From the Department of Bioengineering (W.J.F.), Lewes Katz School of Medicine (B.W.B., S.N.L.), Temple University, Philadelphia, Pennsylvania, USA; Altasciences, Montréal, Québec, Canada (W.J.F.).
From the Department of Bioengineering (W.J.F.), Lewes Katz School of Medicine (B.W.B., S.N.L.), Temple University, Philadelphia, Pennsylvania, USA.
Am J Ophthalmol. 2022 Sep;241:87-107. doi: 10.1016/j.ajo.2022.03.023. Epub 2022 Mar 28.
To explore how finite-element calculations can continue to contribute to diverse problems in ophthalmology and vision science, we describe our recent work on modeling the force on the peripheral retina in intravitreal injections and how that force increases with shorter, smaller gauge needles. We also present a calculation that determines the location and stress on a retinal pigment epithelial detachment during an intravitreal injection, the possibility that stress induced by the injection can lead to a tear of the retinal pigment epithelium.
Advanced computational models can provide a critical insight into the underlying physics in many surgical procedures, which may not be intuitive.
The simulations were implemented using COMSOL Multiphysics. We compared the monkey retinal adhesive force of 18 Pa with the results of this study to quantify the maximum retinal stress that occurs during intravitreal injections.
Currently used 30-gauge needles produce stress on the retina during intravitreal injections that is only slightly below the limit that can create retinal tears. As retina specialists attempt to use smaller needles, the risk of complications may increase. In addition, we find that during an intravitreal injection, the stress on the retina in a pigment epithelial detachment occurs at the edge of the detachment (found clinically), and the stress is sufficient to tear the retina. These findings may guide physicians in future clinical research. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
为了探索有限元计算如何继续为眼科和视觉科学的各种问题做出贡献，我们描述了我们最近在模拟玻璃体腔内注射时周边视网膜受力的模型，以及这种力如何随着更短、更小规格的针头而增加。我们还提出了一种计算方法，用于确定玻璃体腔内注射时视网膜色素上皮脱离的位置和应力，以及注射引起的应力是否会导致视网膜色素上皮撕裂。
先进的计算模型可以为许多手术过程中的潜在物理现象提供关键的洞察力，而这些洞察力可能并不直观。
使用 COMSOL Multiphysics 实现模拟。我们将猴子视网膜的黏附力 18Pa 与本研究的结果进行比较，以量化玻璃体腔内注射过程中发生的最大视网膜应力。
目前使用的 30 号针头在玻璃体腔内注射时对视网膜产生的应力仅略低于可能导致视网膜撕裂的极限。随着视网膜专家试图使用更小的针头，并发症的风险可能会增加。此外，我们发现，在玻璃体腔内注射过程中，色素上皮脱离处的视网膜应力（临床上发现）足以撕裂视网膜。这些发现可能为未来的临床研究指导医生。
本文的发表得到了美国眼科学会的赞助。
