Jurowski Piotr, Goś Roman, Kuśmierczyk Jarosław, Owczarek Grzegorz, Gralewicz Grzegorz
Department of Ophthalmology and Visual Rehabilitation, Medical University of Lodz, Poland.
J Cataract Refract Surg. 2006 Jan;32(1):137-40. doi: 10.1016/j.jcrs.2005.11.025.
To measure the temperature parameters on the corneal surface during the delivery of standardized ultrasound energy assisted with ophthalmic viscosurgical devices (OVDs) or different temperatures of irrigating solutions in an experimental animal model.
Department of Ophthalmology and Visual Rehabilitation, Medical University of Lodz, and Central Institute for Labor Protection, National Research Institute, Warsaw, Poland.
Thirty rabbits (60 eyes) were randomly divided into 6 groups in which different OVD or balanced salt solutions (BSS) were used: group 1: Viscoat (sodium hyaluronate 3%-chondroitin sulfate); group 2: Provisc (sodium hyaluronate 1%); group 3: soft-shell technique; group 4: Celoftal (hydroxypropyl methylcellulose 2%); group 5: BSS 22 degrees C; and group 6: BSS 4 degrees C. After the nucleus and lens cortex were removed, the anterior chamber was filled with OVD or BSS and a phaco tip was introduced into the pupillary plane and switched on. The same phaco tip parameters were used in all groups. For thermographic measurements (ie, maximal temperature [MT], dynamic rise in temperature [DRT], and time when the maximal level of temperature [TMLT] was achieved), a thermocamera was used.
Mean preoperative temperature on the rabbit corneal surface was 22.76 degrees C +/- 1.48 degrees C (SD). Working with a phaco tip increased the temperature in each group. A significantly higher MT was observed in group 5 (27.85 degrees C +/- 0.52 degrees C), followed by group 2 (27.75 degrees C +/- 0.54 degrees C), group 3 (27.74 degrees C +/- 0.46 degrees C), and group 4 (27.25 degrees C +/- 0.60 degrees C), than in group 6 (26.81 degrees C +/- 0.34 degrees C) and group 1 (26.52 degrees C +/- 0.48 degrees C) (P<.05). Significantly higher values of DRT and shorter TMLT values were observed in group 5 (1.16 degrees C/s +/- 0.42 degrees C/s, 4 seconds) and group 6 (0.91 degrees C/s +/- 0.13 degrees C/s, 5 seconds) than in groups 2, 3, 1, and 4 (0.09 degrees C/s +/- 0.07 degrees C/s, 30 seconds; 0.08 degrees C/s +/- 0.04 degrees C/s, 40 seconds; 0.07 degrees C/s +/- 0.03 degrees C/s, 45 seconds; 0.06 degrees C/s +/- 0.02 degrees C/s, 50 seconds, respectively) (P<.0001).
Currently used OVDs potentially offer different levels of protection against the increase in temperature that occurs during phacoemulsification. Therefore, the surgeon should consider this aspect when choosing an OVD, particularly in difficult cases (ie, hard nucleus, shallow anterior chamber, endothelial abnormalities).
在实验动物模型中，测量在使用眼科粘弹剂（OVD）辅助或不同温度的冲洗液进行标准化超声能量传递过程中角膜表面的温度参数。
波兰罗兹医科大学眼科与视觉康复系以及华沙国家劳动保护中央研究所。
30只兔子（60只眼）被随机分为6组，分别使用不同的OVD或平衡盐溶液（BSS）：第1组：Viscoat（3%透明质酸钠 - 硫酸软骨素）；第2组：Provisc（1%透明质酸钠）；第3组：软壳技术；第4组：Celoftal（2%羟丙基甲基纤维素）；第5组：22℃的BSS；第6组：4℃的BSS。在摘除晶状体核和皮质后，向前房注入OVD或BSS，将超声乳化头插入瞳孔平面并开启。所有组均使用相同的超声乳化头参数。使用热成像仪进行热成像测量（即最高温度[MT]、温度动态上升[DRT]以及达到最高温度水平的时间[TMLT]）。
兔子角膜表面术前平均温度为22.76℃±1.48℃（标准差）。使用超声乳化头使每组温度升高。第5组（27.85℃±0.52℃）的MT显著高于第6组（26.81℃±0.34℃）和第1组（26.52℃±0.48℃），其次是第2组（27.75℃±0.54℃）、第3组（27.74℃±0.46℃）和第4组（27.25℃±0.60℃）（P<0.05）。第5组（1.16℃/秒±0.42℃/秒，4秒）和第6组（0.91℃/秒±0.13℃/秒，5秒）的DRT值显著高于第2、3、1和4组（分别为0.09℃/秒±0.07℃/秒，30秒；0.08℃/秒±0.04℃/秒，40秒；0.07℃/秒±0.03℃/秒，45秒；0.06℃/秒±0.02℃/秒，50秒）（P<0.0001）。
目前使用的OVD在超声乳化过程中对温度升高可能提供不同程度的保护。因此，外科医生在选择OVD时应考虑这一方面，尤其是在困难病例（即硬核、浅前房、内皮异常）中。
