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Ogawa K, Ikeda M, Shirai I, Ohshiro K, Maruyama Y, Yokoo T, Tanno Y, Terawaki H, Sakurada T, Yoshikawa K, Inoue H, Higuchi C, Kaneko T, Nogaki F, Ueda A, Maeda Y. Upward-directed exit-site of the swan-neck catheter and "Easy-to-disinfect the backside area of exit-site" may prevent PD complications. Clin Exp Nephrol 2024; 28:547-556. [PMID: 38340245 PMCID: PMC11116190 DOI: 10.1007/s10157-023-02454-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/26/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Upward-directed exit-site has been believed to be the worst for frequent ESI by an old retrospective study using straight catheters. No comparison study of 3 exit-site directions using swan-neck catheter has been performed regarding which direction is the best for our endpoints, Easy-to-see the backside area of exit-site: ESBE, Easy-to-disinfect the backside area of exit-site: EDBE, reduction of both exit-site infection (ESI), symptomatic catheter dislocation and peritonitis. METHODS We assessed the relationship of exit-site direction with our endpoints in a quantitative cross-sectional, multicentered questionnaire survey. Patients who received either non-surgical catheter implantation or exit-site surgery were excluded. RESULTS The numbers (percentage) of exit-site directions in included 291 patients were upward 79 (26.0), lateralward 108 (37.5) and downward 105 (36.5). Cochran-Armitage analysis showed a significant step-ladder increase in the prevalence of ESI as the direction changed from upward to lateralward to downward (0.15 ± 0.41, 0.25 ± 0.54, 0.38 ± 0.69 episodes/patient-year, p = 0.03). Multivariable regression analysis revealed the upward exit-site independently associates with both higher frequency of ESBE (OR 5.55, 95% CI 2.23-16.45, p < 0.01) and reduction of prevalence of ESI (OR 0.55, 95%CI 0.27-0.98, p = 0.04). Positive association between the prevalence of symptomatic catheter dislocation and ESI (OR 2.84, 95% CI 1.27-7.82, p = 0.01), and inverse association between EDBE and either prevalence of symptomatic catheter dislocation (OR 0.27, 95% CI 0.11-0.72) or peritonitis (OR 0.48, 95% CI 0.23-0.99) observed. CONCLUSION Upward-directed swan-neck catheter exit-site may be the best for both ESBE and prevention of ESI. EDBE may reduce catheter dislocation and peritonitis. Symptomatic catheter dislocation may predict ESI.
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Affiliation(s)
- Kyohei Ogawa
- Division of Nephrology and Hypertension, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba, 277-8567, Japan
| | - Masato Ikeda
- Division of Nephrology and Hypertension, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba, 277-8567, Japan.
| | - Izumi Shirai
- Division of Nephrology and Hypertension, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba, 277-8567, Japan
| | - Kentaro Ohshiro
- Division of Nephrology and Hypertension, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba, 277-8567, Japan
| | - Yukio Maruyama
- Division of Nephrology and Hypertension, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, The Jikei University School of Medicine, Tokyo, Japan
| | - Yudo Tanno
- Division of Nephrology and Hypertension, Katsushika Medical Center, Tokyo, Japan
| | - Hiroyuki Terawaki
- Division of Nephrology, Department of Internal Medicine, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Tsutomu Sakurada
- Division of Nephrology and Hypertension, Department of Internal Medicine, Saint Marianna University School of Medicine, Kanagawa, Japan
| | - Kazuhiro Yoshikawa
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, Iwate, Japan
| | - Hironobu Inoue
- Department of Nephrology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Chieko Higuchi
- Department of Nephrology, Tokyo Women's Medical University, East Medical Hospital, Tokyo, Japan
| | - Tomohiro Kaneko
- Department of Nephrology, Nippon Medical School Tamanagayama Hospital, Tokyo, Japan
| | - Fumiaki Nogaki
- Department of Nephrology, Shimada Municipal Hospital, Shizuoka, Japan
| | - Atsushi Ueda
- Department of Nephrology, Hitachi General Hospital, Ibaraki, Japan
| | - Yoshitaka Maeda
- Nephrology Division, Department of Internal Medicine, JA Toride Medical Center, Toride, Japan
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Ameku KA, Berggren CC, Pedrigi RM. Implantation of a capsular tension ring during cataract surgery attenuates predicted remodeling of the post-surgical lens capsule along the visual axis. Front Bioeng Biotechnol 2024; 11:1300830. [PMID: 38312508 PMCID: PMC10834774 DOI: 10.3389/fbioe.2023.1300830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/26/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction: Cataract surgery permanently alters the mechanical environment of the lens capsule by placing a hole in the anterior portion and implanting an intraocular lens (IOL) that has a very different geometry from the native lens. We hypothesized that implant configuration and mechanical interactions with the post-surgical lens capsule play a key role in determining long-term fibrotic remodeling. Methods: We developed the first finite element-growth and remodeling (FE-G&R) model of the post-surgical lens capsule to evaluate how implantation of an IOL with and without a capsular tension ring (CTR) impacted evolving lens capsule mechanics and associated fibrosis over time after cataract surgery. Results: Our models predicted that implantation of a CTR with the IOL into the post-surgical lens capsule reduced the mechanical perturbation, thickening, and stiffening along the visual axis in both the remnant anterior and posterior portions compared to implantation of the IOL alone. Discussion: These findings align with patient studies and suggest that implantation of a CTR with the IOL during routine cataract surgery would attenuate the incidence of visually-debilitating capsule fibrosis. Our work demonstrates that use of such modeling techniques has substantial potential to aid in the design of better surgical strategies and implants.
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Affiliation(s)
| | | | - Ryan M. Pedrigi
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, United States
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Cabeza-Gil I, Calvo B. Predicting the biomechanical stability of IOLs inside the postcataract capsular bag with a finite element model. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 221:106868. [PMID: 35594579 DOI: 10.1016/j.cmpb.2022.106868] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 04/25/2022] [Accepted: 05/07/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Although cataract surgery is a safe operation in developed countries, there is still room for improvement in terms of patient satisfaction. One of the key issues is assessing the biomechanical stability of the IOL within the capsular bag to avoid refractive errors that lead to a second surgery. For that purpose, a numerical model was developed to predict IOL position inside the capsular bag in the short- and long-term. METHODS A finite element model containing the implanted IOL, the postcataract capsular bag, the zonules, and a portion of the ciliary body was designed. The C-loop hydrophobic LUCIA IOL was used to validate the numerical model and two more worldwide IOL designs were tested: the double C-loop hydrophobic POD FT IOL and the plate hydrophilic AT LISA IOL. To analyze the biomechanical stability in the long-term, the effect of the fusion footprint, which occurs days following cataract surgery, was simulated. Moreover, several scenarios were analyzed: the size and location of the capsulorexhis, the capsular bag diameter, the initial geometry of the capsular bag, and the material properties of the bag. RESULTS The biomechanical stability of the LUCIA IOL was simulated and successfully compared with the in vitro results. The plate AT LISA design deformed the capsular bag diameter up to 11.0 mm against 10.5 mm for the other designs. This design presented higher axial displacement and lower rotation, 0.19 mm and 0.2∘, than the C-loop design, 0.09 mm and 0.9∘. CONCLUSIONS All optomechanical biomarkers were optimal, assuring good optical performance of the three IOLs under investigation. Our findings showed that the capsulorexhis size influences the stiffness of the capsular bag; however, the shape in the anterior and posterior curvature surfaces of the bag barely affect. The results also suggested that the IOL is prone to mechanical perturbations with the fusion footprint, but they were not high enough to produce a significant refractive error. The proposed model could be a breakthrough in the selection of haptic design according to patient criteria.
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Affiliation(s)
- I Cabeza-Gil
- Aragón Institute of Engineering Research (i3A), University of Zaragoza, Spain.
| | - B Calvo
- Aragón Institute of Engineering Research (i3A), University of Zaragoza, Spain; Centro de Investigación Biomédica en Red en Bioingenieria, Biomateriales y Nanomedicina (CIBER-BBN), Spain
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