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

著者を宣言する承認があります。

いずれかはプロシージャを勉強する前に、すべての参加者は両方の口頭および書面によるインフォームド コンセントを提供しました。研究のプロトコルはヘルシンキ宣言に従って行われ、人間研究 S.Orsola マルピーギ教育病院の倫理委員会によって承認されました。
1. 術前手順と眼科の評価
<ol><li>距離をテストし、付近の最高補正視力 (BCVA)。</li>
	<li>スリット ランプ biomicroscope を使用して目の眼を評価します。</li>
	<li>局所麻酔の点眼薬を注入、後スリット ランプ隅角鏡レンズを使用して前房角度を調べます。</li>
	<li>非接触眼底レンズを使ってスリット ランプ間接眼底検査で眼底を評価します。視神経の頭に特定の注意を払います。</li>
	<li>
プローブを使用して眼圧を測定します。
	<ol>
<li>角膜麻酔する局所麻酔点眼を植え付けます。</li>
		<li>2% フルオレセイン (眼ストリップ) を用いた涙液膜を色します。 注: 色の涙液層がフルオレセインの適切な量をすることが重要です。大量生成、過大評価の IOP 対策をあまりにも厚いフルオレセイン リング少量生産過少見積りされた眼圧測定値とあまりにも薄いリング。</li>
		<li>スリット ランプ軸上、ガイド プレートに、眼圧計をマウントします。</li>
		<li>広いと完全に開いているスリット ダイアフラムできるだけ明るい青いコバルト フィルター光と光軸を設定します。</li>
		<li>正しく患者さんの鼻によって患者の顔と細隙灯と光軸のカバーを避けるために検査の下で目の同じ患者の側に 60 ° スリット型ビームを入れて眼圧計頭で青い光線をダイレクトします。</li>
		<li>スリット ランプ ヘッドレストに頭を傾く、両方目を見開いて、まっすぐ前を見て、完全にまだ維持患者を求めます。</li>
		<li>バイプリズム ヘッド角膜の表面の中心との接触に優しくなるまでスリット ランプ ジョイスティックを使用して眼圧計を移動: スリット ランプ接眼レンズを通して見るときはフルオレセイン涙メニスカスの 2 つの正規ヘミ円、各プリズムを可視化します。</li>
		<li>自分の内側の境界線はちょうど水平"S"の形を形成、互いに接触するまでを可視化されたフルオレセインのヘミ円近く持って眼圧計の側に調整ノブを時計回りに回します: 校正のノブの数字は IOP を表しますメジャー。 注: 正しく消毒、滅菌水ですすぎ、任意の測定前に眼圧計ヘッドを拭くを必ず。</li>
	</ol>
</li>
	<li>
非接触光バイオによる眼の解剖学的パラメーターを測定します。
	<ol>
<li>ヘッドレストに頭を傾く、両方目を見開いて、まっすぐ前を見て、完全にまだ維持患者を求めます。</li>
		<li>そのジョイスティックを使用して角膜の表面の中心に正しく焦点を当てる光バイオ メーターを移動: 矢印と緑の丸表示正しい位置を見つけること臨床医を助けます。</li>
		<li>測定を開始するジョイスティックのボタンをクリックして: グリーン ライン表示に表示され、円を形作る移動を開始します。位置を保つ、まだこの時間の間に可能な限り。</li>
		<li>可能性のあるエラーを削減し、信頼性を高める目あたり少なくとも 5 の測定を実行します。楽器は、平均値を自動的に計算します。</li>
	</ol>
</li>
	<li>治療プローブの適切なサイズを計算するノモグラム ツール (図 1) を使用して、3 つの可能なオプションの間で (11、12、またはリング径 13 mm)。 メモ: 2 つの眼球の解剖学的パラメーターが必要: 白に差し込みます (ワーク、角膜の水平方向の直径に等しい距離) と軸の長さ (AL, 角膜頂点から中心窩までの距離)。</li>
	<li>プローブ超音波ビームによる毛様体のより正確にターゲット配信できるように適切な術中の縮瞳を確保するため術前に、3 日から一日あたり 3 回患者ピロカルピン点眼薬を処方します。</li>
</ol>2. 術前の手順
<ol><li>手術ベッドに仰臥位で患者を置きます。</li>
	<li>
局所麻酔薬 (メピバカイン プラス ロピバカイン) の 10 mL で 1 つの眼球周囲浸潤手術前に 30 分を実行することにより局所麻酔を管理します。
	<ol>
<li>外側 3 分の 1 と下眼窩縁または 27 ゲージ針を使用して優れた軌道のノッチの下の superonasally の内側 3 分の 2 の接合部に注入 inferotemporally を実行します。</li>
	</ol>
</li>
</ol>3. 治療デバイスの準備
<ol><li>外科医についてのデータを入力し、コントロール ユニットを用いた患者画面をタッチして、治療するために目を選択します。 注: 初代プローブも選べる 4 s や 6 照射時間、第二世代プローブ (だけ今利用可能な市場で) を使用してのみ 8 間の露光時間の s。</li>
	<li>カップリング コーンと治療プローブを含む滅菌の単回使用デバイス パックを開き、コントロール ユニットにケーブルを接続します。</li>
</ol>4. UCP の手順
<ol><li>3 回正確に眼瞼および 10% ポビドン ヨードと眼窩周囲皮膚を消毒します。クリーンな滅菌ガーゼと消毒の肌を拭いてください。</li>
	<li>治療下で目の上に正しくそれを公開するために中心孔を有する患者の顔の上滅菌手術用ドレープを入れてください。</li>
	<li>水平方向にできる快適な配置 (図 2) 装置の円錐形の眼の表面を置くためより少し後方に横になっている患者さんの頭を配置します。</li>
	<li>鏡を使用せず、患者さんの目を開きます。</li>
	<li>一時的な側のチューブと、眼の表面に結合コーンを入れて、静かに位置し、周辺の角膜輪部 (図 3) 制服白い強膜リングの形成を中心に正しく移動します。必要な場合は、コーンの位置を変更する手術のクランプを使用します。 注: 白い強膜の 2 mm の最小リングが角膜輪部と円錐内部国境の間表示されます。このリングは、プローブとその結果 (図 3) 毛様体の正しいターゲットの最適な中心ように目の 360 ° すべてに沿って可能な限り規則的なする必要があります。</li>
	<li>画面に垂直方向のバーが緑色になるまでカップリングの円錐の周辺のリングから低レベルの吸引を開始するフット スイッチの吸引ボタンを押します。これは、プロシージャ (図 4A) 全体で患者さんの目に直接接触結合コーンのメンテナンスをことができます。</li>
	<li>カップリング円錐の鼻の位置でケーブルで内部治療プローブを挿入します。 注:「クリック」サウンド コーン (図 4 b) へのプローブの適切な定着を確認します。</li>
	<li>目、コーンと常温初めと (図 4) の治療上の超音波伝搬の良いように全体の手順中に滅菌平衡塩溶液 (BSS) とプローブによって区切られた空のスペースを埋めます。BSS 漏適切なレベルで補充します。</li>
	<li>患者位置を保持し、頭をまだ完全に維持を求めます。</li>
	<li>治療を開始して、すべてのプロシージャの間に圧力を保持するフット スイッチのスタート ボタンを押して (各治療部門の間の通路はフット スイッチの圧力を解放することがなく完全に自動です)。</li>
	<li>
堅持する最適な位置にプローブと結合コーン全体のプロシージャの間に。移動、回転、または (図 4) 治療中治療超音波ビームの最高の中心を許可するために、プローブを押す避けてください。 注: 治療中六つの探触子の各順番にアクティブ 4、6、または 8 の 20 s (プローブの世代) に依る各活性化、優れた分野から始めて、時計回りに移動する前に間隔の s。コントロール ユニットは、六つのトランスデューサーのシーケンシャル活性化を示しています。外科治療続く 124 s、136 s、または 148 s。<ol>
<li>プロシージャを停止するフット スイッチの圧力を解放します。任意のセクターを失うことがなく、2 つの連続したセクターの活性化までの間の治療の中断の場合治療が続けることができます。逆に、セクターの活性化の中に治療の中断は、場合問題の分野で治療は完了しません。</li>
	</ol>
</li>
	<li>プロシージャの最後に、フット スイッチで吸引ボタンを押して吸引システムを非アクティブにして管を通って BSS が削除されるまでゆっくりとコーンを傾けます。</li>
</ol>5. 手術後の手順
<ol><li>抗生物質を植え付けるに加えてステロイド点眼治療目のプロシージャと扱われた目には 24 h のパッチの直後に。 注: 患者はプロシージャの後 1 h 病院を残すことができます。</li>
	<li>術後後一日目のパッチを削除、扱われた目を検査し、眼圧を測定します。</li>
	<li>1 ヶ月間、一日 4 回患者の抗生物質に加えてステロイドの点眼薬を処方します。</li>
	<li>扱われた目を確認し、1、7、14 日間、1、3、6、9 ヶ月、術後後 1 年間で、眼圧を測定します。</li>
</ol>

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F., Renard, J. P., Bron, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Multicenter+clinical+trial+of+high-intensity+focused+ultrasound+treatment+in+glaucoma+patients+without+previous+filtering+surgery.">Multicenter clinical trial of high-intensity focused ultrasound treatment in glaucoma patients without previous filtering surgery.</a> Acta Ophthalmol. 94 (5), e268-e277 (2016).</li><li>Coleman, D. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Therapeutic+ultrasound+in+the+treatment+of+glaucoma.+II.+Clinical+applications.">Therapeutic ultrasound in the treatment of glaucoma. II. Clinical applications.</a> Ophthalmology. 92 (3), 347-353 (1985).</li><li>Valtot, F., Kopel, J., Haut, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+glaucoma+with+high+intensity+focused+ultrasound.">Treatment of glaucoma with high intensity focused ultrasound.</a> Int Ophthalmol. 13 (1-2), 167-170 (1989).</li><li>Burgess, S. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+glaucoma+with+high-intensity+focused+ultrasound.">Treatment of glaucoma with high-intensity focused ultrasound.</a> Ophthalmology. 93 (6), 831-838 (1986).</li><li>Chen, J., Cohn, R. A., Lin, S. C., Cortes, A. E., Alvarado, J. 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>

著者が明らかに何もありません。

緑内障は、新しい効果的な治療法は、長期的な予後を改善するために必要とする視神経に影響を与える慢性の進行性疾患です。眼圧の低減は、回避または遅延と高架の IOP3なしの目の視野欠損に唯一の効果的な治療とみなされます。
UCP は IOP、2 つの異なる方法で機能を下げることができる新しい非瘢痕 cyclodestructive プロシージャ: 毛様体分泌上皮細胞の...

緑内障は、約 1 億人1に影響を与える、世界中の失明の主要な原因の 1 つを表します。視神経は、視覚障害、最終的に失明せずに進行することが視野の減少で機能的結果に収束する神経線維の進行性変性によって生成される光神経障害は十分な治療2。
高眼圧は緑内障発症と進行と現在3視野の損失を減らすためにのみ治療可能なパラメーターの主な危険因子と見なされます。両方房水の生産を減らすことおよび/または局所または全身の薬物、レーザー、手術3,4の使用増小柱網を通してへの流出による眼圧下降効果を実現できます。多くの物理過程は、既に次の加熱または凍結5,6,7,8,9、毛様体凝固の壊死を誘導するために導入されています。 10、11,12。ただし、標的組織と IOP を減らすことで予測不可能な用量-効果関係の選択性の欠如は、緑内障性従来の医療と手術療法4目にのみ彼らの使用を制限します。
最後の年にわたって高強度集束超音波 (HIFU) を採用した、UCP をという名前の新しいデバイス、開発されているのより選択的凝固を達成することにより従来の cyclodestructive 技術の限界を克服することを目的として、毛様体と隣接する眼構造13,14,15,16,17,18,19,を可能な損傷を回避します。20,21します。 さらに、uveo 強膜流出経路のスープラ脈絡膜と強膜の部分の刺激が最近 IOP22を減らすのにプロシージャの可能な補助メカニズムとして提案されています。日には、7 つの主要な臨床研究はさまざまな種類と重症度緑内障、有効性とこの非切開手順14,15の安全性を示すグレードで UCP デバイスを使用して行われています。 19,20,21,22,23,24。
本研究の目的は、科学医療界への導入の知識を普及するために、外科医はこの新しいフィールドにアプローチしたい人に便利なヒントやトリックを提供するために、詳しくは、上記の手順を説明します。

<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

緑内障は、重度の視覚障害、最終的に失明につながることができる減らされた視野に終って、光の神経線維の進行性変性によって引き起こされる慢性疾患です。本稿では、緑内障患者における眼圧 (IOP) を減らすため超音波シクロ形成術 (UCP) という名前の簡単な外科医向け、非切開技術について説明します。テクニックは、毛様体の選択的凝固壊死を決定しますさらに、uveo 強膜流出経路のスープラ脈絡膜と強膜の部分の刺激が最近提案されています。UCP は、いくつかの技術的な改善超音波技術、従来の技術と比較して提供するより正確なターゲット ゾーンに焦点を当てです。眼球周囲麻酔下で手術室で、手順を実行するとします。簡単に、目と接触して結合コーンを置くし、内部に超音波ビームを生成する六つの圧電素子を含むリング プローブが挿入されます。眼の表面の上の適切な中心とした毛様体の正しいターゲットのための重要なステップを表します。滅菌の平衡塩溶液は、超音波音波伝搬を確保するために空のスペースを埋めるためです。外科的治療は、3 分未満の総持続期間のための六つのトランスデューサーでは、それぞれの連続の自動アクティブ化で構成されます。患者退院 1 h プロシージャ扱われた目のパッチを適用した後。本研究では 10 開放隅角緑内障患者がフォロー アップの手順の後、少なくとも 12 ヶ月間。眼圧は術前と同様に降圧薬の数と比較して各間隔で減った。患者の 20% は治療に応答しませんでした、良い IOP を制御する後続の手術が必要があります。治療の忍容性は良い、低眼圧や眼球癆のケースはありませんでした。UCP 手順は簡単、高速、安全、IOP を減らすことで同様の結果と伝統的な cyclodestructive プロシージャよりも低侵襲です。

10 の 10 目上記の方法に従って UCP デバイスと扱われた患者 (男性 6、女性 4 平均年齢 64.9 ± 13.7 歳、範囲 39-80 歳) 開放隅角緑内障の影響を受けます。治療照射時間は 4 2 患者、6 s 4 患者の s と 8 s 4 患者のため。術前に、平均 IOP 24.8 ± 9.6 mmHg (平均 ± 標準偏差)、平均毎日降圧滴数 3.9 ± 1.0 と毎日アセタゾラミド錠数の平均は 0.6 ± 0.5。さらに、平均視力は 0.48 ログマー ± ...

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

Ultrasound Cyclo Plasty in Eyes with Glaucoma

緑内障は、減らされた視野、視神経線維の進行性変性と慢性疾患です。眼圧は、最も重要でのみ治療可能な危険因子と見なされます。本稿では、簡単な外科医向け、非切開技術、超音波シクロ形成術、緑内障患者における眼圧の低減という名前について説明します。

緑内障の目に超音波シクロ形成術

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

Research

JoVE Journal

Behavior

12.1K ビュー.  University of Bologna. 緑内障は、減らされた視野、視神経線維の進行性変性と慢性疾患です。眼圧は、最も重要でのみ治療可能な危険因子と見なされます。本稿では、簡単な外科医向け、非切開技術、超音波シクロ形成術、緑内障患者における眼圧の低減という名前について説明します。

ビデオ: 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.

胆嚢切開刀で剪断力を用いた新規Capsulorhexisテクニック

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

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.

胆嚢切開刀を使用してCapsulorhexisラジアル涙アウトを救い出すの新しい技術

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.

「オールレーザー」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).

強膜ウサギモデルで軸性近視の予防のためのリボフラビンおよび紫外線A放射線を用いて架橋

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.

架橋 (TXL) 近視治療の組織の評価ツールとしてウサギの強膜の第 2 高調波発生信号

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.

げっ歯類の外科的緑内障に対する辺縁血管神経叢の全周焼灼

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

神経科学

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.

ヒト以外の霊長類モデルにおける変性網膜疾患の網膜色素上皮移植

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.

外部五芒星縫合 による 虹彩固定

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 ...

白内障手術におけるIOL回転による後部被膜混濁の予防

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.

著者スポットライト:白内障手術における視覚転帰の向上:IOL回転による後部嚢混濁を防ぐための新しい技術 

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.

白内障手術における後莢膜不透明化を防ぐための眼内レンズの回転

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

緑内障の目に超音波シクロ形成術

要約

さらに動画を探す

この動画の章

胆嚢切開刀で剪断力を用いた新規Capsulorhexisテクニック

胆嚢切開刀を使用してCapsulorhexisラジアル涙アウトを救い出すの新しい技術

「オールレーザー」内皮移植

強膜ウサギモデルで軸性近視の予防のためのリボフラビンおよび紫外線A放射線を用いて架橋

架橋 (TXL) 近視治療の組織の評価ツールとしてウサギの強膜の第 2 高調波発生信号

げっ歯類の外科的緑内障に対する辺縁血管神経叢の全周焼灼

ヒト以外の霊長類モデルにおける変性網膜疾患の網膜色素上皮移植

外部五芒星縫合による虹彩固定

白内障手術における後莢膜不透明化を防ぐための眼内レンズの回転

白内障手術における後莢膜不透明化を防ぐための眼内レンズの回転

緑内障の目に超音波シクロ形成術

要約

さらに動画を探す

この動画の章

胆嚢切開刀で剪断力を用いた新規Capsulorhexisテクニック

胆嚢切開刀を使用してCapsulorhexisラジアル涙アウトを救い出すの新しい技術

「オールレーザー」内皮移植

強膜ウサギモデルで軸性近視の予防のためのリボフラビンおよび紫外線A放射線を用いて架橋

架橋 (TXL) 近視治療の組織の評価ツールとしてウサギの強膜の第 2 高調波発生信号

げっ歯類の外科的緑内障に対する辺縁血管神経叢の全周焼灼

ヒト以外の霊長類モデルにおける変性網膜疾患の網膜色素上皮移植

外部五芒星縫合 による 虹彩固定

白内障手術における後莢膜不透明化を防ぐための眼内レンズの回転

白内障手術における後莢膜不透明化を防ぐための眼内レンズの回転

外部五芒星縫合による虹彩固定