三件式高折射率硅水凝胶人工晶状体经镊子和注射器植入后切口大小和形状的实验与临床评估
Experimental and clinical evaluation of incision size and shape following forceps and injector implantation of a three-piece high-refractive-index silicone intraocular lens.
作者信息
Kohnen T, Koch D D
机构信息
Department of Ophthalmology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany.
出版信息
Graefes Arch Clin Exp Ophthalmol. 1998 Dec;236(12):922-8. doi: 10.1007/s004170050181.
BACKGROUND
Previous studies have demonstrated that incision sizes required for insertion of various foldable intraocular lenses (IOLs) vary according to the IOL/inserter combination. The purpose of this study was to compare incision sizes and wound shape for both forceps and injector implantation of high-refractive-index silicone IOLs.
METHODS
In fresh human cadaver eyes, limbal corneal tunnel incisions were created, and 12 foldable high-refractive-index silicone (dimethyldiphenylsiloxane) IOLs were inserted in a randomized fashion using either a forceps or an injector. Using incision calipers, internal and external measurements of the tunnel incisions were obtained before and after IOL insertion. Scanning electron microscopy (SEM) was performed on selected corneas following IOL insertion. Additionally, in 12 cataract procedures, the incision sizes following forceps or injector implantation were evaluated intraoperatively.
RESULTS
In the experimental setting, the external and internal tunnel widths (in mm) before insertion were 3.05 mm (+/-0.07) and 3.02 mm (+/-0.03), respectively, with the forceps and 3.06 mm (+/-0.04) and 3.01 mm (+/-0.04) with the injector. Following IOL implantation, the external and internal incision sizes were 3.33 mm (+/-0.07) and 3.33 mm (+/-0.04) with the forceps and 3.32 mm (+/-0.08) and 3.33 mm (+/-0.07) with the injector. SEM showed tearing of corneal structures after implantation through the smallest possible incisions with both devices. In the clinical study, the incision sizes before and after implantation were 3.23 mm (+/-0.10) and 3.36 mm (+/-0.06) with the forceps and 3.11 mm (+/-0.08) and 3.21 mm (+/-0.10) with the injector.
CONCLUSIONS
This study confirms that high-refractive-index silicone IOLs provide one of the smallest currently achievable incisions before and after IOL implantation. In clinical use, the new injector reduces the mean incision size required by approximately 0.1 mm.
背景
先前的研究表明，插入各种可折叠人工晶状体（IOL）所需的切口大小会因IOL/植入器的组合而有所不同。本研究的目的是比较高折射率硅酮IOL通过镊子和注射器植入时的切口大小和伤口形状。
方法
在新鲜的人尸体眼睛上制作角膜缘隧道切口，然后使用镊子或注射器以随机方式插入12枚可折叠的高折射率硅酮（二甲基二苯基硅氧烷）IOL。在IOL插入前后，使用切口卡尺对隧道切口进行内外测量。IOL插入后，对选定的角膜进行扫描电子显微镜（SEM）检查。此外，在12例白内障手术中，术中评估了使用镊子或注射器植入后的切口大小。
结果
在实验环境中，使用镊子时，插入前隧道的外部和内部宽度（单位：mm）分别为3.05 mm（±0.07）和3.02 mm（±0.03），使用注射器时分别为3.06 mm（±0.04）和3.01 mm（±0.04）。IOL植入后，使用镊子时切口的外部和内部大小分别为3.33 mm（±0.07）和3.33 mm（±0.04），使用注射器时分别为3.32 mm（±0.08）和3.33 mm（±0.07）。SEM显示，使用这两种器械通过尽可能小的切口植入后，角膜结构出现撕裂。在临床研究中，使用镊子植入前后的切口大小分别为3.23 mm（±0.10）和3.36 mm（±0.06），使用注射器时分别为3.11 mm（±0.08）和3.21 mm（±0.10）。
结论
本研究证实，高折射率硅酮IOL在IOL植入前后提供了目前可实现的最小切口之一。在临床应用中，新型注射器可使所需的平均切口大小减少约0.1 mm。
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