5-Fu抑制兔眼滤过道成纤维细胞的AgNORs表达

目的　应用细胞增殖指标AgNORs,研究兔眼滤过道成纤维细胞 (Fb)增殖规律及 5 Fu的抗增殖作用。方法　取兔眼滤过道切片作AgNORs及HE染色 ,比较 5 Fu眼和对照眼FbAgNORs染色颗粒数量。结果　对照眼滤过道的咬切口、巩膜瓣下、结膜瓣下均有Fb增殖 ,且增殖活性第 7天最高 ,第 3 0天最低。 5 Fu眼FbAgNORs颗粒数显著低于对照眼 ,5 Fu抑制率为 44.9%～ 73 .0 %。结论　 5 Fu可以有效抑制咬切口、巩膜瓣下、结膜瓣下Fb的增殖活性     

羊膜对兔眼滤过道成纤维细胞活性的抑制作用

目的:应用细胞增殖指标核仁组成区相关嗜银蛋白(AgNORs),研究兔眼滤过道成纤维细胞(Fb)增殖规律及羊膜的抗增殖作用,并对其临床意义进行探讨。方法:模仿人眼滤过手术方式行兔眼巩膜瓣下巩膜咬切术,切开前房前巩膜瓣下植入5mm×6mm大小的羊膜,术后1,2,3,4wk取兔眼滤过道标本,作AgNORs及HE染色,比较羊膜眼和对照眼FbAgNORs染色颗粒数量、眼压、滤过泡变化。结果:不同手术区羊膜眼FbAgNORs颗粒数显著低于对照眼,羊膜抑制率为10.8%～59.5%,羊膜眼眼压低于对照眼,术后3,4wk差异有显著性;羊膜眼滤过泡保持时间1～4wk,对照眼为1～2wk。结论:羊膜可以有效抑制滤过道Fb的增殖活性、延长眼压下降和滤过泡保留时间。     

三氧化二砷对成纤维细胞抑制作用的研究

目的应用细胞增生指标核仁组成区相关嗜银蛋白（argyrophilic nucleoar organ-izer regions granules,AgNORs）,观察兔眼滤过道成纤维细胞（fibroblast,Fb）增生规律及三氧化二砷（arsenic trioxide,As2O3）的抗增生作用。方法48只兔随机分为对照组与实验组,实验组根据As2O3的浓度不同分为0.5μmol·L^-1、5μmol·L^-1、10μmol·L^-13组。行常规青光眼小梁切除术,实验组于巩膜瓣制成后将浸泡过As2O3的棉片置于巩膜瓣与巩膜床之间。4组均于术后第3天、第7天、第15天、第30天分别用气栓法处死动物各3只,取兔眼滤过道切片做AgNORs染色及HE染色,比较As2O3实验组眼与对照组眼咬切口、巩膜瓣下及结膜瓣下Fb AgNORs染色颗粒数量。结果不同手术区As2O3眼AgNORs颗粒数明显低于对照眼,其抑制率与浓度呈正相关。5μmol·L^-1组As2O3抑制率在术后第7天可以达到81.13%.结论5μmol·L^-1As2O3即可以有效抑制咬切口、巩膜瓣下及结膜瓣下Fb的增生活性,且未见明显的眼内毒性反应。     

5—Fu抑制兔眼滤过术后成纤维细胞的AgNORs表达

应用细胞增殖指标ＡｇＮＯＲｓ,研究兔眼滤过道成道成纤维细胞增殖规律及５－Ｆｕ的抗增殖作用。方法取兔眼滤过道切片作ＡｇＮＯＲｓ及ＨＥ染色,比较５－Ｆｕ眼和对照眼,ＦｂＡｇＮＯＲｓ染色颗粒数量。结果对照眼滤过道的咬切口,巩膜瓣下,结膜瓣下均有Ｆｂ增殖,且增殖活性第７天最高,第３０天最低。     

兔眼滤过性手术中植入硅凝胶膜的实验研究

目的：在兔眼行硅凝胶膜植入后，通过观察眼内压、滤过泡、病理组织检查结果评价硅凝胶膜植入的安全性和有效性。 方法：共40只兔随机分为4组，每组10只。每只兔一眼行巩膜瓣下小梁咬切术，术中植入硅凝胶膜，对侧眼单纯行巩膜瓣下小梁咬切术作为对照。术后观察眼内压、滤过泡的变化，并且每只眼行组织病理学检查。 结果：植入眼较对照眼低眼压和滤过泡维持时间长，光镜显示植入眼滤过道、咬切口区保持通畅。成纤维细胞增殖的活性与规律，在植入眼和对照眼是相似的。硅凝胶膜不会刺激成纤维细胞增殖的过度表达。 结论：硅凝胶膜植入术作为一种新型引流术具有安全、有效、操作简单的优点。     

丝裂霉素C抗增殖作用的实验研究

目的　观察丝裂霉素 C (m itomycin C,MMC )在青光眼滤过术中单纯巩膜瓣上应用与巩膜瓣上下联合应用对术后成纤维细胞增殖活性的影响。方法　在兔眼实验性小梁切除术中 ,一组用浸泡有 0 .4 g· L- 1 MMC的海绵片 ,置于巩膜瓣上 5 m in,另一组用浓度相同的 MMC置于巩膜瓣上 3min、巩膜瓣下 2 m in。生理盐水做对照。采用 HE染色及增殖细胞核抗原 (proliferation cell nuclear antigen,PCNA)染色 ,观察术后 1、4、7、14及 2 8d滤过泡区的组织学改变及成纤维细胞增殖活性的变化。结果　应用 MMC组 PCNA阳性成纤维细胞在术后第 4天开始增多 ,但细胞数目远较对照组少。随时间延长 ,细胞数目增加不明显 ,14 d后阳性细胞明显减少。瓣上组与瓣上下组间 PCNA阳性细胞数目经统计学处理无显著性差异 ,而且 2组成纤维细胞增殖的动态变化趋势相同。结论　 MMC瓣上与瓣上下联合应用的抗纤维增殖效果相同。     

兔眼滤过性手术中植入硅凝胶膜的实验研究(英文)

目的:在兔眼行硅凝胶膜植入后,通过观察眼内压、滤过泡、病理组织检查结果评价硅凝胶膜植入的安全性和有效性。方法:共40只兔随机分为4组,每组10只。每只兔一眼行巩膜瓣下小梁咬切术,术中植入硅凝胶膜,对侧眼单纯行巩膜瓣下小梁咬切术作为对照。术后观察眼内压、滤过泡的变化,并且每只眼行组织病理学检查。结果:植入眼较对照眼低眼压和滤过泡维持时间长,光镜显示植入眼滤过道、咬切口区保持通畅。成纤维细胞增殖的活性与规律,在植入眼和对照眼是相似的。硅凝胶膜不会刺激成纤维细胞增殖的过度表达。结论:硅凝胶膜植入术作为一种新型引流术具有安全、有效、操作简单的优点。     

p38丝裂原活化蛋白激酶抑制剂对兔眼滤过术后肌成纤维细胞分化及细胞外基质合成的作用

背景 各种原因导致滤过手术失败的共同点是滤过通道的成纤维细胞过度增生、分化,导致过度纤维化、瘢痕形成.研究发现,p38丝裂原活化蛋白激酶(MAPK)信号通道在成纤维细胞表型转化过程中发挥重要作用. 目的 探讨p38 MAPK抑制剂SB203580对滤过手术后结膜下纤维化反应的抑制效果及其作用机制.方法 12只清洁级新西兰白兔行常规青光眼滤过手术制作双眼滤过手术模型,模型兔按随机数字表法随机分为单纯滤过手术组、SB203580治疗组和丝裂霉素C(MMC)对照组.SB203580治疗组兔眼滤过术毕立即结膜下注射0.2 g/L SB203580溶液1 ml,MMC对照组兔眼术中用浸泡0.2 g/L MMC的棉片置于术区结膜下及巩膜瓣下3 min.各组兔术后进行裂隙灯显微镜观察,术后1、3、7、10、14d使用Icare回弹式眼压计测量眼压,术后14 d抽取房水0.2ml,并获取手术滤过区结膜下组织标本,用ELISA法检测房水及滤过区结膜组织中的α-平滑肌肌动蛋白( α-SMA)、纤维连接蛋白的表达,用荧光实时定量PGR检测各组兔术眼滤过区结膜组织中ACTA2、结缔组织生长因子(CTGF)和Ⅰ型胶原蛋白α2链(COL1 A2) mRNA的表达. 结果 术后14d,单纯滤过手术组滤过泡血管化、瘢痕形成,SB203580治疗组滤过泡扁平、弥散,MMC对照组滤过泡呈苍白缺血状、扁平弥散.单纯滤过手术组、SB203580治疗组和MMC对照组兔间术前眼压值差异无统计学意义( F=0.065,P=0.937),术后眼压值随着时间的延长逐渐升高,各时间点的总体比较差异有统计学意义(F=32.873,P=0.030).ELISA法检测SB203580治疗组和MMC对照组兔房水及滤过区结膜下组织中的α-SMA质量浓度均明显低于单纯滤过手术组,而MMC组α-SMA质量浓度明显低于SB203580治疗组,差异均有统计学意义(P＜0.05).SB203580治疗组和MMC对照组兔房水及滤过区结膜下组织中的纤维连接蛋白质量浓度均明显低于单纯滤过手术组,而MMC对照组α-SMA质量浓度明显低于SB203580治疗组,差异均有统计学意义(P＜0.05).荧光实时定量PCR检测表明,各组兔术眼滤过区结膜下组织ACTA2、CTGF、COL1A2mRNA表达差异均有统计学意义(P＜0.01),以单纯滤过手术组表达量最高,SB203580治疗组次之,MMC对照组最低,差异均有统计学意义(P＜0.05).结论 p38 MAPK抑制剂SB203580能减少肌成纤维细胞分化及细胞外基质合成,减轻兔眼滤过手术后的组织纤维化反应.     

小梁切除术中应用羊膜与丝裂霉素C的比较

目的 比较丝裂霉素C（Mitomycin C,MMC）与羊膜在青光眼小梁切除术中应用的抗滤过通道瘢痕化的作用.方法 原发性闭角型青光眼38例（68眼）随机分为羊膜组和MMC组各34眼.羊膜组在小梁切除术中联合巩膜瓣下生物羊膜植入;MMC组在小梁切除术中巩膜瓣下一次性应用MMC,浓度为0.3 mg/ml,时间3 min.术后随访10个月.结果 手术成功率：羊膜组的总成功率（包括条件成功率和完全成功率）为94.02％,完全成功率为82.09％;MMC组则分别为81.05％和62.03％,两组之间差异无统计学意义（x2=2.403,P=0.238;x2 =2.101P =0.210）.术后并发症：羊膜组的主要并发症有术后浅前房（6眼）、白内障（2眼）、前房积血（2眼）及薄壁滤过泡（2眼）;MMC组的主要并发症有术后浅前房（8眼）、白内障（7眼）、前房积血（9眼）、薄壁滤过泡（9眼）、持续性低眼压（9眼）、滤过泡渗漏（6眼）及低眼压性黄斑病变（6眼）.结论 羊膜应用于小梁切除术中能长期保留功能性滤泡,且并发症较应用MMC者少.     

丁酰化壳聚糖膜在兔眼滤过手术抗瘢痕的研究

目的研究丁酰化壳聚糖膜在兔眼高眼压模型滤过手术中的抗瘢痕作用。方法实验研究。45只青紫蓝兔随机分为3组,每组左眼为实验眼,前房均注射0．3％复方卡波姆溶液（含有0．025％地塞米松）0．3ml,诱导兔眼高眼压模型,3周后眼压为30—40mmHg（1mmHg=0．133kPa）。第1组：单纯小梁切除术;第2组：小梁切除术中使用丝裂霉素c（MMC）;第3组：将丁酰化壳聚糖膜植入小梁切除术的板层巩膜瓣下。右眼均不行手术为对照组。分别于术后1、2、4、8及12周每组随机处死3只兔,制作眼球标本。结果病理切片显示术后2周时,单纯小梁切除组巩膜瓣胶原排列紊乱,炎性细胞浸润较多,伴有新生血管形成。MMC组巩膜瓣胶原排列紊乱,胶原组织短小、断裂,伴有炎性细胞浸润。壳聚糖膜组巩膜瓣间隙可见,胶原排列整齐,炎性细胞较少。术后2周,单纯小梁切除组的眼压〉21mmHg,明显高于MMC组和壳聚糖膜组（F=392．869,P〈0．05）,术后12周。壳聚糖膜组眼压低于单纯小梁切除组和MMC组（F=259．923,P〈0．05）;手术4周后,单纯小梁切除组与MMC组功能性滤过泡比率下降。结论丁酰化壳聚糖膜植入兔眼高眼压模型小梁切除术板层巩膜瓣下,有效抑制纤维细胞增生,维持滤过道通畅,术后并发症少,有助于提高手术成功率。     

Epi-LASIK术中联合MMC治疗高度近视的临床观察

目的：观察丝裂霉素C(MMC)在机械法准分子激光角膜上皮瓣下磨镶术（Epi-LASIK）矫治中高度近视的临床疗效和安全性。 方法：将临床病例406眼随机分为MMC组（203眼）和对照组（203眼）,所有手术采用自动旋转型Epi-LASIK角膜上皮刀制作角膜上皮瓣,以Visx star s4准分子激光仪进行激光切削,MMC组术中用含有0.2g/L MMC液的圆形滤纸片置于切削区基质面,根据屈光度数确定置留时间。对照组术中除不用MMC,其余操作与MMC组完全相同。术后随访两组患者的刺激症状、角膜上皮生长情况、术后视力、验光、眼压、haze情况并进行总结。 结果：所有病例均按预期完成Epi-LASIK手术,随访时间6mo~2a。两组刺激症状较轻,多发生在手术后第1d,一般术后第2d就会好转,术后第3d检查,MMC组有15眼为II~ III级刺激症状,对照组有13眼为II~III级刺激症状,两组差异无统计学意义（P>0.05）;两组角膜上皮完全愈合时间为3~5d,其中MMC组平均为3.78±0.75d , 对照组平均为3.55±0.89d,两组差异无统计学意义（t=1522,P>0.05）。3~5d摘镜时,MMC组有191眼（941%）角膜上皮愈合良好,对照组有198眼(97.5%)。术后6mo检查,MMC组术后视力满意为195眼（93.6%）,对照组为172眼（84.7%）,两组差异有统计学意义（P<005）。术后6mo检查,屈光度较术后3mo时回退超过 -0.50D,MMC组有11眼（5.4%）,对照组有23眼（11.3%）。术后6mo检查, MMC组有167眼（82.3%）为0级haze,对照组有125眼（61.6%）为0级haze,两组差异有统计学意义（P<0.05）。 结论：在Epi-LASIK矫治高度近视手术中,一次性应用02g/L MMC液可以减轻术后haze的反应,减少术后视力的回退,无明显的副作用。     

丝裂霉素C在泪囊鼻腔吻合术中的应用

目的　为明确丝裂霉素C在泪囊鼻腔吻合术后 ,抗吻合口瘢痕形成至吻合口关闭的作用。方法　将 45例 (47眼 )慢性泪囊炎随机分为MMC治疗组 2 5眼和对照组 2 2眼。MMC组在泪囊鼻腔吻合术中一次性使用 0 4mg/ml的MMC ,对照组不使用MMC。术后随访 6～ 1 2月。结果　MMC治疗组成功率为 1 0 0 % ,对照组为 86 36% (P <0 0 1 )。MMC治疗组术后未出现粘膜坏死、溃疡、眼球损伤或持久性疼痛等并发症。结论　MMC的抗瘢痕作用有助于保持泪囊鼻腔吻合术的骨孔面积 ,促进吻合口通畅。     

丝裂霉素C在泪囊鼻腔吻合术中的应用

目的　探讨丝裂霉素C在泪囊鼻腔吻合术中的应用及效果。方法　将92例105眼慢性泪囊炎随机分为MMC组48例55眼和对照组44例50眼,MMC组术中应用0.4g     

5—氟尿嘧啶与丝裂霉素C在青光眼滤过术中的合理应用

目的 探讨青光眼滤过手术抗代谢药物丝裂霉素C（MCC）与5－氟尿嘧啶（5－Fu）的合理应用。方法 对108只需手术的青光眼随机分成3组。5－Fu组术后球结下注射5－Fu6－8次,MMC组术中一次性给予质量浓度为0.2mg/ml的MMC,对照组则不用任何药物,观察各组术后的疗效及并发症。结果 随访3－34个月（平均28．2月）,5－Fu和MMC组手术成功率明显高于对照组,P＜0．05。术后并发症5－Fu组角膜上皮点状损害18只眼（45％）,MMC组低眼压2例（6．7％）,与对照组比有显著差异（P＜0．05）。结论 5－Fu与MMC能提高青光眼手术的成功率,但有一定的毒副作用。临床上应根据病人的年龄、病情及青光眼类型选择用药。     

丝裂霉素C对小梁切除术后角膜散光的影响

目的 了解术中应用丝裂霉素Ｃ（ＭＭＣ）对小梁切除术后角膜散光的影响。方法 应用ＴＯＰＣＯＮ ＯＭ－４型角膜曲率计检测术中应用丝裂霉素的３６只眼切除术前及术后不同时期的角膜散光。４０只眼单纯行小梁切除术组作为对照组。结果 应用丝裂霉素组术后１周、１月、３月时角膜循规性散光〉２．０Ｄ者分别占６３．８８％,４７．２２％,１３．８８％;而对照组分别为３７．５０％,３０．００％,７．５０％,差值呈显著性。结论 尽管随着时间的延长而散光逐渐减小,但术中应用ＭＭＣ可较单纯小梁切除产生更大的散光。     

Mitomycin C in photorefractive keratectomy: effect on epithelialization and predictability

PURPOSE: To evaluate the effect of topical mitomycin C (MMC) after myopic photorefractive keratectomy (PRK) on epithelialization and predictability. METHODS: Prospective, randomized, double-masked, same-day, paired eye study. Inclusion criteria: bilateral spherical equivalent (SE) between -6.5 and -10 D, difference of SE between the 2 eyes of < or =0.75 D, central pachymetry >520 microm, with a difference between the 2 eyes of <20 microm, follow-up 12 months. Planned optical zone was equal in the 2 eyes. After manual deepithelialization and excimer ablation, a Merocel sponge soaked either with MMC 0.2 mg/mL or with balanced salt solution was placed on the stromal bed of either eye for 45 seconds in a randomized fashion. A bandage contact lens was used until epithelialization; fluorometholone 0.1% eyedrops were symmetrically used and tapered in the 2 eyes. RESULTS: Fifty-two patients (23 men; mean age, 33 years) completed the study. Preoperative mean SE was -8.07 +/- 0.92 D in the MMC eyes and -7.96 +/- 0.81 D in the control eyes (not statistically significant). Mean epithelialization time was 3.0 +/- 0.69 days in the MMC eyes and 3.0 +/- 0.71 days in the control eyes (not statistically significant). At 12 months, mean SE was 0.47 +/- 0.43 D in the MMC eyes and 0.17 +/- 0.49 D in the control eyes (P < 0.05). Mean haze in the MMC eyes was 0.02 +/- 0.07 and in the control eyes was 0.19 +/- 0.17 (P < 0.05). CONCLUSIONS: MMC did not delay epithelialization and did not induce adverse effects at 12 months. MMC induced a mean 0.47-D overcorrection (5.8% of attempted correction). All eyes treated with MMC had a haze grade < or =0.25.     

Comparison of single-drop mitomycin C regime with other mitomycin C regimes in pterygium surgery

PURPOSE: To evaluate the safety and efficacy of single-drop instillation of mitomycin C (MMC) in pterygium surgery and to compare the results with both postoperative and intraoperative application of MMC. METHODS: Eighty eyes of 72 patients with pterygium were randomised into 4 equal groups: group 1--control--bare scleral excision (BSE); group 2--BSE with single-drop instillation of mitomycin C (MMC) 0.02% at the end of the surgery; group 3--BSE with postoperative MMC 0.02% drops twice a day for 5 days; and group 4--BSE with intraoperative MMC 0.02%. RESULTS: The recurrence of pterygium was observed in 14 (70%), 4 (20%), 4 (20%) and 3 (15%) eyes of group 1, 2, 3, and 4 respectively. The recurrence rate after BSE with single drop MMC regime (group 2) was significantly lower than group 1 recurrence (P=0.001) and was statistically comparable to that of group 3 and 4. Scleral defects in the bare area occurred in 4 (20%), 16 (80%) and 16 (80%) eyes of group 2, 3, and 4 respectively. The incidence of scleral defects was significantly lower in group 2 compared to group 3 (P=0.0001) and group 4 (P=0.0001). Compared to group 1 and 2, a significant delay in wound epithelialisation occurred in group 3 (P=0.003) and 4 (P=0.004). An ischaemic area in the bare sclera developed in 8 (40%) and 6 (30%) eyes of group 3 and 4 respectively, while ischaemic area did not develop in group 1 and 2. CONCLUSION: Single-drop instillation of 0.02% mitomycin C following pterygium excision appears both safe and efficacious.     

Morphologic proof of the toxicity of mitomycin C on the ciliary body in relation to different application methods

· Background: Since postoperative hypotony has been a frequent complication of glaucomatous filtration surgery with adjunctive use of mitomycin C (MMC), the question arises of whether there may be another application method which can minimize this side effect. The purpose of this study was to establish the morphologic side effects of different application methods. · Methods: MMC 0.2 mg/ml was applied to the episclera of nine eyes of six pigmental rabbits at random via collagen shield (CS), soft contact lens (CL), or lyophilisate (20 μg; LY) for 5 min. Two eyes (controls) had a subconjunctival injection of BSS only. Another control eye was left untreated (no injection). No trabeculectomy was performed. One hour later the amounts of MMC in the conjunctiva and aqueous were analyzed by reverse-phase high-pressure liquid chromatography. Ciliary bodies were dissected from the enucleated eyes, embedded and investigated by transmission electron microscopy (TEM). Cell height of the nonpigmented ciliary epithelium was morphometrically assessed by means of computer-assisted image analysis. · Results: The light-microscopic analysis of the sectioned cell area revealed reduction of the cell height of the non-pigmented ciliary epithelium (NPCE) after application with soft contact lens (foufold) and collagen shield (2.5-fold) but not with lyophilisate compared to the untreated eye. The following ultrastructural changes were seen: loss of apical microvilli (CS, CL, LY), disintegrating melanin granules within NPCE (CS), lysis of entire areas with NPCE cells (CS), myelin figures within mitochondria (LY), intracellular vacuoles (CS, CL), lysis of myelinated nerves (CS), myelin figures in mitochondria of endothelial cells (LY), and lysis of stromal fibrocytes (CS). In the control eyes (injection of BSS) none of these ultrastructural changes were detected in the cylindrical NPCE cells. The concentration of mitomycin in the aqueous humor after topical application of MMC on the episclera for 5 min were all below the detection limit (<10 ng/ml). The concentration of MMC in the conjunctiva ranged from 2.1 to 3.7 μg/g. · Conclusion: Severe morphologic alterations were seen at the electron-microscopic level after application of MMC 0.2 mg/ml with a collagen shield and with a soft contact lens. They were mildest with lyophilisate and absent in the BSS controls. A new administration device is needed if trabeculectomy is to be performed successfully using MMC in human glaucomatous eyes. Received: 28 September 1998 Revised version received: 17 November 1998 Accepted: 17 November 1998     

Long-term results of adjunctive use of mitomycin C in external dacryocystorhinostomy

Objective To assess the long-term results of intraoperative mitomycin C (MMC) in external dacryocystorhinostomy (EXT-DCR). Methods In this prospective randomized controlled study, 35 patients (40 eyes) with primary acquired nasolacrimal duct obstruction were assigned randomly into two groups. In the control group, a standard EXT-DCR procedure was performed. In the MMC group 0.2 mg/ml MMC was applied to the osteotomy site for 30 min. The results of EXT-DCR in both groups were evaluated by both asking patients about the tearing condition and examining the patency of irrigation at one-year follow up. Results Eighteen (90%) of the 20 eyes in the MMC group remained totally symptom-free and one eye (5%) improved; while 12 (60%) of 20 eyes in the control group were reported to be symptom-free and five (25%) of the eyes to have an improvement in the tearing symptoms (P = 0.087). The success rate in the MMC group was 95% compared with 85% in the control group (P = 0.605). No surgical complications occurred. Conclusions The satisfaction and success rates of the MMC group were higher than those of the control group and no deleterious effect was noted with MMC application, however the differences did not reach statistical significance. Intraoperative MMC application seems to be a safe adjuvant that could help in increasing the success rates of EXT-DCR surgery in primary acquired nasolacrimal duct obstruction ,however further studies with larger series are needed to make definite statements.