中华实验眼科杂志
中華實驗眼科雜誌
중화실험안과잡지
CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
2014年
9期
802-806
,共5页
郝兆芹%宋金鑫%吴洁%潘士印%刘先宁%程燕%肖湘华
郝兆芹%宋金鑫%吳潔%潘士印%劉先寧%程燕%肖湘華
학조근%송금흠%오길%반사인%류선저%정연%초상화
角膜交联%真菌%角膜溃疡/治疗%激光扫描共焦显微镜%胶原纤维%动物模型%兔
角膜交聯%真菌%角膜潰瘍/治療%激光掃描共焦顯微鏡%膠原纖維%動物模型%兔
각막교련%진균%각막궤양/치료%격광소묘공초현미경%효원섬유%동물모형%토
Corneal collagen cross-linking%Fungus%Corneal ulcer/therapy%Laser scanning confocal microscope%Collagen fiber%Disease model/animal%Rabbit
背景 真菌性角膜溃疡是一种严重威胁视力的炎症性疾病,严重者需行角膜移植术或眼球摘除术.角膜交联术(CXL)是近年来治疗一些角膜疾病的有效方法,但其用于真菌性角膜溃疡的疗效方面少有研究.目的 观察CXL对真菌性角膜溃疡的治疗作用和效果.方法 选取8周龄健康新西兰白兔15只,其中5只作为正常对照组,另取10只兔刮除右侧角膜上皮行角膜划痕,涂抹镰刀菌液,然后行异种脱细胞角膜片覆盖,制备真菌性角膜溃疡动物模型.按照随机数字表法将模型兔随机分为非治疗组和CXL治疗组,每日行裂隙灯显微镜检查,测量角膜病灶的直径,并观察角膜水肿和炎性细胞浸润情况.于CXL治疗后第3、7、14、21、28天分别对非治疗组和CXL治疗组兔眼行眼前节照相和激光扫描共焦显微镜检查.治疗后4周,收集15只实验兔角膜组织,于扫描电子显微镜下检测正常对照组、非治疗组和CXL治疗组角膜胶原纤维的超微结构.结果 实验兔右眼造模后3d即可见角膜病灶区灰白色溃疡灶,激光扫描共焦显微镜下浅基质层局部见豆荚样菌丝.造模后l周角膜溃疡灶加深,范围扩大,激光扫描共焦显微镜下浅基质层见大量真菌孢子和短棒样菌丝,可见角膜内皮细胞层有炎性细胞及前房内渗出.CXL治疗后3、7、14、21 d,CXL治疗组兔角膜上皮缺失范围均小于非治疗组,差异均有统计学意义(P＜0.05).治疗后28 d,正常对照组、非治疗组和CXL治疗组兔角膜胶原纤维束平均直径分别为(24.6±1.8)、(24.9±1.9)和(43.0±7.4)nm,3个组间差异有统计学意义(F=27.05,P=0.00),其中CXL治疗组胶原纤维直径较非治疗组和正常对照组增粗,差异均有统计学意义(t =-5.30、5.40,P＜0.05),胶原纤维间见较多成纤维细胞;而非治疗组兔角膜胶原纤维直径与正常对照组间差异无统计学意义(t=0.25,P＞0.05),正常对照组胶原纤维间少见成纤维细胞.结论 CXL治疗镰刀菌性角膜溃疡疗效显著,安全性好.CXL可使角膜胶原增粗并刺激成纤维细胞增生,抑制真菌生长和炎症反应,加速角膜修复.
揹景 真菌性角膜潰瘍是一種嚴重威脅視力的炎癥性疾病,嚴重者需行角膜移植術或眼毬摘除術.角膜交聯術(CXL)是近年來治療一些角膜疾病的有效方法,但其用于真菌性角膜潰瘍的療效方麵少有研究.目的 觀察CXL對真菌性角膜潰瘍的治療作用和效果.方法 選取8週齡健康新西蘭白兔15隻,其中5隻作為正常對照組,另取10隻兔颳除右側角膜上皮行角膜劃痕,塗抹鐮刀菌液,然後行異種脫細胞角膜片覆蓋,製備真菌性角膜潰瘍動物模型.按照隨機數字錶法將模型兔隨機分為非治療組和CXL治療組,每日行裂隙燈顯微鏡檢查,測量角膜病竈的直徑,併觀察角膜水腫和炎性細胞浸潤情況.于CXL治療後第3、7、14、21、28天分彆對非治療組和CXL治療組兔眼行眼前節照相和激光掃描共焦顯微鏡檢查.治療後4週,收集15隻實驗兔角膜組織,于掃描電子顯微鏡下檢測正常對照組、非治療組和CXL治療組角膜膠原纖維的超微結構.結果 實驗兔右眼造模後3d即可見角膜病竈區灰白色潰瘍竈,激光掃描共焦顯微鏡下淺基質層跼部見豆莢樣菌絲.造模後l週角膜潰瘍竈加深,範圍擴大,激光掃描共焦顯微鏡下淺基質層見大量真菌孢子和短棒樣菌絲,可見角膜內皮細胞層有炎性細胞及前房內滲齣.CXL治療後3、7、14、21 d,CXL治療組兔角膜上皮缺失範圍均小于非治療組,差異均有統計學意義(P＜0.05).治療後28 d,正常對照組、非治療組和CXL治療組兔角膜膠原纖維束平均直徑分彆為(24.6±1.8)、(24.9±1.9)和(43.0±7.4)nm,3箇組間差異有統計學意義(F=27.05,P=0.00),其中CXL治療組膠原纖維直徑較非治療組和正常對照組增粗,差異均有統計學意義(t =-5.30、5.40,P＜0.05),膠原纖維間見較多成纖維細胞;而非治療組兔角膜膠原纖維直徑與正常對照組間差異無統計學意義(t=0.25,P＞0.05),正常對照組膠原纖維間少見成纖維細胞.結論 CXL治療鐮刀菌性角膜潰瘍療效顯著,安全性好.CXL可使角膜膠原增粗併刺激成纖維細胞增生,抑製真菌生長和炎癥反應,加速角膜脩複.
배경 진균성각막궤양시일충엄중위협시력적염증성질병,엄중자수행각막이식술혹안구적제술.각막교련술(CXL)시근년래치료일사각막질병적유효방법,단기용우진균성각막궤양적료효방면소유연구.목적 관찰CXL대진균성각막궤양적치료작용화효과.방법 선취8주령건강신서란백토15지,기중5지작위정상대조조,령취10지토괄제우측각막상피행각막화흔,도말렴도균액,연후행이충탈세포각막편복개,제비진균성각막궤양동물모형.안조수궤수자표법장모형토수궤분위비치료조화CXL치료조,매일행렬극등현미경검사,측량각막병조적직경,병관찰각막수종화염성세포침윤정황.우CXL치료후제3、7、14、21、28천분별대비치료조화CXL치료조토안행안전절조상화격광소묘공초현미경검사.치료후4주,수집15지실험토각막조직,우소묘전자현미경하검측정상대조조、비치료조화CXL치료조각막효원섬유적초미결구.결과 실험토우안조모후3d즉가견각막병조구회백색궤양조,격광소묘공초현미경하천기질층국부견두협양균사.조모후l주각막궤양조가심,범위확대,격광소묘공초현미경하천기질층견대량진균포자화단봉양균사,가견각막내피세포층유염성세포급전방내삼출.CXL치료후3、7、14、21 d,CXL치료조토각막상피결실범위균소우비치료조,차이균유통계학의의(P＜0.05).치료후28 d,정상대조조、비치료조화CXL치료조토각막효원섬유속평균직경분별위(24.6±1.8)、(24.9±1.9)화(43.0±7.4)nm,3개조간차이유통계학의의(F=27.05,P=0.00),기중CXL치료조효원섬유직경교비치료조화정상대조조증조,차이균유통계학의의(t =-5.30、5.40,P＜0.05),효원섬유간견교다성섬유세포;이비치료조토각막효원섬유직경여정상대조조간차이무통계학의의(t=0.25,P＞0.05),정상대조조효원섬유간소견성섬유세포.결론 CXL치료렴도균성각막궤양료효현저,안전성호.CXL가사각막효원증조병자격성섬유세포증생,억제진균생장화염증반응,가속각막수복.
Background Fungal corneal ulcer is a visual-threatening eye disease,and drug therapy has a limiting efficacy.Corneal transplantation or eye enucleation sometimes is necessary to the severe patients.Corneal collagen cross-linking (CXL) is an effective method for some corneal diseases,but the study on CXL for fungal corneal ulcer is lack.Objective This study was to evaluate the clinical effectiveness and safety CXL for fungal corneal ulcer.Methods Fifteen 8-week-old healthy New Zealand white rabbits were used in this study and other 5 rabbits served as normal controls.Fungal corneal ulcer models were established in the right eyes of other 10 rabbits by infecting sickle bacteria liquid after corneal scratching and removing corneal epithelium,then decellularized ostrich corneal patch covered the defected cornea.The models were randomly divided into the non-treatment group and the CXL treatment group.Corneal lesions were examined under the slit lamp microscope every day,and cornea was pictured by laser scanning confocal microscope on the 3rd,7th,14th,21st and 28th day individually after CXL.All rabbits were sacrificed and corneal tissues were obtained 4 weeks after treatment,and the collagen fiber diameter and fibrocytes were observed under the scanning electron microscope.Results Fungal corneal ulcer models were successfully established by corneal scratching and decellularized ostrich cornea covering.The gray ulcer lesions and hypbae like bean pod were seen by slit lamp microscope and laser scanning confocal microscope 3 days after modeling.Corneal ulcer deepened and expanded 1 week later,and there were a large number of spore and hyphae criss-crossing as short rod in shallow stroma.Inflammatory cells were observed in corneal endothelial cells and ocular anterior chamber.In the CXL treatment group,the range of corneal epithelial deficiency was less than that in the nontreatment group on the 3rd,7th,14th,and 21st (all at P＜ 0.05).The diameters of collagen fibers were (24.6± 1.8) nm,(24.9 ± 1.9) nm and (43.0 ± 7.4) nm in the normal control group,non-treatment group and CXL treatment group,showing a significant difference among the 3 groups (F =27.05,P =0.00),and the collagen diameters were thicker in the CXL treatment group than those in the normal control group and non-treatment group (t =5.40,-5.30,both at P＜0.05),and fibrocytes were seen among the collagen fibers.No significant difference was found in the collagen diameters between the non-treatment group and normal control group,and the fibrocytes were less in the non-treatment group.Conclusions CXL therapy can treat fungal corneal ulcer by enhancing collagen,promoting fibrocytes proliferation,suppressing fungus and inflammatory response and accelerating tissue repair.
