Nishi O, Nishi K
Nishi Eye Hospital, Osaka, Japan.
Arch Ophthalmol. 1998 Oct;116(10):1358-61. doi: 10.1001/archopht.116.10.1358.
To restore accommodation in primate eyes by refilling the lens capsule with injectable silicone compounds.
Eight eyes of 8 monkeys (Macaca fascicularis) were treated by the lens refilling procedure. To prevent leakage of the injected liquid silicone before it polymerized in the capsule in vivo, a silicone plug for sealing the capsular opening was developed. After endocapsular phacoemulsification following an upper minicircular capsulorhexis, the plug was introduced into the capsulorhexis opening. A silicone mixture was injected into the capsular bag through the delivery tube of the plug. Automated refractometry was performed 1 week and 3 months after surgery. Accommodation amplitude was determined as the difference between the refractions before and 1 hour after topical application of 4% pilocarpine chloride.
Five of 8 eyes could be refilled. In 4 of 5 eyes, refraction could be measured. Accommodation amplitude ranged from 1.0 to 4.5 diopters, with a mean of 2.3 +/- 1.3 diopters (8.0 +/- 2.0 preoperative values). At 3-month examination, thick posterior capsule opacification precluded refractometry in all eyes.
The lens refilling procedure with the use of a silicone plug for sealing the capsular opening was feasible in primate eyes. The accommodation amplitude attained was a small fraction of the value before surgery. This may result from the loss of so-called intracapsular accommodation, ie, active participation of lens fiber cells in accommodation. However, since the obtained accommodation may be sufficient for near vision after cataract surgery, this lens refilling procedure warrants further study. Elucidation of the mechanism of intracapsular accommodation may also be necessary.
通过向晶状体囊内注入可注射的硅酮化合物来恢复灵长类动物眼睛的调节功能。
对8只食蟹猴的8只眼睛进行晶状体填充手术治疗。为防止注入的液态硅酮在体内囊内聚合前泄漏，研制了一种用于封闭囊口的硅酮塞。在上方小环形撕囊后行囊内超声乳化术，将塞子插入撕囊口。通过塞子的输送管将硅酮混合物注入囊袋。术后1周和3个月进行自动验光。调节幅度定义为局部应用4%氯化毛果芸香碱前和用药后1小时的屈光度差值。
8只眼中有5只能够进行填充。5只眼中有4只可测量屈光度。调节幅度在1.0至4.5屈光度之间，平均为2.3±1.3屈光度（术前值为8.0±2.0屈光度）。在3个月检查时，所有眼睛均因后囊膜混浊严重而无法进行验光。
在灵长类动物眼中，使用硅酮塞封闭囊口的晶状体填充手术是可行的。所获得的调节幅度仅为手术前的一小部分。这可能是由于所谓的囊内调节丧失，即晶状体纤维细胞在调节过程中失去了主动参与。然而，由于所获得的调节功能可能足以满足白内障手术后的近视力需求，这种晶状体填充手术值得进一步研究。阐明囊内调节机制可能也很有必要。
