Implantation of Hydrophobic Acrylic Toric Intraocular Lens with High-Water Contents Using Swept-Source Optical Coherence Tomography Biometer Integrated with a Surgical Guiding System.

Purpose: To evaluate postoperative outcomes after implantation of toric intraocular lenses (IOLs) made of high-water-content hydrophobic acrylic material in Japanese patients using a swept-source optical coherence tomography (SS-OCT) biometer integrated with a surgical guiding system. Patients and Methods: In this prospective observational study, toric IOL models CNW0T3 to CNW0T9 (Alcon) were implanted in 33 eyes of 33 patients and followed-up for one month. Powers and toric models were determined using an SS-OCT biometer ARGOS® Ver 1.5 (Alcon), and the IOLs were aligned using surgical guidance. Differences between planned and actual axis positions at the end of the surgery (misalignment) and rotations from the end of surgery to one month postoperatively were measured. Additionally, postoperative uncorrected visual acuity, refraction, and residual astigmatism were evaluated. Results: Mean and median misalignments were 2.3° (standard deviation [SD]: 1.6, 95% confidence interval [CI]: 1.7-2.9) and 2°, and those of postoperative rotation were 2.4° (SD: 2.6, 95% CI: 1.5-3.4) and 2°, respectively. Mean postoperative refraction was 0.06 D (SD: 0.62). Prediction errors within ±0.5 and ±1.0 D were 69.7% and 93.9%, respectively. Mean residual astigmatisms were 0.19 D (SD: 0.41), and mean uncorrected visual acuity was 0.00 logMAR (SD: 0.11), and 64% of the eyes scored 20/20 or better. Conclusion: Implantation of high-water-content hydrophobic acrylic toric IOLs using SS-OCT biometry integrated with a surgical guiding system effectively corrected corneal astigmatism with accurate IOL alignment in Japanese patients.

Accurate measurement of the bond stress between rebar and concrete in reinforced concrete using FBG sensing technology.

Recent earthquakes in several developing countries have shown that reinforced concrete (RC) buildings with improper structural detailing experience severe damage under seismic motions. Using low-quality construction materials such as brick aggregates, resulting in low-strength concrete, significantly impacts the bond between rebar and concrete. Accurate evaluation of the bond performance of such low-strength concrete is one of the key issues for seismic safety assessment of RC buildings, especially in Bangladesh; thus, the bond performance is usually evaluated through laboratory tests. However, conventional measurements of bond stress based on rebar strains measured by electrical resistance strain gauges are likely to negatively impact the bond behavior/performance because of the reduced total contact area between rebar and concrete as well as the changing rebar surface boundary conditions. Under the above social and academic backgrounds, in this study, a new measurement technique that applies fiber Bragg grating (FBG) sensors embedded in optical fiber to rebar strain measurements is developed, and its effectiveness is investigated to realize more accurate measurements of the bond stress between rebar and concrete. Two 70% scaled RC beam-column joint specimens in which the beam rebar was anchored in a straight manner were constructed with identical detailing, except for the beam rebar strain measuring methods. The specimens were then subjected to cyclic lateral loading until failure. By comparing the experimental data acquired by the above two different devices (the FBG sensors and conventional strain gauges), it was found that the experimental bond strength on the beam rebar based on the strain data measured by the FBG sensors was much higher than that from the data measured using conventional strain gauges. Which negatively impacted the test data on the beam-column joint's capacity in the specimen applied the conventional measuring method, indicating the necessity of the presented method not only for accurate evaluation of the bond stress between rebar and concrete but also for seismic safety assessments of RC buildings.

Improvement of lateral property of unidirectional-strengthened CFRP laminates using recycled carbon fiber.

The unidirectional carbon fiber reinforced polymer (UD-CFRP) lacks the modulus of elasticity and strength in the lateral direction. This study investigates whether matrix resin with CFRP waste, recycled carbon fiber (rCF), can improve the lateral properties of CFRP. In total, twelve CFRP strips specimen were prefabricated of unidirectional carbon fiber (CF) sheet by hand lay-up (HLU) method and were tested by tensile test and X-ray computed tomography (X-ray CT). Factors such as fiber direction and void distribution significantly affecting its mechanical properties are assessed by X-ray CT inspection. It can be seen that rCF is mixed in a random direction at the position filled with matrix resin without rCF. However, a similar frequency of unimpregnation and voids can be observed in both specimens. Test results showed that experimental values of CFRP laminates with rCF-mixed matrix resin increased compared to the CFRP laminates without rCF. The percentage increase in the lateral tensile strength and modulus of elasticity of the rCFRP compared to the control specimen without rCF is 27.36% and 10.62%, respectively. This study proved that rCF can increase the lateral properties of unidirectional CFRP and shows the effective use of rCF for strengthening material in construction applications.

Multi-Bolted Connection for Pultruded Glass Fiber Reinforced Polymer's Structure: A Study on Strengthening by Multiaxial Glass Fiber Sheets.

Pultruded Glass Fiber Reinforced Polymers (PGFRPs) are becoming a new mainstream in civil construction because of their advantageous properties. One of two main elements, glass fibers, have been constructed by unidirectional glass roving in applicate progress. PGFRPs do not have high shear strength, which is determined by another element is the matrix. In the future, the demand for enhanced serviceability of existing PGFRP structures could be seen as unavoidable. Therefore, multi-bolted connection being the most typical type of connecting member, strengthening the connection performance of PGFRPs through connection is necessary. Previous researchers have studied several methods for improving connection capacity, including pasting glass fiber sheets (GFS). However, experimental research is lacking for multi-bolted connection. This study investigated several strategies of specimens, including the quantity of bolts (two bolts, four bolts, and five bolts); the end distance/diameter ratio (e = 2d; e = 3d) under tensile load; and three types of glass fiber sheets (GFS) (0°/90°, ±45° and chopped strand mat (CSM)). The experiment's results showed the strengthening effects and the failure mode on the specimens. These findings could address the gap in knowledge that needs to be resolved with respect to PGFRPs' composite design, through evaluation and discussion of their behavior.

Quality of life and life-space mobility after total knee arthroplasty in patients with rheumatoid arthritis: a pilot case-controlled study.

[Purpose] The purpose of this study was to identify factors inhibiting improvement in the quality of life after total knee arthroplasty in patients with rheumatoid arthritis. [Participants and Methods] This was a pilot case-control study. The sample comprised of five participants with rheumatoid arthritis and 11 participants with osteoarthritis, who underwent total knee arthroplasty. We compared the groups in terms of physical function, walking ability, Japanese Knee Osteoarthritis Measure, and Life-Space Assessment. Measurements were taken before surgery and at four weeks and five months post-surgery. All patients underwent rehabilitation for five months postoperatively, first as inpatients, and then as outpatients after discharge. [Results] In the period from 4 weeks to 5 months post-surgery, physical function improved similarly in both groups in terms of muscle strength and walking ability. Despite the patients with rheumatoid arthritis being younger, their self-health assessment score by the Japanese Knee Osteoarthritis Measure and measures of life-space mobility by Life-Space Assessment were lower. [Conclusion] It is important to consider exercise therapy, and gait instruction to alleviate anxiety about health status and improve the quality of life and life-space mobility in patients with rheumatoid arthritis who undergo total knee arthroplasty.

Experimental Investigation on the Buckling Capacity of Angle Steel Strengthened at Both Legs Using VaRTM-Processed Unbonded CFRP Laminates.

Strengthening steel structures by using carbon fiber reinforced polymer (CFRP) laminates showed a growth trend in the last several years. A similar strengthening technique, known as adhesive bonding, has also been adopted. This paper presented a promising alternative for strengthening steel members against buckling by using vacuum-assisted resin transfer molding (VaRTM)-processed unbonded CFRP laminates. A total of thirteen slender angle steel members (L65x6), including two control specimens, were prepared and experimentally tested. The specimens were strengthened only at both legs and were allowed to buckle on their weak axes. The test showed that the unbonded CFRP strengthening successfully increased the buckling capacity of the angle steel. The strengthening effect ranged from 7.12% to 69.13%, depending on various parameters (i.e., number of CFRP layers, CFRP length, and angle steel's slenderness ratio). Flexural stiffness of the CFRP governed the failure modes in terms of location of plastic hinge and direction of buckling curvature.

Pilot Demonstration of a Strengthening Method for Steel-Bolted Connections Using Pre-Formable Carbon Fiber Cloth with VaRTM.

In recent years, many seismic retrofitting methods have been performed to improve the structural performance and prevent the brittle failure of structural members. In the case of steel structures, slender seismic braces have been widely used for buildings, towers, and bridges. The brace connections should resist the full plastic axial tension load to ensure adequate plastic deformation performance for vibration energy absorption. However, certain connections do not satisfy these requirements. Recently, carbon fiber reinforced plastic (CFRP) has been used extensively to strengthen existing structures because of its high-strength, high elastic modulus, and light-weight characteristics. In this paper, we investigate the applicability of CFRP strengthening for brace connections and gusset plates with stepped surfaces using the vacuum-assisted resin transfer molding technique as a pilot demonstration. Stepped surfaces can be eliminated by using alternative CFRP layers to straighten the structural CFRP layers in order to effectively transfer the axial stress. Eventually, it is shown that CFRP strengthening can improve the connection strength and plastic deformation with 3% elongation, even if the CFRP is molded on the stepped surface.

Two case reports of continued progression of chronic ocular graft-versus-host disease without concurrent systemic comorbidities treated by amniotic membrane transplantation.

BACKGROUND: Chronic ocular graft-versus-host disease (oGVHD) is an ocular comorbidity of graft-versus-host disease (GVHD) that usually occurs concurrently with systemic manifestations. Failure to detect and treat oGVHD in its early stages may lead to progression of ocular signs and symptoms leading to oGVHD that is refractory to conventional treatment. CASE PRESENTATION: We report the clinical course of a 19-year-old male and a 59-year-old female with severe and progressive chronic oGVHD without concurrent systemic signs of chronic graft-versus-host disease (cGVHD). Although their systemic conditions had been stable, both suffered from severe oGVHD and were referred to our clinic. Both cases exhibited marked improvement in conjunctival inflammation and fibrotic changes after amniotic membrane transplantation (AMT). Both cases underwent keratoplasty eventually to stabilize ocular surface conditions and to improve visual function. CONCLUSIONS: We reported the clinical outcomes of 2 cases of chronic oGVHD without concurrent systemic comorbidities that were treated with AMT. The clinician should be aware that cGVHD may persist in target organs even in the absence of concurrent systemic comorbidities following seemingly successful systemic treatment. A multidisciplinary team approach is essential in the early detection and therapeutic intervention for chronic oGVHD.

Mechanical Behavior of GFRP Connection Using FRTP Rivets.

In recent years, the application of fiber-reinforced plastics (FRPs) as structural members has been promoted. Metallic bolts and rivets are often used for the connection of FRP structures, but there are some problems caused by corrosion and stress concentration at the bearing position. Fiber-reinforced thermoplastics (FRTPs) have attracted attention in composite material fields because they can be remolded by heating and manufactured with excellent speed compared with thermosetting plastics. In this paper, we propose and evaluate the connection method using rivets produced of FRTPs for FRP members. It was confirmed through material tests that an FRTP rivet provides stable tensile, shear, and bending strength. Then, it was clarified that non-clearance connection could be achieved by the proposed connection method, so initial sliding was not observed, and connection strength linearly increased as the number of FRTP rivets increased through the double-lapped tensile shear tests. Furthermore, the joint strength of the beam using FRTP rivets could be calculated with high accuracy using the method for bolt joints in steel structures through a four-point beam bending test.

Finite Element Analysis of Axial Compression Steel Members Strengthened with Unbonded CFRP Laminates.

This paper presented a non-linear finite element (FE) analysis to investigate the potential of unbonded carbon fiber-reinforced polymers (CFRP) strengthening in improving the axial compression performance of steel members. The FE model was firstly developed and validated against experimental works. Four parameters considered in the parametric study were the number of CFRP layers, CFRP length, slenderness ratio, and elastic modulus of CFRP. It was confirmed that the unbonded CFRP strengthening method is effective at enhancing the load-carrying capacity as well as delaying the overall buckling of the axial steel members. The strength increase is highly affected by the first three parameters. In addition, the method of an equivalent slenderness ratio can be used for strength design.

Corneal In Vivo Laser-Scanning Confocal Microscopy Findings in Dry Eye Patients with Sjögren's Syndrome.

PURPOSE: To evaluate the changes in cornea in Sjögren's syndrome (SS) with a novel confocal microscopy device. METHODS: Twenty-three right eyes of patients with SS (23 women; mean age, 65.4 ± 11.4 years) and 13 right eyes of 13 age- and sex-matched control subjects (13 women; mean age, 68.8 ± 9.8 years) were studied. Furthermore, eight right eyes of patients with SS (8 women; mean age, 66.9 ± 9.6 years) were studied to evaluate the corneal microscopic alterations after the treatment with topical 3% diquafosol sodium eye drops. All cases had tear quantity, tear breakup time (BUT), ocular surface staining measurements, and corneal in vivo laser-scanning confocal microscopy examinations. The density and area of corneal epithelial cells (superficial, wing, and basal), density of corneal stromal cells (anterior, intermediate, and posterior), density and area of corneal endothelial cells, density and morphology of corneal sub-basal nerve plexus, density of corneal sub-basal inflammatory cells were also assessed. RESULTS: The tear quantity, stability, and vital staining scores were significantly worse in patients with SS than in control subjects (p < 0.0001). Corneal superficial epithelial cell density was significantly lower in SS compared with control subjects (p < 0.0001). Corneal superficial epithelial cell area was significantly larger in SS compared with control subjects (p = 0.007). Corneal sub-basal nerve fiber density was lower in SS compared with control subjects (p < 0.0001). Morphological abnormality of nerve fibers was observed in SS patients. Corneal sub-basal inflammatory cell density was significantly higher in SS patients compared with control subjects (p < 0.0001). Furthermore, the mean corneal superficial epithelial cell density and area, inflammatory cell density, corneal sub-basal nerve fiber density, and morphological abnormality of nerve fibers, were improved with topical 3% diquafosol sodium treatment in the dry eye patients with SS (p < 0.05). CONCLUSIONS: The diagnostic modality using in vivo laser-scanning confocal microscopy was a useful method for the evaluation of the corneal cell density and area, nerve fiber density and morphology, and inflammatory cell density in patients with SS and also a useful tool in the assessment of treatment effect with topical 3% diquafosol sodium in the SS patients.

Application of In Vivo Confocal Microscopy in Dry Eye Disease.

Confocal microscopy is a new, emerging, noninvasive technology that can aid in the in vivo assessment of structural changes in several ocular surface diseases at the cellular level. In the dry eye field, in vivo confocal microscopy has been applied to the examination of the cornea, bulbar and palpebral conjunctiva, Meibomian gland, and lacrimal gland. The device can assess the morphology, including superficial/wing/basal epithelial cell density, stromal keratocyte density, endothelial cell density, nerve fiber density, the number of beadings, nerve tortuosity, nerve reflectivity, and inflammatory cell density in the cornea. Furthermore, the device can not only assess epithelial cell density and area, goblet cell, microcyst, and inflammatory cell density but also the cellular architecture, including nucleocytoplasmic ratio in conjunctiva. The device also can disclose acinar unit density, acinar unit longest diameter, acinar unit shortest diameter, and inflammatory cell density in the Meibomian gland and lacrimal gland by other potential applications. Relevant research in Europe and the United States focused on the morphologic changes in the cornea in the dry eye field, while Japanese research focused on the conjunctival, Meibomian gland, and lacrimal gland alterations. The application of in vivo confocal microscopy in dry eye disease will be a powerful method to evaluate the morphologic change of the ocular surface around the world in the future.

The Relation of Ocular Surface Irregularity and Visual Disturbance in Early Stage Acanthamoeba Keratitis.

PURPOSE: To evaluate the relation between ocular surface irregularity and visual disturbance in early stage Acanthamoeba keratitis (AK). METHODS: Fifteen patients with culture-proven AK underwent routine ophthalmic examinations, including best-corrected visual acuity (BCVA) measurement, slitlamp biomicroscope examination, and corneal fluorescein dye staining test, in both the eyes. We also evaluated the corneal sensitivity with Cochet-Bonnet esthesiometer, tear functions by Schirmer's test, and ocular surface irregularity by corneal topography and compared the results with the contralateral healthy eyes in this study. RESULTS: The mean logarithm of the minimum angle of resolution BCVA (0.71±0.77) was significantly lower in the eyes with AK (P=0.002). Epithelial disorders were present in all eyes, and radial keratoneuritis in 14 eyes (93.3%). The mean corneal sensitivity (39.3±24.1 mm) was significantly lower in eyes with AK compared with the healthy eyes (P=0.005). The mean Schirmer's test value (22.5±12.0 mm) in eyes with AK was significantly higher compared with the healthy eyes (P=0.01). The ocular surface irregularity indices (the surface regularity index, 2.47±0.42; the surface asymmetry index, 3.24±1.31) were significantly higher in eyes with AK compared with contralateral healthy eyes (P<0.0001 and P<0.0001, respectively). CONCLUSIONS: The ocular surface disease in AK is associated with decrease in corneal sensitivity and increase in Schirmer's test value and ocular surface irregularity indices. The visual disturbance in AK may owe not only to corneal haze but also to ocular surface irregularity.

Microwave Irradiation as a Promising Method of Sterilization for Acanthamoeba polyphaga in Cultures.

PURPOSE: To determine the killing effect of microwave irradiation on Acanthamoeba polyphaga. METHODS: The trophozoites and cysts of A. polyphaga both in water and on agar were exposed to microwave irradiation with a capacity of 750 W for 0, 1, 3, 5, and 10 minutes, respectively. Furthermore, the trophozoites and cysts of A. polyphaga in water were exposed to microwave irradiation with a capacity of 100, 300, and 500 W for 1 minute, respectively. RESULTS: The trophozoites and cysts of A. polyphaga on agar were completely killed by 3 minutes of microwave irradiation with a capacity of 750 W. The trophozoites and cysts of A. polyphaga in water were completely killed by microwave irradiation with a capacity of 300 W for 1 minute. CONCLUSIONS: We demonstrate that microwave treatment is effective in killing A. polyphaga both in water and on agar and may be a helpful modality to prevent Acanthamoeba keratitis.

[A Clinical Case Report Including In Vivo Laser Confocal Microscopic Findings of Keratitis Complicated with Takayasu's Arteritis].

BACKGROUND: We present a clinical case report including in vivo laser confocal microscopic findings of keratitis complicated with Takayasu's arteritis (aortitis syndrome). CASE: A 47-year-old woman was referred to the outpatient clinic of ophthalmology with blurred vision in her both eyes at the onset of Takayasu's arteritis. Since multifocal infiltrates in the stromal corneas with injection were observed with slit-lamp biomicroscope in the both eyes, the diagnosis was keratitis. A large amount of cells infiltrating the stromal cornea and activated keratocytes were also observed with in vivo laser confocal microscope in the both eyes. Systemic and local steroidal agents were initiated, which resolved the keratitis, and the active lesions turned into mild corneal scars. In vivo laser confocal microscopy showed no infiltrating cells in the stromal cornea of both eyes. No recurrence has been observed since. CONCLUSION: A rare case of keratitis complicated with Takayasu's arteritis is reported. An immune response to the stromal cornea as the etiology of the keratitis may be indicated by in vivo laser confocal microscopy.

Successful treatment of Beauveria bassiana fungal keratitis with topical voriconazole.

We describe a 66-year-old woman who suffered from fungal keratitis after corneal transplantation. The causative organism was identified as Beauveria bassiana on the basis of morphological characteristics and the sequence of the internal transcribed spacer region of the ribosomal RNA gene. The patient was successfully treated with topical voriconazole (VRCZ) use only. We, hereby, present the first report of a case with B. bassiana fungal keratitis that responded to topical antifungal VRCZ treatment.

Novel corneal piggyback technique for consecutive intraocular lens implantation and penetrating keratoplasty surgery.

PURPOSE: To report a novel "piggyback" penetrating keratoplasty technique performed in a patient with severe keratoconus. METHODS: A 43-year-old man underwent cataract surgery and a new "piggyback" penetrating keratoplasty (PKP) technique in his right eye, as he suffered from severe keratoconus and mature cataract due to severe atopic dermatitis. Under general anesthesia, phacoemulsification and aspiration (PEA), intraocular lens (IOL) implantation, and "piggyback" PKP while avoiding open-sky surgery was performed to prevent serious complications including IOL and vitreous prolapse. This PKP technique had been completed as a totally closed surgery. RESULTS: One year after "piggyback" PKP and cataract surgery, the grafted cornea remained clear and IOL was also well positioned. Best-corrected visual acuity improved from hand motions to 30/100. CONCLUSIONS: A novel "piggyback" PKP technique was successfully performed in a patient with severe keratoconus. The new "piggyback" corneal transplantation technique may become an indispensable tool for transplant surgeons who want to improve surgical safety and predictability.

Wickerhamomyces anomalus fungal keratitis responds to topical treatment with antifungal micafungin.

We describe a 91-year-old woman who suffered from fungal keratitis after corneal transplantation. The causative organism was identified as Wickerhamomyces anomalus (formerly Pichia anomala or Hansenula anomala) on the basis of morphological characteristics and the sequence of the internal transcribed spacer region of the ribosomal RNA gene. The patient was successfully treated with topical micafungin (MCFG) only. We present the first report of a case of W. anomalus fungal keratitis that responded to topical treatment with the antifungal MCFG.

Clinical backgrounds of postoperative keratoplasty patients with spontaneous wound dehiscence or gaps after suture removal.

PURPOSE: To report that spontaneous postkeratoplasty wound dehiscence or gaps caused by suture removal may occur years after penetrating and deep lamellar keratoplasty. METHODS: We retrospectively reviewed the medical records of 667 keratoplasty patients (890 eyes). This study included 8 eyes of 8 patients (3 men and 5 women) aged 64 to 86 years who suffered from spontaneous wound dehiscence or gaps caused by suture removal. We examined their clinical backgrounds such as surgical procedure, reason for suture removal, and time interval between keratoplasty and suture removal. RESULTS: The surgical procedures included 6 penetrating keratoplasties and 2 deep anterior lamellar keratoplasties. The most common reason for suture removal was high corneal astigmatism. Time interval between keratoplasty and suture removal was 15.9 ± 7.7 months (7-26 months). Three patients underwent suture removal from 6 months to 1 year after keratoplasty, 3 patients from 1 to 2 years, and 2 patients after more than 2 years. CONCLUSIONS: Whenever postoperative keratoplasty suture is removed, it is important to consider that wound dehiscence or gaps may occur without incidence of trauma.