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Hammer M, Muuss M, Herbster L, Herth J, Scheuerle A, Khoramnia R, Labuz G, Uhl P, Auffarth GU. Viscoelastic, Optical, and Surgical Properties of Vitreous Body Replacement Hydrogels After Aging Compared to Porcine Vitreous Bodies And Silicone Oils. Transl Vis Sci Technol 2024; 13:5. [PMID: 38967936 PMCID: PMC11232910 DOI: 10.1167/tvst.13.7.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024] Open
Abstract
Purpose First- (monomers), second- (pre-gelated), and third- (in situ gelating after injection) generation hydrogels were previously introduced to replace the vitreous body after vitrectomy surgery. In this study, we evaluated the surgical, optical, and viscoelastic properties of vitreous body replacement hydrogels before and after an accelerated aging protocol previously applied to intraocular implants. Methods Measurements of injection force, removal speed using a clinically established vitrectomy setup, as well as evaluation of forward light scattering and viscoelastic properties before and after an accelerated aging protocol were conducted. Results were compared to porcine and human vitreous bodies, as well as currently clinically applied lighter- and heavier-than-water silicone oils. Results Removal speed of all tested hydrogels is substantially lower than the removal speed of porcine vitreous body (0.2 g/min vs. 2.7 g/min for the best performing hydrogel and porcine vitreous body, respectively). Forward light scattering in second-generation vitreous body replacement hydrogels was higher after the aging process than the straylight of the average 70-year-old vitreous body (9.4 vs. 5.5 deg2/sr, respectively). The viscoelastic properties of all hydrogels did not change in a clinically meaningful manner; however, trends toward greater stiffness and greater elasticity after aging were apparent. Conclusions This study demonstrates surgical weaknesses of the hydrogels that need to be addressed before clinical use, especially low removal speed. Pre-linked hydrogels (second-generation) showed inferior performance regarding surgical properties compared to in situ gelating hydrogels (third-generation). Translational Relevance This study highlights possible pitfalls regarding surgical and optical properties when applying vitreous replacement hydrogels clinically.
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Affiliation(s)
- Maximilian Hammer
- David J Apple Laboratory for Vision Research, Heidelberg, Germany
- University Eye Clinic Heidelberg, Heidelberg, Germany
| | - Marcel Muuss
- David J Apple Laboratory for Vision Research, Heidelberg, Germany
- University Eye Clinic Heidelberg, Heidelberg, Germany
| | - Lorenz Herbster
- Institute for Pharmacy and Molecular Biotechnology, Heidelberg, Germany
| | - Jonathan Herth
- David J Apple Laboratory for Vision Research, Heidelberg, Germany
- University Eye Clinic Heidelberg, Heidelberg, Germany
| | | | - Ramin Khoramnia
- David J Apple Laboratory for Vision Research, Heidelberg, Germany
- University Eye Clinic Heidelberg, Heidelberg, Germany
| | - Grzegorz Labuz
- David J Apple Laboratory for Vision Research, Heidelberg, Germany
- University Eye Clinic Heidelberg, Heidelberg, Germany
| | - Philipp Uhl
- Institute for Pharmacy and Molecular Biotechnology, Heidelberg, Germany
| | - Gerd Uwe Auffarth
- David J Apple Laboratory for Vision Research, Heidelberg, Germany
- University Eye Clinic Heidelberg, Heidelberg, Germany
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Zhang L, Schickhardt S, Merz P, Auffarth GU. Evaluation of Parameters and Nozzle Tip Damage after Clinical Use of Three Hydrophilic Intraocular Lens Injector Models. J Ophthalmol 2024; 2024:2360368. [PMID: 38846928 PMCID: PMC11156505 DOI: 10.1155/2024/2360368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 04/04/2024] [Accepted: 04/12/2024] [Indexed: 06/09/2024] Open
Abstract
Purpose To assess the nozzle tip damage and the parameters of three different hydrophilic intraocular lens (IOL) injector models. Methods After routine cataract surgeries at the University Eye Hospital Heidelberg, all the used IOL injectors were collected from the operating room and sent to our laboratory. Nozzle tip damage was assessed under a microscope and graded as follows: no damage (grade 0), slight scratches (1), deep scratches (2), extensions (3), cracks (4), and bursts (5). Each damage grade was assigned a score from 0 to 5, and the total damage score for each injector system was calculated and compared. Nozzle tip parameters (diameters and areas), plunger tip parameters, and tip angles were also measured in each model. Results The damage scores were (median, Q3-Q1): 1 (1-1) for Accuject, 1 (1-1) for Bluemixs, and 1 (1-1) for RayOne. There was no statistically significant difference in the damage scores between the study groups (P > 0.05). The outer cross-sectional vertical and horizontal diameters were 1.69 and 1.69 mm for Accuject, 1.69 and 1.69 mm for Bluemixs, and 1.70 and 1.71 mm for RayOne. Plunger tip areas were 0.78 mm2 for Accjuect, 0.74 mm2 for Bluemixs, and 0.43 mm2 for RayOne. Plunger tip area/inner cross-sectional area of the nozzle tip (%) was 31.2% for RayOne, 66.7% for Accuject, and 63.8% for Bluemixs. The tip angles for three injector models were 56° (Accuject), 56° (Bluemixs), and 44° (RayOne). Conclusions All the injector models showed mild to moderate damage to the nozzle tip after IOL implantation, even with smaller diameter tips. RayOne resulted in the lowest ratio between plunger tip area and inner cross-sectional area of the nozzle tip and a better distribution of damage categories than the other two groups. All three injector models had relatively small tip parameters. If smaller incisions are required in certain patients, smaller tip parameters should be considered.
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Affiliation(s)
- Lu Zhang
- David J Apple Center for Vision Research, Department of Ophthalmology, University Hospital Heidelberg, Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Sonja Schickhardt
- David J Apple Center for Vision Research, Department of Ophthalmology, University Hospital Heidelberg, Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Patrick Merz
- David J Apple Center for Vision Research, Department of Ophthalmology, University Hospital Heidelberg, Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Gerd Uwe Auffarth
- David J Apple Center for Vision Research, Department of Ophthalmology, University Hospital Heidelberg, Im Neuenheimer Feld 400, Heidelberg 69120, Germany
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Bin Raja Ghazilla RA, Azuddin M, Bin Ahmad Hairuddin MKF, Risdiana N. An analysis of the effect of syringe barrel volume on performance and user perception. Medicine (Baltimore) 2023; 102:e33983. [PMID: 37335669 DOI: 10.1097/md.0000000000033983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
In the market, there are many types and shapes of syringes. One of the groupings of syringe types is based on barrel volume. The shape of the product design affects performance and user perception. The aim of this study is to investigate the effect of barrel volume on its performance and user perception. We performed analysis following international organization for standardization 7886 procedures on syringe with 1 mL, 3 mL, 5 mL, and 10 mL volume. In addition, a user perception test was conducted on 29 respondents using a questionnaire with the Likert chart method. This study indicates that the bigger the syringe volume, the larger the dead space and the force to operate the piston are. A larger syringe volume also raises the volume that changes due to the plunger position increase. Meanwhile, the barrel volume does not affect water and water leakage, as we did not observe any leak during the syringe tests in our experiment. In addition, the user perception test shows that the barrel's length influences the ease of device control during the injection. The volume of the barrel negatively correlated with its effect to the environment. The safety features of all syringes are similar except for the 3 mL syringe, which has a value of 0.1 points difference to other syringes.
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Affiliation(s)
| | - M Azuddin
- CPDM, Department of Mechanical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Nurvita Risdiana
- Department of Mental Health Nursing, School of Nursing, Universitas Muhammadiyah Yogyakarta, Daerah Istimewa Yogyakarta, Indonesia
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Vacalebre M, Frison R, Corsaro C, Neri F, Santoro A, Conoci S, Anastasi E, Curatolo MC, Fazio E. Current State of the Art and Next Generation of Materials for a Customized IntraOcular Lens according to a Patient-Specific Eye Power. Polymers (Basel) 2023; 15:polym15061590. [PMID: 36987370 PMCID: PMC10054364 DOI: 10.3390/polym15061590] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Intraocular lenses (IOLs) are commonly implanted after surgical removal of a cataractous lens. A variety of IOL materials are currently available, including collamer, hydrophobic acrylic, hydrophilic acrylic, PHEMA copolymer, polymethylmethacrylate (PMMA), and silicone. High-quality polymers with distinct physical and optical properties for IOL manufacturing and in line with the highest quality standards on the market have evolved to encompass medical needs. Each of them and their packaging show unique advantages and disadvantages. Here, we highlight the evolution of polymeric materials and mainly the current state of the art of the unique properties of some polymeric systems used for IOL design, identifying current limitations for future improvements. We investigate the characteristics of the next generation of IOL materials, which must satisfy biocompatibility requirements and have tuneable refractive index to create patient-specific eye power, preventing formation of posterior capsular opacification.
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Affiliation(s)
- Martina Vacalebre
- Dipartimento di Scienze Matematiche ed Informatiche, Scienze Fisiche e Scienze della Terra (MIFT), Università di Messina, V.le Ferdinando Stagno d'Alcontres 31, 98166 Messina, Italy
| | - Renato Frison
- Optical Consultant SIFI SpA, 95025 Aci Sant'Antonio (CT), Italy
| | - Carmelo Corsaro
- Dipartimento di Scienze Matematiche ed Informatiche, Scienze Fisiche e Scienze della Terra (MIFT), Università di Messina, V.le Ferdinando Stagno d'Alcontres 31, 98166 Messina, Italy
| | - Fortunato Neri
- Dipartimento di Scienze Matematiche ed Informatiche, Scienze Fisiche e Scienze della Terra (MIFT), Università di Messina, V.le Ferdinando Stagno d'Alcontres 31, 98166 Messina, Italy
| | - Antonio Santoro
- Dipartimento di Scienze Chimiche, Biologiche, Farmacologiche ed Ambientali (CHIBIOFARAM), Università di Messina, V.le Ferdinando Stagno d'Alcontres 31, 98166 Messina, Italy
| | - Sabrina Conoci
- Dipartimento di Scienze Chimiche, Biologiche, Farmacologiche ed Ambientali (CHIBIOFARAM), Università di Messina, V.le Ferdinando Stagno d'Alcontres 31, 98166 Messina, Italy
| | - Elena Anastasi
- Innovation and Medical Science, SIFI SpA, 95025 Aci Sant'Antonio (CT), Italy
| | | | - Enza Fazio
- Dipartimento di Scienze Matematiche ed Informatiche, Scienze Fisiche e Scienze della Terra (MIFT), Università di Messina, V.le Ferdinando Stagno d'Alcontres 31, 98166 Messina, Italy
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Kim H, Jeong H, Shin K. Development Pattern of Medical Device Technology and Regulatory Evolution of Cataract Treatment. Healthcare (Basel) 2023; 11:healthcare11040453. [PMID: 36832988 PMCID: PMC9957356 DOI: 10.3390/healthcare11040453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
To prevent regulation from becoming an obstacle to healthcare technological innovation, regulation should evolve as new healthcare technologies are developed. Although regulation is closely related to healthcare technology development, there are few studies that view healthcare technological advances from the multi-layered perspective of papers, patents, and clinical research and link this with regulatory evolution. Therefore, this study tried to develop a new method from a multi-layer perspective and draw regulatory implications based on it. This study applied this method to intraocular lens (IOLs) for cataract treatment and detected four major healthcare technologies and two recent healthcare technologies. Moreover, it discussed how current regulations evaluate these technologies. The findings provide implications for healthcare technological advances and the evolutionary direction of regulation through the example of IOLs for cataract treatment. This study contributes to the development of theoretical methods for co-evolution with regulations based on healthcare technology innovation.
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Affiliation(s)
- Heejung Kim
- Department of Biomedical Convergence, College of Medicine, Chungbuk National University, Chungdae-ro 1, Seowon-gu, Cheongju 28644, Chungbuk, Republic of Korea
| | - Harry Jeong
- Central Research Institute, Dr. Chung’s Food Co., Ltd., Cheongju 28446, Republic of Korea
| | - Kwangsoo Shin
- Graduate School of Public Health and Healthcare Management, The Catholic University of Korea, Banpo-daero 222, Secho-gu, Seoul 06591, Republic of Korea
- Catholic Institute for Public Health and Healthcare Management, The Catholic University of Korea, Banpo-daero 222, Secho-gu, Seoul 06591, Republic of Korea
- Correspondence:
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Krisdiyanto, Bin Raja Ghazilla RA, Azuddin M, Bin Ahmad Hairuddin MKF, Muflikhun MA, Risdiana N, Afifuddin E. The hypodermic syringe performance based on the ISO 7886-1:2017: A narrative review. Medicine (Baltimore) 2022; 101:e31812. [PMID: 36626504 PMCID: PMC9750608 DOI: 10.1097/md.0000000000031812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
A syringe is used to inject fluid or medicine into the patient's soft tissue. The main components of the syringe were the needle, barrel, and plunger. The use of syringes in the medical world is relatively high, and especially since the COVID-19 pandemic, the use of hypodermic syringes increased sharply due to vaccination. The syringe used must be effective and of good quality, so the International Organization for Standardization (ISO) has published test procedures and minimum specifications for hypodermic syringes. The performance of the syringe can be observed from the dead space, force piston operation, water and air leakage, and fitting position of the plunger in the barrel. This review shows that most researchers use the weighing method to measure the dead space, although some use other methods. The researchers found that most of the products met the minimum specifications of the ISO, and that the dimensions and shape of the syringe affected the dead space. Researchers have not examined other performance measures recommended by the ISO. Researchers have focused more on force injection than force piston operation, leakage after injection or back spray than air and water leakage, and reduction the friction of the plunger without considering the fitting position of the plunger in the barrel.
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Affiliation(s)
- Krisdiyanto
- CPDM, Department of Mechanical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
- Mechanical Engineering Department, Faculty of Engineering, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | | | - M. Azuddin
- CPDM, Department of Mechanical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Muhammad Akhsin Muflikhun
- Mechanical and Industrial Engineering Department, Faculty of Engineering, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Nurvita Risdiana
- Department of Mental Health Nursing, School of Nursing, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | - Eki Afifuddin
- Mechanical and Industrial Engineering Department, Faculty of Engineering, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Joshi RS. Comparative evaluation of an automated preloaded delivery system with a non-preloaded system. Indian J Ophthalmol 2022; 70:4307-4311. [PMID: 36453335 PMCID: PMC9940551 DOI: 10.4103/ijo.ijo_1635_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose To evaluate a single surgeon's experience with an automated preloaded intraocular lens (IOL) delivery system and a nonpreloaded system. Methods This was a prospective, observational case series. Phacoemulsification was performed under topical anesthesia by creating a temporal clear corneal incision. Patients were consecutively assigned to either the Clareon group (n = 50; the IOL was injected into the capsular bag by using an automated injector system) or the AcrySof group (n = 50; the IOL was injected into the capsular bag by using a conventional injector system). The main outcome measures were ease of implantation, intraoperative complications, postoperative centration, and visual acuity. Results Additional manipulation in the anterior chamber was not required in 38 (74%) eyes in the Clareon group and 41 (82%) eyes in the AcrySof group. However, seven eyes in the Clareon group and one eye in the AcrySof group required trailing haptic dislodgement from the optic. Furthermore, two eyes in the Clareon group and five eyes in the AcrySof group required injector rotation (varying from 10° to 90°) in the wound. Moreover, in two eyes of the Clareon group, the silicon plunger of the injector system crossed over the optic. None of the patients developed iris trauma and PCR during IOL manipulation. All the IOLs were centered in the capsular bag. Conclusion The automated IOL delivery system enables the controlled delivery of an IOL in the capsular bag. The effect of carbon footprints created by plastic generated from the delivery system and the implications of the CO2 cylinder on the environment should be addressed.
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Affiliation(s)
- Rajesh S Joshi
- Department of Ophthalmology, Government Medical College, Nagpur, Maharashtra, India,Correspondence to: Dr. Rajesh S Joshi, 77, Panchatara Housing Society, Manish Nagar, Somalwada, Nagpur - 440 015, Maharashtra, India. E-mail:
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Danese C, El Jabali A, Lanzetta P. Single-hand preloaded intraocular lens implantation through a screw-type single use injector. Eur J Ophthalmol 2022; 32:3113-3115. [PMID: 35389280 DOI: 10.1177/11206721221093026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The most common intraocular lens (IOL) injectors are syringe- and screw-type. Screw-type injectors are useful to control IOL injection speed, but the surgeon needs to use both hands during implantation. It may result in a lack of eye stability, especially under topical anesthesia. METHODS In this paper a single hand implantation technique is described. The second hand is used to hold a second instrument into the anterior chamber in order to stabilize the eye and aid the correct IOL positioning into the capsular bag. RESULTS Surgery was performed uneventfully on six eyes of four patients, affected by senile corticonuclear cataract. In all cases the operation was conducted without complications. All the IOLs were well centered. CONCLUSIONS The technique is safe and easy to replicate, however the shape of the injector plunger needs to be adequate.
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Affiliation(s)
- Carla Danese
- Department of Medicine - Ophthalmology, 9316University of Udine, Italy
| | | | - Paolo Lanzetta
- Department of Medicine - Ophthalmology, 9316University of Udine, Italy.,Istituto Europeo di Microchirurgia Oculare - IEMO, Italy
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Cabeza-Gil I, Calvo B, Rico A, Reinhards-Hervás C, Rodríguez J. Mechanical characterisation of hydrophobic and hydrophilic acrylates used in intraocular lenses through depth sensing indentation. J Mech Behav Biomed Mater 2021; 126:104997. [PMID: 34848137 DOI: 10.1016/j.jmbbm.2021.104997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/08/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
In this work, the mechanical behaviour of hydrophilic and hydrophobic acrylates has been characterised by depth sensing indentation. Time-dependent behaviour has been studied using load-relaxation tests. Experiments have been simulated with a finite element software using a visco-hyperelastic material model. The parameters of this model have been determined using deep learning techniques. The developed material models have been used to mechanically simulate a standard compression test of a prototype intraocular lens.
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Affiliation(s)
- I Cabeza-Gil
- Aragon Institute of Engineering Research (i3A), University of Zaragoza, Spain
| | - B Calvo
- Aragon Institute of Engineering Research (i3A), University of Zaragoza, Spain; Centro de Investigacion Biomedica en Red en Bioingenieria, Biomateriales y Nanomedicina (CIBER-BBN), Spain
| | - A Rico
- Durability and Mechanical Integrity of Structural Materials, Rey Juan Carlos University, Spain
| | - C Reinhards-Hervás
- Durability and Mechanical Integrity of Structural Materials, Rey Juan Carlos University, Spain
| | - J Rodríguez
- Durability and Mechanical Integrity of Structural Materials, Rey Juan Carlos University, Spain.
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