were observed in both groups,with the treatment group showing greater enhancements in naked eye vision and astigmatism six months after the procedure.High-level corneal phase difference tests also indicated significant differences in favor of the treatment group.CONCLUSION This study suggests that femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation appears to be more effective in enhancing postoperative vision in diabetic cataract patients compared to traditional methods offering valuable insights for clinical practice.

Thermal-Mechanical Efect and Removal Mechanism of Ti-6Al-4V During Laser-Assisted Grinding

The low density and high corrosion resistance of titanium alloy make it a material with various applications in the aerospace industry. However, because of its high specifc strength and poor thermal conductivity, there are problems such as high cutting force, poor surface integrity, and high cutting temperature during conventional machining. As an advanced processing method with high efciency and low damage, laser-assisted machining can improve the machinability of titanium alloy. In this study, a picosecond pulse laser-assisted scratching (PPLAS) method considering both the temperature-dependent material properties and ultrashort pulse laser’s characteristics is frst proposed. Then, the efects of laser power, scratching depth, and scratching speed on the distribution of stress and temperature feld are investigated by simulation. Next, PPLAS experiments are conducted to verify the correctness of the simulation and reveal the removal behavior at various combinations of laser power and scratching depths. Finally, combined with simulated and experimental results, the removal mechanism under the two machining methods is illustrated. Compared with conventional scratching (CS), the tangential grinding force is reduced by more than 60% and the material removal degree is up to 0.948 during PPLAS, while the material removal is still primarily in the form of plastic removal. Grinding debris in CS takes the form of stacked fakes with a “fsh scale” surface, whereas it takes the form of broken serrations in PPLAS. This research can provide important guidance for titanium alloy grinding with high surface quality and low surface damage.

Laser-assisted Simulation of Dose Rate Effects of Wide Band Gap Semiconductor Devices

Laser-assisted simulation technique has played a crucial role in the investigation of dose rate effects of silicon-based devices and integrated circuits,due to its exceptional advantages in terms of flexibility,safety,convenience,and precision.In recent years,wide band gap materials,known for their strong bonding and high ionization energy,have gained increasing attention from researchers and hold significant promise for extensive applications in specialized environments.Consequently,there is a growing need for comprehensive research on the dose rate effects of wide band gap materials.In response to this need,the use of laser-assisted simulation technology has emerged as a promising approach,offering an effective means to assess the efficacy of investigating these materials and devices.This paper focused on investigating the feasibility of laser-assisted simulation to study the dose rate effects of wide band gap semiconductor devices.Theoretical conversion factors for laser-assisted simulation of dose rate effects of GaN-based and SiC-based devices were been provided.Moreover,to validate the accuracy of the conversion factors,pulsed laser and dose rate experiments were conducted on GaN-based and SiC-based PIN diodes.The results demonstrate that pulsed laser radiation andγ-ray radiation can produce highly similar photocurrent responses in GaN-based and SiC-based PIN diodes,with correlation coefficients of 0.98 and 0.974,respectively.This finding reaffirms the effectiveness of laser-assisted simulation technology,making it a valuable complement in studying the dose rate effects of wide band gap semiconductor devices.

Comparison of visual performance with iTrace analyzer following femtosecond laser-assisted cataract surgery with bilateral implantation of two different trifocal intraocular lenses

AIM:To compare the postoperative binocular visual performance with an iTrace analyzer following femtosecond laser-assisted cataract surgery(FLACS)combined with bilateral implantation of two different types of diffractive trifocal intraocular lenses(IOL).METHODS:During this retrospective observational study,patients who received bilateral FLACS combined with implantation of two different types of diffractive trifocal IOLs were evaluated.According to the IOLs’different types and design,the patients were divided into AT LISA tri839MP group(tri839 group)and AcrySof PanOptix TFNT00 group(TFNT group).Study parameters included preoperative and postoperative uncorrected distance visual acuity(UDVA)at 5 m,uncorrected near visual acuity(UNVA)at 30 cm and 40 cm,uncorrected intermediate visual acuity(UIVA)at 60 cm and 80 cm,postoperative refractive status,objective visual qualities and total high order aberrations(HOAs)postoperatively.The postoperative complications were also recorded.RESULTS:Totally 56 eyes of 28 patients(tri839 group,n=26;TFNT group,n=30)were included.Preoperative baseline characteristics between groups were not statistically significantly different.UDVA was not significantly different between groups except for 1wk follow-up due to the postoperative corneal edema.TFNT group showed statistically significant better UNIA at 60 cm than tri839 group at the 1wk(0.05±0.19 vs 0.15±0.10 logMAR,P=0.013),1mo(0.05±0.12 vs 0.15±0.09 logMAR,P=0.001)and 3mo(0.04±0.12 vs 0.15±0.11 logMAR,P=0.001)follow-up,while tri839 group showed statistically significant better UNIA at 80 cm than TFNT group at the 1d(0.14±0.15 vs 0.20±0.14 logMAR,P=0.041)and 1mo(0.09±0.07 vs 0.14±0.10 logMAR,P=0.042)follow-up.Postoperative refractive status showed stable at every visit.Modulated transfer function(MTF)values and strehl ratio(SR)values were improved and HOAs were lower significantly after surgery.CONCLUSION:FLACS with bilateral implantations of both tri839 and TFNT00 can achieve satisfactory natural whole-course vision,high postoperative refractive stability and good visual quality but without significantly difference.iTrace aberration instrument can accurately evaluate the visual quality under different status.

Self-assembled germanium nano-structures by laser-assisted oxidation

The investigation on the oxidation behaviour of Si1-xGex alloys （x=0.05, 0.15, and 0.25） is carried out. It is found for the first time that on the oxide film a germanium nano-cap with a thickness of 1.8-2.8nm and a few Ge nanoparticles with diameters ranging from 5.5 nm to 10 nm are formed by the low-temperatu.re laser-assisted dry oxidation of Si1-xGex substrate. A new scanning method on the decline cross-section of the multiple-layer sample is adopted to measure the layer thickness and the composition. Some new peaks in photoluminescence （PL） spectra are discovered, which could be related to the nano-cap and the nano-particles of germanium. A suitable model and several new calculating formulae with the unrestricted Hartree-Fock-Roothaan （UHFR） method and quantum confinement analysis are proposed to interpret the PL spectra and the nano-structure mechanism in the oxide.

Three-year results of small incision lenticule extraction and wavefront-guided femtosecond laser-assisted laser in situ keratomileusis for correction of high myopia and myopic astigmatism

AIM： To compare and calculate the 3-year refractive results, higher-order aberrations （HOAs）, contrast sensitivity （CS） and dry eye parameters after small incision lenticule extraction （SMILE） and wavefront-guided femtosecond laser-assisted laser in situ keratomileusis （FS-LASIK） for correction of high myopia and myopic astigmatism. METHODS： In this prospective, non-randomized comparative study, 78 eyes with spherical equivalent （SE） of -8.11±1.09 diopters （D） received a SMILE surgery, and 65 eyes with SE of -8.05±1.12 D received a wavefront-guided FS-LASIK surgery with the VisuMax femtosecond laser （Carl Zeiss Meditec, Jena, Germany） for flap cutting. Visual acuity, manifest refraction, CS, HOAs, ocular surface disease index （OSDI） and tear break-up time （TBUT） were evaluated during a 3-year follow-up. RESULTS： The difference of uncorrected distance visual acuity （UDVA） postoperatively was achieved at lmo and at 3mo, whereas the difference of the mean UDVA between two groups at 3y were not statistically significant （t=-1.59, P=-0.13）. The postoperative change of SE was 0.89 D in the FS-LASIK group （t=5.76, P=0.00）, and 0.14 D in the SMILE group （t=-0.54, P=0.59） from lmo to 3y after surgery. At 3-year postoperatively, both HOAs and spherical aberrations in the SMILE group were obviously less than those in the FS-LASIK group （P=0.00）, but the coma root mean square （RMS） was higher in the SMILE group （0.59±0.26） than in the FS-LASIK group （0.29±0.14, P=0.00）. The mesopic CS values between two groups were not statistically significant at 3y postoperatively. Compared with the FS-LASIK group, lower OSDI scores and longer TBUT values were found in the SMILE group at Imo and 3mo postoperatively. With regard to safety, no eye lost any line of CDVA in both groups at 3y after surgery. CONCLUSION： Both SMILE and wavefront-guided FS- LASIK procedures provide good visual outcomes. Both procedures are effective and safe, but SMILE surgery achieve more stable long-term refractive outcome and better control of early postoperative dry eye as compared to FS-LASIK.

Dry eye and corneal sensitivity after small incision lenticule extraction and femtosecond laser-assisted in situ keratomileusis:a Meta-analysis

AIM：To assess the corneal sensitivity and the incidences of dry eye after small incision lenticule extraction（SMILE） and femtosecond laser-assisted in situ keratomileusis（FSLASIK）.METHODS：The Meta-analysis was performed using Rev Man 5.3.We searched on Pub Med from inception to March 2016.Summary weighted mean difference（WMD） and 95% confidence intervals（CIs） were used to analyze the datum.Random-effects or fixed-effects models were chosen up to between-study heterogeneity.The main outcomes were composed of the Ocular Surface Disease Index（OSDI） scores,tear film break-up time（TBUT）,Schirmer Test and corneal sensitivity.RESULTS：Eight eligible studies including 772 eyes（386 in SMILE group and 386 in FS-LASIK group） were identified.The parameters have no significiant difference heterogeneity between SMILE and FS-LASIK group preoperatively.There were significant differences between the two groups in OSDI scores at one and three months postoperatively,in TBUT at one and three months postoperatively,in corneal sensitivity at one week,about one month and three months postoperatively.However,there was no significant difference observed in Schirmer Test at the follow-up periods.CONCLUSION：Compare to FS-LASIK,dry eye and the corneal sensitivity recover better in the SMILE group,in first three months after the surgery.

Changes in ocular surface status and dry eye symptoms following femtosecond laser-assisted cataract surgery

AIM: To observe the changes in ocular surface and the dry eye symptoms following femtosecond laser-assisted cataract surgery (FLACS).METHODS: Patients with no eye signs or symptoms in Guangzhou Aier Eye Hospital between October 2017 and September 2018, who underwent FLACS and intraocular lens (IOL) implantation for age-related cataract were enrolled. Tear film stability assessed with OCULUS Keratograph 5M, Schirmer's I test (SIT), and corneal fluorescein staining (CFS) were evaluated before and after surgery at 1d, 1wk, 1, and 3mo in order. Ocular Surface Disease Index scores (OSDI) and Subjective Symptom Questionnaires (SSQs) were recorded at the same time point.RESULTS: Thirty-eight eyes of 38 patients were enrolled. The noninvasive tear film break-up time (first break-up time and average break-up time) decreased in a peak at the 1wk visit, and then increased to basic levels at 1mo. The tear meniscus height (TMH) increased transiently at 1d, and declined in the following 3mo visits. The SIT had a transient increase at 1d (P=0.357) and a decrease at 1wk and 1mo (both P<0.05) but returned to the preoperative levels at 3mo after surgery (P=0.062). CFS scores were significantly improved compared with those before surgery, and had a statistical difference (P<0.05). OSDI scores and SSQs after surgery were obviously higher, and had a statistical difference (P<0.001) but didnJt return to the basic level by 3mo.CONCLUSION: Dry eye signs and symptoms can occur immediately following FLACS and have a peak severity on day 7 postoperatively. Most signs of dry eye can return to preoperative basic levels within 3mo postoperatively. However, all cases can not recover from CFS and dry eye symptoms at 3mo postoperatively.

Challenges in laser-assisted milling of titanium alloys

Several detailed studies have comprehensively investigated the benefits and limitations of laser-assisted machining(LAM)of titanium alloys.These studies have highlighted the positive impact of the application of laser preheating on reducing cutting forces and improving productivity but have also identified the detrimental effect of LAM on tool life.This paper seeks to evaluate a series of the most common cutting tools with different coating types used in the machining of titanium alloys to identify whether coating type has a dramatic effect on the dominant tool wear mechanisms active during the process.The findings provide a clear illustration that the challenges facing the application of LAM are associated with the development of new types of cutting tools which are not subjected to the diffusion-controlled wear processes that dominate the performance of current cutting tools.

Laser-assisted dacryocystorhinostomy in nasolacrimal duct obstruction：5-year follow-up

AIM：To evaluate the long-term sucess rate of laserassisted dacryocystorhinostomy （L-DCR） in patients with nasolacrimal duct obstruction （NDO）.METHODS：Forty-one eyes of forty patients aged between 21-85y （mean 56.7y） who underwent L-DCR for the treatment of NDO were included in this retrospective,non-randomized study. The follow-up time was 72mo.Functional sucess was defined as the disappearance of epiphora under normal conditions and the presence of a patent ostium on lacrimal irrigation. Anatomical success was defined as a patent lacrimal passage on syringing besides continuing epiphora. Surgical failure was defined as persistent epiphora and closed ostium.RESULTS：Twenty-seven of 40 patients （67.5%） were female and 13 of 40 patients （32.5%） were male. The NDO was right-sided in 17 （42.5%） patients and left-sided in 22（55%） patients whereas 1 （2.5%） patient had undergone bilateral surgery. In 11 （27.5%） patients there were additional nasal abnormalities requiring simultaneous surgical approach. The average time for L-DCR was 26.50±4.9min（16-39min） and the average total amount of laser energy used was 287±27.9 J （239-367 J）. At the 5y follow-up, anatomical sucess rate was 75.0%（30 patients） and functional success rate was 65.0%（26 patients）, whereas surgical failure was seen in 25%（10 patients）. Revision of surgery was performed in 10 cases （25.0%）; failure of revision surgery was seen in 2 cases（5.0%）.CONCLUSION： Transcanalicular L-DCR is a reliable and fast procedure in the treatment of NDO. It can be alternative to external DCR which is accepted as the gold standard currently. The functional and anatomical success rate is higher in the first months and years, but still satisfactory at fifth year.

Comparison of perioperative parameters in one-handed rotational phacoemulsification versus conventional phacoemulsification and femtosecond laser-assisted cataract surgery

AIM:To compare perioperative parameters of one-handed rotational phacoemulsification technique(one-handed phaco-roll)with each of other two techniques,“Divide et Conquer”and femtosecond laser-assisted cataract surgery(FLACS)METHODS:In this retrospective and comparative cohort study,eyes with uncomplicated cataract(nuclear density grade 2 to 3)treated routinely with one-handed phacoroll(n=23;Group 1)or“Divide et Conquer”(n=23;Group 2)or FLACS(n=23;Group 3)were enrolled.Intraoperative parameters including effective phaco-time(EPt),ultrasound time(USt),aspiration time,surgical time,phacoemulsification(phaco)-power,balanced salt solution(BSS)use,cumulative dissipated energy(CDE)were recorded and compared.Clinical outcomes including best corrected visual acuity(BCVA),corneal endothelial cell density(ECD),endothelial cell loss(ECL),central corneal thickness(CCT)and central macular thickness(CMT),were assessed and compared pre-operatively and at 1mo after surgery.RESULTS:Aspiration and surgical time,and BSS used were lower in Group 1(P<0.01)than other groups.EPt,phaco-power and CDE were lower in Group 1(P<0.05)than Group 2 but not significantly different from Group 3.In Group 1,USt was lower(P<0.05)than Group 2 but higher(P<0.05)than Group 3.BCVA improved in all groups without significant difference between Group 1 and the other ones.No significant differences regarding all post-operative morphologic outcomes(ECD,ECL,CCT,CMT)were reported.No clinical complications occurred.CONCLUSION:One-handed phaco-roll seems to be less time-consuming than“Divide et Conquer”and FLACS and less energy-consuming than“Divide et Conquer”.Furthermore,one-handed phaco-roll seems to have an equal safety profile compared to the other two techniques.

Effect of femtosecond laser-assisted lens surgery on the optic nerve head and the macula

AIM: To evaluate the effect of femtosecond laser-assisted lens surgery(FLALS;cataract surgery or refractive lens exchange) on the structure of the optic nerve head and the macula.METHODS: This prospective longitudinal study included healthy eyes undergoing FLALS. Eyes with glaucoma or any other ocular disease that could alter optical coherence tomography results were excluded. Retinal nerve fiber layer(RNFL), Bruch’s membrane opening-minimum rim width(BMO-MRW) and macular thickness(MT) were measured preoperatively, 1 and 6 mo after surgery using spectral-domain optical coherence tomography(SD-OCT). Changes between preoperative and postoperative values were evaluated.RESULTS: A total of 87 eyes of 46 patients were included in this study. Preoperative RNFL, BMO-MRW and MT in microns(μm) were 100.77±10.39, 330.31±49.99 and 276.30±33.39, respectively. Postoperative RNFL, BMO-MRW and MT were 104.74±11.55, 348.32±54.05 and 279.83±22.65 1 mo after surgery and 102.93±11.17, 343.11±53.4 and 278.90±22.19 6 mo after surgery, respectively;which equals an increase of 3.93%, 5.45% and 1.27%,respectively, 1 mo after surgery, and 2.14%, 3.87% and 0.94% 6 mo after surgery. The differences between the preoperative and the postoperative RNFL and BMO-MRW values were statistically significant(P<0.001). Regarding MT values, there were not statistically significant differences(P=0.26).CONCLUSION: Our study suggests that FLALS does not have a negative impact on the structural status of the optic nerve head in healthy eyes, assessed by SD-OCT. There is a slight increase in the values of RNFL, BMO-MRW and MT 1 mo and 6 mo after surgery.

Characteristics of plasma in a novel laser-assisted pulsed plasma thruster

A novel laser-assisted pulsed plasma thruster(LA-PPT)is proposed as an electric propulsion thruster,which separates laser ablation and electromagnetic acceleration.It aims for a higher specific impulse than that achieved with conventional LA-PPTs.Owing to the short-time discharge and the novel configuration,the physical mechanism of the discharge is unclear.Time and spatial-resolved optical emission spectroscopy was applied to investigate the variation in the plasma properties in the thruster discharge channel.The plasma species,electron temperature,and electron density were obtained and discussed.Our investigation revealed that there were H_(α),H_(β),H_(γ),H_(ε) atoms,CⅠ,CⅡ,CⅢ,CⅣ,ClⅠ,ClⅡparticles,and a small amount of CH,C_(3),C_(2),H_(2) neutral molecular groups in the plasma.The electron temperature of the discharge channel of the thruster was within 0.6–4.9 e V,and the electron density was within(1.1–3.0)×10^(18)cm^(-3),which shows that the optical emission spectroscopy method is to measure the electron excitation temperature and electron density in heavy particles.But the Langmuir probe method is to measure the temperature and density of free electrons.The use of laser instead of spark plug as the ignition mode significantly changed the plasma distribution in the discharge channel.Unlike the conventional PPT,which has high electron density near the thruster surface,LAPPT showed relatively large electron density at the thruster outlet,which increased the thruster specific impulse.In addition,the change in the ignition mode enabled the electron density in the LA-PPT discharge channel to be higher than that in the conventional PPT.This proves that the ignition mode with laser replacing the spark plug effectively optimised the PPT performance.

Laser-assisted XUV double ionization of helium atoms:Intensity dependence of joint angular distributions

We investigate the intensity effect of ultrashort assisting infrared laser pulse on the single-XUV-photon double ionization of helium atoms by solving full six-dimensional time-dependent Schrodinger equation with implement of finite element discrete variable representation.The studies of joint energy distributions and joint angular distributions of the two photoelectrons reveal the competition for ionized probabilities between the photoelectrons with odd parity and photoelectrons with even parity in single-XUV-photon double ionization process in the presence of weak infrared laser field,and such a competition can be modulated by changing the intensity of the weak assisting-IR laser pulses.The emission angles of the two photoelectrons can be adjusted by changing the laser parameters as well.We depict how the assisting-IR laser field enhances and/or enables the back-to-back and side-by-side emission of photoelectrons created in double ionization process.

The ablation characteristics of laser-assisted pulsed plasma thruster with metal propellant

In this study,a laser-assisted pulsed plasma thruster(LA-PPT)with a novel configuration is proposed as an electric propulsion thruster which separates laser ablation and electromagnetic acceleration.Owing to the unique structure of the thruster,metals can also be used as propellants,and a higher specific impulse is expected.The ablation quality,morphology,and plume distribution of various metals(aluminium alloy,red copper,and carbon steel)with different laser energies were studied experimentally.The ablation morphology and plume distribution of red copper were more uniform,as compared to those of other metals,and the ablation quality was higher,indicating its greater suitability for LA-PPT.The plume generated by nanosecond laser ablation of aluminium alloy expanded faster,which indicated that the response time of the thruster with aluminium alloy as the propellant was shorter.In addition,when the background pressure was 0.005 Pa,an obvious plume splitting phenomenon was observed in the ablation plume of the pulsed laser irradiating aluminium alloy,which may significantly reduce the utilisation rate of the propellant.

Anterior and posterior capsule densitometry levels after femtosecond laser-assisted cataract surgery

AIM： To analyze and compare five different variables over one year follow-up（1 wk, 1, 3, 6 and 12 mo）： anterior capsule（AC）, and posterior capsule（PC） area densitometry values, AC and PC linear densitometry values, and AC opening area reduction ratio after femtosecond laserassisted cataract surgery. METHODS： This was a prospective comparative study. Seventy-one patients underwent femtosecond laser-assisted cataract surgery on single eye between June 2014 and December 2015. A 5.0 mm diameter laser assisted anterior capsulotomy was performed on all eyes. In every postsurgery evaluation, AC opacificaction（ACO） and PC opacification（PCO） density levels were provided by Oculus Pentacam·HR using area and linear densitometry methods. Digital images were captured with a slit-lamp Topcon photographic camera and IMAGEnet· 5 software. The AC opening area on the digital images was measured using the Sketchandcalc area calculator and converted to reduction ratio levels.RESULTS： Using Pearson correlation coefficient（PCC）, we found no correlation（r=-0.091, P=0.46） in the twelfth month assessment between the evolution of ACO area densitometry values and PCO area densitometry values considered as independent variables. We found no correlation, using PCC（r=-0.096, P=0.43） between the evolution of ACO linear densitometry values and PCO linear densitometry values, in the twelfth month visit, working both as independent variables. AC linear densitometry levels and AC area densitometry levels continued to grow strongly from sixth to twelfth months. Analysis of the values of AC opening area reduction ratio（1 wk, 1, 3, 6, 12 mo） revealed statistically significant differences between the values of successive examinations but the magnitude of the change decreased. In the final period of monitoring between six and twelve months the magnitude of change was low.CONCLUSION： Our results show strong increases of Scheimpflug ACO densitometry values from the sixth to the twelfth month while capsulorhexis area reduction ratio levels displayed a considerable decrease. We found no correlation between ACO area and linear densitometry values and PCO area and linear densitometry values, in the twelfth month examination, working as independent variables.

Case report:simultaneous femtosecond laser astigmatic keratotomy and toric intraocular lens implantation in femtosecond laser-assisted cataract surgery in a patient with surgically induced high corneal astigmatism

Background:Femtosecond laser astigmatic keratotomy(FSAK)and toric intraocular lens(IOL)implantation have been studied individually for comparison to treat astigmatism at cataract surgery.We report a case of surgically induced high corneal astigmatism by laser thermal keratoplasty(LTK)in a patient with cataract who was successfully treated with simultaneous combination of FSAK and toric IOL implantation with femtosecond laser-assisted cataract surgery(FLACS).This is the first report of both procedures combined simultaneously,with or without history of LTK.Case Description:A 68-year-old male presented with a history of LTK with two enhancements each eye in 2004,with subsequent surgically induced high corneal astigmatism,and with age-related nuclear cataract of both eyes.IOL master demonstrated+7.71 diopters of astigmatism at 163 degree right eye and+3.29 diopters of astigmatism at 4 degree left eye.After extensive discussion of the risks and benefits,the patient agreed to undergo FLACS with FSAK with two 61 degrees of relaxation incisions(RIs)and toric IOL(Alcon SN6AT9)right eye;FLACS with toric IOL(Alcon SN6AT7)alone left eye.At 2-year follow-up,uncorrected visual acuity was 20/30 right eye,20/25 left eye.His best corrected visual acuity was 20/25(+0.25+1.00 axis 21)right eye and 20/20(plano+0.25 axis 90)left eye;his best corrected near visual acuity was J1+with add+2.50 diopters right eye and left eye.Conclusions:Patients with age-related cataract and LTK induced high corneal astigmatism can hardly be sufficiently treated with FSAK or toric IOL alone at the time of cataract surgery.An effective way is to combine large FSAK and toric IOL of the highest cylindrical power of T9,in our case,simultaneously,which can achieve an excellent long term visual outcome.

Combined Carbon Dioxide Laser Lateral Canthotomy and Femtosecond Laser-Assisted Cataract Surgery

Purpose: The purpose of this study was to evaluate a new procedure aimed at lengthening the palpebral fissure to facilitate femtosecond laser-assisted cataract surgery in patients with small eyes. Method: A quick procedure using the CO2 laser was adapted for patients with small eyes undergoing laser-assisted cataract surgery using the Catalys system. The UniPulse CO2 laser (Nidek) was used for laser lateral canthotomy on patients with small palpebral fissures to allow fitting of the Liquid OpticTM Interface eyepiece. Results: Lateral canthotomies were performed on 19 women and 7 men (ages ranged from 45 to 93 years) with lower eyelid lengths equal to or shorter than 32 mm who then underwent femtosecond laser-assisted cataract surgery. A total of 33 eyelids received laser lateral canthotomy with the CO2 laser;only one eyelid had lateral canthotomy with cold-steel tenotomy scissors. Dockings were completed for all 34 eyes with eyelids receiving lateral canthotomies. The 33 eyes with eyelids that received laser canthotomy with the CO2 laser had successful femtosecond laser-assisted cataract surgery. The one eye with the eyelid that received cold-steel canthotomy could not have femtosecond laser-assisted cataract surgery despite successful docking because of pupillary constriction. The findings were statistically significant;Fisher Exact Test showed a p-value of 0.0294. Conclusion: Laser lateral canthotomy with CO2 laser is a safe and effective method to allow docking and completion of femtosecond laser-assisted cataract surgery.

Six million Q factor micro fused silica shell resonator with teeth-like tines released by femtosecond laser-assisted chemical etching

The quality factor(Q factor)is a crucial performance parameter for resonators.In this paper,a novel release method for highquality micro fused silica shell resonators with teeth-like tines with good surface morphology is proposed.This method is based on femtosecond laser-assisted chemical etching.First,the optimal energy range of femtosecond laser modification is obtained through mechanism analysis.Second,the optimal parameters for a straight line and arc pattern are determined by optimizing the average output power,processing speed,and processing spacing.The results demonstrate why edge breakage in rounded corners is easy under different parameters.Finally,according to these conclusions,the processing is performed on a micro fused silica shell resonator with a Q factor exceeding 6 million.In addition,subsurface damage is rare throughout the fabrication process,and the surface roughness of the released cross section reaches the nanometer level.The improved Q factor helps suppress mechanical thermal noise and reduce zero bias and zero bias drift,constituting the primary method for enhancing the performance of the resonant gyroscope.

Comparison of tympanostomy tubes for endoscopic placement in adults with otitis media with effusion

Objective:To compare the therapeutic effects of two types of tympanostomy tube,in terms of extrusion time and recurrence rate,after endoscopic ventilation tube placement in adults with otitis media with effusion.Materials and methods:The clinical data for 125 ears from 91 patients who underwent endoscopic ventilation tube placement was retrospectively reviewed.The ears included in the study were divided into groups A and B.The Shepard tube was used in all ears from group A.The T-tube was used in all ears from group B.Extrusion time and recurrence rate were recorded and statistically analyzed.Results:Group A included 103 ears(82.4%).Group B included 22 ears(17.6%).The average extrusion time for group A was significantly shorter than that for group B(160.5±106.6 days vs 274.1±120.5 days,p<0.05).No significant difference in recurrence rate was observed between groups A and B(72.8%vs 63.6%,p=0.44).Conclusion:Compared with the Shepard tube,the T-tube lasts longer in the ear drum in adult patients with otitis media with effusion.However,use of the Shepard tube,compared with use of the T-tube,does not significantly reduce the recurrence rate after extrusion.