CAJ | 학술논문

背景滤过泡瘢痕化是抗青光跟滤过性手术失败的主要原因,研究表明汉防己甲素(Tet)可抑制体外培养的人Tenon 囊成纤维细胞的增生,从而具有抗滤过术后瘢痕化的潜在作用.目的了解兔眼滤过性手术中植入Tet缓释系统(DDS)抑制瘢痕形成的作用.方法将18只新西兰白兔36只眼行滤过性小梁切除术,按随机数字表法将白兔随机分为3组,每组12只眼,术中按照分组将含0.3 mg Tet、0.2 mg Tet的DDS及无药物的空白DDS分别植入各组兔眼结膜瓣下.术后1、4、7、10、14 d在裂隙灯下依据邻近角膜厚度标准的滤过泡面积对滤过泡进行评分;术后7 d、14 d行活体滤过泡组织的共焦显微镜检查,然后制备滤过泡组织学标本行常规组织病理学检查.结果各组的平均滤过泡得分显示,术后4～14 d Tet DDS组兔眼的滤过泡评分明显高于空白DDS组,差异有统计学意义(P＜0.01);术后7～14 d,0.3 mg Tet组兔眼的滤过泡评分高于0.2 mg Tet组,差异有统计学意义(P＜0.05).光学显微镜下及共焦显微镜下滤过泡形态学观察显示.术后7 d、14 d Tet DDS组兔眼均可见清晰的滤过泡腔隙,滤过泡七皮下平均囊腔数量值及囊腔面积均大于空白DDS组(P＜0.01),0.3 mg Tet组兔眼滤过泡上皮下平均囊腔数量值及囊腔面积均大于0.2 mg Tet组,差异有统计学意义(P＜0.05).组织病理学研究还表明,0.3 mg Tet组兔眼滤过泡组织中炎性细胞浸润明显轻于0.2 mg Tet组和空白DDS组.结论研究结果表明Tet DDS能有效抑制滤过性手术后成纤维细胞的增生,提高兔眼滤过性手术的成功率.
배경려과포반흔화시항청광근려과성수술실패적주요원인,연구표명한방기갑소(Tet)가억제체외배양적인Tenon 낭성섬유세포적증생,종이구유항려과술후반흔화적잠재작용.목적료해토안려과성수술중식입Tet완석계통(DDS)억제반흔형성적작용.방법장18지신서란백토36지안행려과성소량절제술,안수궤수자표법장백토수궤분위3조,매조12지안,술중안조분조장함0.3 mg Tet、0.2 mg Tet적DDS급무약물적공백DDS분별식입각조토안결막판하.술후1、4、7、10、14 d재렬극등하의거린근각막후도표준적려과포면적대려과포진행평분;술후7 d、14 d행활체려과포조직적공초현미경검사,연후제비려과포조직학표본행상규조직병이학검사.결과각조적평균려과포득분현시,술후4～14 d Tet DDS조토안적려과포평분명현고우공백DDS조,차이유통계학의의(P＜0.01);술후7～14 d,0.3 mg Tet조토안적려과포평분고우0.2 mg Tet조,차이유통계학의의(P＜0.05).광학현미경하급공초현미경하려과포형태학관찰현시.술후7 d、14 d Tet DDS조토안균가견청석적려과포강극,려과포칠피하평균낭강수량치급낭강면적균대우공백DDS조(P＜0.01),0.3 mg Tet조토안려과포상피하평균낭강수량치급낭강면적균대우0.2 mg Tet조,차이유통계학의의(P＜0.05).조직병이학연구환표명,0.3 mg Tet조토안려과포조직중염성세포침윤명현경우0.2 mg Tet조화공백DDS조.결론연구결과표명Tet DDS능유효억제려과성수술후성섬유세포적증생,제고토안려과성수술적성공솔.
Background Scarring of the filtering bleb is a main cause of filtering surgical failure in glaucoma.It has been reposed that tetrandrine could suppress the proliferation of cultured human fibroblast of Tenons capsule in vitro and thus has the potential effect to prevent scarring after the filtering surgery. Objective Present study was to investigate the anti-cicatricial effect of tetrandrine drug delivery system(Tet DDS)during filtration surgery. Methods Filtration surgery was performed in bilateral eyes of 18 New Zealand white rabbits.The Tet DDS with 0.3 mg Tet,0.2 mg Tet or free-Tet were implanted subcunjunctially during the surgery.The filtering blebs were scored in 1 day,4,7,10,14 days after referring to the corneal thickness and bleb range under the slit-lamp biomicroscopy.The morphology of filtering bleb was assessed by in vivo confocal microscopy in 7 and 14 days after operation.The filtering bleb specimen was prepared in 7 and 14 days for the histopathological examination. Results The filtering bleb scores in Tet DDS implantation groups were significantly higher than those in free-Tet DDS group from 4 days through 14 days after trabeculectomy(P＜0.01),and the scores showed a considerably increase in 0.3 mg Tet DDS group compared with 0.2 mg Tet DDS group from 7 days through 14 days after trabeculectomy(P＜0.05).The filtering blebs of Tet DDS implantation groups were found with distinct subepithelial cystic spaces under the light microscopy and in vivo confocal microscopy on the 7th day and 14th day after surgery.Compared with free-Tet DDS group,the numbers of subepithelial mierocysts were much more(P＜0.01)and the area of microcysts was larger(P＜0.01)in Tet DDS group.The filtering tissue presented with more subepithelial microcysts and larger microcysts range in 0.3 mg Tet DDS group than 0.2 mg Tet DDS group in 7 and 14 days after operation(P＜0.05).The inflammatory cell infiltration wag milder in 0.3 mg Tet DDS group in comparison with 0.2 mg Tet DDS group and free-Ted DDS group.Conclusion Tet DDS has strong inhibitory effects on inflammatory cells activity and fibroblagt activity the early stage after filtering surgery and therefore improve the surgery success rate.