中华眼科医学杂志（电子版）
中華眼科醫學雜誌（電子版）
중화안과의학잡지（전자판）
CHINESE JOURNAL OF OPHTHALMOLOGIC MEDICINE(ELECTRONIC EDITION)
2014年
3期
168-172
,共5页
巩膜%大分子物质%通透性%眼后段疾病
鞏膜%大分子物質%通透性%眼後段疾病
공막%대분자물질%통투성%안후단질병
Sclera%Macromolecular substances%Permeability%Posterior segment diseases
当前玻璃体腔注药已经成为治疗眼后段慢性疾病的主要给药途径。但限于玻璃体腔注药难以避免的多种副作用，临床上急需疗效相近且副作用较小的替代方案。眼表给药和全身给药因其作用强度不足和副作用过多等原因不能成为眼后段慢性疾病给药的理想方案，而眼球周围给药则因巩膜的种种特性而成为一种很有前景的给药方法。眼球周围给药，必需要穿透巩膜才能作用于眼内组织。影响巩膜通透性的因素包括药物自身因素，如分子量大小、分子形态、脂溶性及分子所带电荷等；巩膜自身因素，如巩膜厚度及巩膜是否老化等；以及巩膜周围条件因素，如眼内压、巩膜周围温度、巩膜周围电场、巩膜板层切除及胶原生物降解等。了解巩膜的通透性特点不但能够指导药物的开发和设计，还能更有效地指导临床根据患者自身特征及病情状态调整用药剂量，为眼后段慢性疾病提供更安全、有效的治疗方案。笔者仅对巩膜的解剖学特点、组织学特征、生理特点及巩膜通透性的影响因素进行综述。
噹前玻璃體腔註藥已經成為治療眼後段慢性疾病的主要給藥途徑。但限于玻璃體腔註藥難以避免的多種副作用，臨床上急需療效相近且副作用較小的替代方案。眼錶給藥和全身給藥因其作用彊度不足和副作用過多等原因不能成為眼後段慢性疾病給藥的理想方案，而眼毬週圍給藥則因鞏膜的種種特性而成為一種很有前景的給藥方法。眼毬週圍給藥，必需要穿透鞏膜纔能作用于眼內組織。影響鞏膜通透性的因素包括藥物自身因素，如分子量大小、分子形態、脂溶性及分子所帶電荷等；鞏膜自身因素，如鞏膜厚度及鞏膜是否老化等；以及鞏膜週圍條件因素，如眼內壓、鞏膜週圍溫度、鞏膜週圍電場、鞏膜闆層切除及膠原生物降解等。瞭解鞏膜的通透性特點不但能夠指導藥物的開髮和設計，還能更有效地指導臨床根據患者自身特徵及病情狀態調整用藥劑量，為眼後段慢性疾病提供更安全、有效的治療方案。筆者僅對鞏膜的解剖學特點、組織學特徵、生理特點及鞏膜通透性的影響因素進行綜述。
당전파리체강주약이경성위치료안후단만성질병적주요급약도경。단한우파리체강주약난이피면적다충부작용，림상상급수료효상근차부작용교소적체대방안。안표급약화전신급약인기작용강도불족화부작용과다등원인불능성위안후단만성질병급약적이상방안，이안구주위급약칙인공막적충충특성이성위일충흔유전경적급약방법。안구주위급약，필수요천투공막재능작용우안내조직。영향공막통투성적인소포괄약물자신인소，여분자량대소、분자형태、지용성급분자소대전하등；공막자신인소，여공막후도급공막시부노화등；이급공막주위조건인소，여안내압、공막주위온도、공막주위전장、공막판층절제급효원생물강해등。료해공막적통투성특점불단능구지도약물적개발화설계，환능경유효지지도림상근거환자자신특정급병정상태조정용약제량，위안후단만성질병제공경안전、유효적치료방안。필자부대공막적해부학특점、조직학특정、생리특점급공막통투성적영향인소진행종술。
Intra-vitrous injection has become the major treatment option of chronic posterior segment diseases of eye.However,this approach is associated with inevitable side-effects and it is urgent to develop alternative approaches with similar curative effects but fewer and less significant side-effects.While applying drugs onto the ocular surface or administering drugs systematically is not recommended due to the lack of strength and huge side-effects,periocular injection of drugs,which takes the advantage of the large surface area of the sclera, is being increasingly used in ophthalmology departments.The scleral macromolecular permeability is affected by numerous factors including drug features ( e.g., molecular weight, molecular structure,lipophilic property,and electric charge of the drug) ,scleral properties ( e.g.,scleral thickness and degree of degradation),periscleral features (e.g.,intra-ocular pressure,periscleral temperature,periscleral electric field,lamina sclerectomy,and collagen biodegradation) .Fully understanding the permeability of the sclera is essential not only to drug design and development but also to drug applications.This paper reviews the characteristics of sclera in anatomy, histology and physiology as well as factors that influence the permeability of the sclera.
