中国临床康复
中國臨床康複
중국림상강복
CHINESE JOURNAL OF CLINICAL REHABILITATION
2006年
41期
202-205
,共4页
背景:有晶体眼后房型人工晶体(又称眼内接触镜)植入术是近年来兴起的一种矫治高度近视的晶体屈光性手术.Starr公司将Ⅳ型胶原与水凝胶聚合而成的新型材料Collamer,是研制眼内接触镜的理想材料,但国外产品价格昂贵,一定程度上限制了该手术的开展.目的:通过兔眼动物实验摸索理想的胶原性眼内接触镜植入方法,观察眼内接触镜植入术后炎症反应和炎症递质的变化,并对其植入眼内的生物相容性进行评价.设计:单一样本,开放性实验.单位:上海交通大学医学院附属新华医院眼科.材料:实验于1999-08/2000-03在上海交通大学医学院附属新华医院和上海南洋放射免疫测试中心完成.选取成年新西兰纯种白兔20只,随机数字表法分为3组:眼内接触镜植入组8只、手术对照组6只、空白对照组6只.方法:①眼内接触镜植入组右眼行眼内接触镜植入+虹膜周切术,手术对照组右眼单纯行虹膜周切术,手术由专人按同一方式施行.术后两组术眼滴用激素抗菌素眼药水,4次/d,共10 d.均于术后1,4,7 d结膜下注射地塞米松2.5 mg+庆大霉素4万U.空白对照组不进行手术.②分别于术后1,4,7,14 d和1个月对眼内接触镜植入组、手术对照组的术眼进行眼压波动、角膜损伤、前房蛋白细胞渗出、前房深度、前房出血、虹膜后粘连、眼内接触镜偏位以及晶体混浊等监测.③分别于术后1,4,7,14 d和1个月对眼内接触镜植入组、手术对照组的术跟进行房水取样,空白对照组也在相应时间取样,采用放射免疫分析法测定前列腺素E2浓度.主要观察指标:①术前及术后各时间点前房反应检测结果.②术后各组房水中炎症递质前列腺素E2浓度检测结果.结果:实验选取新西兰纯种白兔20只,全部进入结果分析.①术前及术后各时间点眼压的变化:与术前比较,眼内接触镜植入组、手术对照组术后各时间点眼压均无明显变化(P＞0.05).②术后角膜损伤和前房渗出情况:眼内接触镜植入组:5只兔眼术后第1天出现不同程度的前房变浅,1周内均恢复正常;2只兔眼出现少量前房出血,2周后吸收;2只兔眼分别出现虹膜前粘连和后粘连,瞳孔轻度变形;2只兔眼出现不同程度眼内接触镜偏位;1只兔眼术后1个月出现晶体前囊膜下点状混浊.手术对照组:6只兔眼术后第1天前房出现1～2级渗出,1周后均吸收;各兔眼角膜透明,无前房出血、前房变浅、虹膜后粘、晶体混浊等变化.③术后各组房水中炎症递质前列腺素E2浓度检测结果:眼内接触镜植入组术后1～4 d房水中前列腺素E2含量最高,以后含量逐步递减.术后14 d和1个月,各组均基本相似(P＞0.05).结论:眼内接触镜植入术后前房无明显慢性葡萄膜炎发生.房水中前列腺素E2浓度逐步降低,表现了眼内接触镜植入后典型的异物肉芽肿炎症过程,反映其良好的眼内耐受性.
揹景:有晶體眼後房型人工晶體(又稱眼內接觸鏡)植入術是近年來興起的一種矯治高度近視的晶體屈光性手術.Starr公司將Ⅳ型膠原與水凝膠聚閤而成的新型材料Collamer,是研製眼內接觸鏡的理想材料,但國外產品價格昂貴,一定程度上限製瞭該手術的開展.目的:通過兔眼動物實驗摸索理想的膠原性眼內接觸鏡植入方法,觀察眼內接觸鏡植入術後炎癥反應和炎癥遞質的變化,併對其植入眼內的生物相容性進行評價.設計:單一樣本,開放性實驗.單位:上海交通大學醫學院附屬新華醫院眼科.材料:實驗于1999-08/2000-03在上海交通大學醫學院附屬新華醫院和上海南洋放射免疫測試中心完成.選取成年新西蘭純種白兔20隻,隨機數字錶法分為3組:眼內接觸鏡植入組8隻、手術對照組6隻、空白對照組6隻.方法:①眼內接觸鏡植入組右眼行眼內接觸鏡植入+虹膜週切術,手術對照組右眼單純行虹膜週切術,手術由專人按同一方式施行.術後兩組術眼滴用激素抗菌素眼藥水,4次/d,共10 d.均于術後1,4,7 d結膜下註射地塞米鬆2.5 mg+慶大黴素4萬U.空白對照組不進行手術.②分彆于術後1,4,7,14 d和1箇月對眼內接觸鏡植入組、手術對照組的術眼進行眼壓波動、角膜損傷、前房蛋白細胞滲齣、前房深度、前房齣血、虹膜後粘連、眼內接觸鏡偏位以及晶體混濁等鑑測.③分彆于術後1,4,7,14 d和1箇月對眼內接觸鏡植入組、手術對照組的術跟進行房水取樣,空白對照組也在相應時間取樣,採用放射免疫分析法測定前列腺素E2濃度.主要觀察指標:①術前及術後各時間點前房反應檢測結果.②術後各組房水中炎癥遞質前列腺素E2濃度檢測結果.結果:實驗選取新西蘭純種白兔20隻,全部進入結果分析.①術前及術後各時間點眼壓的變化:與術前比較,眼內接觸鏡植入組、手術對照組術後各時間點眼壓均無明顯變化(P＞0.05).②術後角膜損傷和前房滲齣情況:眼內接觸鏡植入組:5隻兔眼術後第1天齣現不同程度的前房變淺,1週內均恢複正常;2隻兔眼齣現少量前房齣血,2週後吸收;2隻兔眼分彆齣現虹膜前粘連和後粘連,瞳孔輕度變形;2隻兔眼齣現不同程度眼內接觸鏡偏位;1隻兔眼術後1箇月齣現晶體前囊膜下點狀混濁.手術對照組:6隻兔眼術後第1天前房齣現1～2級滲齣,1週後均吸收;各兔眼角膜透明,無前房齣血、前房變淺、虹膜後粘、晶體混濁等變化.③術後各組房水中炎癥遞質前列腺素E2濃度檢測結果:眼內接觸鏡植入組術後1～4 d房水中前列腺素E2含量最高,以後含量逐步遞減.術後14 d和1箇月,各組均基本相似(P＞0.05).結論:眼內接觸鏡植入術後前房無明顯慢性葡萄膜炎髮生.房水中前列腺素E2濃度逐步降低,錶現瞭眼內接觸鏡植入後典型的異物肉芽腫炎癥過程,反映其良好的眼內耐受性.
배경:유정체안후방형인공정체(우칭안내접촉경)식입술시근년래흥기적일충교치고도근시적정체굴광성수술.Starr공사장Ⅳ형효원여수응효취합이성적신형재료Collamer,시연제안내접촉경적이상재료,단국외산품개격앙귀,일정정도상한제료해수술적개전.목적:통과토안동물실험모색이상적효원성안내접촉경식입방법,관찰안내접촉경식입술후염증반응화염증체질적변화,병대기식입안내적생물상용성진행평개.설계:단일양본,개방성실험.단위:상해교통대학의학원부속신화의원안과.재료:실험우1999-08/2000-03재상해교통대학의학원부속신화의원화상해남양방사면역측시중심완성.선취성년신서란순충백토20지,수궤수자표법분위3조:안내접촉경식입조8지、수술대조조6지、공백대조조6지.방법:①안내접촉경식입조우안행안내접촉경식입+홍막주절술,수술대조조우안단순행홍막주절술,수술유전인안동일방식시행.술후량조술안적용격소항균소안약수,4차/d,공10 d.균우술후1,4,7 d결막하주사지새미송2.5 mg+경대매소4만U.공백대조조불진행수술.②분별우술후1,4,7,14 d화1개월대안내접촉경식입조、수술대조조적술안진행안압파동、각막손상、전방단백세포삼출、전방심도、전방출혈、홍막후점련、안내접촉경편위이급정체혼탁등감측.③분별우술후1,4,7,14 d화1개월대안내접촉경식입조、수술대조조적술근진행방수취양,공백대조조야재상응시간취양,채용방사면역분석법측정전렬선소E2농도.주요관찰지표:①술전급술후각시간점전방반응검측결과.②술후각조방수중염증체질전렬선소E2농도검측결과.결과:실험선취신서란순충백토20지,전부진입결과분석.①술전급술후각시간점안압적변화:여술전비교,안내접촉경식입조、수술대조조술후각시간점안압균무명현변화(P＞0.05).②술후각막손상화전방삼출정황:안내접촉경식입조:5지토안술후제1천출현불동정도적전방변천,1주내균회복정상;2지토안출현소량전방출혈,2주후흡수;2지토안분별출현홍막전점련화후점련,동공경도변형;2지토안출현불동정도안내접촉경편위;1지토안술후1개월출현정체전낭막하점상혼탁.수술대조조:6지토안술후제1천전방출현1～2급삼출,1주후균흡수;각토안각막투명,무전방출혈、전방변천、홍막후점、정체혼탁등변화.③술후각조방수중염증체질전렬선소E2농도검측결과:안내접촉경식입조술후1～4 d방수중전렬선소E2함량최고,이후함량축보체감.술후14 d화1개월,각조균기본상사(P＞0.05).결론:안내접촉경식입술후전방무명현만성포도막염발생.방수중전렬선소E2농도축보강저,표현료안내접촉경식입후전형적이물육아종염증과정,반영기량호적안내내수성.
BACKGROUND: Intraocular contract lens (ICL) implantation emerges as a crystal refrangibilit operation to rectify and cure high myopia in recent years. Collagen, a new material, is consisted of collagen Ⅳ and aquagel in Starr Company. It is an ideal material for ICL; however, high price is restricted to its development at a certain degree.OBJECTIVE: To find out ideal method of collagen ICL implantation through animal experiment in rabbit eyes and evaluate intraocular biocompatibility by observing inflammatory reaction and variation of inflammatory mediators.DESIGN: Single exponent and opening study.SETTING: Department of Ophthalmology, Xinhua Hospital affiliated to Medical College of Shanghai Jiaotong University.MATERIALS: The experiment was carried out in Xinhua Hospital affiliated to Medical College of Shanghai Jiaotong University and Shanghai Nanyang Radio-immunity Testing Center from August 1999 to March 2000.Twenty New Zealand rabbits were divided into three groups according to randomly digital table: ICL implantation group (n=8), operative control group (n=6) and blank control group (n=6).METHODS: ① Right eyes of rabbits in ICL implantation group were suffered from ICL implantation and peripheral operation of iris [1]; however,right eyes of rabbits in operative control group were only suffered from peripheral operation of iris. After operation, hormone-antibioltic eyedrops were dribbled into eyes four times a day for total 10 days. At 1, 4 and 7days after operation, 2.5 mg dexasone + 40 000 U cidomycin were subconjunctivally injected into eyes. Rabbits in black control group did not receive any operation. ② At 1, 4, 7, 14 days and 1 month after operation,indexes of operative eyes in ICL implantation group and operative control group were measured including luctuation of intraocular pressure, damage of corneal endothelium, protein leakage in anterior chamber, depth of anterior chamber, hyphema, posterior synechiae of iris, ICL decentration and lens opacity. ③ At 1, 4, 7, 14 days and 1 month, samples of aqueous humor were aspirated from operative eyes of rabbits in ICL implantation group, operative control group and blank control group. Radioimmunoassay (RIA) was used to examine the concentration of prostaglandin-E2 (PGE2)in aqueous.MAIN OUTCOME MEASURES: ① Results of reaction in anterior chamber at each time point before and after operation; ② results of PGE2 concentration of inflammatory mediators in aqueous humor after operation.RESULTS: All 20 rabbits were involved in the final analysis. ① Changes of intraocular pressure at each time point before and after operation: As compared with that before operation, intraocular pressure was not changed in ICL implantation group and operative control group at each time point after operation (P ＞ 0.05). ② Damage of corneal endothelium and leakage in anterior chamber after operation: ICL implantation group: Five eyes were shown as shallow anterior chamber at various degrees on the first day after operation, and recovered normally within 1 week; hemorrhage was observed in anterior ch amber of two eyes and absorbed after 2 weeks; two eyes had anterior and posterior synechiae of iris, respectively, and pupil was deformed slightly; ICL decentration at various degrees was observed in two eyes; point-like opacity was observed in anterior bursal membrane of crystal in one eye after 1 month. Operative control group: Leakage of grade 1-2 was observed in 6 eyes on the first day after operation and was absorbed within 1 week. Cornea was clearing, and hyphema, shallow anterior chamber, posterior synechiae of iris and lens opacity were not changed. ③ PGE2 concentration of inflammatory mediators in aqueous humor after operation:PGE2 oncentration was the highest in ICL implantation group at 1-4 days after operation, and then it was decreased gradually; however, PGE2 concentration was similar at 14 days and 1 month after operation (P＞0.05).CONCLUSION: There is no obvious occurrence of chronic uveitis in anterior chamber after ICL implantation. PGE2 concentration in anterior chamber is decreased gradually, and this suggests that a classic foreignbody granulomatous inflammation emerges after ICL implantation, which reflects a good tolerance of ICL for ocular tissue.
