Name: ultrasound cyclo plasty in eyes with glaucoma
Uploaded: 2018-01-26T12:30:00.000+00:00
Duration: 5 min 5 s
Description: Watch this Scientific Journal Video about Ultrasound Cyclo Plasty in Eyes with Glaucoma at JoVE.com

作者没有致谢声明。

所有参加者在任何研究程序之前都提供口头和书面的同意。该项研究的议定书是按照《赫尔辛基宣言》进行的, 并得到了桑特·乌苏拉-Malpighi 教学医院人类研究道德委员会的批准。
1. 术前程序和眼科评价
<ol><li>测试距离和接近最佳矫正视力 (BCVA)。</li>
	<li>用狭缝灯显微镜评价眼前段。</li>
	<li>在注入了局部麻醉眼药水后, 用狭缝灯前房透镜检查前房角。</li>
	<li>用非接触眼底镜对裂隙灯间接眼底眼底进行评价。特别注意视盘头。</li>
	<li>
用 Goldmann 平眼压测量眼压。
	<ol>
<li>灌输局部麻醉眼药水以获得角膜麻醉。</li>
		<li>使用2% 荧光素 (眼科试纸) 对泪膜进行着色。 注: 用适量的荧光素对泪膜进行着色是至关重要的。高剂量产生太厚的荧光环与高估的眼压测量, 而低的数额产生太薄环与低估的眼压读数。</li>
		<li>在导光板上的眼压上安装狭缝灯轴。</li>
		<li>将蓝色钴滤光片和光束尽可能宽而明亮, 并将狭缝膜片完全打开。</li>
		<li>正确引导眼压头上的蓝色光束, 将狭缝光束放在同一个病人的眼睛的一侧, 在检查时, 以避免缝隙灯与病人的脸和病人的鼻子覆盖的光束的接触。</li>
		<li>请病人把头靠在狭缝灯头上, 睁大双眼, 直视前方, 保持完好。</li>
		<li>移动眼压使用狭缝灯操纵杆, 直到棱镜头部轻轻地与角膜表面的中心接触: 两个常规的荧光素撕裂半月圆, 通过每个棱镜, 当透过狭缝灯看目镜。</li>
		<li>顺时针旋转眼压一侧的校准旋钮, 使荧光素半圆圈靠近, 直到它们的内部边界相互接触, 形成一个水平 "S" 形: 在校准旋钮中显示的数字代表眼压措施. 注意: 一定要正确消毒, 用无菌水冲洗, 并在任何测量前擦拭眼压头。</li>
	</ol>
</li>
	<li>
用非接触光学 biometer 测量眼部解剖参数。
	<ol>
<li>让病人把头靠在头枕上, 睁大双眼, 直视前方, 保持完全静止。</li>
		<li>移动光学 biometer 使用它的操纵杆适当地聚焦在角膜表面的中心: 一个箭头和一个绿色圈子在显示帮助临床医生找到正确的位置。</li>
		<li>单击操纵杆上的按钮开始测量: 显示屏上出现一条绿线, 并开始移动形成一个圆圈。在这段时间内尽可能保持位置。</li>
		<li>每只眼睛执行至少5测量, 以减少可能出现的错误并提高可靠性。仪器自动计算平均值。</li>
	</ol>
</li>
	<li>使用图工具 (图 1) 在3可能的选项 (11、12或 13 mm 的环形直径) 中计算处理探头的适当大小。 注意: 需要两个眼部解剖参数: 白-白 (WTW, 距离等于角膜水平直径) 和轴向长度 (AL, 从角膜尖到凹的距离)。</li>
	<li>处方对患者的匹罗卡品眼药水每天3次从3天开始手术前, 以确保正确的术中减数, 使更精确的靶向睫状体由探头交付的超声束。</li>
</ol>2. 手术前的程序
<ol><li>将病人置于手术床上的仰卧位。</li>
	<li>
在手术前30分钟执行一球浸润与10毫升局麻 (哌加罗哌卡因) 进行局部麻醉。
	<ol>
<li>使用27口径的针头, 在下轨道边缘的第三和内两三分之一的外侧或 superonasally 下的 inferotemporally 处进行注射。</li>
	</ol>
</li>
</ol>3. 处理装置的制备
<ol><li>输入有关外科医生和病人的数据使用控制单元触摸屏, 然后选择眼睛治疗。 注: 第一代探头也可以选择4秒或6秒的超声曝光时间, 而第二代探头 (现在市面上唯一的) 只允许8秒的曝光时间。</li>
	<li>打开含有耦合锥和处理探头的无菌单使用设备包, 并将其电缆连接到控制单元。</li>
</ol>4. 程序
<ol><li>用10% 聚维酮碘3次准确消毒眼睑和眶皮肤。用干净无菌纱布擦拭消毒皮肤。</li>
	<li>在病人脸上放一个无菌的外科悬垂, 在治疗中以中心孔为中心, 以便正确地暴露它。</li>
	<li>将患者的头部稍稍向后躺, 以便使眼球表面水平放置, 使设备的锥的位置舒适 (图 2)。</li>
	<li>打开病人的眼睛, 不使用窥镜。</li>
	<li>将耦合锥放在眼表面上, 在颞侧有导管, 并轻轻移动至正确位置并将其居中, 形成一个均匀的白色巩膜环 (图 3)。如果需要, 使用外科钳来重新定位锥。 注意: 在角膜缘和圆锥内边界之间应可见2毫米的白色巩膜的最小均匀环。这个圆环应该是一样规则尽可能的所有沿360°眼睛保证最佳的中心的探针和因而正确目标的睫状体 (图 3)。</li>
	<li>按下脚开关上的吸入按钮, 从耦合锥的外围环开始低电平的吸力, 直到屏幕上的垂直条变为绿色。这使得在整个过程中 (图 4A) 中的连接锥与患者的眼睛保持直接接触。</li>
	<li>将治疗探头插入连接锥内, 并将电缆置于鼻腔位置。 注意: "单击" 声音将探测器的正确锚定到圆锥 (图 4B)。</li>
	<li>在开始和整个过程中, 在室温下, 用无菌平衡盐溶液 (BSS) 填充眼睛、锥和探针的空空间, 使治疗超声波的良好传播 (图 4C)。在适当水平的情况下重新填充 BSS 泄漏。</li>
	<li>让病人保持姿势, 并使头部完全静止。</li>
	<li>按下脚开关的启动按钮开始治疗, 并保持在所有的过程中的压力 (每个治疗部门之间的通道是完全自动的, 而无需释放脚开关的压力)。</li>
	<li>
在整个过程中牢牢地保持探头和耦合锥的最佳位置。避免移动、旋转或推探头, 以便在治疗期间 (图 4D) 允许治疗超声波束的最佳定心。 注: 在治疗过程中, 每一个六个传感器依次激活 4, 6, 或 8 s (取决于探针的生成), 与二十年代的间隔之前, 每次激活, 从上级部门和顺时针移动。控制单元显示了六传感器的顺序激活。外科治疗持续 124s, 136s, 或148s。<ol>
<li>松开脚踏开关的压力, 停止操作。在连续两个部门的激活之间的间歇处理中断的情况下, 治疗可以继续, 而不会失去任何部门;相反, 如果在某一部门的激活期间中断治疗, 有关部门的治疗就没有完成。</li>
	</ol>
</li>
	<li>在该过程结束时, 通过按下脚踏开关上的吸入按钮, 然后缓慢地倾斜锥, 直至 BSS 通过管状移除, 使吸入系统停用。</li>
</ol>5. 手术后的程序
<ol><li>术后立即将抗生素加类固醇滴眼液注入治疗眼中, 并将治疗后的眼部贴上24小时。 注意: 病人在手术后可以出院1小时。</li>
	<li>术后次日取出眼部眼罩, 检查治疗后的眼部, 并测量眼压。</li>
	<li>处方给患者抗生素加类固醇眼药水每天1月4次。</li>
	<li>检查治疗后的眼睛, 并测量眼压在 1, 7, 14 天, 1, 3, 6, 9 月, 和1年后的程序。</li>
</ol>

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A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+photocoagulation+of+the+ciliary+body+for+treatment+of+refractory+glaucomas.">Endoscopic photocoagulation of the ciliary body for treatment of refractory glaucomas.</a> Am J Ophthalmol. 124 (6), 787-796 (1997).</li><li>Iliev, M. E., Gerber, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Long-term+outcome+of+trans-scleral+diode+laser+cyclo-photocoagulation+in+refractory+glaucoma.">Long-term outcome of trans-scleral diode laser cyclo-photocoagulation in refractory glaucoma.</a> Br J Ophthalmol. 91 (12), 1631-1635 (2007).</li></ol>

作者没有什么可透露的。

青光眼是一种慢性渐进性疾病, 影响视神经, 需要新的有效治疗来改善远期预后。眼压的减少仍然被认为是唯一有效的治疗方法, 以防止或延迟视力领域的损失, 在眼睛和没有高眼压3。
是一种新的非切口 cyclodestructive 术, 可以降低眼压, 采取两种不同的方式: 减少水中的体液流入, 确定睫状体分泌上皮的选择性坏死, 增加水的幽默感。uveo-巩膜流出刺激跨巩膜和超脉络膜通路13,16,22。该技术是快速, 容易, 安全, 和外科医生友好, 导致更少的侵入性和同样有效的眼压降低, 比以前的 HIFU25,26,27和传统的 cyclodestructive过程28,29。与以前的技术相比, 在解偶的技术方面进行了一些技术改进, 为目标区域提供了更精确的聚焦。特别地, 探针与眼睛直接接触, 并且在整个过程中使用相同的设置进行治疗, 从而使外科医生的错误风险降到最低。此外, 与以前的系统 (5 mhz) 相比, 更高的工作频率 (21 mhz) 允许将目标区域居中, 同时保留相邻的组织19。
该解耦装置由一个无菌、单使用的治疗包组成, 包括聚合物制成的耦合锥和处理探头。耦合锥和探头通过电缆连接到便携式控制单元 (36 厘米长 x 32 厘米宽 x 26 厘米高度), 允许设置治疗参数, 并通过触摸屏控制过程。探针是30毫米直径和15毫米高度的圆环并且包含六压电变换器, 生产和交付超声束。每个换能器大约是 7.0 mm 长度、4.5 mm 宽度和 10.2 mm 半径的圆柱段, 总表面积约为 35 mm2。他们的焦点活跃容量类似于椭圆形圆筒与轴向长度1.2 毫米, 横向宽度0.4 毫米和侧向宽度 (圆筒的长度) 的3.5 毫米。三不同的探头尺寸 (11、12和 13 mm 的环形直径) 可用于最适合眼睛尺寸和形状的设备。根据直径, 六压电元件是中心在11毫米, 12 毫米, 或13毫米直径圆在眼睛的周长和超声束聚焦2毫米在巩膜之下对应于睫状体的空间位置, 导致了高度精确的组织靶向。
六传感器提供的超声操作的频率为21兆赫, 声学功率为 2 W, 确定快速增加的睫状体的局部温度高达90° c (避免组织沸腾), 并允许治疗多达30% 的睫状身体.
关于做法的有效性和安全的数据这里出现类似于在文学报道的那些。特别是10例开角型青光眼患者在手术后至少12月内随访。与手术前的价值相比, 每隔一段时间, 眼压就减少了, 以及低血压局部和系统性药物的数量。20% 的患者没有达到目标眼压, 没有或最小的减少, 需要进一步的切口手术, 以更好地控制眼压。Aptel et al.先前曾假设过几个假说, 解释了后一种情况下的失败, 包括睫状体凝固的不充分或次优居中, 主要是由于设备的非自愿运动或在手术过程中施加在探针上的过度压力, 随之而来的巩膜和睫状体的变形24。治疗安全和耐受性好, 与以前的研究一致19,21,23,24, 在长期没有眼压或肺结核的情况下, 代表最严重的不良传统 cyclodestructive 方法的事件。此外, 没有病人在手术过程中或术后经历疼痛。然而, 一个最佳的球块是强制性的, 使这个过程舒适。
一个关心与整体 cyclodestructive 规程是长期维护眼压减少9,12。这项试验性研究的随访时间有限, 至少12月, 目前正在进行一项多中心研究, 评估这一程序在较大组患者中的远期疗效。事实上, 该程序是按照一个标准化的, 最小的操作依赖技术, 并似乎特别适合多中心临床试验。这项试验性研究的另一个主要局限是以治疗病人的特点为代表, 这些患者的表现并不均匀, 反映了真实世界的青光眼人群。此外, 非比较设计是该研究的另一个额外限制。
但是, 必须遵循一些基本规则才能正确执行该过程。特别是, 外科医生必须中心的锥和保持探头在最佳位置在整个过程中, 并避免移动, 旋转, 或推动, 以最好的中心治疗超声波的目标网站。另外, 外科医生必须在眼睛、锥体和探针之间填补洞在开始和在整个过程期间, 为了允许治疗超声波的好传播。另一个未解决的问题是, 该解偶的装置不是完全 "定制" 的每一个治疗眼睛, 但可在三不同的大小, 更好地适应形状和眼睛的大小。这一方面可能在理论上削弱程序的有效性由于超声对目标睫状体的不完善的中心, 特别是在高度近视或浅室的患者, 两个解剖学特征频繁地相关与青光眼.
总之, 本研究表明, 使用 HIFU 是一种简单, 安全, 有效的非切口技术, 减少眼压在开角型青光眼患者。

青光眼是导致全世界失明的主要原因之一, 影响约1亿人的1。它是由神经纤维的渐进变性所产生的一种光学神经病, 它会聚在视神经上, 从而在视觉上减少了视力障碍, 最终导致失明而没有足够治疗2。
高眼压仍然被认为是青光眼发病和进展的主要危险因素, 目前唯一可以治疗的参数是减少视觉领域的损失3。通过使用局部或全身药物、激光或外科手术3,4, 可以通过减少水幽默的产生和/或通过小梁网增加其流出来达到眼压降低。在加热或冷冻后, 已经引入了许多物理过程来诱导睫状体的凝固坏死5,6,7,89, 10、11、12。然而, 缺乏选择性的目标组织和不可预知的剂量效应关系, 减少眼压限制他们只使用的眼睛与青光眼的常规医疗和外科治疗4。
在过去的几年中, 一个新的装置, 名为 "统一", 使用高强度聚焦超声 (HIFU) 已经开发, 目的是克服传统的 cyclodestructive 技术的局限性, 实现更有选择性的凝聚睫状体和避免可能损害相邻眼部结构13,14,15,16,17,18,19,20,21. 此外, 最近还提出了 uveo-巩膜流出通路的超脉络膜和反巩膜部分的刺激, 作为减少眼压的一个可能的辅助机制.迄今为止, 在不同类型和严重程度的青光眼中进行了七项主要临床研究, 证明了这种非切口手术的有效性和安全性14,15, 19,20,21,22,23,24。
本研究的目的是详细描述上述程序, 以便将其介绍的知识传播给科学医学界, 并为想接近这一新领域的外科医生提供有用的技巧和技巧。

<table><tbody><tr><td>BM 900 Slit Lamp Biomioscropy</td><td>Haag-Streit, Koeniz, Switzerland</td><td>BM 900</td><td>Slit Lamp Biomiscroscopy</td></tr><tr><td>G-4 Four-Mirror Glass Gonio Lens</td><td>Volk Optical Inc., Mentor, OH, USA</td><td>#VG4</td><td>Contact lens for gonioscopy</td></tr><tr><td>78D Non Contact Slit Lamp Lens</td><td>Volk Optical Inc., Mentor, OH, USA</td><td>#V78C</td><td>Non contact slit lamp lens</td></tr><tr><td>HospiFluo strips</td><td>AIESI Hospital Service S.a.s., Napoli, Italy</td><td>AHS129</td><td>Fluorescein sterile disposable strips</td></tr><tr><td>AT 900 Goldmann Applanation Tonometer</td><td>Haag-Streit, Koeniz, Switzerland</td><td>AT 900</td><td>Goldmann applanation tonometer</td></tr><tr><td>Lenstar LS900</td><td>Haag-Streit, Koeniz, Switzerland</td><td>LS900</td><td>Optical biometer</td></tr><tr><td>Pilocarpina 2% eye drops</td><td>Farmigea, Pisa, Italy</td><td>S01EB01</td><td>Miotic eye drops</td></tr><tr><td>Mepivacaina 20mg/ml injectable solution</td><td>Angelini, Roma, Italy</td><td>N01BB03</td><td>Local anesthetic for injection</td></tr><tr><td>Naropina 10mg/ml injectable solution</td><td>AstraZeneca, Milano, Italy</td><td>N01BB09</td><td>Local anesthetic for injection</td></tr><tr><td>Oftasteril 5% eye drops</td><td>Alfa Intes, Napoli, Italy</td><td>S01AX18</td><td>5% povidone-iodine eye drops</td></tr><tr><td>EyeOP1</td><td>Eye Tech Care, Rillieux-la-Pape, France</td><td></td><td>UCP device</td></tr><tr><td>BSS (balanced salt solution)</td><td>Alcon Inc., Forth Worth, TX, USA</td><td>0065-1795-04</td><td>Sterile irrigating solution</td></tr><tr><td>Tobradex eye drops</td><td>Alcon Italia Spa, Milano, Italy</td><td>S01CA01</td><td>Antibiotic and steroid eye drops</td></tr></tbody></table>

ultrasound cyclo plasty in eyes with glaucoma

青光眼是一种慢性疾病, 由光学神经纤维的渐进变性引起, 导致视力下降, 导致视力严重受损, 最终失明。这份手稿描述了一个简单的, 外科手术友好, 非切口技术, 命名为超声环成形术 (解偶), 以减少眼压 (眼压) 的青光眼患者。该技术决定了睫状体的选择性凝固坏死;此外, 最近还提出了 uveo-巩膜流出通路的超脉络膜和反巩膜部分的刺激。与以前的技术相比, 在超声技术方面有了一些技术上的改进, 为目标区域提供了更精确的聚焦。手术在手术室进行球麻醉。简单地说, 耦合锥是与眼睛和环探头, 其中包含六压电传感器, 产生超声束, 在它里面插入。他们正确的中心在眼表面代表了一个关键的步骤, 正确的靶向睫状体。用无菌平衡盐溶液填充空腔, 保证超声声传播。外科治疗包括在每一个六传感器的顺序自动激活, 总持续时间少于3分钟。病人在手术后离开医院1小时, 用治疗过的眼睛修补。在本研究中, 10 例开角型青光眼患者在术后至少12月内随访。与手术前相比, 每隔一段时间, 眼压降低, 低血压药物的数量也减少。20% 的患者对治疗没有反应, 需要随后的手术来更好地控制眼压。治疗耐受性好, 无眼压或肺结核。与传统的 cyclodestructive 程序相比, 这种方法更简单、更快、更安全、更少侵入, 从而减少眼压。

根据上述技术, 对开放角型青光眼患者10例 (6 男性和4女性, 平均年龄64.9 ±13.7 岁, 范围39–80岁) 十眼进行治疗。治疗暴露时间为2例, 6 例为4例, 8 患者为4秒。术前平均眼压为24.8 ±9.6 柱 (平均±标准差), 每日低血压下降值为3.9 ± 1.0, 每日胺片平均数为0.6 ±0.5。另外, 平均视力为 0.48 logMAR ± 0.6, 平均视场平均偏差为-12.65 ± 12.1 dB。
八例患者完成了1年随访学习期, 两例患者进行切口手术, 分别进行了3和6月的术后眼压控制。每次手术后平均眼压值与术前值相比下降。特别是,图 5显示了随着时间的推移, 眼压值、低血压滴眼液和口服胺片数的减少, 表示为均值 (±标准差) 和还原百分比。在1年, 平均眼压降低与手术前的价值 (16.9 ±2.8 柱), 以及平均数目的术后降压眼药水 (1.9 ± 1.5)。在最后一次随访中, 没有病人需要使用更长的口服胺片。平均术后视力保持大致稳定的1年随访 (平均0.52 ± 0.64 logMAR) 以及视野平均偏差 (平均-13.34 ± 11.8 dB)。
手术期间和术后均无重大并发症发生, 但有固定和扩张性瞳孔的情况下, 3 月后自发解决。
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/56192/56192fig1.jpg"> 图 1: 图工具.图工具, 允许计算的适当探头大小 (11, 12, 或13毫米的直径) 为病人, 根据两个参数计算的光学生物: 白-白 (WTW, 距离等于角膜水平直径) 和轴向长度(AL, 从角膜尖到凹的距离)。<a href="//cloudflare.jove.com/files/ftp_upload/56192/56192fig1large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/56192/56192fig2.jpg"> 图 2: 头部和眼睛位置.正确的头部和眼睛的位置, 以确保适当和舒适的位置的耦合锥。<a href="//cloudflare.jove.com/files/ftp_upload/56192/56192fig2large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/56192/56192fig3.jpg"> 图 3: 耦合锥的正确和错误放置.(A) 在所有360°的情况下, 在角膜缘和圆锥之间的固定和均匀的巩膜环 (红色环) 上的耦合锥的正确位置。这样, 探针正确地瞄准了睫状体, 当插入在联结锥体。(B) 耦合锥的错误放置, 其周围有一个非均匀的巩膜环。<a href="//cloudflare.jove.com/files/ftp_upload/56192/56192fig3large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/56192/56192fig4.jpg"> 图 4: 治疗的主要步骤.(A) 用低电平真空系统将被吸入环固定在患者眼球上的耦合锥正确对准;(B) 将治疗探头插入耦合锥内, 并将电缆置于鼻腔位置。"点击" 声音证实探针的适当的锚地对锥体;(C) 在眼睛、锥和探针之间形成的凹腔在室温开始和整个过程中充满无菌平衡盐溶液, 以使治疗超声波的良好传播;(D) 在整个过程中, 必须由临床医生的两只手在最佳位置牢固地维护探头和耦合锥。<a href="//cloudflare.jove.com/files/ftp_upload/56192/56192fig4large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/56192/56192fig5.jpg"> 图 5: 整个研究期间眼压值的代表性图像.术前和术后眼压值 (±标准差) 在每次随访时均表示为平均值和从基线减少的百分比。在底部, 低血压滴眼液的数量, 胺片剂, 和他们的减少的百分比在1年显示 (d = 天; m = 月; y = 年)。<a href="//cloudflare.jove.com/files/ftp_upload/56192/56192fig5large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>

Watch this Scientific Journal Video about Ultrasound Cyclo Plasty in Eyes with Glaucoma at JoVE.com

Ultrasound Cyclo Plasty in Eyes with Glaucoma

青光眼是一种慢性疾病, 逐渐退化的视神经纤维, 导致视野下降。眼压升高被认为是最重要和唯一可治疗的危险因素。这份手稿描述了一个简单的, 外科手术友好, 非切口技术, 命名为超声环成形术, 以减少眼压在青光眼患者。

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 ...

ultrasound-cyclo-plasty-in-eyes-with-glaucoma

Nanyang Technological University

Research

JoVE Journal

Behavior

12.1K 次观看.  University of Bologna. 青光眼是一种慢性疾病, 逐渐退化的视神经纤维, 导致视野下降。眼压升高被认为是最重要和唯一可治疗的危险因素。这份手稿描述了一个简单的, 外科手术友好, 非切口技术, 命名为超声环成形术, 以减少眼压在青光眼患者。

视频: Ultrasound Cyclo Plasty in Eyes with Glaucoma

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 ...

An &#8220;All-laser&#8221; Endothelial Transplant

The &#8220;all laser&#8221; assisted endothelial keratoplasty is a procedure that is performed with a femtosecond laser used to cut the donor tissue at an intended depth, and a near infrared diode laser to weld the corneal tissue. The proposed technique enables to reach the three main goals in endothelial keratoplasty: a precise control in the thickness of the donor tissue; its easy insertion in the recipient bed and a reduced risk of donor lenticule dislocation. The donor cornea thickness is measured in the surgery room with optical coherence tomography (OCT), in order to correctly design the donor tissue dimensions. A femtosecond laser is used to cut the donor cornea. The recipient eye is prepared by manual stripping of the descemetic membrane. The donor endothelium is inserted into a Busin-injector, the peripheral inner side is stained with a proper chromophore (a water solution of Indocyanine Green) and then it is pulled in the anterior chamber. The transplanted tissue is placed in the final and correct location and then diode laser welding is induced from outside the eyeball. The procedure has been performed on more than 15 patients evidencing an improvement in surgery performances, with a good recovery of visual acuity and a reduced donor lenticule dislocation event.

An all laser procedure is proposed in the endothelial transplant. The surgical technique is based on the use of a femtosecond laser to prepare the donor tissue. Laser welding technique is then used to secure the donor endothelium in the correct position.

"全激光"内皮移植

The &#8220;all laser&#8221; assisted endothelial keratoplasty is a procedure that is performed with a femtosecond laser used to cut the donor tissue at an ...

Scleral Cross-linking Using Riboflavin and Ultraviolet-A Radiation for Prevention of Axial Myopia in a Rabbit Model

Myopic individuals, especially those with severe myopia, are at higher-than-normal risk of cataract, glaucoma, retinal detachment and chorioretinal abnormalities. In addition, pathological myopia is a common irreversible cause of visual impairment and blindness1-3. Our study demonstrates the effect of scleral crosslinking using riboflavin and ultraviolet-A radiation on the development of axial myopia in a rabbit model. The axial length of the eyeball was measured by A-scan ultrasound in New Zealand white rabbits aged 13 days (male and female). The eye then underwent 360&#176; conjunctival peritomy with scleral crosslinking, followed by tarsorrhaphy. Axial elongation was induced in 13 day-old New Zealand rabbits by suturing their right eye eyelids (tarsorrhaphy). The eyes were divided into quadrants, and every quadrant had two scleral irradiation zones, each with an area of 0.2 cm&#178; and a radius of 4 mm. Crosslinking was performed by dropping 0.1% dextran-free riboflavin-5-phosphate onto the irradiation zones 20 sec before ultraviolet-A irradiation and every 20 sec during the 200 sec irradiation time. UVA radiation (370 nm) was applied perpendicular to the sclera at 57 mW/cm&#178; (total UVA light dose, 57 J/cm&#178;). Tarsorrhaphies were removed on day 55, followed by repeated axial length measurements. This study demonstrates that scleral crosslinking with riboflavin and ultraviolet-A radiation effectively prevents occlusion-induced axial elongation in a rabbit model.

We demonstrate the effect of scleral crosslinking with riboflavin and UVA on an axial elongation rabbit eye. Axial elongation was induced in 13 day-old New Zealand rabbits (male and female) by suturing their right eye eyelids (tarsorrhaphy).

巩膜交联兔模型使用核黄素和紫外辐射的轴性近视防治

Myopic individuals, especially those with severe myopia, are at higher-than-normal risk of cataract, glaucoma, retinal detachment and chorioretinal ...

Second Harmonic Generation Signals in Rabbit Sclera As a Tool for Evaluation of Therapeutic Tissue Cross-linking (TXL) for Myopia

Methods to strengthen tissue by introducing chemical bonds (non-enzymatic cross-linking) into structural proteins (fibrillar collagens) for therapy include photochemical cross-linking and tissue cross-linking (TXL) methods. Such methods for inducing mechanical tissue property changes are being employed to the cornea in corneal thinning (mechanically weakened) disorders such as keratoconus as well as the sclera in progressive myopia, where thinning and weakening of the posterior sclera occurs and likely contributes to axial elongation. The primary target proteins for such tissue strengthening are fibrillar collagens which constitute the great majority of dry weight proteins in the cornea and sclera. Fortuitously, fibrillar collagens are the main source of second harmonic generation signals in the tissue extracellular space. Therefore, modifications of the collagen proteins, such as those induced through cross-linking therapies, could potentially be detected and quantitated through the use of second harmonic generation microscopy (SHGM). Monitoring SHGM signals through the use of a laser scanning microscopy system coupled with an infrared excitation light source is an exciting modern imaging method that is enjoying widespread usage in the biomedical sciences. Thus, the present study was undertaken in order to evaluate the use of SHGM microscopy as a means to measure induced cross-linking effects in ex vivo rabbit sclera, following an injection of a chemical cross-linking agent into the sub-Tenon&#39;s space (sT), an injection approach that is standard practice for causing ocular anesthesia during ophthalmologic clinical procedures. The chemical cross-linking agent, sodium hydroxymethylglycinate (SMG), is from a class of cosmetic preservatives known as formaldehyde releasing agents (FARs). Scleral changes following reaction with SMG resulted in increases in SHG signals and correlated with shifts in thermal denaturation temperature, a standard method for evaluating induced tissue cross-linking effects.

Second Harmonic Generation Signals in Rabbit Sclera As a Tool for Evaluation of Therapeutic Tissue Cross-linking TXL for Myopia

This protocol describes techniques for evaluating chemical cross-linking of the rabbit sclera using&#160;second harmonic generation imaging and differential scanning calorimetry.

兔巩膜二次谐波信号作为治疗组织交叉连接 (txl-) 评价近视的工具

Methods to strengthen tissue by introducing chemical bonds (non-enzymatic cross-linking) into structural proteins (fibrillar collagens) for therapy ...

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 ...

神经科学

Retinal Pigment Epithelium Transplantation in a Non-human Primate Model for Degenerative Retinal Diseases

Retinal pigment epithelial (RPE) transplantation holds great promise for the treatment of inherited and acquired retinal degenerative diseases. These conditions include retinitis pigmentosa (RP) and advanced forms of age-related macular degeneration (AMD), such as geographic atrophy (GA). Together, these disorders represent a significant proportion of currently untreatable blindness globally. These unmet medical needs have generated heightened academic interest in developing methods of RPE replacement. Among the animal models commonly utilized for preclinical testing of therapeutics, the non-human primate (NHP) is the only animal model that has a macula. As it shares this anatomical similarity with the human eye, the NHP eye is an important and appropriate preclinical animal model for the development of advanced therapy medicinal products (ATMPs) such as RPE cell therapy.
This manuscript describes a method for the submacular transplantation of an RPE monolayer, cultured on a polyethylene terephthalate (PET) cell carrier, underneath the macula onto a surgically created RPE wound in immunosuppressed NHPs. The fovea-the central avascular portion of the macula-is the site of the greatest mechanical weakness during the transplantation. Foveal trauma will occur if the initial subretinal fluid injection generates an excessive force on the retina. Hence, slow injection under perfluorocarbon liquid (PFCL) vitreous tamponade is recommended with a dual-bore subretinal injection cannula at low intraocular pressure (IOP) settings to create a retinal bleb. 
Pretreatment with an intravitreal plasminogen injection to release parafoveal RPE-photoreceptor adhesions is also advised. These combined strategies can reduce the likelihood of foveal tears when compared to conventional techniques. The NHP is a key animal model in the preclinical phase of RPE cell therapy development. This protocol addresses the technical challenges associated with the delivery of RPE cellular therapy in the NHP eye.

The non-human primate (NHP) is an ideal model for studying human retinal cellular therapeutics due to the anatomical and genetic similarities. This manuscript describes a method for submacular transplantation of retinal pigment epithelial cells in the NHP eye and strategies to prevent intraoperative complications associated with macular manipulation.

非人灵长类动物模型中视网膜色素上皮移植治疗退行性视网膜疾病

Retinal pigment epithelial (RPE) transplantation holds great promise for the treatment of inherited and acquired retinal degenerative diseases. These ...

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 ...

在白内障手术中通过 IOL 旋转预防后囊膜混浊

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

Posterior capsule opacification (PCO) is a common postoperative complication of extracapsular cataract surgery, which is caused by the proliferation and migration of lens epithelial cells and can affect long-term visual outcomes significantly. The most effective treatment for PCO is neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy; however, this treatment is associated with posterior segment complication and can break the stability of capsular bag, affecting the position and function of trifocal or toric intraocular lenses (IOLs). Advances in surgical procedures, IOL design, and pharmacy have reduced the rate of PCO in recent years, concentrating on the inhibition of proliferative lens epithelial cells (LECs). This protocol aimed to clear LECs more thoroughly during phacoemulsification and IOL implantation. The first several steps, including clear corneal incision, continuous circular capsulorhexis, hydrodissection, hydrodelineation, and phacoemulsification, were completed as conventional procedures. After placing the IOL into the capsular bag, rotation of the IOL by at least 360&#176; was performed using an irrigation/aspiration tip or a hook, with slight stress on the posterior capsule. Some residuals occurred in the originally transparent capsular bag after rotation of the IOLs. Then, these materials and the viscoelastic were cleared completely using an irrigation/aspiration system. A clear posterior capsule was observed after the surgery in patients undergoing this method. This method of rotating IOLs is a simple, effective, and safe way to prevent PCO by clearing residual LECs and can be carried out without extra tools or skills.

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 

The present protocol describes removing residual epithelial cells by rotating the intraocular lens in extracapsular cataract surgery without extra tools for preventing posterior capsular opacification.

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 ...

青光眼眼中的超声环成形术

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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

"全激光"内皮移植

巩膜交联兔模型使用核黄素和紫外辐射的轴性近视防治

兔巩膜二次谐波信号作为治疗组织交叉连接 (txl-) 评价近视的工具

角膜缘血管丛全圆烧灼治疗啮齿动物手术诱发的青光眼

非人灵长类动物模型中视网膜色素上皮移植治疗退行性视网膜疾病

虹膜通过外部五角星缝合固定

在白内障手术中旋转人工晶状体以防止后囊混浊

在白内障手术中旋转人工晶状体以防止后囊混浊