Name: rotating the intraocular lens to prevent posterior capsular opacification in cataract surgeries
Uploaded: 2023-07-07T14:10:00.000+00:00
Duration: 4 min 59 s
Description: Watch this Scientific Journal Video about Enhancing Visual Outcomes in Cataract Surgery: A Novel Technique to Prevent Posterior Capsular Opacification Through IOL Rotation at JoVE.com

本文由北京海淀创新与转型项目HDCXZHKC2021212资助。

这项研究遵循了《赫尔辛基宣言》的原则。该研究方案已获得北京大学第三医院机构评审委员会的批准。应该注意的是，这里的新程序是旋转人工晶状体的步骤。纳入标准是50岁以上愿意在北京大学第三医院接受白内障手术的白内障患者。排除标准是存在可能影响悬膜和囊袋稳定性的眼部疾病，例如病理性近视、青光眼、假性剥脱综合征、葡萄膜炎、晶状体半脱位（包括马凡综合征、Marchesani 综合征和高胱氨酸尿症）。
1. 手术准备
<ol><li>患者准备<ol><li>手术前 3 天每天 4 次使用 0.5% 左氧氟沙星滴眼液。手术前每5分钟给予0.4%盐酸奥布普卡因的局部麻醉滴眼液3次（见 材料表）。 注意：手术前1小时，患者用复方托吡卡胺滴眼液（0.5%托吡卡胺和0.5%盐酸去氧肾上腺素）散瞳。</li>
	</ol></li>
	<li>设备设置<ol><li>确保超声乳化装置系统的以下设置（见 材料表）：30%-95%扭转核切碎，90厘米瓶高，260-450毫米汞柱真空，36毫升/分钟抽吸流速。</li>
	</ol></li>
</ol>2. 使用灌溉和抽吸 （I/A） 系统旋转
<ol><li>角膜切口<ol><li>使用3.2毫米狭缝刀片在最陡的经络处做一个3.2毫米的角膜缘切口（见 材料表）。首选“Z”形多平面角膜切口。首先，创建一个垂直于角膜表面的 0.3 mm 深凹槽，并将刀片插入凹槽中，其尖端切向指向角膜表面，从而通过透明角膜进入前房形成一条隧道。</li>
		<li>使用20 G侧口微玻璃体视网膜（MVR）刀逆时针90°创建一个0.8毫米的辅助切口（见 材料表）。</li>
	</ol></li>
	<li>超声乳化<ol><li>在粘弹性条件下，使用Utrata囊溢出钳（见 材料表）用连续的曲线囊溢出打开胶囊。</li>
		<li>进行皮质切割水解，将钝尖套管与平衡盐溶液 （BSS） 放在前囊瓣下，小心地提起包膜，沿径向注射 BSS，将皮质与后囊分离。</li>
		<li>通过将BSS注入细胞核的物质中来执行水化划定，以将较硬的核与外周较软的核分离。</li>
		<li>在“切碎”的模式下，将phaco尖端埋入细胞核的中心，并将phaco尖端（见材料表）插入前囊瓣下，使用Sinskey钩将细胞核裂成两块（见材料表）。重复此步骤以创建细胞核的多个小楔形以进行超声乳化。</li>
	</ol></li>
	<li>灌溉和抽吸 （I/A）<ol><li>在“皮层”模式下调节机器。使用 I/A 吸头（参见 材料表）完成皮质清理。去除柔软的表核和外周皮质物质。</li>
	</ol></li>
	<li>人工晶状体插入<ol><li>用粘弹性填充胶囊袋和前房（见 材料表）。将可折叠的单件人工晶状体（见 材料表）装入预填充有粘弹性的注射器盒中。</li>
		<li>通过切口引入注射器的尖端，并通过推动注射器的尾部插入 IOL，前触觉扩散到囊袋中。使用注射器的尖端将后触觉放在前囊下方。</li>
	</ol></li>
	<li>旋转人工晶状体并去除粘弹性<ol><li>使用 I/A 尖端从前房中去除粘弹性。在此过程中，使用 I/A 尖端以轻微的后压顺时针旋转 IOL 至少 360°。</li>
		<li>通过将 I/A 尖端插入 IOL 的光学部分后面，吸出囊袋中的残留碎片和粘弹性。</li>
	</ol></li>
</ol>3. 使用人工晶状体钩旋转
<ol><li>插入人工晶状体之前的步骤与上述前四个步骤（2.1-2.4）相同。在这种方法中，将人工状体插入囊袋后，使用Fenzl钩（见 材料表）顺时针旋转人工晶状体至少360°，并将IOL从一侧滑到另一侧，同时对后囊施加轻微的压力。</li>
</ol>4. 后续程序
<ol><li>使用钝尖插管从穿刺切口滴注 BSS，以改革前房。</li>
	<li>将BSS注射到角膜隧道切口的两侧。如果切口泄漏，应用10-0尼龙缝合伤口。</li>
</ol>

在白内障手术中通过 IOL 旋转预防后囊膜混浊

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所有作者都没有利益冲突。

这种方法有一些好处。首先，胶囊袋内残留LEC进一步减少，尤其是赤道地区，合理降低PCO发生的可能性;其次，PCO的可能性降低意味着Nd：YAG激光治疗率较低，从而提供了保持胶囊袋完整性和有效镜片位置和功能的机会。第三，这种方法可以在白内障手术中使用可用的仪器来实现，而无需额外的准备。为了达到预防PCO的目的，有必要首先了解其生物过程。猕猴周围的前LEC具有原位生长的特征，似乎更可能表达α平滑肌肌动蛋白并成为肌成纤维细胞，导致前囊混浊和皱纹15,16。赤道LECs（LECs-E）保持干细胞的特性，具有主动分裂和迁移的能力，更容易形成埃尔施尼格珍珠16。当视觉轴中心的PCO影响光散射到眼睛时，视力就会丧失。因此，预防PCO的措施旨在清除LECs-E并防止其增殖和迁移到后囊。这种方法从根本上最大限度地减少了残留LEC的可能性，这是预防PCO的第一步。
许多研究提出了不同的方法来尝试预防PCO，包括药物抑制细胞增殖，诱导LEC细胞凋亡，改善人工晶状体设计和手术技能，但没有一项研究成功地完全预防PCO 1,17,18,19,20.Apple等人确定了影响PCO的六个因素：水切割增强皮质清理，IOL的袋内固定，中等大小的前囊溢出直径，高度生物相容的IOL材料，IOL光学和后囊的最大接触，以及具有方形截短边缘的IOL光学几何形状9。所有这些因素主要针对去除残留的LEC和皮质或在囊袋中保持适当的IOL位置以形成阻止细胞迁移的屏障。人工晶状体工程的进步有助于预防PCO。以前的研究发现，带有AcrySof IOLs（一种聚丙烯酸镜片）的眼睛与PCO程度降低和YAG率降低有关21,22。然而，在一项经典研究中，Nishi等人证明，AcrySof IOL对PCO患病率的有益影响主要是由于其方形边缘分布23。方形边缘通过形成物理屏障15 对其施加更高的压力，从而防止 LEC 迁移到后囊上。荟萃分析的结果支持了这一理论，揭示了预防PCO的一个主要因素是尖边人工晶状体的设计24，在观察期内，与圆边人工晶状体相比，PCO形成更少，Nd：YAG囊切开率更低。与以前的试验不同，Joshi等人提出，通过Sinskey钩旋转囊袋中的亲水性双触觉人工晶状体会降低PCO和Nd：YAG囊切开率，而PCO和激光治疗率仍然很低13。
这项研究旨在通过使用I / A尖端或钩子旋转IOL来清洁荚膜袋中残留的LEC，这提供了更多机械去除LEC的机会，尤其是赤道细胞。在植入触觉板人工晶状体的眼睛中，人工晶状体和包膜袋之间的接触面积更大，锋利的人工晶状体设计使接触更加全面和有效26。此外，先前的研究表明，板触觉人工晶状体比环形触觉具有更高的旋转稳定性27,28。目前尚不清楚针对预防PCO的LEC的最佳方法是什么，并且似乎还不够。改进手术设备，如飞秒激光技术，以完成精确的囊溢出并通过非常小的切口去除白内障，可能有助于PCO率29。
该方法的关键点包括：（1）纳入标准要严格;仅考虑带状带正常且包膜袋完整的患者。（2）应选择设计有触觉的一体式人工晶状体，特别是板式触觉人工晶状体，它为囊袋（尤其是赤道部分）提供了更易于接近的表面。 （3）I/A针应在虹膜平面上操作，以切向力移动人工晶状体。应避免过多的下行压力。在本文中，作者介绍了两种旋转 IOL 的方法，并且可以使用任何其他工具旋转来修改此过程。此方法有一些限制。首先，它可能对外科医生的手术技能有更高的要求。其次，应针对不同的人工晶状体设计进行大样本、精心设计、大规模的比较研究，以获得可靠的结果。第三，需要在动物或供体眼睛中进行体 外 实验研究，以验证人工晶状体的旋转是否影响赤道细胞。
综上所述，这种方法预防PCO的优点是不需要额外的材料或工具，只需白内障手术的一个步骤即可轻松实现。该方法具有成本效益，适用于白内障超声乳化术和人工晶状体植入手术。

白内障是全世界最常见的失明原因，其特征是晶状体混浊。治疗白内障的唯一方法是通过去除不透明的晶状体进行手术干预，从而恢复高视觉质量。然而，在手术后 2-5 年内，20%-40% 的患者会出现视觉质量的继发性下降，称为后囊混浊 （PCO）1。本文介绍了一种通过旋转人工晶状体（IOL）来预防PCO来进一步去除白内障手术中残留的晶状体上皮细胞（LECs）的方法。
PCO是由LEC引起的过程，在白内障手术后不可避免地留在包膜袋中，然后开始增殖和迁移2。在超声乳化过程中，前囊中连续的曲线囊溢出产生囊袋，其包括前囊的一部分、赤道囊和整个后囊2,3。在大多数患者中，将人工晶状体植入包膜袋中。透明的囊袋，尤其是后囊，允许光线透射到眼睛，这对于良好的术后视觉质量是必要的4。一部分 LEC 通常仍附着在包膜袋上。作为对手术创伤的反应和对人工晶状体的异物反应，残留的上皮细胞开始增殖并首先占据前囊的剩余部分，然后是所有可用的表面，包括人工晶状体的表面，最重要的是，先前无细胞的后囊4。随后，细胞继续分裂，最终覆盖整个后囊并影响视觉轴。以下变化，包括纤维化和再生形式5，可能导致严重的视力障碍6。
影响视力的PCO可以通过后囊囊切开术进行治疗，通常通过掺钕钇铝石榴石（Nd：YAG）激光，有时通过外科手术4。最近的研究报告，术后 3 年治疗 PCO 的 Nd：YAG 囊切开术的发生率在 5% 至 20% 之间7,8。然而，该手术会破坏正常的后囊形态并使后囊起皱，从而可能影响人工晶状体的位置，不利于人工晶状体的长期视觉结果，尤其是多灶性人工晶状体和复曲面人工晶状体6。外科手术、人工晶状体设计、LEC 增殖的药理学抑制和诱导 LEC 细胞凋亡方面的进展已被证实可用于预防 PCO，其中大部分针对 LEC9。
LEC通常以单层形式1分布在前晶状体囊的内侧。分布在赤道晶状体周围区域的LEC是分裂的自然部位，称为发芽区，而在前囊10,11上也观察到分裂细胞。还表明，赤道细胞可以在后囊中增殖和迁移12。囊袋中的残留 LEC 负责 PCO。如果在白内障手术期间尽可能清除萌发区的LEC，则术后发生PCO的可能性就会降低。据了解，常规超声乳化术不包括去除赤道LEC的程序。在印度的一项研究中，作者提出，通过囊袋中的Sinskey钩13旋转IOL会降低PCO和Nd：YAG囊切开率。
在这里，我们介绍了一种方法，即使用囊袋中的冲洗/抽吸（I / A）尖端旋转IOL，以防止白内障手术中的PCO。该方法的基本原理依赖于人工晶状体和囊袋（尤其是赤道区域）之间的机械接触，以去除残留的 LEC。与使用Nd：YAG囊切开术治疗PCO相比，预防PCO可保持后囊的完整性和人工晶状体的正确位置。此外，这种方法具有成本效益，不需要额外的工具，适用于白内障超声乳化术和人工晶状体植入术。与在phaco系统6,14的抛光模式下使用I / A尖端进行的前囊抛光不同，IOL的旋转是在人工晶状体植入后进行的，并且应该进一步去除可见的晶状体物质（皮层）和细胞。

<table><tbody><tr><td>20 G Sideport MVR Knife</td><td>BVI</td><td>378231</td><td>To make corneal incision</td></tr><tr><td>3.2 mm Slit Blade</td><td>BVI</td><td>378232</td><td>To make corneal incision</td></tr><tr><td>Balanced salt solution</td><td>Xingqi</td><td>H19991142</td><td>Compound electrolyte intraocular irrigating solution</td></tr><tr><td>Centurion vision system&amp;nbsp;</td><td>Alcon Laboratories</td><td>8065753057</td><td>The Centurion Vision System is indicated for emulsification, separation, irrigation, and aspiration of cataracts, residual cortical material and lens epithelial cells, vitreous aspiration and cutting associated with anterior vitrectomy, bipolar coagulation, and intraocular lens injection.</td></tr><tr><td>Compound tropicamide eye drops</td><td>Xingqi</td><td>Zhuobian</td><td>To dilate the pupils before the surgery</td></tr><tr><td>Disposable sterile irrigator</td><td>WEGO</td><td>100038404339</td><td>To complete hydrodissection and hydrodelineation&amp;nbsp;</td></tr><tr><td>Fenzl lens insertion hook and manipulator</td><td>Belleif</td><td>IF-8100</td><td>IOL positioning hook</td></tr><tr><td>Levofloxacin eye drops</td><td>Santen</td><td>Cravit</td><td>To prevent ocular infection before the surgery</td></tr><tr><td>Mini-flared Kelman tip 30DG</td><td>Alcon Laboratories</td><td>8065750852</td><td>To complete phacoemulsification</td></tr><tr><td>One piece intraocular Lens</td><td>Zeiss</td><td>AT TORBI 709M</td><td>Intraocular lens</td></tr><tr><td>Oxybuprocaine hydrochloride</td><td>Santen</td><td>Benoxil</td><td>Topical anesthesia</td></tr><tr><td>Phaco handpiece</td><td>Alcon Laboratories</td><td>8065751761</td><td>To complete phacoemulsification&amp;nbsp;</td></tr><tr><td>Sinskey hook</td><td>Belleif</td><td>IF-8013</td><td>For chop</td></tr><tr><td>Ultraflow II I/A tip</td><td>Alcon Laboratories</td><td>8065751795</td><td>To complete irrigation and aspiration&amp;nbsp;</td></tr><tr><td>Utrata capsulorhexis forceps</td><td>Belleif</td><td>IF-3003C</td><td>To complete continuous circular capsulorhexis</td></tr><tr><td>Viscoelastics/Medical sodium hyaluronate gel</td><td>Bausch&amp;amp;lomb</td><td>iviz</td><td>Maintaining the anterior chamber and capsular bag</td></tr></tbody></table>

rotating the intraocular lens to prevent posterior capsular opacification in cataract surgeries

后囊混浊（PCO）是囊外白内障手术常见的术后并发症，由晶状体上皮细胞的增殖和迁移引起，可显着影响长期视觉效果。PCO最有效的治疗方法是掺钕钇铝石榴石（Nd：YAG）激光囊切开术;然而，这种治疗与后节并发症有关，并可能破坏包膜袋的稳定性，影响三焦点或复曲面人工晶状体（IOL）的位置和功能。近年来，外科手术、人工晶状体设计和药学的进步降低了PCO的发生率，集中在抑制增殖性晶状体上皮细胞（LECs）上。该协议旨在超声乳化和人工晶状体植入期间更彻底地清除 LEC。前几个步骤，包括透明角膜切口、连续圆形囊溢、水解、水化描写和超声乳化术，作为常规手术完成。将人工晶状体放入囊袋后，使用冲洗/抽吸尖端或钩子将人工晶状体旋转至少 360°，对后囊施加轻微应力。在人工晶状体旋转后，原本透明的荚膜袋中出现了一些残留物。然后，使用灌溉/抽吸系统完全清除这些材料和粘弹性。在接受这种方法的患者中，手术后观察到清晰的后囊。这种旋转人工晶状体的方法是一种简单、有效且安全的方法，可以通过清除残留的 LEC 来预防 PCO，无需额外的工具或技能即可进行。

在I / A步骤后形成一个透明的囊袋（图1A）。然而，在旋转和抛光IOL后，在囊袋中观察到一些皮质碎片（图1B）。
此过程也可以使用钩子执行。同样，通过I / A尖端进行包膜抛光后，后囊是透明的（图2A）。通过人工晶状体的快速旋转和移动，人工晶状体后面的囊袋中出现了一些残留物（图2B）。
IOL在胶囊中的运动有两个功能。一方面，该程序实现了触觉和透镜囊赤道之间的充分接触。在I / A尖端的切向力下，IOL可以在囊袋中旋转，以使触觉破坏赤道区域内的上皮细胞以去除细胞并减少PCO的形成。另一方面，人工晶状体的滑动使人工晶状体的光学部分与后囊接触。I/A 尖端或挂钩将 IOL 载玻片从一侧到另一侧放入胶囊袋中，抛光后囊。
我们收集了20只接受过白内障手术的眼睛（10只眼睛旋转人工晶状体，10只眼睛没有旋转）。术后1天、1周、3个月随访，每次评估PCO的存在。患者的人口统计数据和PCO结果如 表1所示。 图3 是显示PCO示例的复古照明图像，图 4显示了透明荚膜袋。
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/65419/65419fig01.jpg"> 图 1：使用 I/A 尖端进行手术期间的囊袋外观。 （A） 通过 I/A 仪器进行常规抛光后，后囊非常干净。（B）I/A尖端旋转人工晶状体后，后囊前有碎片。放大倍率：10倍。比例尺：1毫米。 <a href="https://www-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/65419/65419fig01large.jpg" target="_blank">请点击此处查看此图的大图。</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/65419/65419fig02.jpg"> 图 2：使用 Fenzl 钩子进行手术期间的囊袋外观 。 （A）后囊经I/A仪器抛光后非常清晰。（B）人工晶状体通过钩子旋转后，人工晶状体后面的囊袋中出现了一些残留物。放大倍率：10倍。比例尺：1毫米。 <a href="https://www-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/65419/65419fig02large.jpg" target="_blank">请点击此处查看此图的大图。</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/65419/65419fig03.jpg"> 图 3： 通过 逆向照明的 PCO 图像。 这是PCO患者的一个例子。放大倍率：20倍。比例尺：1毫米。 <a href="https://www-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/65419/65419fig03large.jpg" target="_blank">请点击此处查看此图的大图。</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/65419/65419fig04.jpg"> 图4：术后1年后胶囊的图像。 1年后，囊袋仍然清晰透明。放大倍率：20倍。比例尺：1毫米。 <a href="https://www-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/65419/65419fig04large.jpg" target="_blank">请点击此处查看此图的大图。</a>
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody><tr><td colspan="2"></td>
			<td>年龄（岁）</td>
			<td>性别（女：男）</td>
			<td>多囊卵巢综合征患者人数</td>
		</tr><tr><td colspan="2">旋转组 （n = 10）</td>
			<td>71.3 ± 7.7</td>
			<td>04:06</td>
			<td>1</td>
		</tr><tr><td colspan="2">非旋转组 （n = 10）</td>
			<td>70.3 ± 7.5</td>
			<td>05:05</td>
			<td>3</td>
		</tr></tbody></table>表1：患者的人口统计数据和PCO结果。 PCO：后囊混浊。

Watch this Scientific Journal Video about Enhancing Visual Outcomes in Cataract Surgery: A Novel Technique to Prevent Posterior Capsular Opacification Through IOL Rotation at JoVE.com

作者聚焦：增强白内障手术的视觉效果：一种通过 IOL 旋转防止后囊膜混浊的新技术 

本协议描述了在囊外白内障手术中通过旋转人工晶状体去除残留的上皮细胞，而无需额外的工具来防止后囊混浊。

在白内障手术中旋转人工晶状体以防止后囊混浊

Posterior capsule opacification (PCO) is a common postoperative complication of extracapsular cataract surgery, which is caused by the proliferation and ...

这项研究描述了一种新技术，以增强去除可能残留在囊袋中的残留晶状体上皮细胞。国外白内障手术通过旋转人工晶状体来防止后囊混浊。PCO的主要治疗方法是荚膜。然而，此过程可能会导致后囊形状发生变化，这可能会影响人工晶状体的位置。这可能会导致多灶性或复曲面人工晶状体患者的长期视觉结果不理想。我们开发了一种预防白内障手术中PCO的技术，通过使用Envision和抽吸尖端旋转囊袋内的IOL。这种预防PCO的方法简单且具有成本效益。在白内障手术期间，它只需要一个额外的步骤，从而降低了PCO的可能性和对未来治疗的需求。我们计划对各种人工晶状体设计和PCO进行广泛的研究，旋转和非旋转设计中都包括大量参与者。此外，我们将对动物眼睛进行体外实验，以确定IOL旋转对赤道细胞的影响。

rotating-intraocular-lens-to-prevent-posterior-capsular-opacification

Universidad San Sebastian

Research

JoVE Journal

Medicine

Rotating the Intraocular Lens to Prevent Posterior Capsular Opacification in Cataract Surgeries

2.2K 次观看.  Peking University Third Hospital. 这项研究描述了一种新技术，以增强去除可能残留在囊袋中的残留晶状体上皮细胞。国外白内障手术通过旋转人工晶状体来防止后囊混浊。PCO的主要治疗方法是荚膜。然而，此过程可能会导致后囊形状发生变化，这可能会影响人工晶状体的位置。这可能会导致多灶性或复曲面人工晶状体患者的长期视觉结果不理想。我们开发了一种预防白内障手术中PCO的技术，通过使用E...

视频: 作者聚焦：增强白内障手术的视觉效果：一种通过 IOL 旋转防止后囊膜混浊的新技术 

A Novel Capsulorhexis Technique Using Shearing Forces with Cystotome

Purpose:
To demonstrate a capsulorhexis technique using predominantly shearing forces with a cystotome on a virtual reality simulator and on a human eye.
Method:
Our technique involves creating the initial anterior capsular tear with a cystotome to raise a flap. The flap left unfolded on the lens surface. The cystotome tip is tilted horizontally and is engaged on the flap near the leading edge of the tear. The cystotome is moved in a circular fashion to direct the vector forces. The loose flap is constantly swept towards the centre so that it does not obscure the view on the tearing edge.
Results:
Our technique has the advantage of reducing corneal wound distortion and subsequent anterior chamber collapse. The capsulorhexis flap is moved away from the tear leading edge allowing better visualisation of the direction of tear. This technique offers superior control of the capsulorhexis by allowing the surgeon to change the direction of the tear to achieve the desired capsulorhexis size.
Conclusions:
The EYESI Surgical Simulator is a realistic training platform for surgeons to practice complex capsulorhexis techniques. The shearing forces technique is a suitable alternative and in some cases a far better technique in achieving the desired capsulorhexis.

This video demonstrates a novel capsulorhexis technique in modern cataract surgery. Capsulorhexis is the most difficult and important part of phacoemulsification surgery.

一种新型撕囊技术，使用剪切力与Cystotome

Purpose:
To demonstrate a capsulorhexis technique using predominantly shearing forces with a cystotome on a virtual reality simulator and on a human eye....

科研

医学

A Novel Technique of Rescuing Capsulorhexis Radial Tear-out using a Cystotome

Part 1 : Purpose: To demonstrate a capsulorhexis radial tear out rescue technique using a cystotome on a virtual reality cataract surgery simulator and in a human eye. Part 2 : Method: Steps: When a capsulorhexis begins to veer radially towards the periphery beyond the pupillary margin the following steps should be applied without delay. 2.1) Stop further capsulorhexis manoeuvre and reassess the situation. 2.2) Fill the anterior chamber with ophthalmic viscosurgical device (OVD). We recommend mounting the cystotome to a syringe containing OVD so that the anterior chamber can be reinflated rapidly. 2.3) The capsulorhexis flap is then left unfolded on the lens surface. 2.4) The cystotome tip is tilted horizontally to avoid cutting or puncturing the flap and is engaged on the flap near the leading edge of the tear but not too close to the point of tear. 2.5) Gently push or pull the leading edge of tear opposite to the direction of tear. 2.6) The leading tearing edge will start to do a 'U-Turn'. Maintain the tension on the flap until the tearing edge returns to the desired trajectory. Part 3 : Results: Using our technique, a surgeon can respond instantly to radial tear out without having to change surgical instruments. Changing surgical instruments at this critical stage runs a risk of further radial tear due to sudden shallowing of anterior chamber as a result of forward pressure from the vitreous. Our technique also has the advantage of reducing corneal wound distortion and subsequent anterior chamber collapse. Part 4 : Discussion The EYESI Surgical Simulator is a realistic training platform for surgeons to practice complex capsulorhexis tear-out techniques. Capsulorhexis is the most important and complex part of phacoemulsification and endocapsular intraocular lens implantation procedure. A successful cataract surgery depends on achieving a good capsulorhexis. During capsulorhexis, surgeons may face a challenging situation like a capsulorhexis radial tear-out. A surgeon must learn to tackle the problem promptly without making the situation worse. Some other methods of rescuing the situation have been described using a capsulorhexis forceps. However, we believe our method is quicker, more effective and easier to manipulate as demonstrated on the EYESi surgical simulator and on a human eye. Acknowledgments: List acknowledgements and funding sources. We would like to thank Dr. Wael El Gendy, for video clip. Disclosures: describe potential conflicting interests or state We have nothing to disclose. References: 1. Brian C. Little, Jennifer H. Smith, Mark Packer. J Cataract Refract Surg 2006; 32:1420 1422, Issue-9. 2. Neuhann T. Theorie und Operationstechnik der Kapsulorhexis. Klin Monatsbl Augenheilkd. 1987; 1990: 542-545. 3. Gimbel HV, Neuhann T. Development, advantages and methods of the continuous circular capsulorhexis technique. J Cataract Refract Surg. 1990; 16: 31-37. 4. Gimbel HV, Neuhann T. Continuous curvilinear capsulorhexis. (letter) J Cataract Refract Sur. 1991; 17: 110-111.

Capsulorhexis is an important step in phacoemulsification surgery. A surgeon creates a continous curvilinear tear on the anterior lens capsule by controlling the tearing vector forces. A peripherally extended tear is a serious complication. This video demonstrates a novel technique of rescuing capsular radial tear out using a cystotome.

径向的抢救囊撕式的新技术，使用一个Cystotome

Part 1 : Purpose:   To demonstrate a capsulorhexis radial tear out rescue technique using a cystotome on a virtual reality cataract surgery simulator and ...

Ultrasound Cyclo Plasty in Eyes with Glaucoma

Glaucoma is a chronic disease caused by the progressive degeneration of the optical nerve fibers, resulting in decreased visual field that can lead to severe visual impairment, and eventually blindness. This manuscript describes a simple, surgeon-friendly, non-incisional technique, named Ultrasound Cyclo Plasty (UCP), for reducing intraocular pressure (IOP) in glaucoma patients. The technique determines a selective coagulation necrosis of the ciliary body; in addition, the stimulation of supra-choroidal and trans-scleral portions of the uveo-scleral outflow pathway has been recently proposed. UCP shows several technical improvements in ultrasound technology compared to previous techniques, providing more precise focusing on the target zone. The procedure is performed in the operating room under peribulbar anesthesia. Briefly, the coupling cone is put in contact with the eye and the ring probe, that contains six piezoelectric transducers which produce the ultrasound beams, is inserted inside it. Their proper centering over the ocular surface represents a crucial step for the correct targeting of the ciliary body. Sterile balanced salt solution is used to fill the empty spaces to ensure ultrasound acoustic propagation. Surgical treatment consists in the sequential automatic activation of each of the six transducers, for a total duration of less than 3 min. The patient leaves the hospital 1 h after the procedure with the treated eye patched. In the present study, 10 patients with open-angle glaucoma were followed-up during at least 12 months after the procedure. IOP was reduced at each interval compared to pre-operative, as well as the number of hypotensive medications. Twenty percent of patients did not respond to the treatment, and needed subsequent surgery to better control IOP. Treatment tolerability was good, with no cases of hypotony or phthisis. The UCP procedure is simpler, faster, safer, and less invasive than traditional cyclodestructive procedures with similar results in reducing IOP.

Glaucoma is a chronic disease with progressive degeneration of optic nerve fibers resulting in decreased visual field. Elevated intraocular pressure is considered the most important and the only treatable risk factor. This manuscript describes a simple, surgeon-friendly, non-incisional technique, named Ultrasound Cyclo Plasty, for reducing intraocular pressure in glaucoma patients.

青光眼眼中的超声环成形术

Glaucoma is a chronic disease caused by the progressive degeneration of the optical nerve fibers, resulting in decreased visual field that can lead to ...

行为学

Synthesis of Soft Polysiloxane-urea Elastomers for Intraocular Lens Application

This study discusses a synthesis route for soft polysiloxane-based urea (PSU) elastomers for their applications as accommodating intraocular lenses (a-IOLs). Aminopropyl-terminated polydimethylsiloxanes (PDMS) were previously prepared via the ring-chain equilibration of the cyclic siloxane octamethylcyclotetrasiloxane (D4) and 1,3-bis(3-aminopropyl)-tetramethyldisiloxane (APTMDS). Phenyl groups were introduced into the siloxane backbone via the copolymerization of D4 and 2,4,6,8-tetramethyl-2,4,6,8-tetraphenyl-cyclotetrasiloxane (D4Me,Ph). These polydimethyl-methyl-phenyl-siloxane-block copolymers were synthesized for increasing the refractive indices of polysiloxanes. For applications as an a-IOL, the refractive index of the polysiloxanes must be equivalent to that of a young human eye lens. The polysiloxane molecular weight is controlled by the ratio of the cyclic siloxane to the endblocker APTMDS. The transparency of the PSU elastomers is examined by the transmittance measurement of films between 200 and 750 nm, using a UV-Vis spectrophotometer. Transmittance values at 750 nm (upper end of the visible spectrum) are plotted against the PDMS molecular weight, and &#62; 90% of the transmittance is observed until a molecular weight of 18,000 g&#183;mol&#8722;1. Mechanical properties of the PSU elastomers are investigated using stress-strain tests on die-cut dog-bone-shaped specimens. For evaluating mechanical stability, mechanical hysteresis is measured by repeatedly stretching (10x) the specimens to 5% and 100% elongation. Hysteresis considerably decreases with the increase in the PDMS molecular weight. In vitro cytotoxicity of some selected PSU elastomers is evaluated using an MTS cell viability assay. The methods described herein permit the synthesis of a soft, transparent, and noncytotoxic PSU elastomer with a refractive index approximately equal to that of a young human eye lens.

This study describes synthetic routes for aminopropyl-terminated polydimethylsiloxanes and polydimethyl-methyl-phenyl-siloxane-block copolymers and for soft polysiloxane-based urea (PSU) elastomers. It presents the application of PSUs as accommodating an intraocular lens. An evaluation method for in vitro cytotoxicity is also described.

软聚聚硅氧烷-尿素弹性体在人工晶体中的应用

This study discusses a synthesis route for soft polysiloxane-based urea (PSU) elastomers for their applications as accommodating intraocular lenses ...

化学

Translaminar Autonomous System Model for the Modulation of Intraocular and Intracranial Pressure in Human Donor Posterior Segments

There is a current unmet need for a new preclinical human model that can target disease etiology ex vivo using intracranial pressure (ICP) and intraocular pressure (IOP) which&#160;can identify various pathogenic paradigms related to the glaucoma pathogenesis. Ex vivo human anterior segment perfusion organ culture models have previously been successfully utilized and applied as effective technologies for the discovery of glaucoma pathogenesis and testing of therapeutics. Preclinical drug screening and research performed on ex vivo human organ systems can be more translatable to clinical research. This article describes in detail the generation and operation of a novel ex vivo human translaminar pressure model called the translaminar autonomous system (TAS). The TAS model can independently regulate ICP and IOP using human donor posterior segments. The model allows for studying pathogenesis in a preclinical manner. It can reduce the use of living animals in ophthalmic research. In contrast to in vitro experimental models, optic nerve head (ONH) tissue structure, complexity, and integrity can also be maintained within the ex vivo TAS model.

We describe and detail the use of the translaminar autonomous system. This system utilizes the human posterior segment to independently regulate the pressure inside the segment (intraocular) and surrounding the optic nerve (intracranial) to generate a translaminar pressure gradient that mimics features of glaucomatous optic neuropathy.

用于调节人类供体后段眼内压和颅内压的跨层自主系统模型

There is a current unmet need for a new preclinical human model that can target disease etiology ex vivo using intracranial pressure (ICP) and intraocular ...

神经科学

Full-Circle Cauterization of Limbal Vascular Plexus for Surgically Induced Glaucoma in Rodents

Glaucoma, the second leading cause of blindness worldwide, is a heterogeneous group of ocular disorders characterized by structural damage to the optic nerve and retinal ganglion cell (RGC) degeneration, resulting in visual dysfunction by interrupting the transmission of visual information from the eye to the brain. Elevated intraocular pressure is the most important risk factor; thus, several models of ocular hypertension have been developed in rodents by either genetic or experimental approaches to investigate the causes and effects of the disease. Among those, some limitations have been reported such as surgical invasiveness, inadequate functional assessment, requirement of extensive training, and highly variable extension of retinal damage. The present work characterizes a simple, low-cost, and efficient method to induce ocular hypertension in rodents, based on low-temperature, full-circle cauterization of the limbal vascular plexus, a major component of aqueous humor drainage. The new model provides a technically easy, noninvasive, and reproducible subacute ocular hypertension, associated with progressive RGC and optic nerve degeneration, and a unique post-operative clinical recovery rate that allows in vivo functional studies by both electrophysiological and behavioral methods.

The goal of this protocol is to characterize a novel model of glaucomatous neurodegeneration based on 360&#176; thermic cauterization of limbal vascular plexus, inducing subacute ocular hypertension.

角膜缘血管丛全圆烧灼治疗啮齿动物手术诱发的青光眼

Glaucoma, the second leading cause of blindness worldwide, is a heterogeneous group of ocular disorders characterized by structural damage to the optic ...

Iris Fixation via External Pentagram Suturing

Extensive anterior synechia of the iris can result in the gradual disappearance of the anterior chamber. It is one of the most common outcomes of both oculopathy and complicated post anterior segment surgery. This can impact visual function and lead to bullous keratopathy, making it one of the most complex clinical problems. Conventional anterior chamber plasty will partially create the anterior chamber, but the anterior chamber disappears again in some cases. The main reasons are: (1) the iris lens diaphragm is loose with atrophied and tension-free iris so that the aqueous humor circulation will push and squeeze the iris forward; (2) the effect of "roller" formed in the process of inflammation or restoration will change the iris structure from peripheral anterior synechia (PAS) to extensive anterior synechia again; (3) the fibration will result in synechia from iris to the cornea. In such cases, corneal endothelium deficiency can't stop the aqueous humor from entering the cornea. This results in persistent corneal edema post-conventional anterior chamber plasty, resulting in progressive rubbing and lachrymation. Therefore, anterior chamber plasty is not the first choice for patients without surgical indications of Descemet's stripping automated endothelial keratoplasty (DSAEK). However, this can be performed in patients with surgical indications who plan to receive DSAEK. A unique method of iris fixation via external pentagram suturing anterior chamber plasty (PSACP) is described here. The present technique is also compared with the conventional anterior chamber plasty. PSACP and DSAEK might be an effective way to cure the bullous keratopathy with extensive anterior synechia of the iris and disappeared anterior chamber.

Iris Fixation via External Pentagram Suturing

The present protocol describes how a 10-0 polypropylene suture crosses the anterior surface of the iris, forming a pentagram to prevent both iris and pupil from moving toward the cornea. This can be combined with subsequent keratoplasty to cure bullous keratopathy with extensive anterior synechia of the iris.

虹膜通过外部五角星缝合固定

Extensive anterior synechia of the iris can result in the gradual disappearance of the anterior chamber. It is one of the most common outcomes of both ...

<meta charset="utf8"></head><body>通过 LEC 提取在小鼠模型中复制白内障手术技术

Modeling Cataract Surgery in Mice

Cataract surgery (CS) is an effective treatment for cataracts, a major cause of visual disability worldwide. However, CS leads to ocular inflammation, and in the long term, it can result in posterior capsular opacification (PCO) and/or lens dislocation driven by the post-surgical overgrowth of lens epithelial cells (LECs) and their conversion to myofibroblasts and/or aberrant fiber cells. However, the molecular mechanisms by which CS results in inflammation and PCO are still obscure because most in vitro models do not recapitulate the wound healing response of LECs seen in vivo, while traditional animal models of cataract surgery, such as rabbits, do not allow the genetic manipulation of gene expression to test mechanisms. Recently, our laboratory and others have successfully used genetically modified mice to study the molecular mechanisms that drive the induction of proinflammatory signaling and LEC epithelial to mesenchymal transition, leading to new insight into PCO pathogenesis. Here, we report the established protocol for modeling cataract surgery in mice, which allows for robust transcriptional profiling of the response of LECs to lens fiber cell removal via RNAseq, the evaluation of protein expression by semi-quantitative immunofluorescence, and the use of modern mouse genetics tools to test the function of genes that are hypothesized to participate in the pathogenesis of acute sequelae like inflammation as well as the later conversion of LECs to myofibroblasts and/or aberrant lens fiber cells.

<meta charset="utf8"></head><body>作者聚焦：揭示白内障手术后 PCO 和纤维化的分子机制

This method models cataract surgery in vivo by removing lens fiber cells from adult mice and leaving behind the capsular bag with attached lens epithelial cells (LECs). The injury response is then assessed at various times post-surgery using molecular and morphological criteria.

小鼠白内障手术建模

Cataract surgery (CS) is an effective treatment for cataracts, a major cause of visual disability worldwide. However, CS leads to ocular inflammation, and ...

在白内障手术中旋转人工晶状体以防止后囊混浊

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此视频中的章节

一种新型撕囊技术，使用剪切力与Cystotome

径向的抢救囊撕式的新技术，使用一个Cystotome

青光眼眼中的超声环成形术

软聚聚硅氧烷-尿素弹性体在人工晶体中的应用

用于调节人类供体后段眼内压和颅内压的跨层自主系统模型

角膜缘血管丛全圆烧灼治疗啮齿动物手术诱发的青光眼

虹膜通过外部五角星缝合固定

小鼠白内障手术建模

小鼠白内障手术建模

小鼠白内障手术建模