Efficacy and Planning in Ophthalmic Surgery - A Vision of Logical Programming

Different variables should be considered in order to identify the critical aspects that influence ophthalmologic surgery and, in particular, the patient's conditions that can become the key factor in this process, i.e., in situations that can influence the stability and surgery of the patient. Protocol of ophthalmologic surgery has as main concern Glycemic Index, Maximum Blood Pressure, Abnormal Cardiac Index, and Cardiac-Respiratory Insufficiency. Such variables will be used to construct a dynamic virtual world of complex and interacting entities that map real cases of surgical planning situations, understood here as the terms that make the extensions of mathematical logic functions that compete against one another in a rigorous selection regime in which fitness is judged by one criterion alone, its Quality-of-Information. Indeed, one focus is on the development of an Evolutionary Clinical Decision Support System to evaluate patient stability and assist the physicians in the decision of doing or postponing surgery, once cataract is the leading cause of blindness in the world

Sexual health in adolescents

“Saved sex” and parental involvement are key to improving outcome

Computational planning tools in ophthalmology: Intrastromal corneal ring surgery

This thesis addresses the problem of the simulation of intrastromal corneal ring segment surgery for the reduction of myopia and astigmatism, as well as the stabilisation of keratoconus (KC). This disease causes high myopia, irregular astigmatism and reduction of the patient's visual acuity to the point of blindness. Therefore there are several techniques to try to stabilise it and, thus, prevent its progression. For mild keratoconus, it is enough to use special spectacles or lenses to try to correct it, but in more advanced cases it would be necessary to use refractive surgery to try to stop the progression of the disease. The most common ones to avoid the cornea transplant (PK) are the cross-linking and the additive surgery of intrastromal rings. The current planning tools are empirical, based on the nomograms of the ring manufactures, and rely on the experience of the surgeon. Unfortunately, deterministic tools able to estimate the postsurgical visual results of this treatment do not exist. Therefore, the aim of the current thesis is to establish a realistic numerical framework to simulate intrastromal ring surgeries and estimate the mechanical and optical postsurgical outcomes. There are different types of rings depending on their angle and cross-section. There are two large groups of rings: segments which have an angle of less than 360º and those that cover the entire circumference. In the first group we find rings of triangular section such as the Keraring (Mediaphacos, BeloHorizonte, Brazil) and the Ferrara (AJL Ophthalmic Ltd, Spain) and rings of hexagonal section like the Intacs (Additional Technology Inc.). In the second group we can find the MyoRing (Dioptex, GmbH.) whose cross-section is the combination of a parabola and a circumference and the Intacs SK whose section is oval. Due to the complexity of the simulation, since multiple variables are involved, such as the type of rings, the model of the corneal material, the contact conditions between them, etc., two methodologies arised which simulated the insertion of the rings. Both are based on generating a hole in the corneal stroma, introducing the ring and closing the hole with the ring inside, establishing contact until the simulation is completed. In the first of the methodologies the hole was generated by introducing a pressure, while the second was used to an auxiliary tool, such as balloon angioplasty to introduce endovascular stents, which is displaced generating enough hole to insert the rings. As with all numerical simulations, they were not exempt of limitations, although with the first of the methodologies only circular cross--section rings were simulated and in some configurations, there was pressure inside the hole, so it was decided to focus on the second. Nevertheless, interesting conclusions were obtained: the greatest correction was obtained by placing the rings with the largest section near the apex, and whether the ring is located near the epithelium, the stresses generated in the stroma can cause the ring to extrude. With the second methodology based on a displacement control, it was possible to simulate most of the cross-sections and very interesting studies were carried out that gave conclusive results. The most important were: i) the most influential parameter is the depth of insertion; ii) considering the physiological depth of the surgery, the greater optical change is provided by the diameter of the ring, and the fine adjusted is reached with the size of the implant cross--section, i.e the diameter of the implant and the size of the cross--section are the key on regulating the refractive correction; iii) the friction between ring and stroma is important to consider it because a prediction of 2 or 3 diopters could be lost; iv) whether the KC progression is stress-driven, only MyoRing can stop its progression; v) when the covered arc of the segments is more than 320º, axisymmetric model could be used instead of tridimensional model, saving computational time; vi) the anisotropy of the model does not play an important role because the rings are much stiffer than corneal tissue; vii) the implants cannot consider such as second limbus since they act as a dynamic pivot that moves along the circadian cycles of intraocular pressure (IOP); viii) preliminary nomograms is built which allow the estimation of the optical outputs according to the size and typology of the ring and optical zone of implantation.Additionally, a characterisation of ring material was carried out by means two complementary methods: uncertainty analysis and iFEM optimisation, concluding that the manufacturing process of the rings could be the cause of the alteration of the material between the raw PMMA and the ring already prepared for its insertion.<br /

Robot Control for Remote Ophthalmology and Pediatric Physical Rehabilitation

The development of a robotic slit-lamp for remote ophthalmology is the primary purpose of this work. In addition to novel mechanical designs and implementation, it was also a goal to develop a control system that was flexible enough to be adapted with minimal user adjustment to various styles and configurations of slit-lamps. The system was developed with intentions of commercialization, so common hardware was used for all components to minimize the costs. In order to improve performance using this low-cost hardware, investigations were made to attempt to achieve better performance by applying control theory algorithms in the system software. Ultimately, the controller was to be flexible enough to be applied to other areas of human-robot interaction including pediatric rehabilitation via the use of humanoid robotic aids. This application especially requires a robust controller to facilitate safe interaction. Though all of the prototypes were successfully developed and made to work sufficiently with the control hardware, the application of advanced control did not yield notable gains as was hoped. Further investigations were made attempting to alter the performance of the control system, but the components selected did not have the physical capabilities for improved response above the original software implemented. Despite this disappointment, numerous novel advances were made in the area of teleoperated ophthalmic technology and pediatric physical rehabilitation tools. This includes a system that is used to remote control a slit-lamp and lens for examinations and some laser procedures. Secondly, a series of of humanoid systems suitable for both medical research and therapeutic modeling were developed. This included a robotic face used as an interactive system for ophthalmic testing and training. It can also be used as one component in an interactive humanoid robotic system that includes hands and arms to allow use of teaching sign language, social skills or modeling occupational therapy tasks. Finally, a humanoid system is presented that can serve as a customized surrogate between a therapist and client to model physical therapy tasks in a realistic manner. These systems are all functional, safe and low-cost to allow for feasible implementation with patients in the near future

The evolution of corneal and refractive surgery with the femtosecond laser

The use of femtosecond lasers has created an evolution in modern corneal and refractive surgery. With accuracy, safety, and repeatability, eye surgeons can utilize the femtosecond laser in almost all anterior refractive procedures; laser in situ keratomileusis (LASIK), small incision lenticule extraction (SMILE), penetrating keratoplasty (PKP), insertion of intracorneal ring segments, anterior and posterior lamellar keratoplasty (Deep anterior lamellar keratoplasty (DALK) and Descemet's stripping endothelial keratoplasty (DSEK)), insertion of corneal inlays and cataract surgery. As the technology matures, it will push surgical limits and open new avenues for ophthalmic intervention in areas not yet explored. As we witness the transition from femto-LASIK to femto-cataract surgery it becomes obvious that this innovation is here to stay. This article presents some of the most relevant advances of femtosecond lasers to modern corneal and refractive surgery

Clamp-assisted retractor advancement for lower eyelid involutional entropion

Scientific Poster 144PURPOSE: To describe a novel approach to internal repair of lower lid entropion using the Putterman clamp. METHODS: Retrospective, consecutive case series of patients with entropion who underwent retractor advancement using the clamp. RESULTS: Seven eyes of 6 patients (average age: 80; 4 women and 2 men) were analyzed. Complete resolution was achieved in 5 of the 6 patients (83.3%). The 1 patient with recurrence had 2 previous entropion surgeries on each eye over the past 4 years; there was lid laxity, and horizontal tightening was needed. No severe adverse events occurred in the patients. CONCLUSION: Clamp-assisted lower lid retractor advancement offers a safe and effective, minimally invasive approach to involutional entropion. Further study is needed to assess its role in recurrent entropion.postprin

Bulletin of the University of Nebraska: Annual Catalog of the College of Medicine, 1980-1981

•Dean\u27s Introduction •Governance of the University Medical Center and College of Medicine •Emeriti Faculty •Educational Programs •Academic Calendar •History and Standing-College of Medicine •Educational Goals •Learning Facilities-Clinical, Laboratory, Library •Office of Educational Research and Services •Office of Minority Student Affairs •Curriculum •Admission Requirements •Applications for Admission &Procedures •Registration and Student Records •Examinations and Grading System •Special Assistance to Students •Class Performance and Promotion •The Student Research Opportunities •Leave of Absence or Withdrawal •Graduation Requirements and Procedures •Alumni Association •Fees •Financial Assistance •Student Health Service •Residency Requirements •Departments and Courseshttps://digitalcommons.unmc.edu/bulletin_com/1075/thumbnail.jp

Visual Impairment and Blindness

Blindness and vision impairment affect at least 2.2 billion people worldwide with most individuals having a preventable vision impairment. The majority of people with vision impairment are older than 50 years, however, vision loss can affect people of all ages. Reduced eyesight can have major and long-lasting effects on all aspects of life, including daily personal activities, interacting with the community, school and work opportunities, and the ability to access public services. This book provides an overview of the effects of blindness and visual impairment in the context of the most common causes of blindness in older adults as well as children, including retinal disorders, cataracts, glaucoma, and macular or corneal degeneration