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?...

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 border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<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&#160;</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&#160;</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&#160;</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&#160;</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&#38;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</str...

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

Research

JoVE Journal

Medicine

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

2.1K 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 

The Measurement and Treatment of Suppression in Amblyopia

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current estimates put the prevalence of amblyopia at approximately 1-3%1-3, the majority of cases being monocular2. Amblyopia is most frequently caused by ocular misalignment (strabismus), blur induced by unequal refractive error (anisometropia), and in some cases by form deprivation.
Although amblyopia is initially caused by abnormal visual input in infancy, once established, the visual deficit often remains when normal visual input has been restored using surgery and/or refractive correction. This is because amblyopia is the result of abnormal visual cortex development rather than a problem with the amblyopic eye itself4,5 . Amblyopia is characterized by both monocular and binocular deficits6,7 which include impaired visual acuity and poor or absent stereopsis respectively. The visual dysfunction in amblyopia is often associated with a strong suppression of the inputs from the amblyopic eye under binocular viewing conditions8. Recent work has indicated that suppression may play a central role in both the monocular and binocular deficits associated with amblyopia9,10 .
Current clinical tests for suppression tend to verify the presence or absence of suppression rather than giving a quantitative measurement of the degree of suppression. Here we describe a technique for measuring amblyopic suppression with a compact, portable device11,12 . The device consists of a laptop computer connected to a pair of virtual reality goggles. The novelty of the technique lies in the way we present visual stimuli to measure suppression. Stimuli are shown to the amblyopic eye at high contrast while the contrast of the stimuli shown to the non-amblyopic eye are varied. Patients perform a simple signal/noise task that allows for a precise measurement of the strength of excitatory binocular interactions. The contrast offset at which neither eye has a performance advantage is a measure of the "balance point" and is a direct measure of suppression. This technique has been validated psychophysically both in control13,14 and patient6,9,11 populations.
In addition to measuring suppression this technique also forms the basis of a novel form of treatment to decrease suppression over time and improve binocular and often monocular function in adult patients with amblyopia12,15,16 . This new treatment approach can be deployed either on the goggle system described above or on a specially modified iPod touch device15.

Amblyopia is a developmental disorder of the visual cortex that is often accompanied by strong suppression of one eye. We present a new technique for measuring and treating interocular suppression in patients with amblyopia that can be deployed using virtual reality goggles or a portable iPod Touch device.

测量和制止在弱视治疗

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current ...

科研

医学

Characterization of Molecular Mechanisms of In vivo UVR Induced Cataract

Cataract is the leading cause of blindness in the world 1. The World Health Organization defines cataract as a clouding of the lens of the eye which impedes the transfer of light. Cataract is a multi-factorial disease associated with diabetes, smoking, ultraviolet radiation (UVR), alcohol, ionizing radiation, steroids and hypertension. There is strong experimental 2-4 and epidemiological evidence 5,6 that UVR causes cataract. We developed an animal model for UVR B induced cataract in both anesthetized 7 and non-anesthetized animals 8.
The only cure for cataract is surgery but this treatment is not accessible to all. It has been estimated that a delay of onset of cataract for 10 years could reduce the need for cataract surgery by 50% 9. To delay the incidence of cataract, it is needed to understand the mechanisms of cataract formation and find effective prevention strategies. Among the mechanisms for cataract development, apoptosis plays a crucial role in initiation of cataract in humans and animals 10. Our focus has recently been apoptosis in the lens as the mechanism for cataract development 8,11,12. It is anticipated that a better understanding of the effect of UVR on the apoptosis pathway will provide possibilities for discovery of new pharmaceuticals to prevent cataract.
In this article, we describe how cataract can be experimentally induced by in vivo exposure to UVR-B. Further RT-PCR and immunohistochemistry are presented as tools to study molecular mechanisms of UVR-B induced cataract.

Characterization of Molecular Mechanisms of In vivo UVR Induced Cataract

Cataract is the leading cause of blindness in the world. Solar ultraviolet radiation (UVR) is the main risk factor for cataract development. An animal model of far UVR-B induced cataract was developed. In this article we describe methods for investigation of cataract formation: exposure to UVR, quantitative RT-PCR and immunohistochemistry.

表征的分子机制<em在体内</em&gt;紫外线辐射诱发白内障

Cataract is the leading cause of blindness in the world 1. The World Health Organization defines cataract as a clouding of the lens of the eye which ...

Rat Model of Photochemically-Induced Posterior Ischemic Optic Neuropathy

Posterior Ischemic optic neuropathy (PION) is a sight-devastating disease in clinical practice. However, its pathogenesis and natural history have&#160;remained poorly understood. Recently, we developed a reliable, reproducible animal model of PION and tested the treatment effect of some neurotrophic factors in this model1. The purpose of this video is to demonstrate our photochemically induced model of posterior ischemic optic neuropathy, and to evaluate its effects with retrograde labeling of retinal ganglion cells. Following surgical exposure of the posterior optic nerve, a photosensitizing dye, erythrosin B, is intravenously injected and a laser beam is focused onto the optic nerve surface. Photochemical interaction of erythrosin B and the laser during irradiation damages the vascular endothelium, prompting microvascular occlusion mediated by platelet thrombosis and edematous compression. The resulting ischemic injury yields a gradual but pronounced retinal ganglion cell dieback, owing to a loss of axonal input - a remote, injury-induced and clinically relevant outcome. Thus, this model provides a novel platform to study the pathophysiologic course of PION,&#160;and can be further optimized for testing therapeutic approaches for optic neuropathies as well as other CNS ischemic diseases.

The goal of this protocol is to photochemically induce ischemic injury to the posterior optic nerve in rat. This model is critical to studies of the pathophysiology of posterior ischemic optic neuropathy, and therapeutic approaches for this and other optic neuropathies, as well as of other CNS ischemic diseases.

光化学诱导后部缺血性视神经病变的大鼠模型

Posterior Ischemic optic neuropathy (PION) is a sight-devastating disease in clinical practice. However, its pathogenesis and natural history ...

Circumscribed Capsular Infarct Modeling Using a Photothrombotic Technique

Recent increase in the prevalence rate of white matter stroke demands specific research in the field. However, the lack of a pertinent animal model for white matter stroke has hampered research investigations. Here, we describe a novel method for creating a circumscribed capsular infarct that minimizes damage to neighboring gray matter structures. We used pre-surgery neural tracing with adeno-associated virus-green fluorescent protein (AAV-GFP) to identify somatotopic organization of the forelimb area within the internal capsule. The adjustment of light intensity based on different optical properties of gray and white matter contributes to selective destruction of white matter with relative preservation of gray matter. Accurate positioning of optical-neural interface enables destruction of entire forelimb area in the internal capsule, which leads to a marked and persistent motor deficit. Thus, this technique produces highly replicable capsular infarct lesions with a persistent motor deficit. The model will be helpful not only to study white matter stroke (WMS) at the behavioral, circuit, and cellular levels, but also to assess its usefulness for development of new therapeutic and rehabilitative interventions.

This manuscript describes a modeling technique of capsular infarct. Here we utilized a modified photothrombotic technique with low intensity of light after pre-surgery target mapping. Using this technique, we created a circumscribed capsular infarct model with persistent motor impairment.

外切囊梗死模型使用光化学技术

Recent increase in the prevalence rate of white matter stroke demands specific research in the field. However, the lack of a pertinent animal model for ...

Use of Rabbit Eyes in Pharmacokinetic Studies of Intraocular Drugs

The intraocular route of drug administration enables the delivery of high concentrations of therapeutic drugs, while minimizing their systemic absorption. Several drugs are administered into the anterior chamber or vitreous, and the intraocular injection has been effective in curing various intraocular diseases. Rabbit eyes have been widely used for ophthalmic research, as the animal is easy to handle and economical compared to other mammals, and the size of a rabbit eye is similar to that of a human eye. Using a 30 G needle, drugs can be injected into the intracameral and intravitreal spaces of rabbit eyes. The eyeballs are then frozen until analysis, and can be divided into the aqueous humor, vitreous, and retina/choroid. The vitreous and retina/choroid samples can be homogenized and solubilized before analysis. Then, immunoassays can be performed to measure the concentrations of intraocular drugs in each compartment. Appropriate pharmacokinetic models can be used to calculate several parameters, such as the half-life and maximum concentration of the drug. Rabbit eyes can be a good model for pharmacokinetic studies of intraocular drugs.

Rabbits are widely used to study the pharmacokinetics of intraocular drugs. We describe a method for conducting pharmacokinetic studies of intraocular drugs using rabbit eyes.

眼内药物的药代动力学研究采用兔眼

The intraocular route of drug administration enables the delivery of high concentrations of therapeutic drugs, while minimizing their systemic absorption. ...

Impression Cytology of the Lid Wiper Area

Few reports on the cellular anatomy of the lid wiper (LW) area of the inner eyelid exist and only one report makes use of cytological methods. The optimization of a method of collecting, staining and imaging cells from the LW region using impression cytology (IC) is described in this study. Cells are collected from the inner surface of the upper eyelid of human subjects using hydrophilic polytetrafluoroethylene (PTFE) membranes, and stained with cytological dyes to reveal the presence of goblet cells, mucins, cell nuclei and various degrees of pre- and para-keratinization. Immunocytochemical dyes show cell esterase activity and compromised cell membranes by the use of a confocal scanning laser microscope. Up to 100 microscopic digital images are captured for each sample and stitched into a high-resolution, large scale image of the entire IC span. We demonstrate a higher sensitivity of IC than reported before, appropriate for identifying cellular morphologies and metabolic activity in the LW area. To our knowledge, this is the first time this selection of fluorescent dyes was used to image LW IC membranes. This protocol will be effective in future studies to reveal undocumented details of the LW area, such as assessing cellular particularities of contact lens wearers or patients with dry eye or lid wiper epitheliopathy.

We collected, stained and imaged cells from the conjunctiva of the inner eyelid margin of human subjects. By characterizing cell morphology and metabolic activity, this method may further our understanding of dry eye and the role that friction between the ocular surfaces may play in perceiving ocular discomfort.

盖雨刮区的印象细胞学

Few reports on the cellular anatomy of the lid wiper (LW) area of the inner eyelid exist and only one report makes use of cytological methods. The ...

ADSC-sheet Transplantation to Prevent Stricture after Extended Esophageal Endoscopic Submucosal Dissection

In past years, the cell-sheet construct has spurred wide interest in regenerative medicine, especially for reconstructive surgery procedures. The development of diversified technologies combining adipose tissue-derived stromal cells (ADSCs) with various biomaterials has led to the construction of numerous types of tissue-engineered substitutes, such as bone, cartilage, and adipose tissues from rodent, porcine, or human ADSCs. Extended esophageal endoscopic submucosal dissection (ESD) is responsible for esophageal stricture formation. Stricture prevention remains challenging, with no efficient treatments available. Previous studies reported the effectiveness of mucosal cell-sheet transplantation in a canine model and in humans. ADSCs are attributed anti-inflammatory properties, local immune modulating effects, neovascularization induction, and differentiation abilities into mesenchymal and non-mesenchymal lineages. This original study describes the endoscopic transplantation of an ADSC tissue-engineered construct to prevent esophageal stricture in a swine model. The ADSC construct was composed of two allogenic ADSC sheets layered upon each other on a paper support membrane. The ADSCs were labeled with the PKH67 fluorophore to allow probe-based confocal laser endomicroscopy (pCLE) monitoring. On the day of transplantation, a 5-cm and hemi-circumferential ESD known to induce esophageal stricture was performed. Animals were immediately endoscopically transplanted with 4 ADSC constructs. The complete adhesion of the ADSC constructs was obtained after 10 min of gentle application. Animals were sacrificed on day 28. All animals were successfully transplanted. Transplantation was confirmed on day 3 with a positive pCLE evaluation. Compared to transplanted animals, control animals developed severe strictures, with major fibrotic tissue development, more frequent alimentary trouble, and reduced weight gain. In our model, the transplantation of allogenic ADSCs, organized in double cell sheets, after extended ESD was successful and strongly associated with a lower esophageal stricture rate.

This study reports a successful method of endoscopical adipose tissue-derived stromal cell (ADSC)-sheet transplantation for esophageal stricture prevention after an extended endoscopic submucosal dissection (ESD) in a swine model.

ADSC表移植到扩展食管内镜黏膜下剥离术之后防止狭窄

In past years, the cell-sheet construct has spurred wide interest in regenerative medicine, especially for reconstructive surgery procedures. The ...

Ultrahigh Resolution Mouse Optical Coherence Tomography to Aid Intraocular Injection in Retinal Gene Therapy Research

HR-SD-OCT is utilized to monitor the progression of photoreceptor degeneration in live mouse models, assess the delivery of therapeutic agents into the subretinal space, and to evaluate toxicity and efficacy in vivo. HR-SD-OCT uses near infrared light (800-880 nm) and has optics specifically designed for the unique optics of the mouse eye with sub-2-micron axial resolution. Transgenic mouse models of outer retinal (photoreceptor) degeneration and controls were imaged to assess the disease progression. Pulled glass microneedles were used to deliver sub retinal injections of adeno-associated virus (AAV) or nanoparticles (NP) via a trans-scleral and trans-choroidal approach. Careful positioning of the needle into the subretinal space was required prior to a calibrated pressure injection, which delivers fluid into the sub retinal space. Real time subretinal surgery was conducted on our retinal imaging system (RIS). HR-SD-OCT demonstrated progressive uniform retinal degeneration due to expression of a toxic mutant human mutant rhodopsin (P347S) (RHOP347S) transgene in mice. HR-SD-OCT allows rigorous quantification of all the retinal layers. Outer nuclear layer (ONL) thickness and photoreceptor outer segment length (OSL) measurements correlate with photoreceptor vitality, degeneration, or rescue. The RIS delivery system allows real-time visualization of subretinal injections in neonatal (~P10-14) or adult mice, and HR-SD-OCT immediately determines success of delivery and maps areal extent. HR-SD-OCT is a powerful tool that can evaluate the success of subretinal surgery in mice, in addition to measuring vitality of photoreceptors in vivo. HR-SD-OCT can also be used to identify uniform animal cohorts to evaluate the extent of retinal degeneration, toxicity, and therapeutic rescue in preclinical gene therapy research studies.

Here we demonstrate a novel approach to using high resolution spectral-domain optical coherence tomography (HR-SD-OCT) to assist delivery of gene therapy agents into the subretinal space, assess its areal coverage, and characterize photoreceptor vitality.

超高分辨率小鼠光学相干层析成像辅助眼内注射在视网膜基因治疗中的应用

HR-SD-OCT is utilized to monitor the progression of photoreceptor degeneration in live mouse models, assess the delivery of therapeutic agents into the ...

Posterior Approach for Debridement of the Psoas Abscess

This method focuses on outlining a safe zone for irrigation and debridement of a psoas abscess through a posterior approach. Initially, an anterior approach to the spine was performed to ensure that the anterior longitudinal ligament and the psoas muscle could be visualized. All the abdominal organs were removed. Subsequently, a posterior approach was performed to remove the paraspinal muscles from L1&#8211;L5. The transverse processes, pars interarticularis and lamina of L1&#8211;L5 were identified. The exiting nerve root was identified between the transverse processes and followed into the substance of the psoas muscle. Using the anterior and posterior approach, the lumbar plexus was isolated from the substance of the psoas muscle. Before and after various steps of dissection, digital photographs were obtained. These images were uploaded into ImageJ and multiple measurements, including the distance between the lateral superior and inferior tip of each TP to the most lateral region of the plexus, the distance between the lateral superior and inferior tip of the TP to the lateral edge of the psoas, and the width of the lumbar plexus were recorded. The safe zone for entering the substance of the psoas muscle was defined between the lateral edge of the psoas muscle and the lateral edge of the lumbar plexus. The relationship of this interval to the tip of the transverse process at each level was measured and reported.

This is a cadaveric study investigating the landmarks for the posterior approach for irrigation and debridement of the psoas abscess. The interval between the transverse processes (TP) was used to access the substance of the psoas muscle.

切除普索阿脓肿的后向方法

This method focuses on outlining a safe zone for irrigation and debridement of a psoas abscess through a posterior approach. Initially, an anterior ...

Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity

Old compression vertebrae fracture or congenital kyphoscoliosis with abnormal vertebral body development and other diseases that invade the spine may cause severe thoracolumbar kyphotic deformity, often accompanied by intractable low back pain or compression of the spinal cord, leading to severe neurological symptoms or even paralysis. If conservative treatment cannot relieve the symptoms or correct the deformities, surgical treatment is usually needed. For severe kyphotic deformity, reconstruction of the physiological curvature and rigid fixation determine the prognosis of the patients. Osteotomy and orthopedics are the standard procedure for deformities with severe compression of the front and middle column, but the trauma to the patients is high, with a long operation time and massive blood loss. To avoid these disadvantages, we have developed a modified technique to remove the diseased vertebra unilaterally. In this technique, we use a modified trephine to resect the vertebral columns like in the pedicle screw technique by adding a locking instrument that can restrict the trephine to lower the risk of osteotomy and shorten the surgery time and blood loss.

We describe a modified technique for resecting the posterior vertebral column unilaterally based on a modified trephine for patients with thoracolumbar kyphotic deformity.

胸腰椎后凸畸形患者改良后椎柱切除术

Old compression vertebrae fracture or congenital kyphoscoliosis with abnormal vertebral body development and other diseases that invade the spine may ...