Comparative study of functional optical zone:small incision lenticule extraction versus femtosecond laser assisted excimer laser keratomileusis

AIM:To investigate the size of functional optical zone(FOZ)after small incision lenticule extraction(SMILE)versus femtosecond laser assisted excimer laser keratomileusis(FS-LASIK)for myopia correction and potential associated factors for FOZ.METHODS:A total of 133 patients who received corneal refractive surgery in our hospital between November 2018 and July 2021 were retrospectively enrolled.There were 63 patients(123 eyes)in SMILE group and 70patients(139 eyes)in FS-LASIK group.The size of FOZ was measured using Pentacam 3-dementional anterior segment analyzer before and 3mo after surgery,so as to analyze postoperative achieved functional optical zone(AFOZ)and its contributing parameters.RESULTS:When planned functional optical zone(PFOZ)was 6.5 mm for both groups,AFOZ was 1.45±0.27 and 1.67±0.25 mm smaller than preoperative FOZ in SMILE group and FS-LASIK group 3mo after surgery.AFOZ in SMILE group was significantly larger than that in FS-LASIK group(P<0.001).Variation of FOZ was negatively correlated with preoperative spherical equivalent(SE)and positively correlated with variation of mean keratometry value(△Km),variation of spherical aberration(△SA),and variation of Q-value(△Q,all P<0.001)in both groups.Multiple variable linear regression equations were△FOZ=1.354-0.1×pre-SE+0.336×△Q+1.462×△SA in SMILE group and△FOZ=1.512+0.137×△Q+0.468×△SA in FS-LASIK group.CONCLUSION:AFOZ is significantly smaller than preoperative FOZ in both SMILE and FS-LASIK groups.With the same PFOZ,larger AFOZ is achieved in SMILE group than in FS-LASIK group.

Estimation of deformed laser heat sources and thermal analysis on laser assisted turning of square member

Laser assisted machining （LAM） has difficulties in estimating temperature after applying a LAM process due to its very small heat input area, large energy and movement. In particular, in the case of laser assisted turning （LAT） process, it is more difficult to estimate the temperature after preheating because it has a shape of ellipse when a laser heat source is rotated. A prediction method and thermal analysis method for heat source shapes were proposed as a square shaped member was preheated. The temperature distribution was calculated according to the rotation of the member. Compared with the results of the former study, the maximum temperature of the calculation results, 1 407.1 ℃, is 8.5 ℃ higher than that of the square member, which is 1 398.6 ℃. In a LAT process for a square member, the maximum temperature is 1 850.8 ℃. It is recognized that a laser power control process is required because square members show a maximum temperature that exceeds a melting temperature at around a vertex of the member according to the rotation.

Clinical outcomes of transepithelial photorefractive keratectomy versus femtosecond laser assisted keratomileusis for correction of high myopia in South Egyptian population

AIM: To evaluate the safety and efficacy of transepithelial photorefractive keratectomy(t-PRK) with adjuvant mitomycin C(MMC) versus femtosecond laser assisted keratomileusis(Femto-LASIK) in correction of high myopia.METHODS: Prospective randomized comparative study including 156 eyes of 156 patients with high myopia and a spherical equivalent refraction(SER) <-6.00 D. They were divided randomly into two groups: Group A included 72 eyes treated with t-PRK with adjuvant MMC and Group B included 84 eyes treated with Femto-LASIK. Visual acuity, SER, corneal topography, pachymetry and keratometry were assessed for 12 mo postoperatively.RESULTS: The preoperative mean SER was-8.86±1.81 and-9.25±1.70 D in t-PRK MMC group and Femto-LASIK respectively(P=0.99) which improved to-0.65±0.43 D and-0.69±0.50 D at 12 mo follow up. Mean SER remained stable during the 12 mo of follow-up, with no statistically significant difference between the two groups(P=0.64). In t-PRK MMC group, only six eyes needed retreatment after six months of follow up. And two eyes showed haze(one reversible haze grade 2, while the other had dense irreversible haze grade 4).CONCLUSION: t-PRK MMC provides safe and satisfactory visual outcomes and acceptable risk as Femto-LASIK in patients with high myopia.

Prediction of preheating conditions for inclined laser assisted machining

For laser assisted machining,shape of preheating laser heat source is changed irregularly because of complexity of material shape.So,the preheating temperature should be controlled by adjusting the feed rate or the laser power.Thermal analyses of the laser assisted machining process for inclination planes were performed.By analyzing the obtained temperature profile,a proper feed rate control method was proposed according to the inclination angles.In addition,the temperature distribution of the cross section after feed rate control was predicted.The correlation equation between inclination angles and adjusted proper feed rate was proposed.The results of this analysis can be used to predict the preheating effect on workpiece and can be applied as a preheating temperature control method in laser assisted machining processes.

Optical and visual quality comparison of implantable collamer lens and femtosecond laser assisted laser in situ keratomileusis for high myopia correction

AIM:To compare clinical outcomes and refractive stability of implantable collamer lens(ICL)implantation and femtosecond laser assisted laser in situ keratomileusis(FSLASIK)for high myopia correction.METHODS:The Optical Quality Analysis System(OQAS)was used to evaluate clinical outcomes objectively after operation for high myopia correction.We compared the two procedures in terms of 1-year changes in uncorrected distance visual acuity(UDVA),corrected distance visual acuity(CDVA),safety index,efficacy index,spherical equivalent,modulation transfer function(MTF)cutoff frequency,strehl ratio(SR)and objective scatter index(OSI).RESULTS:At 1 y postoperatively,the safety indices were 1.33±0.27 in ICL group,and 1.17±0.24 in FS-LASIK group.39.58%in the ICL group and 27.59%in the FS-LASIK group gained CDVA in 2 lines or better than that in preoperative CDVA.The efficacy indices were 1.28±0.22 in ICL group,and 1.13±0.26 in FS-LASIK group.The changes of spherical equivalent from 1 wk to 1 y postoperatively was-0.12±0.37 D in ICL group,and-0.79±0.58 D in FS-LASIK group(P<0.05).Spherical equivalent within±0.50 D was achieved in 97.92%in ICL group and 68.97%in FS-LASIK group.MTF cutoff frequency were higher with ICL as compared to FSLASIK(P<0.05)at each postoperative follow-up stage;for postoperative 1 mo later,SR was statistically significant difference between two groups(P<0.05);with no statistically significant difference in OSI between two groups(P>0.05)in postoperative 3 mo later.CONCLUSION:ICL implantation and FS-LASIK procedures both provide good safety and predictability in high myopia correction.ICL implantation provides better clinical outcomes and refractive stability than FS-LASIK.

Design and Implementation of a System for Laser Assisted Milling of Advanced Materials

Laser assisted machining is an effective method to machine advanced materials with the added benefits of longer tool life and increased material removal rates. While extensive studies have investigated the machining properties for laser assisted milling（LAML）, few attempts have been made to extend LAML to machining parts with complex geometric features. A methodology for continuous path machining for LAML is developed by integration of a rotary and movable table into an ordinary milling machine with a laser beam system. The machining strategy and processing path are investigated to determine alignment of the machining path with the laser spot. In order to keep the material removal temperatures above the softening temperature of silicon nitride, the transformation is coordinated and the temperature interpolated, establishing a transient thermal model. The temperatures of the laser center and cutting zone are also carefully controlled to achieve optimal machining results and avoid thermal damage. These experiments indicate that the system results in no surface damage as well as good surface roughness, validating the application of this machining strategy and thermal model in the development of a new LAML system for continuous path processing of silicon nitride. The proposed approach can be easily applied in LAML system to achieve continuous processing and improve efficiency in laser assisted machining.

NC code generation for laser assisted turn-mill of various type of clovers and square section members

Laser assisted turning （LAT） is one of the advanced machining technologies, which uses laser power to heat the surface of a workpiece before the material is removed. It has several advantages of low manufacturing costs, high productivity and high qualities to machine difficult-to-cut materials such as silicon nitride, muUite, zirconia and Ni. A large part of studies on LAT have been focused on a round bar. With increasing demands for high quality products and high performance engineering system, the researches on LAT for clover and square section members are necessary. But, these workpieces are impossible to be machined on conventional CNC lathe and to generate NC code with current CAM softwares. As a basic research for combining LAT with a tilting index table type 5-axis machining center, i.e. laser assisted turn-mill, a new method is suggested to generate NC code that can process various types of clover and square section members through development of C＋＋ program.

Dislocation,fold and striae of comeal flap with laser assisted in situ keratomileusis after ocular trauma:a case report

Objective： To report the occurrence, management and outcome ot late-onset traumauc aemscence ana dislocation of laser assisted in situ keratomileusis （LASIK） flaps. Treatment and Results： One patient occurred late-onset LASIK corneal flap dislocation after ocular trauma 7days after surgery. The flap was lifted, stretched, and repositioned after irrigation and scraping of the stromal bed and the underside of the flap. A bandage contact lens was placed, and topical antibiotic and corticosteroids were given postoperatively. The dislocated corneal flap was successfully repositioned in the case. The dislocated flap was repositioned 7 days after the trauma, and the patient recovered his uncorrected visual acuity （UCVA） of 10/20, 20/20 day 1 and day 20 after the procedure, of 20/20 20 days later and had a well-positioned flap with a clear interface. Diffuse lamellar keratitis developed in the patients that resolved with the use of topical corticosteroids. Conclusion： Laser in situ keratomileusis corneal flaps are vulnerable to traumatic dehiscence and dislocation, which should be pay more attention to it for us.

Above-average defocus curves in photopic and mesopic vision with multifocal intraocular lenses after laser assisted in situ keratomileusis

I am Dr. David P Pifiero from the Department of Optics, Pharmacology and Anatomy of the University of Alicante and from the Department of Ophthalmology of Vithas Medimar （Oftalmar） and Vithas Virgen del Carmen （Qvision） hospitals in Spain.

Nasopharyngeal Obstruction: A Rare Post Laser Assisted Tonsillectomy Complication

Tonsillectomy once was a most common ENT procedure, being referred in past as the “bread and butter of otorhinolaryngologists” though not so commonly performed these days. The usual complications of this procedure have been haemorrhage-primary/reactionary/secondary, infection, tonsillar bed structures injury, and even death. With the advent of newer technologies like lasers, microdebriders, coblators, harmonic scalpel, radiofrequency, newer complications also arise. This case report focuses on one such complication of laser assisted tonsillectomy, not much spoken of in books.

High performance micromachining of sapphire by laser induced plasma assisted ablation(LIPAA)using GHz burst mode femtosecond pulses

GHz burst-mode femtosecond(fs)laser,which emits a series of pulse trains with extremely short intervals of several hundred picoseconds,provides distinct characteristics in materials processing as compared with the conventional irradiation scheme of fs laser(single-pulse mode).In this paper,we take advantage of the moderate pulse interval of 205 ps(4.88 GHz)in the burst pulse for high-quality and high-efficiency micromachining of single crystalline sapphire by laser induced plasma assisted ablation(LIPAA).Specifically,the preceding pulses in the burst generate plasma by ablation of copper placed behind the sapphire substrate,which interacts with the subsequent pulses to induce ablation at the rear surface of sapphire substrates.As a result,not only the ablation quality but also the ablation efficiency and the fabrication resolution are greatly improved compared to the other schemes including single-pulse mode fs laser direct ablation,single-pulse mode fs-LIPAA,and nanosecond-LIPAA.

Differences in energy and corneal endothelium between femtosecond laser-assisted and conventional cataract surgeries：prospective,intraindividual,randomized controlled trial

AIM： To compare intraoperative phacoemulsification parameters and its effect on the corneal endothelium of eyes undergoing femtosecond laser-assisted cataract surgery（FLACS） versus conventional phacoemulsification（CP） cataract surgery.METHODS： Two hundred eyes from one hundred patients were included in a prospective, non-blinded, randomized, controlled, intraindividual clinical study. One hundred eyes underwent FLACS while their one hundred fellow eyes underwent CP. All surgeries were performed using the Victus？ femtosecond laser platform and Infinity？ Vision System phacoemulsification machine. Primary outcome measure was endothelial cell density 6 mo after surgery. Secondary outcome measures included central corneal thickness（CCT）, average cell area, standard deviation, coefficient of variation and hexagonality before surgery and 6 mo after surgery and endothelial cell density loss during this period were also evaluated. Intraoperative efficiency parameters [cumulative dissipated energy（CDE）, total intraocular surgery time, total ultrasound time, total phacoemulsification time, total torsional energy time, total aspiration time, ultrasound energy, torsional amplitude and fluid required during surgery] were also collated. RESULTS： Data from these patients was not considered for analysis. Data from 92 patients were analysed. Postoperative endothelial cell density（cells/mm2） between groups（2211.88±392.49 CP; 2246.31±403.48 FLACS） was not statistically significant（P=0.869）. Total ultrasound time, torsional energy time, CDE and fluid requirements were significantly lower the FLACS group（P〈0.05）. Other parameters did not show statistically significant difference between FLACS and CP.CONCLUSION： FLACS displays significant improvements in phacoemulsification parameters in comparison to CP. There are no significant differences in corneal endothelium measures between FLACS and CP.

Human lens epithelial cell apoptosis and epithelial to mesenchymal transition in femtosecond laser-assisted cataract surgery

AIM： To evaluate human lens epithelium cell apoptosis and epithelial to mesenchymal transition （EMT） induced by femtosecond laser in femtosecond laser assisted cataract surgery （FLACS）. METHODS： Sixty cataract patients with N2 to N3 stage according to the LOCS III were enrolled in this study and divided into three groups randomly： FLACSl group （cataract surgery by FLACS with LenSx）, FLACS2 group （cataract surgery by FLACS with LensAR） and manual group （cataract surgery by phacoemulsification）. Patients in two FLACS groups performed anterior capsulotomy by LenSx or LensAR laser system. Patients in the manual group were performed continuous curvilinear capsulorrhexis （CCC） manually. The anterior capsules were fixed right after moved out of eye. Hematoxylin-eosine staining, immunofluorescence staining and real-time PCR were performed in order to observe human lens epithelium cells changes after cataract surgery. RESULTS： The capsule cutting edge was shown irregularity and roughness in two FLACS groups and smooth edge in manual capsulotomy by pathologic staining. Irregularities of the cell configuration with partly swollen and destroyed nuclei were observed in two FLACS groups. Femtosecond laser could induce a significantly higher cell apoptosis in human lens epithelium cell than manually performed CCC （P〈0.05）. Lens epithelium cells apoptosis were correlated with femtosecond laser duration according to Pearson correlation analysis. Decreased N-cadherin expression, alpha-SMA and FSP-1 level in two FLACS groups showed the inhibition of cell EMT. CONCLUSION： Femtosecond laser may affect the apoptosis and EMT of lens epithelium cells which are under the peeled central lens capsule.

Improvement of Surface Morphology of Yttrium-Stabilized Zirconia Films Deposited by Pulsed Laser Deposition on Rolling Assisted Biaxially Textured Substrate Tapes

The surface morphology of buffer layer yttrium-stabilized zirconia （YSZ） of YBa2CuaO7-σ （YBCO） high temperature superconducting films relies on a series of controllable experimental parameters. In this work, we focus on the influence of pulsed laser frequency and target crystalline type on surface morphology of YSZ films deposited by pulsed laser deposition （PLD） on rolling assisted biaxially textured substrate tapes. Usually two kinds of particles are observed in the YSZ layer： randomly distributed ones on the whole film and self-assembled ones along grain boundaries. SEM images are used to prove that particles can be partly removed when choosing dense targets of single crystalline. Lower frequency of pulsed laser also contributes to a smoother film surface. TEM images are used to view the crystalline structure of thin film. Thus we can obtain a basic understanding of how to prepare a particle-free YSZ buffer layer for YBCO in optimized conditions using PLD. The YBCO layer with nice structure and critical current density of around 5 MA/cm2 can be reached on smooth YSZ samples.

Prediction and Analysis of Surface Quality of Northeast China Ash Wood during Water-Jet Assisted CO_(2) Laser Cutting

As a natural and environmentally friendly renewable material,Northeast China ash wood(NCAW)(Fraxinus mandshurica Rupr.)was cut by water-jet assisted CO_(2) laser(WACL),the surface quality was evaluated by surface roughness of cut section.The surface roughness was measured by three-dimensional(3D)profilometry.Furthermore,the micromorphology of machined surface was observed by scanning electronic microscopy(SEM).Carbon content changes of machined surface were measured by energy dispersive spectrometer(EDS).A relationship between surface roughness and cutting parameters was established using response surface methodology(RSM).It is concluded that the cutting speed,laser power and water pressure played an important role in surface roughness of cut section.The surface roughness increased as an increase in laser power.It decreased caused by increasing of cutting speed and water pressure.Measurements revealed that the surface quality of NCAW part was improved using the optimized combination of cutting parameters.The established quadratic mathematical model of a good prediction is helpful for matching suitable cutting parameters to obtain expected surface quality.

Early results of circularity and centration of capsulotomy prepared by three different methods

AIM:To compare the difference of capsulotomy produced by precision pulse capsulotomy(PPC),manual(M-CCC),and femtosecond laser assisted capsulotomy(FLAC)in relation to intraocular lens(IOL)centration,circularity and its effect on visual outcomes.METHODS:Prospective,non-randomized comparative study conducted at LV Prasad Eye Institute,Hyderabad,India.Sixty eyes of 52 patients were grouped into 3(FLAC,PPC and M-CCC)based on capsulotomy techniques used.Twenty consecutive eyes with uneventful phacoemulsification and with no comorbidities affecting the capsulotomy or visual outcome were included in each group.The main outcome measure was IOL centration in relation to capsulotomy and pupil.Secondary outcome measures were post-operative visual acuity,manifest refraction and aberration profile between groups.RESULTS:At 5 wk the visual,refractive outcomes and endothelial cell density were comparable between the 3 groups.The median circularity index of FLAC was statistically significantly different to M-CCC or PPC(1-10)groups(P<0.01)but PPC(11-20)was comparable to FLAC.Decentration of IOL center in relation to capsulotomy was seen only between the PPC(1-10)group and FLAC group(P=0.02).The IOL was well centered in relation to the pupil in all the groups(P=0.46).The quality of vision parameters like the higher order aberrations,spherical aberration,coma,trefoil,modular transfer function,and Strehl ratio were comparable between the groups.CONCLUSION:Our study shows that despite differences in the morphology of capsulotomy produced by PPC,M-CCC,FLAC a well-centered IOL can be achieved.The measured capsular morphology parameters do not affect visual outcomes.

Visual outcomes after three different surgical procedures for correction of refractive error in patients with thin corneas

AIM:To investigate and compare the visual and refractive outcomes of small incision lenticule extraction(SMILE),laser assisted sub-epithelial keratomileusis(LASEK),and LASEK combined with corneal collagen cross-linking(LASEKCXL)surgery in patients with less than 500μm of central corneal thickness(CCT).METHODS:The retrospective medical records review was conducted on the patients with CCT less than 500μm treated with SMILE,LASEK,and LASEK-CXL.There was a total of 172 eyes,76 eyes were in the SMILE group,53 eyes in the LASEK group,and 43 eyes in the LASEK-CXL group.Uncorrected distance visual acuity(UDVA),spherical equivalent refraction(SE),and corneal haze were followed up in the three groups for 12 mo.RESULTS:At 12 mo postoperatively,there were no statistically significant differences in UDVA and in the absolute value of SE between the three groups.The predictability within±0.50 D in the SMILE group(85.5%)was significantly higher than in both the LASEK group(64.2%,P<0.01)and the LASEK-CXL group(69.8%,P=0.04).The efficacy index and safety index were not significantly different among the three groups.Corneal haze at 12 mo postoperatively was higher in the LASEK-CXL group(27.9%)than in the SMILE group(2.6%,P<0.01)and in the LASEK group(7.5%,P<0.01).CONCLUSION:In patients with CCT less than 500μm,SMILE,LASEK,and LASEK-CXL appear to be effective for myopic correction.Among them,SMILE surgery shows the highest predictability.

MALDI-TOF-MS法对重组人内皮抑素蛋白分子质量测定

肿瘤的生长依赖于血管的生成,新生血管不仅为肿瘤生长提供必需的营养物质,而且为肿瘤细胞扩散提供了重要的途径[1].1997年哈佛大学的O'Reilly等[2]发现了一种内源性新血管生成抑制因子内皮抑素(Endostatin),显示出特异抑制激活的血管内皮细胞增殖和肿瘤新血管生成的生物学活性,其抗肿瘤作用具有高效、低毒、无耐药性的优点.……

Safety of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification for cataract:A meta-analysis and systematic review

Purpose:To compare the complications of femtosecond laser-assisted cataract surgery(FLACS)with those of conventional phacoemulsification surgery(CPS)for age-related cataracts.Methods:PubMed,Cochrane Library,and EMBASE were systematically searched for studies comparing FLACS and CPS.Outcomes were operative complications,including the intraoperative capsule tear,postoperative corneal edema,macular edema,uncontrolled IOP,etc.The effect measures were weighted with odds ratios with 95%CIs.Results:Nineteen RCTs and 18 cohort studies,including 24,806 eyes(11,375 of the FLACS group and 13,431 of the CPS group),were identified.There were no significant differences between the two groups in anterior capsule tear,corneal edema,macular edema,uncontrolled IOP,vitreous loss,posterior vitreous detachment,etc.Posterior capsule tear rate showed a significantly lower in RCT subgroups(P=0.04)and without differences in total(P=0.63).Significant differences were observed in the incidence of descemet membrane tear/trauma(P=0.02)and IFIS/iris trauma(P=0.04.Additionally,The FLACS specific complications showed a significantly higher rate of miosis(P=0.0001),corneal epithelial defect(P=0.001),corneal haze(P=0.002),and subconjunctival hemorrhage(P=0.01).Conclusions:FLACS maintains the same safety compared with CPS in terms of all intraoperative and postoperative complications.Although FLACS did show a statistically significant difference for several FLACS specific complications,it would not influence the visual outcome and heal itself.

Identification of differentially expressed proteins in poplar leaves in-duced by Marssonina brunnea f. sp. Multigermtubi

Black spot disease in poplar is a disease of the leaf caused by fungus. The major pathogen is Marssonina brunnea f. sp. multigermtubi. To date, little is known about the molecular mechanism of poplar （M. brunnea） interaction. In order to identify the proteins related to disease resistance and understand its molecular basis, the clone ＂NL895＂ （P. euramericana CL＂NL895＂）, which is highly resistant to M. brunnea f. sp. multigermtubi, was used in this study. We used two-dimensional gel electrophoresis （2-DE） and mass spectrometry （MS） to identify the proteins in poplar leaves that were differentially expressed in response to black spot disease pathogen, M. brunnea f. sp. multigermtubi. Proteins extracted from poplar leaves at 0, 12, 24, 48, and 72 h after pathogen-inoculation were separated by 2-DE, About 500 reproducible protein spots were detected, of which 40 protein spots displayed differential expression in levels and were subjected to Matrix assisted laser desorption/ionization time of flight mass spectrometry （MALDI-TOF MS） followed by database searching. According to the function, the identified proteins were sorted into five categories, that is, protein synthesis, metabolism, defense response and unclassified proteins.