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Biomedical subjects

Paulo Schor

Publications and source records attributed to Paulo Schor.

12 recordsLinked to original sources

Ocular wavefront aberrations in patients after diffuse lamellar keratitis.

PURPOSE: To study ocular wavefront aberrations after laser in situ keratomileusis (LASIK) in patients who developed diffuse lamellar keratitis (DLK). METHODS: A case-control evaluation of 47 patients with DLK and 30 uneventful LASIK-operated controls. Measurements of visual acuities, cycloplegic refraction, eye's wave aberrations using a LADARWAVE aberrometer (up to eighth order), and corneal topography were obtained after LASIK treatment. All of the surgeries were performed using the Hansatome or the Moria microkeratome and the LadarVision excimer laser system. RESULTS: Mean follow-up interval from the day of the operative procedure to the examination day was 6.26 (DLK group; range, 2-13 months) and 6.23 months (control group; range, 3-9 months). Mean preoperative spherical equivalent was -3.7 D in patients with DLK and -3.7 D in controls. High-order aberration S7+7 (P = 0.015) was statistically different in the DLK group from that in controls. High-order aberrations S3+3 (P = 0.091) and S8+4 (chi = 8.014, P = 0.046) showed a tendency to be different from controls. Loss of best-corrected visual acuity was greater in patients with DLK. CONCLUSIONS: The occurrence of DLK after LASIK surgery may not significantly affect the visual outcome.

Adult↗

Quantitative comparison of different-shaped wavefront sensors and preliminary results for defocus aberrations on a mechanical eye.

PURPOSE: There is a general acceptance among the scientific community of Cartesian symmetry wavefront sensors (such as the Hartmann-Shack (HS) sensor) as a standard in the field of optics and vision science. In this study it is shown that sensors of different symmetries and/or configurations should also be tested and analyzed in order to quantify and compare their effectiveness when applied to visual optics. Three types of wave-aberration sensors were developed and tested here. Each sensor has a very different configuration and/or symmetry (dodecagonal (DOD), cylindrical (CYL) and conventional Hartmann-Shack (HS)). METHODS: All sensors were designed and developed in the Physics Department of the Universidade de São Paulo--São Carlos. Each sensor was mounted on a laboratory optical bench used in a previous study. A commercial mechanical eye was used as control. This mechanical eye has a rotating mechanism that allows the retinal plane to be positioned at different axial distances. Ten different defocus aberrations were generated: 5 cases of myopia from -1D to -5D and 5 cases of hyperopia, from +1D to +5D, in steps of 1D following the scale printed on the mechanical eye. For each wavefront sensor a specific image-processing and fitting algorithm was implemented. For all three cases, the wavefront information was fit using the first 36 VSIA standard Zernike polynomials. Results for the mechanical eye were also compared to the absolute Zernike surface generated from coefficients associated with the theoretical sphere-cylinder aberration value. RESULTS: Precision was analyzed using two different methods: first, a theoretical approach was used by generating synthetic Zernike coefficients from the known sphere-cylinder aberrations, simply by applying sphere-cylinder equations in the backward direction. Then comparisons were made of these coefficients with the ones obtained in practice. Results for DOD, HS and CYL sensors were, respectively, as follows: mean of root mean square (RMSE) for all aberrations, when theoretical Zernike coefficients were used as control, was 0.22, 0.66 and 0.26 microns; RMSE of sphere-cylinder values when compared to autorefractor measurements was 0.18D, 0.22D and 0.35D for sphere, 0.14D, 0.24D and 0.17D for cylinder, 34.36 degrees, 35.16 degrees and 26.36 degrees for axis; RMSE of sphere-cylinder values when theoretical values were used as control was 0.11D, 0.29D and 0.46D for sphere, 0.15D, 0.28D and 0.17D for cylinder, 19.71 degrees, 25.56 degrees and 18.56 degrees for axis. CONCLUSION: The main conclusion is that the symmetry of an optical sensor is not an important consideration when measuring typical eye aberrations such as defocus (myopic and hyperopic), but there are differences. In this sense, the polar symmetry sensors render results that are equivalent to the traditional Cartesian Hartmann-Shack sensor, but furnish an easier method for determining the optical center.

Calibration↗

The effect of phenylephrine and cyclopentolate on objective wavefront measurements.

PURPOSE: To investigate the impact of phenylephrine and cyclopentolate on wavefront refraction and fourth order spherical aberration C12. METHODS: This cohort study comprised 151 eyes with sphere up to -10.00 diopters (D) and cylinder -3.75 D. Aberrometry was performed using the ALLEGRO WAVE (WaveLight Laser Technologies AG, Erlangen, Germany) after instillation of phenylephrine 5% yielding objective phenylephrine refraction in accommodated steady-state, as well as after cyclopentolate 0.5% providing objective cyclopentolate refraction in non-accommodated state. Accommodation target fogging was turned off. Wavefront aberrations were expressed by Zernike expansion up to the sixth order, and paraxial curvature matching with Taylor series was used to calculate objective wavefront sphere. RESULTS: Objective wavefront sphere was not influenced by pupil size. Eyes showed substantial accommodation after phenylephrine with a myopic shift of -0.66 D comparing objective to subjective manifest sphere (r=0.942, P<.001). Cycloplegic eyes behaved like a model eye, with a difference of -0.08 D between objective and subjective cycloplegic sphere (r=0.976, P<.001). C12 increased ten-fold from 4.0- to 7.0-mm pupil size, keeping the same sign. Comparing cyclopentolate with phenylephrine, the sign of C12 changed in a positive direction by an average +0.124 +/- 0.109 microm (range: -0.052 to +0.632 microm) at 7.0 mm, whereas the total higher order aberrations changed very little. A good correlation was found between C12 and the change in objective wavefront sphere between cyclopentolate and phenylephrine (r=0.75, P<.001). CONCLUSIONS: Fogging of the accommodation target should be used for wavefront measurements. Weaker cycloplegic agents, such as tropicamide, may be used to ensure relaxed but not completely paralyzed accommodation, which would yield "manifest" aberration values close to the natural resting state.

Accommodation, Ocular↗

A new wavefront sensor with polar symmetry: quantitative comparisons with a Shack-Hartmann wavefront sensor.

PURPOSE: A novel wavefront sensor has been developed. It follows the same principle of the Shack-Hartmann wavefront sensor in that it is based on slope information. However, it has a different symmetry, which may offer benefits in terms of application. METHODS: The new wavefront sensor consists of a set of donut-shaped acrylic lenses with a charge coupled device located at the focal plane. From detection of shift in the radial direction, radial slopes are computed for 2880 points. Theoretical computations for higher order aberrations and lower order aberrations were implemented for the Shack-Hartmann wavefront sensor and the new wavefront sensor, and practical measurements were conducted on several sphere-cylinder trial lenses. RESULTS: The overall mean value of root mean square error (RMSE) (in microns) for theoretical computations was 0.03 for the Shack-Hartmann wavefront sensor and 0.02 for the new wavefront sensor. The mean value of RMSE for lower order aberrations (1-5) was 0.01 and 0.00003, and for higher order aberrations was 0.02 and 0.02, for the Shack-Hartmann and new wavefront sensors, respectively. For practical measurements (sphere, cylinder, axis), the standard deviation was 0.04 diopters (D), 0.04 D, and 4 degrees for the new wavefront sensor and 0.02 D, 0.02 D, and 5 degrees for the Shack-Hartmann wavefront sensor. CONCLUSIONS: Precision of the new wavefront sensor when measuring astigmatic and spherical surfaces is compatible with the Shack-Hartmann wavefront sensor. Centration with this new sensor is an absolute process using the center of the entrance pupil, which is where the line of site passes. This wavefront sensor, similar to the Shack-Hartmann sensor, does not eliminate the possibility of tilt. For more conclusive and statistically valid data, in vivo measurements are needed.

Cornea↗

Iris recognition as a biometric method after cataract surgery.

BACKGROUND: Biometric methods are security technologies, which use human characteristics for personal identification. Iris recognition systems use iris textures as unique identifiers. This paper presents an analysis of the verification of iris identities after intra-ocular procedures, when individuals were enrolled before the surgery. METHODS: Fifty-five eyes from fifty-five patients had their irises enrolled before a cataract surgery was performed. They had their irises verified three times before and three times after the procedure, and the Hamming (mathematical) distance of each identification trial was determined, in a controlled ideal biometric environment. The mathematical difference between the iris code before and after the surgery was also compared to a subjective evaluation of the iris anatomy alteration by an experienced surgeon. RESULTS: A correlation between visible subjective iris texture alteration and mathematical difference was verified. We found only six cases in which the eye was no more recognizable, but these eyes were later reenrolled. The main anatomical changes that were found in the new impostor eyes are described. CONCLUSIONS: Cataract surgeries change iris textures in such a way that iris recognition systems, which perform mathematical comparisons of textural biometric features, are able to detect these changes and sometimes even discard a pre-enrolled iris considering it an impostor. In our study, re-enrollment proved to be a feasible procedure.

Algorithms↗

A direct method to measure the power of the central cornea after myopic laser in situ keratomileusis.

OBJECTIVE: To measure the corneal power after myopic laser in situ keratomileusis (LASIK). METHODS: Six central areas in 6 corneal power maps were studied using the Orbscan II statistical analysis device in 26 eyes that underwent myopic LASIK. Refractive and corneal power changes were compared. Factors related to wrong corneal power measurement were evaluated. MAIN OUTCOME MEASURES: Cycloplegic refraction, refractive change at the corneal plane, and Orbscan II corneal power maps. RESULTS: Preoperatively, only posterior-mean power (P<<.001) and anterior-posterior power ratio (P<<.001) varied according to the size of the analyzed area. Postoperatively, total-optical (P =.03), keratometric-mean (P =.04), total-mean (P<.001), anterior-mean (P =.03), and posterior-mean (P<<.001) powers; and anterior-posterior power ratio (P<<.001) varied according to the area. Postoperatively, the difference between keratometric-mean and total-mean powers became larger (P<.001), and the anterior-posterior power ratio was reduced (P<<.001). A posterior-mean power change occurred (P =.04). Refractive change after myopic LASIK was best estimated by 2-mm total-mean power (mean +/- SD difference, 0.07 +/- 0.62 diopters [D]; P =.55) and 4-mm total-optical power (mean +/- SD difference, -0.08 +/- 0.53 D; P =.37). CONCLUSIONS: Total corneal power is more positive and refractive change is underestimated when deduced from the anterior surface radius and keratometric refractive index. The anterior-posterior power ratio is not a fixed value. The best area to estimate the refractive change depends on the method used to obtain the power in diopters. Refractive change tended to be underestimated in larger areas and higher preoperative myopia. Orbscan II total-mean and total-optical power maps accurately assess the corneal power after myopic LASIK independent of preoperative data or correcting factors, and should improve intraocular lens calculation.

Adult↗

Shifting trends in in vitro antibiotic susceptibilities for common ocular isolates during a period of 15 years.

PURPOSE: To assess the in vitro susceptibility of the most common ocular bacterial isolates to several antibiotics and verify changing trends in the antibiotic susceptibility in a 15-year period. DESIGN: Experimental study. METHODS: All cultures positive for Staphylococcus aureus, coagulase-negative Staphylococcus (CNS), Streptococcus sp, and Pseudomonas sp in conjunctival (n = 4,585) and corneal (n = 3,779) samples from patients seen at the Federal University of São Paulo from 1985 to 2000 were evaluated. Cultures were performed in liquid and solid media, and susceptibility tests were done to amikacin, gentamicin, neomycin, tobramycin, ciprofloxacin, norfloxacin, ofloxacin, cephalothin, and chloramphenicol. RESULTS: Amikacin and neomycin showed an improvement of their sensitivity during the study period (88%-95% and 50%-85%, respectively) for corneal and conjunctival samples. Gentamicin and tobramycin revealed a decrease of sensitivity in time, from 95% to less than 80% in corneal and conjunctival samples. Ciprofloxacin, norfloxacin, and ofloxacin had good sensitivity to all evaluated bacteria, better in conjunctiva (95%) than in cornea (90%). Sensitivity of S. aureus to cephalothin decreased during the study but was still 98% for CNS. Chloramphenicol had good sensitivity to S. aureus (85% in corneal and 92%in conjunctival samples), CNS (87% and 88.5%), and Streptococcus sp (95% and 96%). CONCLUSIONS: Gentamicin, tobramycin, and cephalothin decreased their in vitro susceptibility to all tested pathogens. The fluoroquinolones remained a good choice in the treatment of ocular infections, with high suscep-tibility to all pathogens tested. Chloramphenicol also revealed an increase in its susceptibility to all bacteria evaluated.

Anti-Bacterial Agents↗

Corneal infections after implantation of intracorneal ring segments.

PURPOSE: To report risk factors, clinical course, and outcome in patients with infectious keratitis following implantation of intracorneal ring segments (ICRS). METHODS: The records of 8 patients with culture-proven infectious keratitis after ICRS (Ferrara or Intacs) implantation were retrospectively reviewed. Age, gender, corneal findings, ocular abnormalities, the condition that led to ICRS implantation, immediate prior use of a contact lens, elapsed time between implantation and the onset of symptoms, previous medications, and systemic disorders were noted. RESULTS: Culture-positive infectious keratitis developed in 7 eyes of 7 patients (2 men and 5 women) with a mean age of 35 years who underwent Ferrara implantation for the treatment of keratoconus and in a 29-year-old man who underwent Intacs implantation for correction of low myopia. Contact lens use, diabetes, and trauma were factors possibly associated with the risk of infection in three cases. Microorganisms, identified in all cases, included Staphylococcus aureus, Streptococcus viridans, Streptococcus pneumoniae, Pseudomonas sp, Nocardia sp, Klebsiella sp, and Paecylomices sp. Onset of symptoms of infection varied from less than 1 week to 22 months postoperatively, depending on the infecting organism. CONCLUSIONS: Infectious keratitis following ICRS implantation is a sight-threatening complication for which early recognition and rapid institution of appropriate treatment may result in a better visual outcome.

Adult↗

Videokeratoscopes for dioptric power measurement during surgery.

PURPOSE: To evaluate 2 versions of a computerized surgical videokeratoscope that measures a central region of the cornea of approximately 4.0 to 6.0 mm in diameter to provide information on dioptric power and astigmatism. SETTING: Grupo de Optica Oftalmica Universidade de São Paulo, and Departamento de Oftalmologia da Escola Paulista de Medicina, São Paulo, Brazil. METHODS: The first videokeratoscope system with 10 Placido rings is based on a 15 000 fiber-optic illuminated disk attached to the objective lens of a surgical microscope. With this system, the light intensity can be adjusted during surgery for better contrast of the Placido image. The second system with 14 Placido rings is based on a neon light source behind the Placido disk. With both systems, a 480 x 640 pixel resolution charge-coupled device camera and an IBM-compatible personal computer frame grabber were used. Image processing was used for boundary detection of the rings. An axial curvature algorithm based on the spherical surfaces was used to calculate the dioptric power for each examination. Measurements of 4 real spherical surfaces and 4 simulated aspheric surfaces (ellipsotoric surfaces with different apical radii and different shape factors) were performed. RESULTS: Twenty corneas of 10 healthy volunteers were measured on both videokeratoscope systems and an EyeSys System 2000 corneal topographer. The root- mean-square error for the spherical and simulated aspheric surfaces was, respectively, less than 0.20 diopter (D) and 1.30 D for the 10-disk videokeratoscope system and less than 0.16 D and 1.40 D for the 14-disk system. The mean deviation in corneal measurements with both systems was 0.09 mm for the radius of curvature, 0.51 D for dioptric power, and 5 degrees for cylinder. CONCLUSIONS: The results indicate that the 2 surgical videokeratoscopes are sufficiently precise to aid the anterior segment surgeon in reducing residual astigmatism in cataract surgery and keratoplasty.

Adult↗

[Comparative analysis of visual function and the quality of life index with eyeglasses or a progressive contact lens].

PURPOSE: To compare the visual function and the answers to a questionnaire of quality of life of patients wearing a progressive contact lens or eyeglasses. METHODS: The Focus Progressive contact lens had been fitted in 35 patients with far visual acuity with progressive-addition eyeglasses equal to zero (log MAR) and near J1 (Jaeger). The far and near visual acuities and the measurement of contrast sensitivity were compared when the patients were wearing the eyeglasses or the contact lens and the patients' results of the scores of the quality of life questionnaire (NEI VFQ-25) were analyzed statistically considering the type of ametropy and the age. RESULTS: The far and near visual acuities and the contrast sensitivity measurement were worse with the contact lens than with eyeglasses. The answers to the questionnaire did not differ when were comparing the same patients wearing eyeglasses or contact lens, no matter the type of ametropy. The myopic and the hyperopic subgroups had worse answers to the quality of life questionnaire when corrected with the contact lens than with eyeglasses, both with age equal to or less than their median. CONCLUSIONS: The visual function was worse with the contact lens. The type of ametropy did not influence the answers to the quality of life questionnaire considering the optical correction, but age did.

Adult↗

[Development of ophthalmologic software for handheld devices].

INTRODUCTION: The formulas for calculation of intraocular lenses have evolved since the first theoretical formulas by Fyodorov. Among the second generation formulas, the SRK-I formula has a simple calculation, taking into account a calculation that only involved anteroposterior length, IOL constant and average keratometry. With the evolution of those formulas, complexicity increased making the reconfiguration of parameters in special situations impracticable. In this way the production and development of software for such a purpose, can help surgeons to recalculate those values if needed. PURPOSE: To idealize, develop and test a Brazilian software for calculation of IOL dioptric power for handheld computers. METHODS: For the development and programming of software for calculation of IOL, we used PocketC program (OrbWorks Concentrated Software, USA). We compared the results collected from a gold-standard device (Ultrascan/Alcon Labs) with the simulation of 100 fictitious patients, using the same IOL parameters. The results were grouped for ULTRASCAN data and SOFTWARE data. Using SRK/T formula the range of those parameters included a keratometry varying between 35 and 55D, axial length between 20 and 28 mm, IOL constants of 118.7, 118.3 and 115.8. RESULTS: Using Wilcoxon test, it was shown that the groups do not differ (p=0.314). We had a variation in the Ultrascan sample between 11.82 and 27.97. In the tested program sample the variation was practically similar (11.83-27.98). The average of the Ultrascan group was 20.93. The software group had a similar average. The standard deviation of the samples was also similar (4.53). CONCLUSION: The precision of IOL software for handheld devices was similar to that of the standard devices using the SRK/T formula. The software worked properly, was steady without bugs in tested models of operational system.

Computers, Handheld↗