Fluid Dynamic Assessment of Hypersonic and Guillotine Vitrectomy Probes in Viscoelastic Vitreous Substitutes

Role of gamma-irradiated sodium alginate on growth, physiological and active components of iceberg lettuce (Lactuca sativa) plant

BACKGROUND

One of the most widely recognized biostimulators of plant development; is oligoalginate, which regulates the biological processes of plants and was used in horticultural fields as a plant growth regulator. The plan of the current research was to study, however, the foliar application of un-irradiated and irradiated Na-alginate (UISA and ISA) to improve the growth, physiological activity, and other active components of the Egyptian iceberg lettuce plant. Degraded Na-alginate is equipped with exposure of sodium alginate in its solid state to gamma-rays at different dose levels (0.0, 25, 50, 75, and 100 kGy). The characterization of the oligo-alginates achieved by γ-radiation deprivation at different dose levels was performed by FTIR, XRD, TGA, SEM, and TEM. Different concentrations of irradiated sodium alginate at dose levels of 100 kGy (200, 400, 600, and 800 ppm, as well as deionized water used as a control) were sprayed with a hand sprayer every week after transplanting the iceberg lettuce seedlings in the field until the harvest stage. Morphological traits were evaluated, as well as pigments, ascorbic acid, phenols, flavonoids, soluble proteins, and antioxidant activity.

RESULTS

Irradiated Na-alginate resulted in the depolymerization of Na-alginate into small molecular-weight oligosaccharides, and the best dose to use was 100 kGy. Certain chemical modifications in the general structure were observed by FTIR analysis. Two absorbed bands at 3329 cm-1 and 1599 cm-1, were recognized that are assigned to O-H and C-O stretching, respectively, and peaks achieved at 1411 cm-1 represent the COO-stretching group connected to the sodium ion. The peak obtained at 1028 cm-1 was owing to the stretching vibration of C-O. The results of TGA provided that the minimum weight reminder was in the ISA at 100 kGy (28.12%) compared to the UISA (43.39%). The images of TEM pointed out that the Na-alginate was globular in shape, with the particle distribution between 12.8 and 21.7 nm in ISA at 100 kGy. Irradiated sodium alginate caused a noteworthy enhancement in the vegetative growth traits (leaf area, stem length, head weight, and leaf number). By spraying 400 ppm, ISA showed a maximum increase in total pigments (2.209 mg/g FW), ascorbic acid (3.13 mg/g fresh weight), phenols (1.399 mg/g FW), flavonoids (0.775 mg/g FW), and antioxidant activities (82.14. %). Also, there were correlation coefficients (R values) between leaf area, stem length, head weight, and leaf number values with total pigment content, antioxidant activity, total soluble proteins, and ascorbic acid.

CONCLUSIONS

The outcomes of the recent investigation demonstrated that the application of spraying irradiated Na-alginate (100 kGy) resulted in an improvement of the considered characters.

Ultrasonic Vitrectomy Performance Assessment Using Micro-Extensional Rheology

Purpose

The purpose of this study was to assess the performance of ultrasonic (US) vitrectomy devices by quantifying and comparing its impact on extracted vitreous properties to conventional pneumatic blade (PB) cutters using micro-extensional rheology. US vitrectomy is a new technology that offers an alternative to PB cutters used in vitreo-retinal surgeries.

Methods

Thirty-six porcine vitreous samples were extracted using US and PB cutters. Each sample was kept at 4°C and tested within 24 hours postmortem and 4 hours post-vitrectomy. A recently developed micro-extensional rheology technique is used to infer the relative protein fragment size of extracted vitreous by quantifying the extensional relaxation time.

Results

US-extracted vitreous exhibited extensional relaxation times orders of magnitude lower than PB-extracted vitreous (0.37 ms and 27.25 ms, respectively). Relaxation time is directly correlated to the fragment size of the collagen fibers in the vitreous. The formation of beads-on-a-string droplets within the PB samples indicates the presence of larger collagen fragments. These droplets were not seen on US samples.

Conclusions

This new micro-extensional rheology technique can identify significant differences in physical properties of extracted vitreous. Long relaxation times and beads-on-a-string droplets within the PB vitreous samples indicate larger protein fragments compared to the US samples.

Translational Relevance

Higher fragmentation of vitreous and lower extensional relaxation times may improve retina safety due to a reduction in vitreo-retinal traction resulting from the continuous shear action and aspiration applied by ultrasonic vitrectomy technology.

Dynamic Pressure Measurements During Vitrectomy in a Model of the Eye

Purpose

To accurately evaluate pressure changes during vitrectomy in a rigid model of the vitreous chamber and to test the efficiency of the EVA phacovitrectomy system (Dutch Ophthalmic Research Center) in terms of compensation of intraocular pressure variations.

Methods

We tested 23-, 25-, and 27-gauge double-blade vitreous cutters in both vented global pressure control and automatic infusion compensation (AIC) modes in a vitreous chamber model, mimicking the real surgical procedure. Balanced salt solution and artificial vitreous, similar to the real vitreous body, were used. We tested both standard-flow (SF) and high-flow (HF) infusion systems, varying the infusion pressure between 20 and 40 mm Hg. In each experiment, flow rate was also measured.

Results

Pressure drop was rapidly and efficiently compensated when 23- and 25-gauge cutters were used in AIC mode, with infusion pressures ranging between 30 and 55 mm Hg. The 27-gauge cutter was less efficient in compensating pressure variations. Pressure fluctuations related to the high-frequency motion of the cutter blade were small compared to the overall pressure variations. The use of the HF infusion system resulted in larger flow rates and lower pressure changes compared to the SF infusion system.

Conclusions

Despite the rigid material of the model, the present pressure measurements are in line with previous studies performed on porcine eye. The use of AIC mode compensates intraoperative pressure drops efficiently, with both 23- and 25-gauge cutters. The HF infusion system is more efficient than the SF infusion system.

Translational Relevance

The AIC infusion mode efficiently compensates intraoperative pressure drops, in both 23- and 25-gauge experimental vitrectomy. The HF infusion system resulted in larger flow rate and lower pressure changes.

TWENTY-THREE-GAUGE HYPERSONIC VITRECTOMY: Real-World Surgical Evidence

PURPOSE

To evaluate the safety, effectiveness, and the best parameters setup of hypersonic vitrectomy.

METHODS

A prospective, multicentric, interventional study on 50 eyes that had undergone hypersonic vitrectomy because of various vitreoretinal diseases. We primarily assessed the effectiveness of vitreous removal, intraoperative complications, and surgical setup. Secondarily, we evaluated single-surgery anatomical success and postoperative best-corrected visual acuity.

RESULTS

Intraoperative complications occurred in 5 eyes (10%), whereas technical problems were detected in 23 eyes (46%), resulting in conversion to guillotine vitrectomy in 15 cases. The most common finding related to the technical problems was an inadequate vitreous liquefaction with the formation of vitreous strands and consequent inadequate vitreous outflow, sometimes complicated by vitreous incarceration in the vitrectomy probe. The best settings were considered a stroke of 60 µm and vacuum of 40 mmHg for both core and peripheral vitrectomy. At 3-month follow-up, primary anatomical success was achieved in 49 eyes (98%) and the mean best-corrected visual acuity overall improved.

CONCLUSION

The availability of hypersonic vitrectomy in the current surgical practice opens a new era in vitreoretinal surgery. Despite the potential advantages in fluidics, the performance of hypersonic vitrectomy system needs to be further optimized, mainly for the occurrence of inadequate vitreous liquefaction and vitreous strands formation.

In Vitro Comparison of Various High-Speed Vitrectomy Machines Using Dual Blade Cutters

Objectives

The objective of this study is to compare various dual blade vitrectomy cutters for their efficiency in an in vitro setting.

Methods

In this in vitro experimental study, we compared various vitrectomy systems including EVA (Dutch Ophthalmic Research Center, Zuidland, The Netherlands), REVOLUTION (Optikon 2000, Inc., Rome, Italy), and OS4 (Oertli Instrumente AG, Berneck, Switzerland) in terms of efficiency in vitreous cutting and aspiration for various vitreous substitutes. These substitutes included water, chicken egg albumin, and goat vitreous. We only used 23-gauge dual blade cutters across all platforms to maintain uniformity. The cutting and aspiration efficiency was measured across various cut and vacuum settings of vitrectomy machines and measured as mass aspirated in a given time. Data analysis included comparing the amount of mass aspirated by these machines at preset cut and vacuum settings.

Results

Scatter plots showed a comparable mass of water aspirated by the EVA and REVOLUTION at 1000 to 5000 cuts per minute at a constant vacuum of 500 mm Hg whereas OS4 aspirated lesser mass at similar settings. Same trends were noted for goat vitreous for EVA and REVOLUTION but aspirated mass of albumin fluctuated widely across various platforms. At peak machine settings, REVOLUTION showed superiority across all three vitreous models due to its higher peak settings. The area under curve (AUC) analysis showed no significant differences among machines for water and goat vitreous at comparable settings but results were fluctuating for egg albumin.

Conclusion

Employing higher cut rates for dual blade cutters results in better efficiency of vitrectomy machines.

Effect of sodium alginate molecular structure on electrospun membrane cell adhesion

Alginate-based electrospun nanofibers prepared via electrospinning technique represent a class of materials with promising applications in the biomedical and pharmaceutical industries. However, to date, the effect of alginate molecular mass and block composition on the biological response of such systems remains to some extent unclear. As such, in the present work, three alginates (i.e., M.pyr, L.hyp, A.nod) with different molecular features are employed to prepare nanofibers whose ability to promote cell adhesion is explored by using both skin and bone cell lines. Initially, a preliminary investigation of the raw materials is carried out via rheological and zeta-potential measurements to determine the different grade of polyelectrolyte behaviour of the alginate samples. Specifically, both the molecular mass and block composition are found to be important factors affecting the alginate response, with long chains and a predominance of guluronic moieties leading to a marked polyelectrolyte nature (i.e., lower dependence of the solution viscosity upon the polymer concentration). Subsequently, physically crosslinked alginate nanofibrous mats are first morphologically characterized via both scanning electron and atomic force microscopy, which show a homogenous and defect-free structure, and their biological response is then evaluated. Noticeably, fibroblast and keratinocyte cell lines do not show significant differences in terms of cell adhesion on the three mats (i.e., 30-40% and 10-20% with respect to the seeded cells, respectively), with the formers presenting a greater affinity toward the alginate-based nanofibers. Conversely, both the investigated osteoblast cells are characterized by a distinct behaviour depending on the alginate type. Specifically, polysaccharide samples with an evident polyelectrolyte nature are found to better promote cell viability (i.e., cell adhesion in the range 15-36% with respect to seeded cells) compared to the ones displaying a nearly neutral behaviour (i.e., cell adhesion in the range 5-25% with respect to seeded cells). Therefore, the obtained results, despite being preliminary, suggest that the alginate type (i.e., molecular structure properties) may play a topical role in conditioning the efficiency of healing patches for bone reparation, but it has a negligible effect in the case of skin regeneration.

Experimental assessment of the performance of vitreous cutters with fluids with different rheological properties

PURPOSE

To assess the influence of rheological properties of an artificial vitreous (AV) on the performance of double-blade (DB) and single-blade (SB) guillotine vitreous cutters, with 23-, 25-, and 27-gauge (G) probes.

METHODS

We evaluate the aspiration flow rate, using an optical method, based on image processing. Experiments are conducted using ten viscoelastic vitreous phantoms, with different properties that are measured with rheological tests.

RESULTS

Aspiration rate strongly varies with fluid properties. Regardless of cutter geometry and operational conditions, the flow rate significantly decreases as vitreous viscosity and elasticity increase.

CONCLUSIONS

All tested vitreous probes are very sensitive to changes in fluid rheology. SB cutters produce smaller flow rates compared with DB ones of the same caliber; however, they are less sensitive to fluid properties at low aspiration pressures. The use of vitreous substitutes for test performance guarantees comparability between flow rate results achieved with different vitrectomy systems operating in different media. This outcome is further confirmed by the low values of estimated flow rate relative errors.

Macro- and Microscale Properties of the Vitreous Humor to Inform Substitute Design and Intravitreal Biotransport

Research on the vitreous humor and development of hydrogel vitreous substitutes have gained a rapid increase in interest within the past two decades. However, the properties of the vitreous humor and vitreous substitutes have yet to be consolidated. In this paper, the mechanical properties of the vitreous humor and hydrogel vitreous substitutes were systematically reviewed. The number of publications on the vitreous humor and vitreous substitutes over the years, as well as their respective testing conditions and testing techniques were analyzed. The mechanical properties of the human vitreous were found to be most similar to the vitreous of pigs and rabbits. The storage and loss moduli of the hydrogel vitreous substitutes developed were found to be orders of magnitude higher in comparison to the native human vitreous. However, the reported modulus for human vitreous, which was most commonly tested in vitro, has been hypothesized to be different in vivo. Future studies should focus on testing the mechanical properties of the vitreous in situ or in vivo. In addition to its mechanical properties, the vitreous humor has other biotransport mechanisms and biochemical functions that establish a redox balance and maintain an oxygen gradient inside the vitreous chamber to protect intraocular tissues from oxidative damage. Biomimetic hydrogel vitreous substitutes have the potential to provide ophthalmologists with additional avenues for treating and controlling vitreoretinal diseases while preventing complications after vitrectomy. Due to the proximity and interconnectedness of the vitreous humor to other ocular tissues, particularly the lens and the retina, more interest has been placed on understanding the properties of the vitreous humor in recent years. A better understanding of the properties of the vitreous humor will aid in improving the design of biomimetic vitreous substitutes and enhancing intravitreal biotransport.