Walton Nosé

Universidade Federal de São Paulo, San Paulo, São Paulo, Brazil

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Publications (99)132.45 Total impact

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    ABSTRACT: Purpose: To report a case series of 4 patients with Descemet membrane detachment (DMD) after undergoing femtosecond laser-assisted cataract surgery incisions. Methods: Case report. Results: DMD was noted at the secondary incision (n = 2) or at the main incision (n = 2). All the secondary incision and 1 main incision DMD were resolved with intraoperative maneuvers. Delay in recognizing DMD intraoperatively at the principal incision in 1 case led to inadvertent aspiration of a part of it and persistent postoperative corneal edema. This complication was handled with Descemet membrane endothelial keratoplasty 1 month after initial surgery. Conclusions: DMD can occur after femtosecond laser-assisted cataract surgery, although it is a rare complication as it is in traditional phacoemulsification. The surgeon must be prepared to recognize it, manage it intraoperatively, and treat it postoperatively to reduce the risk of permanent damage to the eye.
    No preview · Article · Feb 2016 · Cornea
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    Joao Crispim · Ricardo Nose · Milton Yogi · Walton Nose
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    ABSTRACT: Purpose: To evaluate the visual performance of different types of intraocular lens (IOL) in eyes submitted to femtosecond laser (FSL) cataract surgery and to analyze whether this technology could result in spectacles independence. Design: Retrospective comparative case series. Methods: Consecutive eyes that were scheduled for FSL cataract surgery were included in this study. After one month postoperative, patients were divided into two groups: cases that required prescription for eyeglasses and cases that did not require prescription. In addition, the patients were analyzed according to the type of IOL that was implanted (monofocal, monofocal toric, multifocal and multifocal toric). Results: Thirty-five cataract surgeries were analyzed. Twenty-three eyes had a monofocal IOL implanted, and 12 had a multifocal IOL implanted. After 1 month, 12 cases required prescription (Group 1), and 23 did not require prescription (Group 2). The proportion of eyes that did not require corrective lenses was significantly greater (P = 0.02) in eyes that received multifocal IOL (91.67%) compared with those that received monofocal IOL (47.83%). Additionally, 100% of eyes that received multifocal toric IOL did not require eyeglasses at one month postoperatively. Conclusion: The FSL surgical precision associated with modern IOL technology may be an important factor related to vision satisfaction after cataract surgery.
    Preview · Article · Sep 2015 · The Open Ophthalmology Journal
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    ABSTRACT: Este vídeo mostra uma complicação em uma cirurgia refrativa a laser com laser de femtosegundo IntraLase FS 60. Após realizar a cirurgia sem intercorrências no primeiro olho, começa a cirurgia no segundo olho. Perceba que nos dois procedimentos não foi utilizado aqui um campo estéril descartável para ajudar a manter as pálpebras abertas e separar os cílios do campo cirúrgico. Ao posicionar o anel de sucção e o “dock” do laser de femtosegundo durante a cirurgia do segundo olho, encarcera-se a pálpebra superior, cortando-a profundamente. Neste momento o paciente convulsiona. Na sequencia mostra-se a resolução do caso.
    No preview · Article · Mar 2015
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    ABSTRACT: Objective: To evaluate the introduction of the femtosecond laser (FSL) to perform the key steps of the traditional cataract surgery process and the operational difficulties and safety of this new technology during routine use in an operating room in Brazil. Methods: A retrospective study was conducted using the first cases operated on at a single center using the laser platform LenSx/Alcon with a soft contact lens patient interface. All patients underwent a detailed preoperative assessment. The anterior capsulotomy, nuclear fragmentation, and corneal incisions were created with the FSL; then, the surgery was completed following the standard phacoemulsification procedure. The main outcome measurements were difficulties and complications related to the learning curve and an analysis of postoperative uncorrected distance visual acuity (UDVA). Results: Of 31 patients (40 eyes), 9 patients had FSL cataract surgery in both eyes. The mean age was 64 ± 12 years (ranging from 42 to 82), the mean cataract nuclear sclerosis was grading 2 ± 0.6 (ranging from 1 to 4), and the preoperative mean UDVA in logMAR was 0.4 ± 0.2 (ranging from 0.1 to 1.3). Anterior capsulotomy was complete in all patients, and scissors were not needed to cut off any intact portion. The postoperative corneal incisions were not completely linear and showed some irregularities. Laser phaco-fragmentation was effective, with the division of the nucleus into smaller segments easily performed before phacoemulsification. After 1 month, the postoperative mean UDVA in logMAR was 0.1 ± 0.1 (ranging from 0.0 to 0.4) (P < 0.0001). Conclusion: With increasing surgical cases and experience, the phacoemulsification steps are performed precisely and effectively with FSL pretreatment, resulting in a safe learning curve.
    Preview · Article · Jan 2015 · Revista brasileira de oftalmologia

  • No preview · Article · Jun 2014 · Journal of Cataract and Refractive Surgery

  • No preview · Article · May 2014 · Journal of Cataract and Refractive Surgery
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    ABSTRACT: This case report describes the production of an ultrathin endothelial donor corneal lamella using a femtosecond laser with low energy and a high frequency. In addition, we report its use in vivo in an eye with pseudophakic bullous keratopathy. The outcomes were observed 3 months after surgery in terms of the change in endothelial donor lamella and full cornea thickness (including pachymetric mapping), visual acuity, and endothelial cell count.
    No preview · Article · Apr 2014 · Arquivos Brasileiros de Oftalmologia
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    ABSTRACT: To compare the outcomes of congenital cataract surgery using intraoperative intracameral triamcinolone versus postoperative oral prednisolone to modulate ocular inflammation. Department of Congenital Cataract, Altino Ventura Foundation, Recife, Brazil. Randomized clinical trial. Children younger than 2 years were randomly divided into 2 groups. The study group received an intraoperative intracameral injection of 1.2 mg/0.03 mL of triamcinolone acetonide. The control group (29 eyes) received 1 mg/kg per day of prednisolone syrup for 15 days postoperatively, which was then tapered over the following 2 weeks. Intraocular pressure (IOP), central corneal thickness (CCT), cell deposits on the intraocular lens (IOL), posterior synechiae, visual axis obscuration, additional surgical procedures, and IOL centration were assessed 12 months postoperatively. The mean patient age at surgery was 10.45 months ± 6.22 (SD) in the study group (31 eyes) and 10.0 ± 6.15 months in the control group (29 eyes) (P = .779). In both groups, the mean IOP and CCT did not change significantly postoperatively (study group P = .922 and P = .149, respectively; control group P = .483 and P = .416, respectively). The groups had similar incidences of cell deposits (P = .517) and posterior synechiae (P = .247). No eye developed visual axis obscuration or had additional surgical procedures. All eyes had a clinically centered IOL. One year postoperatively, the outcomes were similar with intraoperative intracameral triamcinolone injection and postoperative oral prednisolone for modulating inflammation after congenital cataract surgery. No author has a financial or proprietary interest in any material or method mentioned.
    Full-text · Article · Feb 2014 · Journal of Cataract and Refractive Surgery
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    ABSTRACT: Purpose: To evaluate the efficacy and reliability of a low-energy femtosecond laser with a high repetition rate for construction of deep anterior donor corneal lamellae. Methods: This was a prospective laboratory investigation. Twenty-five human corneal buttons were femtosecond laser cut to create thick anterior lamellae (diameter, 10mm; thickness, 500μm). The laser cuts were made using an LDV® femtosecond laser in a Ziemer® anterior chamber. To obtain a better edge, the lamellae were trephined with an 8mm trephine (Katena®). The central corneal thickness and the anterior lamellae were measured using a Mitutoyo® thickness gauge with an accuracy of 0.001mm. Results: The central thickness of the 25 corneas ranged from 500 to 705μm (mean, 584 ± 51μm). The thickness of the anterior lamellae ranged from 420 to 480μm (mean, 455 ± 12.7μm). The anterior lamellae diameters were 7.90 ± 0.1mm, and all laser cuts were round. The lamellar interfaces appeared regular by surgical microscopy. There were no cases of inter-lamellar adhesion. Conclusion: The LDV® femtosecond laser appears to be a safe and reliable instrument for cutting deep anterior lamellae from donor corneoscleral buttons. Minimal variation in donor lamellar depth with the laser will be useful for creating donor corneal tissue for deeper anterior lamellar keratoplasty or endothelial keratoplasty surgery or both from a single donor cornea.
    Preview · Article · Jan 2014 · Revista brasileira de oftalmologia
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    ABSTRACT: To relate the outcomes of 7 eyes of 7 patients in which a dexamethasone 0.7 mg implant (Ozurdex®) was placed inside the capsule bag after phacoemulsification and intraocular lens (IOL) implantation and compare with the fellow eyes, that were operated by the same technique and received dexamethasone eyedrops in the post-operatory. Report review of 7 eyes of 7 patients who received dexamethasone 0.7 mg implant after phacoemulsification and IOL, comparing them to the fellow eyes. All the patients underwent bilateral cataract surgery, with one month interval, by the same technique and by experienced surgeons, without complications. Post operatory medication consisted of moxifloxacin eye drops for all the 14 eyes and topic dexamethasone for the 7 eyes that did not received the implant. Nuclear cataract classification (according to LOCS III) was 3.28 ± 0.69 in the implant eye group and 3.14 ± 0.83 in the fellow eye group. Postoperative best spectacle correct visual acuity (BSCVA) was 0.85 ± 0.12 and 0.87 ± 0.13, respectively in the implant and fellow eye groups. The intraocular pressure remained stable and similar to the pre-operative measurements. Anterior chamber reaction and cornea edema were similar in both groups in the follow-up. Two of the four no sutured pellet migrated to the anterior chamber during the first post-operative week and had to be repositioned. Another no sutured pellet dislocated and remained partially inside the capsule bag. The 3 patients with IOL haptic-sutured pellet had no complications. In the present study, dexamethasone 0.7mg implant were effective in controlling the inflammation after phacoemulsification and IOL implantation, with no significant side effects.
    Full-text · Article · Aug 2013 · Arquivos brasileiros de oftalmologia
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    ABSTRACT: To report the visual outcomes and complications of congenital cataract surgery with primary intraocular lens implantation in microphthalmic eyes of children younger than 4 years of age. This retrospective interventional case series included 14 microphthalmic eyes from 10 children who underwent congenital cataract surgery with primary intraocular lens implantation younger than 4 years of age. Seven patients had bilateral cataracts (11 eyes met the study's inclusion criteria) and 3 patients had unilateral cataract. Patients' medical charts were reviewed to obtain information regarding the preoperative and postoperative ophthalmological examination. Main outcome measures were intraocular pressure (IOP), best-corrected visual acuity, and intraoperative and postoperative complications. Mean age at the time of surgery was 21.7 ± 2.9 months. Mean ocular axial length was 19.2 ± 0.9 mm. Mean preoperative IOP was 9.7 ± 1.7 mmHg and 10.3 ± 3.1 mmHg on final follow-up (P=0.18). There were no intraoperative complications. Two (15.4%) eyes developed secondary visual axis opacification, of which only one needed to be reoperated due to significantly decreased vision (0.5 logMAR). Preoperative and postoperative best-corrected visual acuity was 2.09 ± 0.97 logMAR and 0.38 ± 0.08 logMAR in bilateral cases and 1.83 ± 1.04 logMAR and 0.42 ± 0.13 logMAR in unilateral cases, respectively. Primary intraocular lens implantation in congenital cataract surgery in microphthalmic eyes resulted in a significant best-corrected visual acuity improvement with no intraoperative complications and minimal postoperative complications.
    Preview · Article · Aug 2013 · Arquivos brasileiros de oftalmologia
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    ABSTRACT: Purpose: To evaluate the nasolacrimal duct reconstitution with radio frequency for restoration of lacrimal flow in cases of nasolacrimal duct obstruction. Methods: The procedure was carried out in 16 eyes of 16 patients (13 women and 3 men) by the same surgeon, with monopolar high-frequency device at 450 kHz and 150 W, with local anesthesia under sedation. Inclusion criteria were lower lacrimal system obstruction (confirmed by dacryocystogram) and age over 18 years old. Exclusion criteria were previous trauma, acute dacryocystitis, cutaneous fistula, mucocele, previous lacrimal surgery and cardiac pacemaker. Results: Patients were followed for at least 120 days, patients were clinically evaluated at outpatient clinics for the presence of secretion, epiphora, reflux at compression of the lacrimal sac, placement of silicone tube and Milder test. At the 90-day postoperative visit, 13 patients had positive irrigation (81.25%) with clearance of lacrimal duct and 3 cases (18.75%) presented irrigation failure. Conclusion: Nasolacrimal duct reconstitution with radio frequency was effective in treating nasolacrimal duct obstruction.
    Preview · Article · Dec 2012 · Arquivos brasileiros de oftalmologia
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    ABSTRACT: To evaluate the change in intraocular pressure (IOP) and central corneal thickness (CCT) of children who underwent congenital cataract surgery with injection of triamcinolone acetonide into the anterior chamber at the end of the procedure. Fifty-three eyes of 34 children <2 years of age who underwent congenital cataract surgery with injection of 1.2 mg/0.03 mL of preservative-free triamcinolone acetonide into the anterior chamber at the end of the procedure were included in this study. IOP and CCT were measured preoperatively and at a mean of 2 and 12 months' follow-up. The mean IOP was 8.7 ± 0.4 mm Hg preoperatively, 8.4 ± 0.6 mm Hg at the 2-month follow-up, and 8.1 ± 0.3 mm Hg at the 12-month follow-up. The mean CCT was 562 ± 11 μm preoperatively, 563 ± 10 μm at the 2-month follow-up, and 570 ± 10 μm at the 12-month follow-up. There was no significant change in either pre- or postoperative IOP (P = 0.700) or CCT (P = 0.419) over the study period. Injection of 1.2 mg triamcinolone acetonide at the end of congenital cataract surgery in children <2 years of age did not significantly affect IOP or CCT in the first year after surgery.
    No preview · Article · Oct 2012 · Journal of AAPOS: the official publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus
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    Walton Nosé · Adriana dos Santos Forseto
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    ABSTRACT: The phakic intraocular lenses (pIOLs) are a good option for the correction of high refractive errors. According to their anatomical position there are two types of pIOLs: anterior or posterior chamber. The anterior chamber pIOL may be iris-fixated or angle-supported. The iris-fixated pIOLs are available not only for myopia correction, but also for hyperopia and astigmatism. During the last decades many modifications on the pIOLs designs were proposed in order to reduce late complications, such as progressive endothelial cell loss. Acute endothelial cell trauma related to the surgical procedure may be minimized with proper intraoperative care. Advances in the preoperative screening methods have improved the safety of the procedure. Estimation of the pIOL power is based on the van der Heijde calculations and is dependent on the anterior chamber depth, the spherical equivalent and the mean keratometric values. Long-term results show the efficacy, predictability and safety of the procedure. According to the type of the pIOL, complications other than endothelial cell loss include iritis, pigment dispersion, iris atrophy, pupil ovalization, pIOL rotation, decentration or dislocation, intraocular pressure elevation and pupillary block glaucoma. Foldable models actually available show promising results with lower complication rate.
    Preview · Article · Aug 2012 · Revista brasileira de oftalmologia
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    ABSTRACT: To assess the visual quality of life in patients with multiple sclerosis (MS), and to observe whether this parameter could be correlated to the findings of the ophthalmologic examination. The translated and validated 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25) was used to assess the visual quality of life. Clinical data on MS, visual acuity, visual fields, optic coherence tomography (OCT) and disc cupping were used for assessing correlation with VFQ-25. The mean VFQ-25 value was 78.6 ± 18.2% in 27 patients. VFQ-25 did not correlate with patients' ages, with disability (EDSS), disease duration or medication use. Visual acuity showed a relatively poor (<60%) correlation to VFQ-25, while no correlation could be established between visual fields, OCT and disc cupping with VFQ-25. MS patients present several alterations in their eyes and sight that cannot be assessed by isolated measures. Ophthalmological examination of these patients must include many parameters not usually used in standard ophthalmologic consultations.
    Preview · Article · Oct 2011 · Arquivos de neuro-psiquiatria
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    ABSTRACT: To compare visual acuity, aberrometry, and contrast sensitivity in patients who had a spherical intraocular lens (IOL) (SoFlex SE, Bausch & Lomb) implanted in one eye and an aspheric IOL (SofPort AO, Bausch & Lomb) implanted in the fellow eye during uncomplicated cataract surgery. A prospective, multicenter, double-blind study was performed. Forty patients (80 eyes) underwent bilateral phacoemulsification with implantation of a spherical IOL in one eye and an aspheric IOL in the fellow eye. Postoperatively, visual acuity, aberrometry, and contrast sensitivity tests were performed. Statistical analyses were performed using Student t and Wilcoxon tests, and mixed effects were used for each contrast condition situation. Thirty-nine patients (30 women, 9 men; 78 eyes) with a mean age of 69.3±6.17 years (range: 51 to 82 years) completed the study. No statistical differences were found regarding visual acuity among eyes. Lower levels of higher order aberrations were achieved in the aspheric group. No statistical difference between groups under photopic conditions was noted. In low spatial frequencies, better performance was observed with the aspheric IOL under mesopic conditions. In high spatial frequencies, the spherical IOL produced better quality of vision. Comparing mesopic conditions with glare, visual performance was statistically better using the aspheric IOL. Cataract surgery results cannot be measured by means of visual acuity alone. Quality of vision must be considered, and implantation of IOLs with low levels of spherical aberrations and better contrast sensitivity are preferred. In this study, the aspheric IOL demonstrated better visual function, especially at night, when compared with spherical IOLs.
    No preview · Article · Aug 2011 · Journal of refractive surgery (Thorofare, N.J.: 1995)
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    ABSTRACT: To compare corneal hysteresis (CH) and corneal resistance factor (CRF) in eyes with keratoconus with a central corneal thickness (CCT) ≥ 520 μm with CH and CRF in matched controls, and to estimate the sensitivity and specificity of these parameters for discriminating between the two groups. This prospective, comparative case series comprised 19 eyes of 19 patients with keratoconus with CCT ≥ 520 μm and 19 eyes of 19 healthy sex-, age-, and CCT-matched patients who underwent a complete clinical eye examination, corneal topography, tomography, and biomechanical evaluation. The receiver operating characteristic (ROC) curve was used to identify cutoff points that maximized the sensitivity and specificity for discriminating between groups. Central corneal thickness was 543.1 ± 13.9 μm (range: 520 to 568 μm) in the keratoconus group and 545 ± 12.5 μm (range: 527 to 575 μm) in the control group (P=.6017). Corneal hysteresis was 9.22 ± 1.44 mmHg (range: 6.2 to 11.35 mmHg) in the keratoconus group and 10.58 ± 1.91 mmHg (range: 7.34 to 13.53 mmHg) in the control group (P=.0075). Corneal resistance factor was 8.62 ± 1.52 mmHg (range: 5.60 to 11.20 mmHg) in the keratoconus group and 10.30 ± 1.92 mmHg (range: 6.95 to 14.12 mmHg) in the control group (P=.0049). The ROC curve analyses showed a poor overall predictive accuracy of CH (cutoff, 9.90 mmHg; sensitivity, 78.9%; specificity, 63.2%; test accuracy, 71.05%) and CRF (cutoff, 8.90 mmHg; sensitivity, 68.4%; specificity, 78.9%; test accuracy, 73.65%) for detecting keratoconus in the eyes studied. Corneal hysteresis and CRF were statistically lower in the keratoconus group compared with the control group. Given the large overlap, both CH and CRF had low sensitivity and specificity for discriminating between groups.
    Full-text · Article · Mar 2011 · Journal of refractive surgery (Thorofare, N.J.: 1995)
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    ABSTRACT: To evaluate and compare corneal hysteresis (CH) and corneal resistance factor (CRF) in healthy eyes with a central corneal thickness (CCT) < 505 µm with CH and CRF in gender-, age-, and CCT-matched keratoconus cases, and to estimate the sensitivity and specificity of these parameters for discriminating between the two groups. Prospective, comparative case series. In total 46 eyes from 30 healthy patients with CCT < 505 µm, and 42 eyes from 30 CCT-, gender- and age-matched keratoconus cases were enrolled. Biomechanical metrics (CH and CRF) were measured using the Ocular Response Analyzer (ORA) and then compared. A receiver operating characteristic (ROC) curve was used to identify cut-off points to maximize the sensitivity and specificity for discriminating between the groups. The CCT was 485.96 ± 17.61 µm (range, 438 - 505) in healthy thin corneas and 483.64 ± 16.19 µm (range, 452 - 505) in keratoconus; p=0.5225. CH was 8.63 ± 1.23 mmHg (range, 5.95 - 12.2) and 8.07 ± 1.17 mmHg (range, 4.9 - 9.85), respectively; p=0.0312. CRF was 8.43 ± 1.29 mmHg (range, 5.45 - 11.10) and 7.22 ± 1.34 mmHg (range, 4.7 - 9.45), respectively; p<0.001. ROC curve analysis showed a poor overall predictive accuracy of CH (cut-off, 8.95 mmHg; sensitivity, 63%; specificity, 23.8%; test accuracy, 44.30%) and CRF (cut-off, 7.4 mmHg; sensitivity, 28.3%; specificity, 40.5%; test accuracy, 34.12%) for detecting keratoconus in the eyes studied. CH and CRF were statistically lower in keratoconus than in healthy thin corneas. However, CH and CRF offered very low sensitivity and specificity for discriminating the groups.
    Full-text · Article · Feb 2011 · Arquivos brasileiros de oftalmologia
  • Adriana S Forseto · Ricardo M Nosé · Walton Nosé
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    ABSTRACT: To report the unexpected induction of astigmatism after phacoemulsification and toric intraocular lens (IOL) implantation in an eye with previous corneal refractive surgery. Case report of a 46-year-old man with bilateral nuclear cataract and previous photorefractive keratectomy. Because corneal topography identified regular corneal astigmatism at the central optical zone, phacoemulsification and implantation of a one-piece hydrophobic acrylic toric IOL were performed. Unexpected induction of astigmatism occurred in the first operated eye despite proper alignment of the IOL according to the preoperative calculations using simulated K values to determine toric IOL power and alignment. A retrospective qualitative analysis of corneal topography showed mismatching of the steepest meridian, leading to an off-axis IOL. Secondary IOL rotation improved both uncorrected and corrected distance visual acuity. Qualitative analysis of the corneal topography is mandatory during the assessment of toric IOL alignment in eyes with previous corneal refractive surgery to identify the actual location of the steepest meridian.
    No preview · Article · Feb 2011 · Journal of refractive surgery (Thorofare, N.J.: 1995)
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    Gustavo Victor · Milton Ruiz Alves · Walton Nosé
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    ABSTRACT: The authors describe a case of fungal keratitis that the in vivo confocal microscopy helped in the diagnosis and follow-up. Confocal microscopy was done in a patient's ulcer that did not improve with several topical medicines. Corneal scrapings were obtained and culture results were without conclusion. We observed hyphae and infectious collections on confocal microscopy. New corneal culture showed Fusarium sp ten days after confocal diagnosis.
    Preview · Article · Jan 2011 · Arquivos Brasileiros de Oftalmologia

Publication Stats

878 Citations
132.45 Total Impact Points

Institutions

  • 2003-2015
    • Universidade Federal de São Paulo
      • Departamento de Oftalmologia
      San Paulo, São Paulo, Brazil
  • 2003-2014
    • University of São Paulo
      San Paulo, São Paulo, Brazil
  • 2008-2011
    • Universidade Metropolitana de Santos
      Santos, São Paulo, Brazil
  • 2007
    • Universidade Gama Filho
      Rio de Janeiro, Rio de Janeiro, Brazil
  • 2005
    • Senac São Paulo
      San Paulo, São Paulo, Brazil
  • 2001-2004
    • Wolfe Eye Clinic
      Spencer, Iowa, United States