Rickels Kaersti L, Gunderman Anthony L, McLellan Mattie S, Shamim Muhammad M, Sanford Joseph A, Uwaydat Sami H
Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
Department of Mechanical Engineering, University of Arkansas, Fayetteville, AR 72701, USA.
Bioengineering (Basel). 2024 Jul 15;11(7):718. doi: 10.3390/bioengineering11070718.
Infusion-related iatrogenic retinal breaks (IRBs) are a significant complication in vitrectomies, particularly when smaller-gauge cannulas are used during fluid infusion. Using two-dimensional finite element analysis (FEA), we analyzed forces exerted on the retina from different cannulas: traditional 25-gauge, 20-gauge, 23-gauge, and 27-gauge, then investigated four alternative new cannula designs: (A) oblique orifices, (B) external obstruction, (C) side ports, and (D) perpendicular orifices. The analysis revealed that the standard 25-gauge cannula had a force of 0.546 milli-Newtons (mN). Optimized cannulas demonstrated decreased forces: 0.072 mN (A), 0.266 mN (B), 0.417 mN (C), and 0.117 mN (D). While all the designs decrease fluid jet force, each has unique challenges: Design A may complicate manufacturing, B requires unique attachment techniques, C could misdirect fluid toward the lens and peripheral retina, and D requires a sealed trocar/cannula design to prevent unwanted fluid ejection. These four innovative cannula designs, identified with detailed engineering simulations, provide promising strategies to reduce the risk of IRBs during vitrectomy, bridging the gap between engineering insights and clinical application.
输液相关的医源性视网膜裂孔（IRB）是玻璃体切除术中的一种严重并发症，尤其是在液体输注过程中使用较小规格的套管时。我们使用二维有限元分析（FEA），分析了不同套管（传统的25G、20G、23G和27G）对视网膜施加的力，然后研究了四种新型套管设计方案：（A）斜孔，（B）外部阻塞，（C）侧孔，以及（D）垂直孔。分析表明，标准的25G套管产生的力为0.546毫牛顿（mN）。优化后的套管所产生的力有所降低：（A）为0.072 mN，（B）为0.266 mN，（C）为0.417 mN，（D）为0.117 mN。虽然所有设计都降低了流体喷射力，但每种设计都有独特的挑战：设计A可能会使制造过程复杂化，设计B需要独特的连接技术，设计C可能会将液体导向晶状体和周边视网膜，而设计D需要密封的套管针/套管设计以防止不必要的液体喷射。通过详细的工程模拟确定的这四种创新套管设计，为降低玻璃体切除术中IRB的风险提供了有前景的策略，弥合了工程见解与临床应用之间的差距。
