CAJ | 학술논문

背景猪源纤维蛋白黏合剂已广泛应用于临床手术中,能够起到止血和闭合伤口的作用.目前眼科学者认为猪源纤维蛋白黏合剂在玻璃体切割术中可替代长效气体或硅油作为填充物,但国产猪源纤维蛋白黏合剂是否对视网膜有毒性作用仍在研究中. 目的研究国产猪源纤维蛋白黏合剂在眼内应用后对视网膜组织的生物安全性. 方法 15只青紫兰兔任选一眼作为实验眼,对侧眼作为对照眼.兔眼行玻璃体切割术,实验眼术毕于玻璃体腔内注射猪源纤维蛋白胶0.5 ml,对照眼注射等量平衡盐溶液.术后1、3、7、15、30 d用裂隙灯及直接/间接检眼镜检查眼前后节的炎症反应,术后1、3、7d用Schi(o)tz眼压计测量眼压,分别于术前和术后30 d进行视网膜电图(ERG)检查,评估视网膜的功能变化,术后30 d行眼科B型超声检查.玻璃体腔内注射后第30天摘除眼球并制备视网膜切片,光学显微镜下检查视网膜的组织形态学变化,透射电子显微镜下观察视网膜的超微结构变化. 结果实验组15只兔眼中出现并发症者7只眼,其中晶状体损伤后发生白内障者3只眼,术后增生性玻璃体病变和视网膜脱离者5只眼,眼内炎者1只眼.对照组15只兔眼晶状体损伤后发生白内障者2只眼,术中发生视网膜损伤者2只眼.眼内注射后30d实验组未出现并发症的8只眼及对照组的11只眼均未见明显的眼内炎症反应,术后眼压均正常,2个组间及手术前后各时间点间的眼压变化差异均无统计学意义(F分组=0.008,P=0.929;F时间=3.600,P=0.075).实验组及对照组间兔眼注药前后ERG a波、b波振幅的总体差异均无统计学意义(a波:F分组=0.728,P=0.405;b波:F分组=0.222,P=0.644);各组兔眼手术前后ERG a波、b波振幅的总体差异均无统计学意义(a波:F时间=0.516,P=0.482;b波:F时间=0.057,P=0.814).眼内注射后30 d,实验眼和对照眼视网膜组织层次清晰,无水肿及阳性细胞浸润,各层视网膜的细胞及视网膜光感受器、视网膜色素上皮的色素细胞形态均正常,亚细胞器结构清晰,细胞膜和核膜完整,线粒体嵴排列整齐. 结论国产猪源纤维蛋白黏合剂玻璃体腔注射后对兔眼视网膜无毒性作用. 揹景豬源纖維蛋白黏閤劑已廣汎應用于臨床手術中,能夠起到止血和閉閤傷口的作用.目前眼科學者認為豬源纖維蛋白黏閤劑在玻璃體切割術中可替代長效氣體或硅油作為填充物,但國產豬源纖維蛋白黏閤劑是否對視網膜有毒性作用仍在研究中. 目的研究國產豬源纖維蛋白黏閤劑在眼內應用後對視網膜組織的生物安全性. 方法 15隻青紫蘭兔任選一眼作為實驗眼,對側眼作為對照眼.兔眼行玻璃體切割術,實驗眼術畢于玻璃體腔內註射豬源纖維蛋白膠0.5 ml,對照眼註射等量平衡鹽溶液.術後1、3、7、15、30 d用裂隙燈及直接/間接檢眼鏡檢查眼前後節的炎癥反應,術後1、3、7d用Schi(o)tz眼壓計測量眼壓,分彆于術前和術後30 d進行視網膜電圖(ERG)檢查,評估視網膜的功能變化,術後30 d行眼科B型超聲檢查.玻璃體腔內註射後第30天摘除眼毬併製備視網膜切片,光學顯微鏡下檢查視網膜的組織形態學變化,透射電子顯微鏡下觀察視網膜的超微結構變化. 結果實驗組15隻兔眼中齣現併髮癥者7隻眼,其中晶狀體損傷後髮生白內障者3隻眼,術後增生性玻璃體病變和視網膜脫離者5隻眼,眼內炎者1隻眼.對照組15隻兔眼晶狀體損傷後髮生白內障者2隻眼,術中髮生視網膜損傷者2隻眼.眼內註射後30d實驗組未齣現併髮癥的8隻眼及對照組的11隻眼均未見明顯的眼內炎癥反應,術後眼壓均正常,2箇組間及手術前後各時間點間的眼壓變化差異均無統計學意義(F分組=0.008,P=0.929;F時間=3.600,P=0.075).實驗組及對照組間兔眼註藥前後ERG a波、b波振幅的總體差異均無統計學意義(a波:F分組=0.728,P=0.405;b波:F分組=0.222,P=0.644);各組兔眼手術前後ERG a波、b波振幅的總體差異均無統計學意義(a波:F時間=0.516,P=0.482;b波:F時間=0.057,P=0.814).眼內註射後30 d,實驗眼和對照眼視網膜組織層次清晰,無水腫及暘性細胞浸潤,各層視網膜的細胞及視網膜光感受器、視網膜色素上皮的色素細胞形態均正常,亞細胞器結構清晰,細胞膜和覈膜完整,線粒體嵴排列整齊. 結論國產豬源纖維蛋白黏閤劑玻璃體腔註射後對兔眼視網膜無毒性作用.
배경 저원섬유단백점합제이엄범응용우림상수술중,능구기도지혈화폐합상구적작용.목전안과학자인위저원섬유단백점합제재파리체절할술중가체대장효기체혹규유작위전충물,단국산저원섬유단백점합제시부대시망막유독성작용잉재연구중. 목적 연구국산저원섬유단백점합제재안내응용후대시망막조직적생물안전성. 방법 15지청자란토임선일안작위실험안,대측안작위대조안.토안행파리체절할술,실험안술필우파리체강내주사저원섬유단백효0.5 ml,대조안주사등량평형염용액.술후1、3、7、15、30 d용렬극등급직접/간접검안경검사안전후절적염증반응,술후1、3、7d용Schi(o)tz안압계측량안압,분별우술전화술후30 d진행시망막전도(ERG)검사,평고시망막적공능변화,술후30 d행안과B형초성검사.파리체강내주사후제30천적제안구병제비시망막절편,광학현미경하검사시망막적조직형태학변화,투사전자현미경하관찰시망막적초미결구변화. 결과 실험조15지토안중출현병발증자7지안,기중정상체손상후발생백내장자3지안,술후증생성파리체병변화시망막탈리자5지안,안내염자1지안.대조조15지토안정상체손상후발생백내장자2지안,술중발생시망막손상자2지안.안내주사후30d실험조미출현병발증적8지안급대조조적11지안균미견명현적안내염증반응,술후안압균정상,2개조간급수술전후각시간점간적안압변화차이균무통계학의의(F분조=0.008,P=0.929;F시간=3.600,P=0.075).실험조급대조조간토안주약전후ERG a파、b파진폭적총체차이균무통계학의의(a파:F분조=0.728,P=0.405;b파:F분조=0.222,P=0.644);각조토안수술전후ERG a파、b파진폭적총체차이균무통계학의의(a파:F시간=0.516,P=0.482;b파:F시간=0.057,P=0.814).안내주사후30 d,실험안화대조안시망막조직층차청석,무수종급양성세포침윤,각층시망막적세포급시망막광감수기、시망막색소상피적색소세포형태균정상,아세포기결구청석,세포막화핵막완정,선립체척배렬정제. 결론 국산저원섬유단백점합제파리체강주사후대토안시망막무독성작용.
Background Porcine fibrin sealant kit has been widely used in surgery for clotting and woundssealing.It is thought to be a substitution for inert gas and silicone oil in vitrectomy.But whether it produce toxic effect on retina or not after intravitreal injection is still studying.Objective This study aimed to investigate the retinal toxicity of porcine fibrin sealant kit following intraocular application.Methods Vitrectomy was performed on bilateral eyes of 15 pigmented rabbits.Porcine fibrin sealant kit of 0.5 ml was intravitreally injected in the lateral eyes of the rabbits as the experimental group,and equal volume of BSS was used at the same way in contralateral eye as control group.The inflammatory response of eye was observed under the slit lamp and ophthalmoscopy in 1 day,3,7,15,30 days after injection.Schi(o)tz tonometer was used to measure intraocular pressure(IOP) in 1 day,3,7 days,and retinal function was evaluated by electroretinogram (ERG) before operation and 30 days after operation.B-ultrasonic examination was carried out 30 days after surgery.Animals were sacrificed and eyeballs were obtained for retinal histopathological and ultrastructural examination in 30 days after operation.Results Complications appeared in 7 eyes of the experimental group,including cataract in 3 eyes,proliferation vitreoretinopathy and retinal detachment in 5 eyes,endophthalmitis in 1 eye,however,the cataract in 2 eyes and retina injury in 2 eyes were found in 15 control eyes.On the 30 days after injection,no inflammation was found in the 8 eyes without complication in the experimental group and 11 eyes in the control group.The IOP change was insignificant in different groups and various time points (Fgroup =0.008,P =0.929 ;Ftime =3.600 P =0.075).No significant difference was found in a-wave amplitude between groups and various time points(Fgroup =0.728,P =0.405 ; Ftime =0.516,P =0.482),and so was the b-wave amplitude (Fgroup =0.222,P =0.644 ; Ftime =0.057,P =0.814).On the 30th day after operation,arrangement of the retina was regular and no tissue edema and inflammatory cell infiltration were seen in both groups under the light microscope.Transmission electron microscope revealed that the ultrastructures of retinal cells,photoreceptor and retinal pigment cell were normal with the clear subcellular organelle,intact cellular membrane structure and mitochondria in both groups.Conclusions Domestic porcine fibrin sealant kit does not produce toxic effect on retina after intravitreal injection in rabbit.