title: Experimental Application of Piezoelectric Actuator-Driven Pulsed Water Jets in Retinal Vascular Surgery.
abstract: OBJECTIVE
  To report on the effectiveness and safety of an ophthalmic piezoelectric actuator-driven pulsed water jet (ADPJ) system adapted for intraocular use.
  
  
  METHODS
  First, we determined the highest ADPJ flow rate that did not cause an unsafe rise in intraoperative intraocular pressure (IOP) in rabbits (n= 4). Next, we determined the most effective ADPJ frequency (in hertz) at that flow rate. Finally, we visualized the ADPJ stream, measured its pressure, and determined the minimum voltage and distance between the ADPJ needle and retinal veins to induce intravenous displacement of the blood column (DBC) through massage of the outer retinal vessels (n= 3) while not causing retinal tearing or hemorrhage.
  
  
  RESULTS
  We found that a 0.05 mL/min ADPJ flow rate caused IOP to rise above 40 mm Hg after 1 minute, but that at 0.025 mL/min, IOP stayed below 40 mm Hg even after 3 minutes. Moreover, we found that a 0.025 mL/min ADPJ stream was stable at a pulse frequency of 10 Hz and that at this flow rate/frequency the ADPJ pressure was closely correlated with the applied voltage (P< 0.001,r2= 0.9991). The minimum voltage and distance to achieve intravenous DBC without causing retinal tearing or hemorrhage were 40 V and 0.5 mm, respectively.
  
  
  CONCLUSIONS
  With an appropriate flow rate and surgical time, ADPJ successfully induced massage of the retinal vessels and intravenous DBC while maintaining safe IOP and not causing retinal complications.
  
  
  CONCLUSIONS
  The ADPJ system has promise as a safe and minimally invasive instrument for the intraocular surgical treatment of human retinal vascular diseases.
authors: Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan ; Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
authors: Hiroshi
authors: H
authors: Kunikata
authors: Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
authors: Yuji
authors: Y
authors: Tanaka
authors: Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
authors: Naoko
authors: N
authors: Aizawa
authors: Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
authors: Atsuhiro
authors: A
authors: Nakagawa
authors: Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
authors: Teiji
authors: T
authors: Tominaga
authors: Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan ; Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan ; Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
authors: Toru
authors: T
authors: Nakazawa
keywords: intraocular pressure; piezoelectric actuator-driven pulsed water jet; retinal complication; retinal vascular surgery; retinal vein occlusion