Optimization of patient positioning for improved healing after corneal transplantation
Optimization of patient positioning for improved healing after corneal transplantation
复制标题
DOI：
10.1016/j.jbiomech.2023.111510
复制
发表时间：
2023-02-28
影响因子：
2.4
通讯作者：
Pralits, J. O.
中科院分区：
文献类型：
--
作者：
Bennett, V. Garcia;Alberti, M.;Pralits, J. O.
角膜移植是避免视力丧失的唯一解决方案，当内皮细胞急剧丧失时。手术包括将气体注入眼睛的前房，以产生一个气泡，推动供体角膜（移植物），实现与宿主角膜的无缝粘附。在术后期间，患者体位影响气泡。为了改善愈合，我们研究了整个术后期间的气泡界面的形状，通过数值求解流体运动方程。对于有晶状体眼（使用天然透镜）和人工晶状体眼（使用人工透镜），考虑了具有可变前房深度（ACD）的患者特异性前房（AC）。对于每个AC，针对不同的气体填充和患者定位计算气体移植物覆盖。结果表明，只要ACD很小，定位的影响可以忽略不计，无论气体填充。然而，当ACD值增加时，患者定位变得重要，特别是对于人工晶状体AC。对于每个AC，随着时间的推移，最佳和最差患者定位之间的差异对于小ACD可以忽略不计，但对于较大ACD，特别是对于人工晶状体眼，最佳定位指南变得至关重要。最后，气泡位置的标测突出了患者定位对于均匀气体移植物覆盖的重要性。
Corneal transplantation is the only solution which avoids loss of vision, when endothelial cells are dramatically lost. The surgery involves injecting gas into the anterior chamber of the eye, to create a bubble that pushes onto the donor cornea (graft), achieving sutureless adherence to the host cornea. During the postoperative period, patient positioning affects the bubble. To improve healing, we study the shape of the gas-bubble interface throughout the postoperative period, by numerically solving the equations of fluid motion. Patient-specific anterior chambers (ACs) of variable anterior chamber depths (ACD) are considered, for either phakic (with natural lens) and pseudophakic (with artificial lens) eyes. For each AC, gas-graft coverage is computed for different gas fill and patient positioning. The results show that the influence of positioning is negligible, regardless of gas filling, as long as the ACD is small. However, when the ACD value increases, patient positioning becomes important, especially for pseudophakic ACs. The difference between best and worst patient positioning over time, for each AC, is negligible for small ACD but significant for larger ACD, especially for pseudophakic eyes, where guidelines for optimal positioning become essential. Finally, mapping of the bubble position highlights the importance of patient positioning for an even gas-graft coverage.