【作者】 张辉；

【导师】 姚克；

【作者基本信息】 浙江大学 ， 眼科学， 2006， 硕士

【摘要】 白内障技术的成熟,使小切口白内障手术得到广泛普及,它对病人损伤小、术后伤口愈合快从而视力恢复早、引起小的散光等。特别是伴随超声乳化小切口白内障手术的出现,各种材料的可折叠式人工晶状体更是应运而生。现代无菌操作的规范化及抗生素的广泛应用,使得白内障术后细菌性眼内炎的发生率已经降至很低。尽管如此,它仍是白内障摘除及人工晶状体(IOL)植入术后最严重的并发症 目的 通过建立体外模型比较植入镊及推注植入器法植入折叠型人工晶状体(IOL)对细菌沾染的影响,并比较两种植入法对IOL表面及其细菌黏附的影响。 方法 A.分别用植入镊及推注植入器两种方法将IOL植入表面沾染细菌的模拟眼,随后将附着在IOL表面的细菌作定量培养;B.分别用植入镊及推注植入器两种方法将IOL植入无菌模拟眼,后将其取出后在细菌悬液中浸泡,分别行IOL表面细菌定量培养及扫描电镜形态学观察。 结果 A.经植入镊及推注植入器两种方法植入带菌模拟眼后,IOL表面的细菌沾染量平均分别为2621±902个/IOL和320±38个/IOL,差异具有统计学显著性(P=0.004);B.经两种方法植入无菌模拟眼后,IOL在细菌悬液中浸泡后其表面黏附的细菌分别为5477±1842个/IOL和1337±756个/IOL,差异具有统计学显著性(P=0.000)。扫描电镜显示6枚经植入镊植入后的IOL中3枚表面可见折更多还原

【Abstract】 Small incision cataract surgery has been widely used as the development of the technology. The impetus behind smaller cataract incisions includes diminished ocular surgical trauma, faster visual recovery through rapid wound stabilization and less induced astigmatism. Foldable intraocular lenses made of several different materials has been used as the development of phacoemulsification. Although the incidenceof infectious endophthalmitis has been lowered significantly, endophthalmitis is still one of the most serious complications after cataract surgery and intraocular lens implantation.Objectives To investigate the influence of different methods (forceps vs injectors) on the bacterial contamination during foldable intraocular lens (IOL) implantation, and to compare the influence of these two methods on IOL surface as well as bacteria adherence to IOL surface through an in vitro experiment.Methods A. A Foldable IOL was implanted by forceps or an injector into a surface-bacteria-contaminated model eye, the bacteria carried by the IOL were counted by a quantitative-culture method. B. After the IOL was implanted by these two methods into a sterile model eye, the IOL was taken out and put into a bacterial suspension. The IOL surface was then analyzed under scanning electron microscope (SEM) and the bacteria adhered to the surface was again counted.Results A. When forceps or an injector was used, the bacteria number carried by a IOL into the contaminated model eye was 2621 ± 902 and 320±38 per IOL, respectively. The difference was statistically significant (P = 0.004) . B. After being implanted by forceps or an injector into a sterile model eye followed by bacteria adherence, the bacteria number on the IOL surface was 5477 ± 1842 and 1337 ± 756 per IOL, respectively. The difference was again statistically significant (P =0.000) .SEM examination showed clear folds with clusters of bacteria on the surface of 3 IOLs from 6 that were implanted by forceps, while this could not be found on any of the 4 IOLs that were implanted by an injector.Conclusion When compared to forceps, the use of IOL injector can reduce bacterial contamination and adherence during IOL implantation, which may theoretically reduce the risk of bacterial infection after cataract surgery.更多还原