Study on the biological properties of SMILE-derived corneal stromal lenticules after long-term cryopreservation in nutrient capsules.

PURPOSE: To investigate the long-term preservation effects of nutrient capsules on the physiological activity, collagen fiber structure and transmittance of corneal stromal lenticules derived from small incision lenticule extraction (SMILE). METHODS: A new nutrient capsule was constructed for long-term preservation of SMILE-derived corneal stromal lenticules. The lenticules were randomly divided into 99% anhydrous glycerol, and hydrogel nutrient capsules. After preserving for 1 year at -80 °C, lenticules were compared with fresh lenticules. The optical transmittance, tissue morphology, ultrastructure, cells activity and immunogenicity of the lenticules was detected and compared between different groups. RESULTS: The rate of apoptotic cells was significantly higher in the glycerol group compared with the nutrient capsule group (P < 0.0001). More viable cells were present in the lenticules after nutrient capsule preservation compared to the glycerol group (P = 0.0003). The mean transmittance of the lenticules in the glycerol group (50 ± 18%) was significantly lower (P = 0.0008) compared to the control group (75 ± 11%), and the lenticules transmittance of the nutrient capsule group (64 ± 15%) after long-term preservation was not significantly different (P = 0.23) compared to the control group. The structure of HE staining showed that the collagen fibers in the nutrient capsule group were arranged in parallel and neatly, and a few cavitation vesicles were visible inside the tissue. There was no significant difference in the number of lenticular collagen fibers in the nutritional capsule group compared to the fresh lenticule group (P = 0.06). HLA-DR, HLA-ABC, CD45, CD25 and CD69 expression was low in all groups of lenticules after preservation. CONCLUSIONS: Nutrient capsules can preserve lenticules for a long time and maintain the transmission structure and cells activity of lenticules.

Self-starting high-order mode oscillation fiber laser.

In this paper, we proposed and demonstrated two kinds of all few-mode fiber lasers with self-starting high-order mode (HOM) oscillation. The fundamental mode can be completely suppressed by using a bandpass filter with a few-mode fiber pigtail. In the continuous-wave (CW) regime, the fiber laser directly oscillates in HOM with a signal-to-noise ratio as high as 70 dB, and the slope efficiency is up to 46%. The self-starting HOM mode-locked pulse can be easily achieved by employing a saturable absorber. The HOM oscillation pulsed fiber laser stably operates at 1063.72 nm with 3dB of 0.05 nm, which can deliver cylindrical vector beams with a high mode purity of over 98%. To our knowledge, this is the first demonstration for self-starting HOM direct oscillation in stable CW and pulsed operation states without additional adjustment. This compact and stable HOM fiber laser with a simple structure can have important applications in materials processing, optical trapping, and spatiotemporal nonlinear optics. Moreover, this work may offer a promising approach to realizing high-power fiber laser with arbitrary HOMs stable output.

All-fiber bidirectional mode-locked laser to generate cylindrical vector beam asynchronous noise-like pulses.

We proposed and demonstrated a bidirectional mode-locked fiber laser to generate cylindrical vector beam (CVB) asynchronous pulses based on a graded index multimode fiber. A homemade fused taper two-mode fiber optical coupler (TMF-OC) is employed as a mode converter. The central wavelength for clockwise (CW) pulses can be tuned from 1030.32 nm to 1041.04 nm due to the filtering effect based on multimode interference, that of counterclockwise (CCW) pulses is from 1030.81 nm to 1039.28 nm. When the central wavelengths are 1033.22 nm and 1032.71 nm for CW direction and CCW direction respectively, CVB asynchronous noise-like pulses with a repetition rate difference of ∼436.9 Hz can be obtained. The purity of CVB in CW direction and CCW direction is 95.7% and 93.4% respectively. This bidirectional mode-locked fiber laser with CVB output can be better applied to laser gyroscopes, asynchronous sampling, and dual-comb technique, and impel the interdisciplinary studies in the future.

Generation of cylindrical vector beams in a linear cavity mode-locked fiber laser based on nonlinear multimode interference.

In this paper, a linear cavity mode-locked pulsed fiber laser generating cylindrical vector beams (CVBs) is proposed and demonstrated based on a nonlinear multimode interference. A homemade long-period fiber grating with a broad bandwidth of 121 nm is used as a mode converter inside the cavity. The saturable absorber was formed by single-mode fiber-graded index multimode fiber-single mode fiber (SMF-GIMF-SMF) structure. By controlling the pump power, the operation states are switchable among continuous-wave, Q-switched mode-locked (QML), and mode-locked regimes. The repetition rate of the QML CVB pulse envelope varies from 57.4 kHz to 102.7 kHz at the pump range of 118 to 285 mW. When increasing pump power to 380 mW, mode-locked CVB pulse repetition rate of 3.592 MHz, and pulse duration of 4.62 ns are achieved. In addition, the maximum single-pulse envelope energy can reach 510 nJ, and 142 mW average-power CVBs with a slope efficiency of as high as 20.2% can be obtained. Moreover, azimuthally and radially polarized beams can be obtained with mode purity over 95% in different operating regimes. The proposed fiber laser has a simple structure, and the operation is controllable in both temporal and spatial domains, which presents a flexible pulsed CVB source for application of laser processing, time or mode division multiplexing system, and spatiotemporal nonlinear optics.

High-efficiency mode-locked fiber laser with a switchable oscillating transverse mode in an all few-mode fiber linear cavity.

In this paper, an oscillating transverse mode switchable mode-locked fiber laser with a few-mode fiber linear cavity is proposed and demonstrated. An artificial filter is used to realize the mode gain modulation of the laser. The stable mode-locked pulsed operation with switchable wavelength is easily achieved and the oscillating transverse mode can be flexibly switched between the fundamental mode and high-order mode by adjusting the polarization controller. The mode-locked fiber laser directly oscillates in the high-order mode stably with a slope efficiency of as high as 12%, and the corresponding operating wavelength, repetition rate as well as pulse duration are 1054.07 nm, 22.662 MHz, 31.5 ps, respectively. Besides, a cylindrical vector beam with a high mode purity of 98.6% is obtained by removing the degeneracy of the LP11 mode. This compact and high-efficiency mode-locked fiber laser operating in switchable transverse mode has the potential application for laser processing, particle trapping, bioimaging, and mode division multiplexing system.

Tailoring the spectrum and spatial mode of Yb-doped random fiber laser.

In this paper, we make a comprehensive study on tailoring the spectrum and transverse mode of random fiber lasers (RFLs). By simply temperature tuning, the mode gain profile of RFL can be flexibly and precisely manipulated. The spectrum of laser output can be easily tailored in single-wavelength, dual-wavelength, and three-wavelength, respectively. Meanwhile, the operating transverse mode is also optional among LP01 mode, LP11 mode, and hybrid mode. The slope efficiency of 17.9% and 27.3% are obtained for LP11 mode and LP01 mode operation, respectively. Besides, the coherence control can be confirmed by making speckle contrast measurements. This high-efficiency RFL with the customizable spectrum and spatial mode would have unique applications in wavelength or mode division multiplexing systems, speckle-free imaging, secure communication, and information encryption.

High-power cylindrical vector beam fiber laser based on an all-polarization-maintaining structure.

We propose and demonstrate an all-polarization-maintaining (PM) high-power cylindrical vector beam (CVB) fiber laser based on the principle of mode superposition. The non-degenerated LPy 11a is generated from the oscillator with the maximum power of 11.9W, whose slope efficiency is 24.4%. Then the stable single TE01 vector beam is achieved by the superposition of LPy 11a and LPx 11b in an all-PM architecture, its output power is 3.1W and mode purity of 91.2%. Due to the all-PM architecture, our configuration is free of adjusting polarization controller (PC) and reliable during long-term operation. This laser could be used as a high-power CVBs source for a wide range of applications towards scientific research and industrial field.

Effects of tilt and decentration of Visian Implantable Collamer Lens (ICL V4c) on visual quality: an observational study.

BACKGROUND: The central hole of the Visian Implantable Collamer Lens (ICL V4c) provides a reference to observe its tilt or decentration. This study aimed to investigate the tilt and decentration effects of ICL V4c on visual quality after implantation. METHODS: A total of 135 eyes from 69 patients who underwent ICL V4c implantation were included in this study. Evaluation of uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and aberrations were performed 6-months postoperatively. The anterior segment parameters were collected using CASIA2 anterior segment-optical coherence tomography, tilt and decentration of ICL V4c were analyzed using MATLAB software. All patients received questionnaires to investigate the visual quality postoperatively. RESULTS: The safety and effectiveness were 1.18 ± 0.17 and 1.11 ± 0.18, respectively. No significant changes were observed regarding higher-order and spherical aberrations after the operation; however, coma and trefoil significantly increased compared to preoperative values. The average total decentration and tilt was 0.21 ± 0.12 mm and 2.54 ± 1.00°, respectively. Horizontal, vertical, and total values of tilt and decentration were not significantly associated with postoperative CDVA, UDVA, and aberrations. The most common visual symptom was halo, and 97.04% of patients had a satisfaction score ≥ 8. The total or horizontal tilt was significantly positively correlated with the frequency, severity, and bothersome scores from the questionnaires. CONCLUSIONS: ICL V4c implantation can obtain high visual quality and patient satisfaction. Although the degree of tilt and decentration after ICL V4c implantation was small, a positive effect on subjective visual quality was observed.

Visual outcomes after small incision lenticule extraction and implantable collamer lens V4c for moderate myopia: 1-year results.

PURPOSE: To compare 1-year visual outcomes after implantable collamer lens V4c (EVO-ICL) implantation and small incision lenticule extraction (SMILE) for moderate myopia. METHODS: In this retrospective study, 67 eyes of 39 patients with a preoperative manifest refraction spherical equivalent between - 3.00 and - 6.00 diopters (D) were selected from a database of SMILE and ICL implantation procedures performed from April 2018 to December 2018. Thirty-two eyes of 20 patients underwent EVO-ICL implantation, and 35 eyes of 19 patients underwent SMILE. At the routine 1-year follow-up appointment, all selected patients were examined for higher-order ocular aberrations, retinal image quality, and a quality of vision (QoV) questionnaire. This data was then analyzed. RESULTS: No complications were observed. Uncorrected and corrected visual acuities at 1 year after surgery were - 0.13 ± 0.07 and - 0.15 ± 0.06 logMAR in the SMILE group, and - 0.10 ± 0.07 and - 0.16 ± 0.05 logMAR in the ICL group. Twenty-nine eyes (90.6%) which underwent ICL implantation and 34 eyes (97.1%) which underwent SMILE were within ± 0.5 D of the attempted spherical equivalent (P = 0.49). Changes in coma after ICL were significantly less than after SMILE (P = 0.002). The leading complaints after ICL and SMILE were halos (84.4%) and blurred vision (65.7%), respectively. CONCLUSIONS: Both SMILE and ICL implantation provided good safety, efficacy, and predictability in correcting moderate myopia. The subjective visual complaints consisted mainly of halos after ICL and starbursts and blurred vision after SMILE.

Ophthalmic services in Shanghai 2017: a cataract-centric city-wide government survey.

BACKGROUND: Demand for eye care has increased in recent decades in China due to rapid socioeconomic development and demographic shift. Knowledge of output and productivity of ophthalmic services would allow policymakers to optimize resource allocation, and is therefore essential. This study sought to map the landscape of ophthalmic services available in Shanghai, China. METHODS: In 2018, a government-led survey was conducted of all 86 tertiary/secondary hospitals and five major private hospitals providing eye care in Shanghai in the form of electronic questionnaire, which encompassed ophthalmic services (outpatient and emergency room [ER] visit, inpatient admissions, and surgical volume) and service productivity in terms of annual outpatient and ER visits per doctor, inpatient admissions per bed, and surgical volume per doctor. Comparisons were made among different levels of hospitals with categorical variables tested by Chi-square analysis. RESULTS: The response rate was 85.7%. The Eye and Ear, Nose, and Throat (EENT) Hospital was the largest tertiary specialty hospital, and alone contributed to the highest 21.0% of annual ophthalmic outpatient and ER visits (visits per doctor: 5460), compared with other 26 tertiary hospitals, 46 secondary hospitals and five private hospitals (visits per doctor: 3683, 4651 and 1876). The annual inpatient admission was 20,103, 56,992, 14,090, and 52,047 for the EENT Hospital, all the other tertiary hospitals, secondary hospitals and five private hospitals, respectively. Turnover rates were highest for the EENT Hospital and private hospitals. The average surgical volume at the EENT Hospital was 72,666, exceeding that of private (15,874.8) and other tertiary hospitals (3366.7). The EENT Hospital and private hospitals performed 16,982 (14.2%) and 55,538 (46.6%) of all cataract surgeries. Proportions of both complicated cataractous cases and complicated cataract surgeries at the EENT Hospital was the highest, followed by other tertiary and secondary/private hospitals (P < 0.0001). CONCLUSIONS: In Shanghai, public providers dominate ophthalmic services especially for complicated cases, with almost one fifth of services provided by the EENT Hospital alone, while private sectors, though not large in number, still effectively help meet large proportions of eye care demand. Optimization of hierarchical medical system is warranted to improve the efficiency and standardization of ophthalmic services.

Generation of stable orbital angular momentum beams with an all-polarization-maintaining fiber structure.

In this paper, we propose a stable orbital angular momentum (OAM) mode fiber laser with an all-polarization-maintaining fiber (PMF) structure based on a combination of two linearly polarized modes. The mode intensity ratio between the two linearly polarized modes can be adjusted by adopting a double-pump structure. A pair of polarization-maintaining long-period fiber gratings (PM-LPFGs) are used as a mode converter. The number of topological charges of the OAM mode beam can be tuned between +1 and -1 by stretching the fiber. By adopting an all-PMF structure, we can build an OAM mode fiber laser without a polarization controller and that is resistant to environmental disturbances. The purity of the OAM mode was approximately 93.6%. This stable and compact OAM mode fiber laser can be used as a laser source in practical applications and scientific research.

Few-mode random fiber laser with a switchable oscillating spatial mode.

Random fiber lasers are of tremendous interest to diverse applications for optical fiber sensing, speckle-free imaging. To date, random fiber lasers with fundamental mode oscillation have been well developed. However, controllable oscillating spatial mode in random fiber lasers have not been reported yet. Here, we propose and demonstrate a few-mode random fiber laser with a switchable oscillating spatial mode based on mode injection locking. An external signal light is injected to realize the locking of transverse mode in this random fiber laser and the direct oscillations of the fundamental mode, hybrid mode, and high order mode can be realized, respectively. This random fiber laser operates in the high-order LP11 mode stably with a threshold of as low as 88 mW. High efficiency and high purity cylindrical vector beams can be obtained by removing the degeneracy of the LP11 mode. This work may pave a path towards random fiber lasers with controllable spatial modes for specific applications in mode division multiplexing, imaging, and laser material processing.

Stable generation of cylindrical vector beams with an all-fiber laser using polarization-maintaining and ring-core fibers.

An all-fiber laser using polarization-maintaining and ring-core fibers that are capable of automatically generating stable TE01 and TM01 modes is proposed and demonstrated experimentally. Two vector-mode coupling long-period fiber gratings (LPFGs) fabricated by a high-frequency CO2 laser are used in the fiber laser to realize efficient coupling between HE11 mode and TE01/TM01 mode. The polarization dependence of the LPFGs is simulated using the coupled-mode theory and verified by experiments. A ring-core fiber is employed to support the stable propagation of TE01 and TM01 modes. By carefully aligning the polarization direction of the input light, the mode coupling ratios of both LPFGs exceed 15 dB. The mode purities of TE01 and TM01 modes are 92.4% and 97.3%, respectively. Owing to the all-polarization-maintaining structure, the laser output is highly stable under environmental disturbance. This laser can be used as a stable cylindrical vector beam source for a wide range of applications, including surface plasmon excitation, optical tweezers, high-resolution metrology and so on.

Optical transmittance and ultrastructure of SMILE-derived lenticules subjected to three different preservative methods.

PURPOSE: To investigate the optical transmittance and ultrastructure of small incision lenticule extraction (SMILE)-derived lenticules preserved via three different methods. METHODS: A total of 90 lenticules obtained from myopic patients undergoing SMILE surgery were divided into control and experimental groups. Fresh lenticules served as the control. The preserved lenticules of the experimental group were randomly divided into three subgroups according to different storage conditions: anhydrous glycerol, silicone oil and allochroic silica gel groups. Optical transmittance was evaluated, histological changes were analysed by haematoxylin eosin (HE) staining, and collagen fibril densities and necrotic response were assessed via transmission electron microscopy (TEM) at 48 h, 14 days and 4 weeks. RESULTS: After storage for 4 weeks, the mean percentage transmittance values in glycerol and silicone oil groups significantly decreased (P = 0.034 and P = 0.042, respectively), but the lenticules preserved in silica gel remained unchanged when compared with the control lenticules. In all the groups, HE staining results showed a regular arrangement of collagen fibers with a few keratocytes and several cavitation bubbles. TEM revealed that the fibril densities in the glycerol group (273.70 ± 31.42/µm2) after 4 weeks were significant less than those in the other two groups (silicone oil, 335.20 ± 33.09/µm2; silica gel, 371.80 ± 37.60/µm2) and control group (340 ± 33.61/µm2) (all P < 0.001). In each group, a few necrotic and apoptotic keratocytes were observed. CONCLUSIONS: All the three agents, namely glycerol, silicone oil and silica gel, could be used for lenticule preservation. Silica gel facilitates better maintenance of optical transmittance than the other two agents.

Adaptive modal gain controlling for a high-efficiency cylindrical vector beam fiber laser.

We propose and experimentally demonstrate an ytterbium-doped fiber laser emitting the single high-order cylindrical vector beams with a high efficiency and a high modal purity based on adaptive modal gain control. By the combination of a high-order pump with a self-designed ytterbium-ring doped fiber, modal dependent gain was tailored and specific transverse mode can be selected in the laser cavity. A model based on multimode propagation-rate equations is built up to demonstrate the behaviors of transverse mode competition in the fiber laser. Modal dependent gain of high-order mode pump are simulated numerically, which agree well with our experiment results. The slope efficiency of the fiber laser reaches 79.61% with a low threshold of 47.73mw. The purity of the generated high-order CVBs are in excess of 95%. Such a strategy enables the controllability of modal gain in a fiber laser and reveals the potential to offer a new and promising way to achieve a high-power fiber laser with an arbitrary single high-order transverse modes output.

Generation of mode-locked square-shaped and chair-like pulse based on reverse saturable absorption effect of nonlinear multimode interference.

In this paper, the phenomenon of reverse saturable absorption of offset-spliced graded index multimode fibers (OS-GIMF) is revealed. And based on that, the stable square-shaped and chair-like mode-locked pulses are demonstrated with the maximum pulse energy of 0.14 µJ and 23.8 nJ respectively, while the OS-GIMF acts as a saturable absorber (SA) in fiber laser. By adjusting polarization controller (PC) and the pump power, square-shaped and chair-like pulse can be switched to each other. This multimode SA could sever as high power light source owing to its high damage threshold, compact structure and low cost.

The comparison of visual outcomes, aberrations, and Bowman's layer micro-distortions after femtosecond laser small-incision lenticule extraction (SMILE) for the correction of high and moderate myopia and myopic astigmatism.

BACKGROUND: This study compares the clinical outcomes of femtosecond laser small-incision lenticule extraction (SMILE) for the correction of myopia and myopic astigmatism greater than - 10 D, and - 10 D or less respectively. METHODS: 60 eyes/patients were equally selected into group 1 (myopia and myopic astigmatism of - 10 D or less) and group 2 (myopia and myopic astigmatism of over - 10 D), both of which were treated with SMILE. Visual and refractive outcomes, corneal higher-order aberrations, and Bowman's layer micro-distortions were evaluated preoperatively, 3 months, and 6 months postoperatively. RESULTS: LogMAR corrected distance visual acuity (CDVA) of group 1 and group 2 was - 0.069 ± 0.047 and - 0.053 ± 0.073 6 months postoperatively (P = 0.48). 100% eyes in group 1 and 97% in group 2 were within 1 D of targeted correction (P = 0.45). Meanwhile, 100% eyes in group 1 and 97% in group 2 had an uncorrected distance visual acuity of 20/25 or better (P = 0.20). Changes in corneal higher-order aberrations root mean square, coma, and trefoil were similar between the two groups but spherical aberration was higher in group 2 (P < 0.01). Micro-distortions were observed in 53% in group 1 and 77% in group 2. More micro-distortions were observed in group 2 (3.40 ± 2.66) than in group 1 (2.07 ± 2.29) (P = 0.041). The total number of micro-distortions was not correlated with postoperative CDVA (P = 0.77). CONCLUSIONS: Visual outcomes showed similar results of SMILE for myopic correction of > - 10 D and ≤ - 10 D. Refractive outcomes showed slightly under-correction in higher myopic eyes. Higher myopic treatment tends to induce more spherical aberrations. Micro-distortions had no impact in visual and refractive outcomes.

Chirp-adjustable square-wave pulse in a passively mode-locked fiber laser.

A passively mode-locked fiber laser to generate chirp-adjustable square-wave pulses is reported. A simple chirp measurement system is designed to study the output chirp of the fiber laser. The results indicate that the chirp of the square-wave pulses in our fiber laser can be adjusted by the polarization controllers inside the cavity. Three typical chirp states, including random chirp, V-shaped chirp and linear chirp, are achieved. This kind of fiber laser cannot only help to further understand the characteristics of square-wave pulse but also serve as multifunction light source for potential applications.

All-fiber high-order mode laser using a metal-clad transverse mode filter.

We propose and demonstrate an all-fiber laser with LP11 mode output. A transverse mode filter is designed and fabricated to suppress the fundamental mode and enable the fiber laser to oscillate in the second-order (LP11) transverse mode. The mechanism is to introduce relatively low ohmic loss for the TE01 mode and much higher ohmic losses for other modes through the loss of evanescent waves in the metal clad. The fiber laser operates at the center wavelength of 1053.9 nm with a narrow 3 dB linewidth of 0.019 nm. Four states of cylindrical vector mode with high modal purity are obtained through adjusting the intra-cavity polarization controller. This approach has great potentiality and scalability of realizing single high-order mode fiber laser, from which a wide range of applications could benefit.

All-fiber laser with flattop beam output using a few-mode fiber Bragg grating.

We report a novel method of beam shaping in an all-fiber laser. Flattop beams are first generated from the all-fiber laser using a few-mode fiber Bragg grating by superposing the fundamental mode (LP01) with a solid central beam distribution, and the second-order mode (LP11) gives rise to a donut-shape beam distribution. Two modes are obtained in the fiber laser simultaneously, and the wavelengths of the two modes are 1053.7 nm and 1055.4 nm, respectively. An experiment has been carried out, and a high-quality flattop profile is obtained for the normalized root-mean-square of the light intensity less than 5% under no numerical aperture illumination, consistent with the theoretical prediction.