去炎松与道诺霉素脂质体联合应用对玻璃体切除兔眼视网膜的影响

研究去炎松与道诺霉素脂质体联合应用对玻璃体切除兔眼视网膜的影响。方法对１６只兔双眼行玻璃体切除术并分为４组，分别在各组兔的１眼玻璃体内注入空内脂质体、１ｍｇ去炎松、１０μｇ道诺霉素脂质体，另１眼作对照。结论１ｍｇ去炎松和１０μｇ道诺霉素脂质体联合应用的对玻璃体切除兔眼视网膜无损害。     

去炎松预防实验性增殖性玻璃体视网膜病变

采用巨噬细胞诱发的增殖性玻璃体视网膜病变实验模型以评价去炎松的预防效果。对兔玻璃体注入巨噬细胞后，注入１ｍｇ去炎松，对照组注入０．１ｍｌ生理盐水。２８天时，对照组发生视网膜脱离者占７７％，而去炎松治疗组为１３％（ｎ＝３０，Ｐ＜０．０１）。去炎松自玻璃体的清除时间为３５．０～６３．０ｄ（平均４５．５ｄ）。视网膜电流图和电镜检查证实，４ｍｇ去炎松对视网膜无毒性。结果提了，在炎症期给予去炎松能，安全、有效地预防增殖性玻璃体现网膜病变。     

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)     

姜黄素防治兔眼增生性玻璃体视网膜病变的实验研究

背景先前的系列研究表明,姜黄素可以诱导体外培养的兔视网膜色素上皮（RPE）细胞凋亡,抑制其RPE细胞的增生,且在玻璃体内应用后不良反应较小,具有防治增生性玻璃体视网膜病变（PVR）的潜在价值。目的探讨姜黄素玻璃体内注射对RPE细胞诱导的兔眼PVR模型的防治效果。方法新西兰白兔20只40只眼,所有兔眼玻璃体注射前先抽取0．2ml玻璃体液,然后在兔眼玻璃体内注射0．1ml（2×10^6）同种RPE细胞,每只兔随机选取1只眼立即注入1mg／L的姜黄素0．1ml作为姜黄素组（20只眼）,对侧眼注入等量的含质量分数0．5‰DMSO的生理盐水作为对照组（20只眼）。注药后1、3、7、14、21、28d裂隙灯显微镜下观察角膜、房水、晶状体的透明度及眼前节炎症反应情况;使用间接检眼镜、眼底彩色照相和B型超声检查玻璃体视网膜情况。以视网膜脱离发生眼数作为检测指标,评价姜黄素对PVR的防治效果。结果玻璃体注药后1d、3d所有兔眼发生眼前节炎症反应,玻璃体轻中度混浊,但未见增生条带及视网膜脱离。玻璃体注药后7d,所有兔眼前节炎症反应基本消退,对照组14只眼（75％）玻璃体出现增生条带,姜黄素组2只眼（10％）玻璃体内出现增生条带,差异有统计学意义（P〈0．01）,但2组均未见视网膜脱离。注药后14d,对照组11只眼（55％）出现视网膜脱离,姜黄素组2只眼（10％）出现视网膜脱离,差异有统计学意义（P〈0．01）;注药后21d,对照组16只眼（80％）出现视网膜脱离,姜黄素组3只眼（15％）出现视网膜脱离;注药后28d,对照组19只眼（95％）出现视网膜脱离,姜黄素组3只眼（15％）出现视网膜脱离,差异有统计学意义（P〈0．01）。结论姜黄素玻璃体腔内注射可以有效预防RPE细胞诱导的兔眼实验性PVR的发生发展。     

白介素1受体拮抗剂对兔实验性增生性玻璃体视网膜病变的抑制作用

目的 :评价白细胞介素 1受体拮抗剂 (IL 1recep toranti gonist,IL 1Ra)对实验性增生性玻璃体视网膜病变(proliferativevitreoretinopathy ,PVR)的抑制作用。方法 :32只兔眼分为对照组、IL 1Ra组、地塞米松组和联合用药组 (每组 8眼 ) ,将 2 .5× 10 5个视网膜色素上皮细胞 (retinalpigmentep ithelium ,RPE)注入玻璃体腔内建立PVR模型 ,各组分别给予IL 1Ra和地塞米松并联合用药 ,观察PVR的形成 ,计算各组PVR的发生率。结果 :第 4周末对照组 10 0 %发生视网膜脱离 ,IL 1Ra组 6 2 .5 %发生视网膜脱离 ,地塞米松组有 5 0 .0 %发生视网膜脱离 ,而联合用药组 2 5 .0 %发生牵拉性视网膜脱离。联合用药组比所有其他组的视网膜玻璃体病变轻 ,视网膜脱离的面积也较小。结论 :IL 1Ra可以降低兔实验性PVR的发生率 ,IL 1Ra与地塞米松联合应用能够增加地塞米松的作用效果。     

增生性玻璃体视网膜病变的动物模型

孔源性视网膜脱离并发的增生性玻璃体视网膜病变（PVR）为一系列的细胞活动导致的视网膜脱离手术失败的病变。其发生机制尚不完全清楚，药物治疗效果也不理想。为了研究PVR的发生、发展和治疗，需要首先建立PVR的动物模型。由于PVR的主要病理变化是细胞的过度增生，因而动物模型多以细胞增生模型为主，细胞种类有视网膜色素上皮（RPE）细胞、成纤维细胞、软骨细胞、血管内皮细胞等。其他的模型还包括炎症和细胞迁移模型。实验动物主要有兔、猴、猪和豚鼠等。文章就不同动物模型的制作方法和特点作一简要回顾。     

Syndecan-1在增生性玻璃体视网膜病变增生膜中的表达

增生性玻璃体视网膜病变(proliferative vitreoretinopathv，PVR)属于眼内组织创伤愈合的一种特殊表现，可以分为炎症期、增生期和瘢痕期3个阶段，其中在增生期可以形成视网膜表面的增生膜组织，这些膜组织在瘢痕期收缩，形成对视网膜的牵拉而导致视网膜脱离。视网膜色素上皮(retinal pigment epithelium，RPE)细胞的过度增生在PVR过程中起重要作用。     

道诺霉素脂质体防治实验性增殖性玻璃体视网膜病变

采用巨噬细胞诱发的增殖性玻璃体视网膜病变模型，评价了抗代谢药道诺霉素及其脂质体的防治效果。在兔眼玻璃体注入巨噬细胞后，再分别注入5μg 道诺霉素（40眼），10μg 道诺霉素脂质体（DL,30眼）或磷酸缓冲液/空白脂质体（40眼）。28天时77.5%的对照眼发生视网膜脱离，而DL治疗组为33.3%（P＜0.01），道诺霉素组为50%（P＜0.05）.由此提示脂质体载药能增强药效。根据发病阶段选择不同的药物，是影响疗效的重要因素。 （中华眼底病杂志，1993，9：77-80）     

视网膜脱离巩膜扣带术后严重增生性玻璃体视网膜病变发生的危险因素

目的 探讨孔源性视网膜脱离巩膜扣带术后严重增生性玻璃体视网膜病变（proliferative vitreoretinopathy, PVR）发生的临床危险因素。 方法 采用病例对照研究方法，回顾性分析4031例（4031只眼）PVR低于C1级、行视网膜脱离巩膜扣带术患者的临床资料。记录患眼眼压值、晶状体和玻璃体状态、视网膜脱离特征、是否伴发脉络膜脱离 等22个临床特征。4031例患者中，有2660例手术后随访时间3个月以上，其中72例 （72只眼）因为巩膜扣带术后［12~210 d ,平均时间（60.3±41.0）d］发生严重PVR导致视网膜再脱离，回到我科行第2次玻璃体切割术，纳入PVR组；从剩下的2588例患者资料中随机调取72例（72只眼）视网膜复位3个月以上患者的临床资料纳入对照组。应用SPSS（10.0）软件将2组分析结果进行单元和多元Logistic回归分析。 结果 视网膜脱离巩膜扣带术后严重PVR发生的相关因素为：巩膜扣带术前呈现不完全性玻璃体后脱离 （P<0.001），眼压低于7 mm Hg（1 mm Hg=0.133 kPa)(P＜0.002），以及单一视网膜裂孔大小大于2个视盘直径(disc diameter,DD)（P＜0.005）。 结论 孔源性视网膜脱离患者巩膜扣带术前有不完全性玻璃体后脱离、低眼压及单一视网膜裂孔大小大于2 DD可能是PVR发生的主要危险因素。 （中华眼底病杂志，2003，19：141-143）     

重硅油填充治疗下方裂孔源性视网膜脱离的临床研究

目的评价用重硅油填充治疗下方裂孔源性视网膜脱离伴严重增生性玻璃体视网膜病变（PVR）的手术效果及并发症。方法对下方视网膜裂孔和严重PVR的复杂性视网膜脱离12例（12只眼）行玻璃体切割联合玻璃体腔重硅油填充术。术后对视力、角膜、眼底及眼压等情况进行随访。结果术后随访2.5～27个月,平均7.7个月,83.3%的病例视网膜裂孔封闭、视网膜完全复位;术后视力6只眼（50%）提高,4只眼（33.3%）不变;2只眼（16.7%）下降;4只眼（33.3%）术后眼压异常,其中2只眼（16.7%）为一过性低眼压,2只眼（16.7%）为一过性高眼压;2只眼（16.7%）并发性白内障;2只眼（16.7%）重硅油乳化;1只眼（8.3%）重硅油进入前房;1只眼（8.3%）严重的前房炎症反应。结论对下方裂孔源性视网膜脱离伴严重PVR,行玻璃体切割联合玻璃体腔重硅油填充术,可获得满意的视网膜复位率,而且并发症的发生率低。     

Prevention of experimental proliferative vitreoretinopathy with daunomycin and triamcinolone based on the time course of the disease

· Background: Our previous experiments showed a limited effect of treatment with daunomycin when given at the inflammatory phase of the development of proliferative vitreoretinopathy (PVR) induced by macrophages in rabbits. In the present study, we tested the efficacy of daunomycin when given at the proliferative phase and combined with triamcinolone given separately at the inflammatory phase in the same model. · Methods: Four groups of rabbits, 16 animals in each, respectively received 5 μg daunomycin on day 6; 1 mg triamcinolone immediately after macrophage injection; 1 mg triamcinolone immediately and 5 μg daunomycin on day 6 (combined drugs); and 0.1 ml saline (controls). Ophthalmoscopy and ³H-thymidine autoradiography were use to evaluate the effects of drugs on traction retinal detachments and cellular proliferation in the vitreous and on the retina. · Results: Retinal detachment occurred in 33.3%, 16.1%, 8.3% and 83.3% (P<0.01) of the eyes treated with daunomycin, triamcinolone, combined drugs, and the controls, respectively. Autoradiography revealed significantly decreased numbers of labelled nuclei on days 7 and 14 in daunomycin-treated eyes compared with controls. Significantly decreased numbers of inflammatory cells and labelled cells were noted in eyes treated with triamcinolone and combined drugs. · Conclusion: Daunomycin given at the proliferative phase, and combined with triamcinolone given at the inflammatory phase of PVR, can be more effective in preventing PVR development than daunomycin given at the inflammatory phase. Received: 24 July 1998 Revised version received: 15 September 1998 Accepted: 17 September 1998     

增殖性玻璃体视网膜病变玻璃体白细胞介素6(IL-6)表达的研究

目的 :研究白细胞介素 6(IL 6)在增殖性玻璃体视网膜病变 (PVR)玻璃体中的表达水平 ,分析IL 6在PVR中的作用。方法 :对 3 7例增殖性玻璃体视网膜病变及 1 2例正常对照玻璃体IL 6进行定量测定 ,其中视网膜脱离PVR 2 2例 ,外伤性PVR 1 5例。IL 6的测定采用双抗夹心法 (ELISA)。结果 :3 7例PVR玻璃体IL 6水平为 2 64 87± 1 3 6 4 1 pg/ml,其中 2 2例视网膜脱离并发PVR者玻璃体IL 6水平为 2 61 4 2± 1 3 1 2 7pg/ml,外伤性PVR者玻璃体IL 6水平为 2 97 97± 1 4 1 53 pg/ml。正常对照玻璃体IL 6水平为 3 5 69± 2 0 64 pg/ml。PVR玻璃体IL 6水平显著高于正常对照组 (P <0 0 1 )。IL 6水平在PVRC、D级最高。结论 :白细胞介素 6(IL 6)在PVR中呈上行性表达 ,参与PVR的发生发展。IL 6主要在PVR中晚期发挥作用。     

Antiproliferative drugs in the treatment of experimental proliferative vitreoretinopathy

We used an experimental model of proliferative vitreoretinopathy (PVR) and cell-induced traction retinal detachment to study the therapeutic value of six cytotoxic drugs (actinomycin C, colchicine, cytosine arabinoside hydrochloride, 5-fluorodeoxyuridine, vinblastine sulfate, and daunomycin). Pigmented rabbits were injected with 2.5 X 10(5) cultured homologous dermal fibroblasts. At the same time, cytotoxic drugs were injected into the vitreous in an attempt to inhibit cellular proliferation. The sensitivity of the cells to the drug was also tested in vitro before injection. Daunomycin at a dose of 10 nmol per eye stopped cellular proliferation and subsequent traction retinal detachment in vivo. The electroretinogram (ERG) showed no evidence of drug-induced retinal toxicity with this dose of daunomycin. No alteration in frequency or severity of vitreal membranes and retinal detachment was observed after injection of equivalent doses of the other drugs.     

Corticosteroids and daunomycin in the prevention of experimental proliferative vitreoretionopathy induced by macrophages

An experimental model of proliferative vitreoretionpathy (PVR) induced by macrophages simulates a special form of wound healing process in the eye and mimics the development of PVR from its initial stage. We used this model for the evaluation of drug efficacy in the prevention of PVR. One mg triamcinolone acetonide (TA), 10 g daunomycin-liposome (DL), 5 g free daunomycin (FD) and 0.1 ml saline or empty liposomes (as controls) were injected into the vitreous in four groups of animals (30 or 40 rabbit eyes each) after macrophage injection. Retinal detachment developed in 77.5% of the control eyes on day 28, compared to 13.3% of the TA-treated eyes (P<0.01), to 33.3% of the eyes treated with DL (P<0.01), and 50% of the FD-treated eyes (P<0.05). TA cleared up from the vitreous within 35–63 days (average 45.5 days). The half-time of FD clearance was 145.5 min. Although DL declined rapidly during the first 2 days, there was an average of 0.64 g/ ml daunomycin in the vitreous on day 14. Transmission electron microscopy showed that FD at a dosage of over 5 g or DL over 20 g was toxic to the retina and that up to 4 mg TA was nontoxic. These results suggest that steroids such as TA, given at the inflammatory stage, can effectively and savely prevent the development of PVR, and that encapsulation in liposomes of cytotoxic agents such as daunomycin can enhance drug efficacy and reduce toxicity. The time course of initiation and development of PVR is important in the selection of particular drugs.Supported in part by DAAD/K.C. Wong Fellowship     

Combined pars plana vitrectomy–scleral buckle versus pars plana vitrectomy for proliferative vitreoretinopathy

The purpose of the study is to evaluate the surgical outcomes of combined pars plana vitrectomy–scleral buckle (PPV–SB) versus pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment complicated with proliferative vitreoretinopathy (PVR). One thousand one hundred and seventy four patients with rhegmatogenous retinal detachment surgery between January 2002 and December 2013 were retrospectively reviewed. Patients with grade C PVR treated with either combined PPV–SB or PPV alone were included in the study. Study outcomes included single surgery anatomic success rate and postoperative visual outcome at 12 months postoperatively. Seventy-seven patients with grade C PVR were identified for analysis. At the end of 12-month follow-up, 80.5 % eyes (33/41) in the PPV–SB group and 58.3 % eyes (21/36) in the PPV group achieved single surgery anatomical success. In a multiple logistic regression model, none of the baseline variables (age, gender, macula status, grade of PVR, extent of detachment, presence of vitreous hemorrhage, lens status, status of high myopia) nor types of retinal detachment surgery (use of scleral buckle, barrier endolaser, 360 degree endolaser, cryopexy, retinectomy, tamponade agent, phacoemulsification) had significant effect on single surgery anatomical success. The post-treatment mean logMAR visual acuity of the PPV–SB group was 1.58 ± 0.58 and the PPV group was 1.57 ± 0.61. There was no significant difference in the postoperative visual acuity between the two groups (P = 0.849). For patients with grade C PVR, PPV–SB did not demonstrate a superiority over PPV alone in achieving single surgery anatomical success.     

ILMP及玻璃体腔注药联合硅油填充治疗高度近视MHRD合并脉络膜脱离

目的:观察内界膜剥除(internal limiting membrane peeling,ILMP)和玻璃体腔注射曲安奈德联合硅油填充治疗高度近视黄斑裂孔性视网膜脱离合并脉络膜脱离的临床疗效.方法:高度近视黄斑裂孔性视网膜脱离合并脉络膜脱离患者28例28眼,均行玻璃体切割(pars plana vitrectomy,PPV)吲哚菁绿辅助的ILMP以及硅油填充手术,术中将曲安奈德注射于玻璃体腔,术后随访6~24mo,观察术后视网膜复位率、视力恢复情况和术后并发症.结果:术后随访6~24mo,患者手术后平均LogMAR矫正视力为1.01± 0.31,与手术前平均LogMAR矫正视力比较,差异有统计学意义(t=-39.28,P<0.01).黄斑裂孔闭合19眼(68%),黄斑裂孔未闭合9眼(32%),26眼视网膜复位(93%),6眼出现高眼压.结论:玻璃体切割联合ILMP及硅油填充和玻璃体腔注射曲安奈德治疗高度近视黄斑裂孔性视网膜脱离合并脉络膜脱离,可阻止增生性玻璃体视网膜病变的再生,提高视网膜复位率.     

裂孔源性视网膜脱离显微外路手术临床观察

目的 观察手术显微镜直视下经外路手术治疗裂孔源性视网膜脱离的疗效.方法 在手术显微镜直视下,8眼PVR分级A级和9眼B级实行了裂孔定位、冷凝和外加压术,9眼C1级行裂孔冷凝、外加压和环扎术,共36例36眼.术后随访6个月,观察手术疗效.结果 一次手术视网膜复位34眼(94.4％),二次手术视网膜复位35眼(97.2％),1眼失败改行玻璃体视网膜手术.无明显手术并发症发生.结论 手术显微镜直视下治疗简单性裂孔源性视网膜脱离立体感好、疗效可靠.     

玻璃体切除联合重硅油填充治疗下方PVR视网膜脱离

目的探讨玻璃体切除联合重硅油眼内填充治疗下方严重PVR视网膜脱离的效果。方法对26例（26眼）诊断为合并下方PVR视网膜脱离者行玻璃体切除联合眼内重硅油填充,并同时随机抽取26眼患相似类型的视网膜脱离者,在玻璃体切除术后给予眼内硅油填充作为对照治疗。术后随访7～12月,观察其视网膜复位、视力、眼压及硅油乳化等情况。结果重硅油组视网膜一次性完全复位者24眼,占92．30％,硅油组一次性视网膜完全复位者18眼,占69．23％,（P〈0．05）。视网膜完全复位者绝大部分视力有不同程度提高。所有患者均未见明显炎症反应。结论玻璃体切除联合重硅油眼内填充是治疗下方PVR视网膜脱离的有效方法,可以降低术后视网膜脱离的复发率。