人工晶状体植入装置的发展

Development of Intraocular Lens Delivery Devices

摘要: 人工晶状体(Intraocular Lens, IOL)植入是白内障手术治疗过程中的关键步骤，而现代IOL的植入过程依赖IOL植入装置这一器械。IOL植入装置从问世至今已有40余年，其演进与手术安全性与术后恢复有着重要影响。本文将IOL植入装置的发展划分为“早期原型、手动非预装式、手动预装式、自动化植入装置”四个阶段，以时间顺序综述了IOL植入装置的发展与演变过程。在此过程中，演化的目标从最初的减小手术切口逐步转向提升效率及术后切口恢复质量，最终尝试以自动式植入消除人为操作因素而实现标准化。尽管目前自动化系统仍面临着性价比不突出、IOL兼容性受限及生态可持续性等挑战，但若能克服，其未来应用空间仍将十分广阔。未来如能通过在植入装置中集成微型阻力传感器以实现推注阻力的实时反馈，并结合大量临床数据分析出并建立损伤最小的植入阻力曲线模型，以指导后续新型自动植入设备的推注动力与速率，手术安全性将有希望得到进一步的提升。

Abstract: The modern process of Intraocular Lens (IOL) implantation, which is a critical step in cataract surgery, relies on a surgical instrument called IOL delivery device. Spanning over forty years, the continuous evolution of IOL delivery devices has had a significant influence on surgical safety and the quality of postoperative visual recovery. This review retrospectively analyzes the development history of IOL delivery devices, categorizing them into four stages: Early Prototypes, Manual Non-preloaded Devices, Manual Preloaded Systems, and Automated Delivery Systems. Throughout this process, the focus of the design has shifted from minimizing surgical trauma of incisions to improving efficiency and quality of incision recovery, and finally aiming to eliminate the human factor and achieve standardization by implanting the IOL automatically. Although there are some challenges that automated systems are facing, such as the high costs, limited compatibility and ecological sustainability issues, their future application prospects remain broad if these obstacles are overcome. Looking forward, if real-time feedback of injection resistant force could be achieved by integrating micro-sensors into delivery system, combined with the analysis of large-scale clinical data to establish optimal resistance curve models for guiding the power and rate of next-generation automated systems, surgical safety is expected to be further reinforced.