人工晶状体注射器插入导致最终切口大小的致病因素的实验室分析。
Laboratory Analysis of Causative Factors for the Final Incision Size due to Intraocular Lens Injector Insertion.
作者信息
Friedrich Maximilian, Baur Isabella D, Yildirim Timur M, Augustin Victor A, Khoramnia Ramin, Auffarth Gerd U
机构信息
Department of Ophthalmology, The David J Apple International Laboratory for Ocular Pathology, University Hospital Heidelberg, Heidelberg, Germany.
出版信息
Ophthalmol Sci. 2023 Jun 25;4(1):100356. doi: 10.1016/j.xops.2023.100356. eCollection 2024 Jan-Feb.
PURPOSE
In intraocular lens (IOL) implantation, insertion of the IOL injector enlarges the clear corneal incision. A larger incision size (IS) is associated with a higher risk for surgically induced astigmatism and endophthalmitis. The goal of this study was to determine which parameters most influence the final IS.
DESIGN
Experimental study.
SUBJECTS
A total of 126 cadaver porcine eyes were included in this study.
METHODS
We analyzed 409 clear corneal incisions made with 126 injectors from 13 injector models. We noted the vertical diameter and the tip angulation for every model. The corneal thickness of each incision location was measured using Scheimpflug tomography. The IS was measured before and after injector insertion and described as preoperative and final ISs, respectively. During surgery, the insertion depth and incision length were documented. A mixed effects model was applied to analyze the influence of the parameters on the final IS.
MAIN OUTCOME MEASURES
Influence on the final IS.
RESULTS
Increases in the vertical diameter of the injector tip, the preoperative IS and the insertion depth, and a reduction of incision length were all significantly associated with increased final IS ( < 0.05). The conditional Pseudo-R-Measure was 0.92. The preoperative IS had the largest standardized estimated effect on the final IS, followed by the vertical diameter of the injector tip, insertion depth, and lastly, incision length. Neither corneal thickness nor the tip angle of the injector had a significant effect on the final IS ( > 0.05).
CONCLUSIONS
The IOL injector's vertical diameter should be as small as possible to ensure a minimal final IS. The injector's insertion depth may be minimized, and the incision length should be long enough to reduce the final IS. Further studies are needed to confirm the findings in human autopsy eyes and in clinical practice.
FINANCIAL DISCLOSURES
Proprietary or commercial disclosure may be found after the references in the Footnotes and Disclosures at the end of this article..
目的
在人工晶状体（IOL）植入术中，IOL注射器的插入会扩大透明角膜切口。较大的切口尺寸（IS）与手术诱导性散光和眼内炎的较高风险相关。本研究的目的是确定哪些参数对最终的IS影响最大。
设计
实验研究。
对象
本研究共纳入126只猪尸体眼。
方法
我们分析了用13种注射器型号的126个注射器制作的409个透明角膜切口。我们记录了每个型号的垂直直径和尖端角度。使用Scheimpflug断层扫描测量每个切口位置的角膜厚度。在注射器插入前后测量IS，并分别描述为术前和最终IS。在手术过程中，记录插入深度和切口长度。应用混合效应模型分析参数对最终IS的影响。
主要观察指标
对最终IS的影响。
结果
注射器尖端垂直直径、术前IS和插入深度的增加以及切口长度的减少均与最终IS的增加显著相关（P<0.05）。条件伪R测量值为0.92。术前IS对最终IS的标准化估计效应最大，其次是注射器尖端的垂直直径、插入深度，最后是切口长度。角膜厚度和注射器尖端角度对最终IS均无显著影响（P>0.05）。
结论
IOL注射器的垂直直径应尽可能小，以确保最终IS最小。注射器的插入深度可最小化，切口长度应足够长以减小最终IS。需要进一步研究以在人类尸检眼和临床实践中证实这些发现。
财务披露
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