更昔洛韦玻璃体腔注药术治疗急性视网膜坏死

目的 探讨更昔洛韦玻璃体腔注药术治疗急性视网膜坏死（ARN）的手术适应证、手术时机及其疗效。方法ARN住院患者14例（14只眼）,均符合美国葡萄膜炎学会ARN诊断标准。患者初诊视力为光感、眼前手动、数指者各1只眼,0．08～0．1者4只眼,0．2～0．4者5只眼,0．5、0．8者各1只眼。角膜后沉着物、房水闪光均阳性。眼底表现为周边部局灶性和（或）片状视网膜坏死、视网膜动脉白线、视网膜出血等。全身分别给予阿昔洛韦或更昔洛韦静脉滴注,患者病情继续发展、恶化,但尚未出现视网膜脱离。再对14只眼行更昔洛韦玻璃体腔注药术。其中2只眼注药后,病情不能控制,出现了增生性玻璃体视网膜病变（PVR）和视网膜脱离,即行玻璃体切除术。术后患者随访4～74个月,平均25个月。结果更昔洛韦玻璃体腔注药术后,12只眼视力显著提高,提高至1．0～1．5者5只眼,0．5～0．9者5只眼,0．3者2只眼。玻璃体切除术后的2只眼,术后视力较术前亦有提高,分别由眼前数指提高至0．4,光感提高至眼前数指。14只眼的眼前节炎性反应和玻璃体混浊消失或明显减轻,视网膜黄白色病变消退,出血吸收,视网膜在位。结论对全身抗病毒药物治疗不能控制病情的ARN患者,在尚未发生PVR或视网膜脱离时,及早给予更昔洛韦玻璃体腔注药术可获得满意疗效,能显著提高患者视力。（中华跟科杂志,2007,43：631-637）     

药物性玻璃体后脱离对增生性玻璃体视网膜病变影响的实验研究

目的 观察药物性玻璃体后脱离（PVD）对增生性玻璃体视网膜病变（PVR）的影响。方法 24只有色成年家兔,左眼为实验眼。兔自体富含血小板血浆玻璃体腔注射建立兔眼PVR模型,同时随机将实验兔分为A、B组及对照组,每组各8只眼。建模后3 h A组玻璃体腔内注入1 U纤溶酶（0.05 ml）+20 U透明质酸酶（0.05 ml）共0.1 ml、B组玻璃体腔内注入纤溶酶0.1 ml、对照组玻璃体腔内注入等量的平衡盐溶液。给药后1、7、28 d记录实验眼PVR级别,进行各组PVR等级评分,并行闪光视网膜电图（F-ERG）、眼部B型超声检查及视网膜组织病理学检查。结果 PVR模型成功建立,并在注药后7 d,A组发生完全性PVD 5只眼,不完全性PVD3只眼;B组不完全性PVD 5只眼,未见完全性PVD,另3只及对照组无PVD发生。A、B组在注药后28 d PVR等级评分均低于对照组,差异有统计学意义（D=75.6, 98.9;P=0.003,P=0.011）;注药后7、28 d,A、B 两组F-ERG b 波波幅均高于对照组;产生PVD的眼中PVR级别均较无PVD的眼级别低,其中完全性PVD眼中PVR级别仅为0～1级。结论 在兔眼PVR建模后3 h,纤溶酶与透明质酸酶联合玻璃体腔注射诱导的完全性PVD在一定程度上可以阻止兔眼PVR的发生和发展,纤溶酶单独或联合透明质酸酶玻璃体腔注射诱导的不完全 性PVD对PVR的发展有减缓作用。     

玻璃体腔药物注射联合玻璃体手术治疗脉络膜脱离型视网膜脱离的探讨

目的 探讨术前玻璃体腔注射曲安奈德及healon联合玻璃体手术治疗脉络膜脱离型视网膜脱离的疗效及安全性.方法 选择未经有效治疗的脉络膜脱离型视网膜脱离患者11例(1 1只眼),于手术前经睫状体平坦部向玻璃体腔内注入曲安奈德混悬液和healon,注药后观察眼压葡萄膜炎反应及脉络膜脱离消失情况,并于5日之内行玻璃体手术.结果 注药后11只眼眼压均恢复良好,葡萄膜炎反应症状均不同程度减轻,10只眼脉络膜脱离眼于注药后5日内消失,所有病例均行玻璃体手术,术后11只眼均视力有不同程度提高,10只眼视网膜复位良好.结论 术前玻璃体腔注射曲安奈德和healon联合玻璃体手术是一种安全有效地治疗脉络膜脱离型视网膜脱离的方法.     

Intravitreal toxicity of garenoxacin

PURPOSE: To assess the retinal toxicity of varying concentrations of intravitreally injected garenoxacin. METHODS: Twenty eyes of 20 New Zealand albino rabbits were used for this study. The animals were anesthetized with ketamine (35-50 mg/kg) and xylazine (3-5 mg/kg). Garenoxacin was titrated using distilled water to the following concentrations: 4,000, 2,000, 1,000, 400, 200, and 100 microg/0.1 mL. Each concentration was injected intravitreally (0.1 mL) into three rabbit eyes. Three control eyes were injected with 0.1 mL of balanced saline solution. All animals were examined before and after injection by indirect ophthalmoscopy and slit-lamp biomicroscopy. Electroretinography was performed on all animals before intravitreal injection and 14 days after injection. The animals were examined by indirect ophthalmoscopy and slit-lamp biomicroscopy before they were killed; the eyes were enucleated and examined with light microscopy. RESULTS: No electroretinographic changes or signs of retinal toxicity by slit-lamp examination, indirect ophthalmoscopy, or light microscopy were seen in any eyes 14 days after intravitreal injection of garenoxacin (< or =4,000 microg/0.1 mL). CONCLUSIONS: Garenoxacin injected intravitreally appeared safe at concentrations of < or =4,000 microg/0.1 mL.     

组织型纤溶酶原激活剂、肝素和高三尖杉酯碱对 术后增生性玻璃体视 网膜病变的抑制作用

目的观察组织型纤溶酶原激活剂(tissue plasminogen acti vator,t-PA)、肝素和高三尖杉酯碱联合用药对术后增生性玻璃体视网膜病变(proliferative vitreoretinopathy,PVR)的抑制效果。方法43例44 只眼接受玻璃体视网膜手术的复杂性视网膜脱离患者,根据手术及是否同时球内联合用药分为 A、B两组(A组为用药组,B组为对照组)。随访观察两组术后PVR再发生及视网膜脱离复发情况,平均随访期为7．9个月。结果PVR发生率：A组15.8%,B组45.5%,χ² 检验,P＜0.05。视网膜脱离复发率A组5.5%,B组33.3%,χ² 检验,P＜0.05。结论手术辅以球内联合用药可有效抑制术后PVR再形成,降低视网膜脱离复发率。(中华眼底病杂志,2001,17:24-25)     

Effect of adriamycin on experimental proliferative vitreoretinopathy in the rabbit

The cell injection model of proliferative vitreoretinopathy (PVR) in the rabbit was used to study the therapeutic value of intravitreal adriamycin (doxorubicin). Adriamycin in a dose of 10 nmol per eye, if injected at the same time as the cells, controls PVR. At the cell doses used, PVR is not affected if there is a time interval between cell and drug injection. Because of retinal toxicity, as evidenced by electroretinographic and histopathologic changes, the beneficial effects of adriamycin on membrane formation cannot be exploited at this time.     

The efficacy of plasminogen-urokinase combination in inducing posterior vitreous detachment

PURPOSE: To investigate the toxicity of intravitreal plasminogen, urokinase, and their combination, and to evaluate their efficacy in the production of posterior vitreous detachment (PVD) in the rabbit eye. METHODS: Fifty-six albino New Zealand rabbits were examined before and after injection using the indirect ophthalmoscope, slit-lamp biomicroscopy, and electroretinography. Various concentrations of urokinase or recombinant plasminogen or a combination were injected intravitreally into the right eyes of four rabbits for each concentration. The left eyes of the animals served as controls and received 0.1 mL balanced salt solution. Group 1 was injected with pure urokinase (1,000, 5,000, or 10,000 IU); Group 2 with recombinant plasminogen (0.1, 0.4, 1.0, 2.0, 4.0, 8.0, or 16.0 caseinolytic units [CU]); and Group 3 with a combination of 1,000 IU urokinase (highest nontoxic dose) and nontoxic concentrations of plasminogen (0.1, 0.4, 1.0, or 2.0 CU). The animals were killed and the eyes enucleated 15 days after injection. Electron and light microscopy were performed. RESULTS: A concentration of 1,000 IU of urokinase was found to be nontoxic to the retina. Plasminogen concentrations of 2.0 CU or less did not produce retinal toxicity, whereas 4.0, 8.0, and 16.0 CU of plasminogen caused minimal-to-severe inflammatory response in the vitreous without histologic or electroretinographic changes. Neither plasminogen nor urokinase alone was successful in producing PVD. The combination of 1,000 IU of urokinase and 1.0 to 2.0 CU of plasminogen was effective without causing retinal toxicity. CONCLUSION: Posterior vitreous detachment can be produced in the rabbit eye using a combination of plasminogen and urokinase.     

曲安奈德玻璃体腔注射治疗脉络膜脱离型视网膜脱离的初步研究

目的探讨玻璃体腔注射曲安奈德治疗脉络膜脱离型视网膜脱离的疗效及安全性。方法选择未经有效治疗的脉络膜脱离型视网膜脱离患者,于手术前经睫状体平坦部向玻璃体腔内注入曲安奈德混悬液0．1ml(4mg),注药后观察葡萄膜炎反应及脉络膜脱离消失情况,并于5—10d后行视网膜脱离复位手术。结果有葡萄膜炎反应的13只眼其症状均不同程度减轻,裂孔检出率由注药前的2／13只眼提高至注药后的7／13只眼,绝大多数脉络膜脱离眼于注药后10d内消失,5只眼采用巩膜扣带术,6只眼采用玻璃体切除联合眼内填充术,2例患者放弃手术治疗。手术后平均随访4．45个月,接受手术者最终视网膜全部复位,无1例出现全身应用糖皮质激素的副作用。结论玻璃体腔注射曲安奈德能迅速、安全、有效地治疗脉络膜脱离型视网膜脱离,减轻葡萄膜炎反应,提高脉络膜脱离型视网膜脱离的手术复位率。(中华眼科杂志,2005,41：606-609)     

Platelet-derived growth factor receptor kinase inhibitor AG1295 and inhibition of experimental proliferative vitreoretinopathy

PURPOSE: Receptor tyrosine kinase (RTK) activation is critical for growth factor-mediated cell proliferation. The present study was designed to determine the effect of tyrphostin AG1295, a selective blocker of platelet-derived growth factor (PDGF) RTK, on proliferative vitreoretinopathy (PVR) development. METHODS: Rabbit conjunctival fibroblasts cells (1 x 10(4)) were seeded into 96-well plates and maintained in Dulbecco's modified essentialmedium (DMEM) with 0.5% fetal bovine serum. The cells were exposed to 50 ng/mL PDGF-AAor PDGF-BBor phosphate-buffered saline with or without AG1295 (1 microM, 10 microM, and 100 microM). After 3 days, the viable cells in each well were measured by 3,(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay. Homologous rabbit conjunctival fibroblasts were injected intravitreally, followed by injection of 100 microM of AG1295. The development of tractional retinal detachment (TRD) was assessed to evaluate the effect of AG1295 in vivo. Electroretinography and histologic studies were performed after intravitreal injection of AG1295 into untreated eyes to evaluate toxicity. RESULTS: Two concentrations of AG1295 (10 and 100 microM) significantly inhibited rabbit conjunctival fibroblast cell growth stimulated by PDGF-AA or PDGF-BB in vitro. Development of TRD was significantly attenuated (P <.01) with 100 microM of AG1295 until day 21. No significant histologic or retinal functional damage was found in the AG1295-treated group. CONCLUSIONS: PDGF receptor specific inhibitor AG1295 attenuated PVR without significant side effects in rabbits. This reagent could be a useful treatment to prevent PVR.     

视网膜脱离外路显微手术中色素颗粒进入玻璃体临床观察

目的 观察在视网膜脱离外路显微手术中做视网膜裂孔冷凝或定位时,色素颗粒从裂孔播散入玻璃体腔,对手术效果的影响.方法 回顾性统计分析视网膜脱离外路显微手术中有色素颗粒从裂孔涌人玻璃体腔的连续38例39只眼,均是初发裂孔性视网膜脱离患者,PVR分级为B级以下.平均每只眼裂孔数2.67个.单纯硅压11只眼,硅胶填压联合环扎28只眼.结果 随访至少6个月以上,涌入玻璃体腔内的色素颗粒逐渐减少或消失.一次手术后视网膜脱离复位38只眼(96.7%),1只眼出现新的视网膜裂孔,经玻璃体手术后视网膜复位,最终视网膜脱离复位率为100%.无过度冷凝视网膜表现,没有发生严重PVR病例.结论 视网膜脱离外路显微手术中色素细胞播散进入玻璃体腔不会引起PVR发生或加重,只要裂孔被有效封闭.手术效果良好.     

Hyperthermia reduces the occurrence of proliferative vitreoretinopathy in a rabbit model.

The effects of hyperthermia on experimental proliferative vitreoretinopathy (PVR) in rabbits were studied. Heat treatment (42.4 degrees C for 30 min) of the retinal surface (as estimated from temperature measurement of the retrobulbar space) 2 to 3 hr after fibroblast injection reduced the occurrence of traction retinal detachment compared with control rabbits (P less than 0.02), but the incidence of pucker formation plus traction detachment was not significantly different between the two groups. In a separate experiment, heat treatment applied to normal rabbit eyes showed only reversible elongation in the latency of the electroretinographic b-wave without affecting the amplitude. Histologic examination revealed no significant changes in the heat-treated normal rabbit retina. Hyperthermia may be used as a new therapeutic tool for PVR.     

氟尿嘧啶脂质体玻璃体内注射对兔视网膜毒性

目的了解氟尿嘧啶脂质体玻璃体内注射对兔眼视网膜的毒性作用,探索其安全剂量范围。方法30只家兔,随机分为5组。右眼为实验眼,玻璃体内注射药物,其中氟尿嘧啶脂质体组,浓度分别为0.8 mg/0.1 mL,1.6 mg/0.1 mL,3.2 mg/0.1 mL,6.0 mg/0.1 mL;游离氟尿嘧啶组,浓度为1.6 mg/0.1 mL。左眼为对照眼,注射磷酸缓冲液0.1 mL。注药前后分别行双眼闪光及图形视网膜电图检查,求出双眼振幅平均值的比率(实验眼/对照眼)。注药后第28天摘除眼球行光镜和透射电镜检查。结果氟尿嘧啶脂质体组浓度0.8 mg,1.6 mg,3.2 mg剂量组未见视网膜电图及光镜下异常.6.0 mg氟尿嘧啶脂质体组及1.6 mg游离氟尿嘧啶组均呈现视网膜电图及光镜下异常。透射电镜在3.2 mg剂量脂质体组即发现视网膜结构异常。结论脂质体作为氟尿嘧啶的缓释载体能降低其视网膜毒性作用,其玻璃体内注射的最大安全剂量不超过1.6 mg。     

玻璃体腔注气在巩膜扣带术中的应用

目的：评价巩膜扣带术中玻璃体腔注气的临床效果。方法：对我科自1996年1月－1999年10月为在巩膜扣带术中施和行玻璃体腔注气的48眼及未行注气组150眼的进行比较。结果：巩膜扣带术中未行玻璃腔注气者1次手术复位率（91.33％）明显高于玻璃体腔注气者（77.08％）,玻璃体腔注气者再手术率（22.92％）相应的高于未行玻璃体腔注气者（8.77％）。最终视力改善两者之间无明显差异。结论：治疗孔源性视网膜脱离,巩膜扣带术中可附加使用玻璃体腔注气,但存在着术后出现视网膜新裂孔、玻璃体视网膜牵引发生率高等并发症。     

Tenascin-C levels in the vitreous of patients with proliferative vitreoretinopathy

PURPOSE: To determine whether tenascin-C levels are elevated in the vitreous of patients with proliferative vitreoretinopathy (PVR). METHODS: We assayed tenascin-C levels in vitreous samples of 110 consecutive patients with PVR (30 eyes), rhegmatogenous retinal detachment (RRD; 32 eyes), and macular hole or idiopathic epiretinal membrane (controls, 48 eyes) using an enzyme-linked immunosorbent assay. RESULTS: Vitreous levels of tenascin-C (median [range]) were significantly greater in PVR (845.0 ng/ml [411.0-1,050.0]) than in RRD (21.9 ng/ml [13.2-127.0]) and in the controls (18.0 ng/ml [9.9-199.0]) (p < 0.0001). CONCLUSION: The results indicate the possibility that tenascin-C is involved in the pathogenesis of PVR.     

Glaucoma after vitreo-retinal surgery with silicone oil injection: epidemiologic aspects

Purpose: To evaluate the prevalence of glaucoma after pars plana vitrectomy with silicone oil injection and to determine the different clinical forms. Methods: Authors have carried out a retrospective longitudinal study on patients who underwent pars plana vitrectomy with silicone oil injection from 1981 to 1995. The examined population consists of 301 patients (301 eyes), with an age ranging from 8 to 85 years, affected by retinal detachment and proliferative vitreoretinopathy. Results: The prevalence of the secondary glaucoma has been 18.5%. In all cases glaucoma was caused by trabecular meshwork obstruction due to silicone oil emulsification. The glaucoma has been more frequent after surgery for recurrent rhegmatogenous retinal detachment with fibrous PVR (52.86%) and for particular forms of rhegmatogenous retinal detachment (giant tears, multiple breaks, pseudophakia) with incipient PVR (30%). Conclusion: Glaucoma after intravitreal silicone oil injection for complicated retinal detachments is a relatively frequent complication mostly when surgery needs endophotocoagulation, endodiatermy and lensectomy.     

Effects of topoisomerase II inhibitors on retinal pigment epithelium and experimental proliferative vitreoretinopathy.

AIMS: The aim of this study was to compare the effect of several commercially available topoisomerase II inhibitors on the proliferation of retinal pigment epithelium (RPE) cells in vitro and to test the toxicity and efficacy of the inhibitor against experimental proliferative vitreoretinopathy (PVR). METHODS: Three different topoisomerase II inhibitors (etoposide, doxorubicin, and daunorubicin) were tested in vitro. Rabbit RPE cells were cultured with or without the drugs at various concentrations. An MTT assay was used to determine the cell viability at 48 h and 96 h. Etoposide, a drug which showed a broad therapeutic range in vitro, was injected to the rabbit eye for the evaluation of the toxicity in vivo. Therapeutic effects of an intravitreal injection of etoposide were evaluated in an experimental PVR model induced by the intravitreal implantation of RPE cells in rabbits. RESULTS: All tested topoisomerase II inhibitors showed a significant reduction of cell viability in vitro. The slope of the dose-response curve was slowly declined for etoposide, and declined sharply for doxorubicin and daunorubicin. Therefore, etoposide was selected for further toxicity and efficacy studies in vivo. There was no significant change in b-wave amplitudes in the etoposide-injected eyes (0.02 mg, 10 microg/mL) after 2 weeks, but a significant reduction occurred in the etoposide-injected eyes (0.2 mg, 100 microg/mL). In the study of the experimental model of PVR, the rabbit eyes injected with RPE cells and etoposide (0.02 mg, 10 microg/mL) showed a significantly lower grading of PVR than that of the control eyes (injected RPE cells and PBS). CONCLUSIONS: These results indicate that etoposide would be an adjunctive for the prevention of PVR. Further pharmacokinetic study of the intravitreal injection of etoposide is required.     

道诺霉素和去炎松对实验性眼内细胞增生的抑制

以往的实验证实增殖性玻璃体视网膜病变（PVR）炎症期给以道诺霉素效果有限。我们在巨噬细胞注入兔玻璃体后6天再注入道诺霉素5μg,采用³H-胸腺嘧啶放射自显影观察了眼内细胞增生素，并与去炎松和两药联合的作用进行了比较。在28天时，道诺霉素组、去炎松组、联合用药组及对照组视网膜脱离率分别为33.3%、16.1%、8.3%和83.3%（P＜0.01）。放射自显影观察，道诺霉素使1、2周的标记细胞数明显减少（与对照组比分别为18.8±3.2对35.7±3.4;52.1±8.0对81.3±14.6，P＜0.01）；而去炎松及联合用药使炎细胞和标记细胞都明显减少。由此证实在PVR炎症期应用去炎松、细胞增生期应用道诺霉素或联合用药可防治牵拉性视网膜脱离。 （中华眼底病杂志，1994，10：229-231）     

Problems in pneumatic retinopexy

Fifty-four phakic eyes with selected rhegmatogenous retinal detachment (one retinal tear or a circumscribed group of tears in the upper two-thirds of the fundus, no sign of PVR) were treated by pneumatic retinopexy (transconjunctival cryopexy, intraocular gas injection with appropriate postoperative head positioning). After postoperative follow-up of six months or more primary reattachment of the retina was found in 27 patients (50%). In 12 eyes (22%) there was insufficient relief of traction, so that the detachment persisted (seven eyes) or recurred (five eyes). New retinal tears developed in 12 eyes (22%) between three days and six months postoperatively. This was probably due to interaction of the gas bubble with the vitreous base, an incompletely detached posterior vitreous border, or intravitreal condensations. Three eyes (6%) developed PVR. Other complications were vitreous hemorrhage (one eye) and subretinal gas bubble (one eye). The higher rate of complications, including the development of new tears, as compared to episcleral buckling procedures is discussed. In the authors's view appropriate experience on the part of the retinal surgeon and a level of intraoperative asepsis adequate for intraocular procedures are of major importance.     

周边视网膜冷冻联合tPA和C3F8玻璃体腔注射诱导玻璃体后脱离的动物实验研究

目的探讨周边视网膜冷冻后玻璃体腔注射酶或/和膨胀气体诱导玻璃体后脱离（Posterior vitreous detachment,PVD）的效果、机制并观察其对视网膜的毒性作用。方法选用新西兰白兔48只,随机分为实验组和对照组。实验组I行周边视网膜冷冻及玻璃体腔内注射纤维蛋白溶解酶原激活剂（tissue plasminogen activator,tPA）,实验组Ⅱ玻璃体腔单纯注射C3F80.3ml,实验组Ⅲ行周边视网膜冷冻,24小时后注射tPA25μg和C3F80.3ml。记录各实验组产生玻璃体后脱离的时间并观察眼内的反应性变化,最后行光镜和扫描电镜检查,观察各实验组用药后的组织形态学变化。结果三组均有效诱导PVD,组间两两比较差异有显著性（〈0.05）,实验组Ⅰ和Ⅱ眼内反应较轻,实验组Ⅲ反应最重,并有视网膜结构及功能损害。结论周边视网膜冷冻后tPA注射是诱导玻璃体后脱离安全有效的方法。单纯膨胀气体注射并非真正意义的玻璃体后脱离。酶与气体联合用药可缩短玻璃体后脱离产生时间,但容易造成视网膜药物毒性变化。     

Safety of intravitreal injection of bevacizumab in rabbit eyes

PURPOSE: To evaluate the safety of intravitreal injection of bevacizumab in rabbits using electrophysiological testing and histopathologic analysis. METHODS: New Zealand albino rabbits were injected in one eye with control antibody (n = 2), 0.05 mL of bevacizumab (n = 3), or 0.2 mL of bevacizumab (n = 3). Electroretinograms were obtained 1 week and 4 weeks after injection. Histologic analysis was performed after completion of the electroretinographic studies. RESULTS: No statistical differences were seen in scotopic and photopic a- and b-wave amplitudes between untreated control and bevacizumab-injected eyes. No histopathologic differences were identified between untreated control and bevacizumab-injected eyes. CONCLUSION: Our study did not find evidence of retinal toxicity from a single intravitreal injection of bevacizumab in rabbits.