中华实验眼科杂志
中華實驗眼科雜誌
중화실험안과잡지
CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
2013年
4期
323-327
,共5页
马海燕%刘红玲%高轶悝%张艳艳
馬海燕%劉紅玲%高軼悝%張豔豔
마해연%류홍령%고질리%장염염
雷帕霉素%人工晶状体/表面修饰%晶状体后囊膜混浊%药物缓释
雷帕黴素%人工晶狀體/錶麵脩飾%晶狀體後囊膜混濁%藥物緩釋
뢰파매소%인공정상체/표면수식%정상체후낭막혼탁%약물완석
Rapamycin%Intraocular lens/surface modification%Posterior capsule opacification%Release of medicine
背景 晶状体后囊膜混浊(PCO)是白内障囊外摘出术后视力下降的主要原因. 目的 研究兔眼透明晶状体超声乳化囊外摘出联合人工晶状体(IOL)植入术后雷帕霉素对晶状体PCO的影响.方法 将30只新西兰大白兔以随机数字表法分为3个组,分别采用不同的IOL植入方式.对侧眼为正常对照组,普通IOL组兔眼植入普通IOL,高分子涂层IOL组兔眼植入用高分子涂层但无雷帕霉素的IOL,雷帕霉素涂层IOL组兔眼植入用雷帕霉素表面处理的高分子涂层IOL,手术眼均为左眼.术后1～7d裂隙灯显微镜下检查各组兔眼眼前节及PCO情况,并对前房闪辉和房水炎性细胞情况进行分级,术后12d对各组兔眼PCO严重程度进行分级,并用Kruskal-WallisH检验法进行比较.于术后12周处死实验动物并获取动物眼球,对晶状体后囊膜组织进行苏木精-伊红染色,检查并比较各组兔眼晶状体后囊膜晶状体上皮细胞(LECs)的生物学行为.结果 涂层后的IOL涂层区半透明,表面光滑,光学显微镜下涂层在IOL表面分布均匀,颗粒细腻.术后第1天普通IOL组和高分子涂层IOL组3级、4级房水闪辉的眼数明显多于雷帕霉素涂层IOL组,但3个组间差异无统计学意义(H=4.038,P=0.133);普通IOL组和高分子涂层IOL组3级、4级房水炎性细胞的眼数明显多于雷帕霉素涂层IOL组,3个组间差异有统计学意义(H=8.604,P=0.014).术后第7天,普通IOL组和高分子涂层IOL组2级、3级房水闪辉的眼数及房水炎性细胞为2级、3级的眼数均明显多于雷帕霉素涂层IOL组,差异均有统计学意义(H=8.891,P=0.012;H=7.664,P=0.022).组织病理学检查结果显示,普通IOL组和高分子涂层IOL组晶状体后囊膜可见大量增生的LECs,聚集于前囊膜和后囊膜之间,而雷帕霉素涂层IOL组未观察到LECs的增生及再生的晶状体皮质. 结论 携带雷帕霉素的载药IOL能抑制兔眼透明晶状体摘出联合IOL植入术后前房的炎症反应,减轻PCO的严重程度,有望成为防治PCO发生的新的治疗途径.
揹景 晶狀體後囊膜混濁(PCO)是白內障囊外摘齣術後視力下降的主要原因. 目的 研究兔眼透明晶狀體超聲乳化囊外摘齣聯閤人工晶狀體(IOL)植入術後雷帕黴素對晶狀體PCO的影響.方法 將30隻新西蘭大白兔以隨機數字錶法分為3箇組,分彆採用不同的IOL植入方式.對側眼為正常對照組,普通IOL組兔眼植入普通IOL,高分子塗層IOL組兔眼植入用高分子塗層但無雷帕黴素的IOL,雷帕黴素塗層IOL組兔眼植入用雷帕黴素錶麵處理的高分子塗層IOL,手術眼均為左眼.術後1～7d裂隙燈顯微鏡下檢查各組兔眼眼前節及PCO情況,併對前房閃輝和房水炎性細胞情況進行分級,術後12d對各組兔眼PCO嚴重程度進行分級,併用Kruskal-WallisH檢驗法進行比較.于術後12週處死實驗動物併穫取動物眼毬,對晶狀體後囊膜組織進行囌木精-伊紅染色,檢查併比較各組兔眼晶狀體後囊膜晶狀體上皮細胞(LECs)的生物學行為.結果 塗層後的IOL塗層區半透明,錶麵光滑,光學顯微鏡下塗層在IOL錶麵分佈均勻,顆粒細膩.術後第1天普通IOL組和高分子塗層IOL組3級、4級房水閃輝的眼數明顯多于雷帕黴素塗層IOL組,但3箇組間差異無統計學意義(H=4.038,P=0.133);普通IOL組和高分子塗層IOL組3級、4級房水炎性細胞的眼數明顯多于雷帕黴素塗層IOL組,3箇組間差異有統計學意義(H=8.604,P=0.014).術後第7天,普通IOL組和高分子塗層IOL組2級、3級房水閃輝的眼數及房水炎性細胞為2級、3級的眼數均明顯多于雷帕黴素塗層IOL組,差異均有統計學意義(H=8.891,P=0.012;H=7.664,P=0.022).組織病理學檢查結果顯示,普通IOL組和高分子塗層IOL組晶狀體後囊膜可見大量增生的LECs,聚集于前囊膜和後囊膜之間,而雷帕黴素塗層IOL組未觀察到LECs的增生及再生的晶狀體皮質. 結論 攜帶雷帕黴素的載藥IOL能抑製兔眼透明晶狀體摘齣聯閤IOL植入術後前房的炎癥反應,減輕PCO的嚴重程度,有望成為防治PCO髮生的新的治療途徑.
배경 정상체후낭막혼탁(PCO)시백내장낭외적출술후시력하강적주요원인. 목적 연구토안투명정상체초성유화낭외적출연합인공정상체(IOL)식입술후뢰파매소대정상체PCO적영향.방법 장30지신서란대백토이수궤수자표법분위3개조,분별채용불동적IOL식입방식.대측안위정상대조조,보통IOL조토안식입보통IOL,고분자도층IOL조토안식입용고분자도층단무뢰파매소적IOL,뢰파매소도층IOL조토안식입용뢰파매소표면처리적고분자도층IOL,수술안균위좌안.술후1～7d렬극등현미경하검사각조토안안전절급PCO정황,병대전방섬휘화방수염성세포정황진행분급,술후12d대각조토안PCO엄중정도진행분급,병용Kruskal-WallisH검험법진행비교.우술후12주처사실험동물병획취동물안구,대정상체후낭막조직진행소목정-이홍염색,검사병비교각조토안정상체후낭막정상체상피세포(LECs)적생물학행위.결과 도층후적IOL도층구반투명,표면광활,광학현미경하도층재IOL표면분포균균,과립세니.술후제1천보통IOL조화고분자도층IOL조3급、4급방수섬휘적안수명현다우뢰파매소도층IOL조,단3개조간차이무통계학의의(H=4.038,P=0.133);보통IOL조화고분자도층IOL조3급、4급방수염성세포적안수명현다우뢰파매소도층IOL조,3개조간차이유통계학의의(H=8.604,P=0.014).술후제7천,보통IOL조화고분자도층IOL조2급、3급방수섬휘적안수급방수염성세포위2급、3급적안수균명현다우뢰파매소도층IOL조,차이균유통계학의의(H=8.891,P=0.012;H=7.664,P=0.022).조직병이학검사결과현시,보통IOL조화고분자도층IOL조정상체후낭막가견대량증생적LECs,취집우전낭막화후낭막지간,이뢰파매소도층IOL조미관찰도LECs적증생급재생적정상체피질. 결론 휴대뢰파매소적재약IOL능억제토안투명정상체적출연합IOL식입술후전방적염증반응,감경PCO적엄중정도,유망성위방치PCO발생적신적치료도경.
Background Posterior capsule opacification (PCO) is a main cause for visual acuity decline after modern extracapsular cataract surgery.Objective The aim of this study was to investigate the effect of rapamycin on PCO formation following phacoemulsification combined with intraocular lens (IOL) implantation in rabbit eyes.Methods Thirty New Zealand albino rabbits were randomized into three groups according to the difference in the implanted IOLs:conventional IOL without modification,IOL coated by a polymer material and IOL with sustained released rapamycin.Phacoemulsification combined with intraocular lens implantation surgery was performed in the left eye.The anterior ocular segment and PCO formation in the rabbit eyes were examined by slit lamp biomicroscope 1-7 days after operation,and the flare and inflammatory response of the anterior chamber as well as the degree of PCO severity were graded based on the criteria of Yang.The differences in examination outcomes were compared by the Kruskal-Wallis H test.The animals were sacrificed 12 days after surgery and eye specimens were prepared for histopathological examination to evaluate the biological behavior of lens epithelial cells (LECs) on the posterior capsule.Results The coated area of the implanted lens was semi-transparent with a smooth surface.The number of eyes with aqueous flare at grades 3 and 4 insignificantly increased but those with an inflammatory response at grades 3 and 4 significantly increased in the conventional IOL group and the polymer modified IOL group,compared with the rapamycin modified IOL group on the first day after operation (H =4.038,P =0.133 ; H =8.604,P =0.014).On the seventh day,the number of eyes with aqueous flare at grades 3 and 4 and inflammatory response at grades 3 and 4 significantly increased in the conventional IOL group and the polymer modified IOL group,compared with the rapamycin modified IOL group (H =8.891,P =0.012 ; H =7.664,P =0.0220).The histopathological examination showed that marked proliferation of LECs appeared between the anterior and posterior capsule in the conventional IOL group and the polymer modified IOL group;however,less LECs and regenerative cortex were seen in the rapamycin modified IOL group.Conclusions IOL loaded with rapamycin can inhibit the inflammatory response and alleviate the severity of PCO after phacoemulsification combined with IOL implantation.The implantation of IOL loaded with rapamycin may be a new approach to the prevention and treatment of PCO.
