Deep Anterior Lamellar Keratoplasty versus Penetrating Keratoplasty for Macular Corneal Dystrophy: A Randomized Trial

Purpose: To compare outcomes of big-bubble deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) for macular corneal dystrophy. Design: Prospective, randomized, interventional case series. Methods: Setting: Single hospital. Patients: Eighty-two eyes of 54 patients requiring keratoplasty for the treatment of macular corneal dystrophy without endothelial involvement were included. Main outcome measures: Operative complications, uncorrected visual acuity, best-corrected visual acuity, contrast sensitivity function, higher-order aberrations, and endothelial cell density were evaluated. Results: The DALK and PK group consisted of 35 and 41 eyes, respectively. Best-corrected visual acuity after surgery was 20/40 or better 68.5% and 70.7% of the eyes in the DALK and PK groups, respectively (P > .05). No statistically significant differences between groups were found in contrast sensitivity function with and without glare for any spatial frequency (P > .05). Significantly higher levels of higher-order aberrations were found in the DALK group (P < .01). In both groups, a progressive and statistically significant reduction in endothelial cell density was found (P < .01). At the last follow-up, the mean endothelial cell loss was 18.1% and 26.9% in DALK and PK groups, respectively (P = .03). Graft rejection episodes were seen in 5 eyes (12.1%) in the PK group, and regrafting was necessary in 3 eyes (7.3%). Recurrence of the disease was documented in 5.7% and 4.8% of the eyes in the DALK and PK groups, respectively. Conclusions: Deep anterior lamellar keratoplasty with the big-bubble technique provided comparable visual and optical results as PK and resulted in less endothelial damage, as well as eliminating endothelial rejection in macular corneal dystrophy. Deep anterior lamellar keratoplasty surgery is a viable option for macular corneal dystrophy without endothelial involvement.

A methodology for evacuation route planning inside buildings using geospatial technology

Evacuation route planning is a fundamental task for building engineering projects. Safety regulations are established so that all occupants are driven on time out of a building to a secure place when faced with an emergency situation. As an example, Spanish building code requires the planning of evacuation routes on large and, usually, public buildings. Engineers often plan these routes on single building projects, repeatedly assigning clusters of rooms to each emergency exit in a trial-and-error process. But problems may arise for a building complex where distribution and use changes make visual analysis cumbersome and sometimes unfeasible. This problem could be solved by using well-known spatial analysis techniques, implemented as a specialized software able to partially emulate engineer reasoning. In this paper we propose and test an easily reproducible methodology that makes use of free and open source software components for solving a case study. We ran a complete test on a building floor at the University of Alicante (Spain). This institution offers a web service (WFS) that allows retrieval of 2D geometries from any building within its campus. We demonstrate how geospatial technologies and computational geometry algorithms can be used for automating the creation and optimization of evacuation routes. In our case study, the engineers’ task is to verify that the load capacity of each emergency exit does not exceed the standards specified by Spain’s current regulations. Using Dijkstra’s algorithm, we obtain the shortest paths from every room to the most appropriate emergency exit. Once these paths are calculated, engineers can run simulations and validate, based on path statistics, different cluster configurations. Techniques and tools applied in this research would be helpful in the design and risk management phases of any complex building project.