A Prospective Comparison of Wavefront-Guided LASIK versus Wavefront-Guided PRK After Previous Keratorefractive Surgery.

PURPOSE: To compare the results of retreatment with wavefront-guided LASIK versus wavefront-guided PRK for residual refractive error following previous myopic keratorefractive surgery. METHODS: In this prospective study, 32 eyes of 28 patients after prior myopic keratorefractive surgery underwent retreatment with flap-lift wavefront-guided LASIK (n = 12) or wavefront-guided PRK (n = 20) for residual refractive error. Safety, efficacy, predictability, and wavefront outcomes were evaluated. RESULTS: At last follow-up, both LASIK and PRK retreatment resulted in similar improvement in visual acuity with respective mean ± standard deviation (SD) uncorrected distance visual acuity of -0.07 ± 0.11 logMAR and -0.06 ± 0.13 logMAR (p = 0.87). In the study, 16.7% of LASIK and 33.3% of PRK eyes gained one or more lines of best-corrected distance visual acuity (CDVA), while 16.7% and 9.5% of eyes lost one or more lines of CDVA with LASIK and PRK, respectively. One hundred % of LASIK eyes and 89.5% of PRK eyes were within ± 0.50 diopters of emmetropia. Wavefront analysis demonstrated similar reductions in total RMS error higher-order aberrations (p = 0.84) with no difference in coma, trefoil, or spherical aberration between eyes undergoing LASIK or PRK retreatment. CONCLUSION: Wavefront-guided LASIK and wavefront-guided PRK following previous keratorefractive surgery demonstrate similar safety, efficacy, and predictability with comparable wavefront outcomes.

Rescue technique for a partially expulsed descemet membrane endothelial keratoplasty (DMEK) graft.

PURPOSE: To describe a novel surgical technique to rescue a partially expulsed DMEK graft after insertion. OBSERVATIONS: We present a case of a 66-year-old woman with visually significant Fuchs endothelial dystrophy who underwent a DMEK surgery complicated by partial expulsion of the DMEK graft during insertion. To rescue the graft, MicroSurgical Technology (MST) forceps were inserted through a nasal paracentesis to grasp the DMEK graft and redirect it back into the anterior chamber. The surgical technique and postoperative outcomes are described. The partially expulsed graft was centered and attached successfully during surgery. Postoperatively, the patient required two rebubbling procedures, but achieved best-corrected visual acuity of 20/20 vision 1 month after surgery. CONCLUSIONS: and Importance: We describe an underreported complication and present a novel rescue technique for a partially expulsed DMEK graft that is effective and minimizes manipulation of the graft.

Management of Complex Epithelial Ingrowth After Laser In Situ Keratomileusis Using Fibrin Tissue Glue.

OBJECTIVES: To evaluate the efficacy and safety of adjunctive fibrin tissue glue in the treatment of complex epithelial ingrowth after laser in situ keratomileusis (LASIK). METHODS: A retrospective review was performed of 12 eyes in 12 patients treated for clinically significant epithelial ingrowth after LASIK with mechanical debridement of the ingrowth and placement of fibrin tissue glue. Primary outcome measurements including recurrence of ingrowth, visual acuity, and manifest refraction were evaluated at each postoperative examination. Changes in higher-order aberrometry were also evaluated. RESULTS: After epithelial ingrowth removal with adjunctive fibrin tissue glue, 11 eyes (91.7%) had no recurrence of ingrowth at the final follow-up examination. Uncorrected distance visual acuity changed from 20/20 or better in 3 eyes (25%) and 20/40 or better in 6 eyes (50%) preoperatively to 20/20 or better in 5 eyes (41.7%) and 20/40 or better in 10 eyes (83.3%) postoperatively. Nine eyes (75%) gained one or more lines of best-corrected distance visual acuity (CDVA). No eyes lost any lines of CDVA. There was no significant change in mean spherical equivalent (P=0.22) or mean cylinder (P=0.26) before and after surgery. Higher-order aberrations also remained stable with no significant change in root-mean-square error, coma, trefoil, and spherical aberration. There were no complications associated with the treatment. CONCLUSIONS: Adjunctive fibrin tissue glue seems to be a safe and effective treatment for epithelial ingrowth after LASIK. This therapy may be particularly useful in managing challenging cases of complex or recalcitrant ingrowth.

Comparison of femtosecond and excimer laser platforms available for corneal refractive surgery.

PURPOSE OF REVIEW: The evolution of laser technology has left today's refractive surgeon with a choice between multiple laser platforms. The purpose of this review is to compare currently available femtosecond and excimer laser platforms, providing a summary of current evidence. RECENT FINDINGS: Femtosecond lasers create LASIK flaps with better accuracy, uniformity, and predictability than mechanical microkeratomes. Newer higher-frequency femtosecond platforms elicit less inflammation, producing better visual outcomes. SMILE achieved similar safety, efficacy, and predictability as LASIK with greater preservation of corneal nerves and biomechanical strength. The emergence of wavefront technology has resulted in improved excimer laser treatments. Comparisons of wavefront-guided and wavefront-optimized treatments suggest that there is an advantage to using wavefront-guided platforms in terms of visual acuity and quality of vision. Topography-guided ablations are another well tolerated and effective option, especially in eyes with highly irregular corneas. SUMMARY: Advances in femtosecond and excimer laser technology have not only improved the safety and efficacy of refractive procedures, but have also led to the development of promising new treatment modalities, such as SMILE and the use of wavefront-guided and topography-guided ablation. Future studies and continued technological progress will help to better define the optimal use of these treatment platforms.

Measuring surface dislocation nucleation in defect-scarce nanostructures.

Linear defects in crystalline materials, known as dislocations, are central to the understanding of plastic deformation and mechanical strength, as well as control of performance in a variety of electronic and photonic materials. Despite nearly a century of research on dislocation structure and interactions, measurements of the energetics and kinetics of dislocation nucleation have not been possible, as synthesizing and testing pristine crystals absent of defects has been prohibitively challenging. Here, we report experiments that directly measure the surface dislocation nucleation strengths in high-quality 〈110〉 Pd nanowhiskers subjected to uniaxial tension. We find that, whereas nucleation strengths are weakly size- and strain-rate-dependent, a strong temperature dependence is uncovered, corroborating predictions that nucleation is assisted by thermal fluctuations. We measure atomic-scale activation volumes, which explain both the ultrahigh athermal strength as well as the temperature-dependent scatter, evident in our experiments and well captured by a thermal activation model.

Continuous wireless pressure monitoring and mapping with ultra-small passive sensors for health monitoring and critical care.

Continuous monitoring of internal physiological parameters is essential for critical care patients, but currently can only be practically achieved via tethered solutions. Here we report a wireless, real-time pressure monitoring system with passive, flexible, millimetre-scale sensors, scaled down to unprecedented dimensions of 1 × 1 × 0.1 cubic millimeters. This level of dimensional scaling is enabled by novel sensor design and detection schemes, which overcome the operating frequency limits of traditional strategies and exhibit insensitivity to lossy tissue environments. We demonstrate the use of this system to capture human pulse waveforms wirelessly in real time as well as to monitor in vivo intracranial pressure continuously in proof-of-concept mice studies using sensors down to 2.5 × 2.5 × 0.1 cubic millimeters. We further introduce printable wireless sensor arrays and show their use in real-time spatial pressure mapping. Looking forward, this technology has broader applications in continuous wireless monitoring of multiple physiological parameters for biomedical research and patient care.

Temperature controlled tensile testing of individual nanowires.

We present a novel experimental method for quantitatively characterizing the temperature-dependent mechanical behavior of individual nanostructures during uniaxial straining. By combining a microelectromechanical tensile testing device with a low thermal mass and digital image correlation providing nm-level displacement resolution, we show successful incorporation of a testing platform in a vacuum cryostat system with an integrated heater and temperature control. Characterization of the local sample temperature and time-dependent response at both low and high temperature demonstrates a testing range of ∼90-475 K and steady-state drift rates less than 0.04 K/min. In situ operation of the tensile testing device employing resistively heated thermal actuators while imaging with an optical microscope enables high-resolution displacement measurements, from which stress-strain behavior of the nanoscale specimens is deduced. We demonstrate the efficacy of our approach in measuring the temperature dependence of tensile strength in nominally defect-free ⟨110⟩ Pd nanowhiskers. We uncover a pronounced sensitivity of the plastic response to testing temperature over a range of ∼300 K, with an ultimate strength in excess of 6 GPa at low temperature. The results are discussed in the context of thermally activated deformation mechanisms and defect nucleation in defect-free metallic nanostructures.

Mass fabrication and delivery of 3D multilayer µTags into living cells.

Continuous monitoring of in vivo biological processes and their evolution at the cellular level would enable major advances in our understanding of biology and disease. As a stepping stone towards chronic cellular monitoring, we demonstrate massively parallel fabrication and delivery of 3D multilayer micro-Tags (µTags) into living cells. Both 10 µm × 10 µm × 1.5 µm and 18 µm × 7 µm × 1.5 µm devices containing inductive and capacitive structures were designed and fabricated as potential passive radio-frequency identification tags. We show cellular internalization and persistence of µTags over a 5-day period. Our results represent a promising advance in technologies for studying biology and disease at the cellular level.

Effect of organometallic clamp properties on the apparent diversity of tensile response of nanowires.

The influence of the experimental boundary conditions used for tensile testing of individual nanowires on the measured apparent mechanical response is reported. Using a microelectromechanical platform designed for in situ tensile testing, in combination with digital image correlation of sequences of scanning electron microscope images, the mechanical behavior of single crystalline Si, Pd, and Ge2Sb2Te5 nanowires was measured during load-unload cycles. In situ testing enables direct determination of the nanowire strain. Comparison of the direct strain with common metrics for apparent strain that include any compliance or slipping of the clamping materials (electron-beam induced Pt-containing deposits) highlights several different artifacts that may be manifested. Calculation of the contact stiffness is thus enabled, providing guidelines for both proper strain measurement and selection of clamping materials and geometries that facilitate elucidation of intrinsic material response. Our results suggest that the limited ability to tailor the stiffness of electron-beam induced deposits results from the predominance of the organic matrix in controlling its mechanical properties owing to relatively low Pt content and sparse morphology.

Lattice anharmonicity in defect-free Pd nanowhiskers.

We have investigated anharmonic behavior of Pd by applying systematic nanoscale tensile testing to near defect-free nanowhiskers offering a large range of elastic strain. We measured size-dependent deviations from bulk elastic behavior in nanowhiskers with diameters as small as ∼30 nm. In addition to size-dependent variations in Young's modulus in the small strain limit, we measured nonlinear elasticity at strains above ∼1%. Both phenomena are attributed to higher-order elasticity in the bulklike core upon being biased from its equilibrium configuration due to the role of surface stresses in small volumes. Quantification of the size-dependent second- and third-order elastic moduli allows for calculation of intrinsic material nonlinearity parameters, e.g., δ. Comparison of the size-independent values of δ in our nanowhiskers with studies on bulk fcc metals lends further insight into the role of length scales on both elastic and plastic mechanical behavior.

Isolated endogenous Nocardia endophthalmitis after immunosuppression.

PURPOSE: This study is aimed to report a case of endogenous Nocardia endophthalmitis in the setting of immunosuppression from chronic steroid use. METHODS: A case report was conducted. RESULTS: A 79-year-old woman presented with decreased vision with floaters in the left eye. Ophthalmic examination revealed severe inflammation in the anterior chamber, vitreous opacities, and retinal detachment. Vitreous cultures grew Nocardia farcinica without any systemic foci of infection found during further workup. The patient was treated with intravitreal amikacin and oral trimethoprim-sulfamethoxazole, and her retinal detachment was later repaired in the operating room. The patient has since remained stable with no signs of retinal detachment or active infection. CONCLUSIONS: Nocardia endophthalmitis is a rare, but serious intraocular infection that should be considered in the differential diagnosis in any immunosuppressed patient, including those receiving steroids, who presents with signs of intraocular infection.