Hypotony and ciliochoroidal detachment following pharmacologic aqueous suppressant therapy in previously filtered patients

This is the first report describing the syndrome of hypotony and ciliochoroidal detachment following pharmacologic aqueous suppressant therapy in previously filtered eyes. Four patients had a history of advanced primary open-angle glaucoma treated with multiple medical therapies, including timolol for 11 to 36 months. They then underwent filtration surgery, which failed in two cases. Timolol and/or acetazolamide therapy was instituted 1 to 18 months following surgery. The patients then developed hypotony and ciliochoroidal detachment, which resolved spontaneously after cessation of the pharmacologic aqueous suppressant therapy. In three of the cases, the episode of hypotony and ciliochoroidal detachment recurred after a second challenge with timolol and/or acetazolamide therapy. Inflammation, tumor, wound leakage, retinal detachment and cyclodialysis cleft were excluded. A mechanism of formation of ciliochoroidal detachment in this syndrome is proposed. Long-term timolol therapy followed by filtration surgery and its attendant postoperative hypotony and ciliochoroidal detachment sensitizes the ciliary epithelium. Subsequent pharmacologic aqueous suppressant therapy results in almost total reduction of aqueous production, causing hypotony and ciliochoroidal detachment.     

Ciliochoroidal effusion with persistent hypotony after trabectome surgery

The trabectome is a novel form of ab interno trabeculectomy that ablates and remove the trabecular meshwork and the inner wall of Schlemm''s canal and subsequently expose the natural drainage pathway (the collector channels) to aqueous humor. Complications associated with the trabectome are few and among them is transient hypotony. We report a case of a prolonged ciliochoroidal effusion with hypotony after ab interno trabeculectomy using the trabectome with cyclodialysis cleft detected by 80 MHz ultrasound biomicroscopy in a previously neither nonoperated nor traumatized eye. Transient hypotony has been reported after the trabectome surgery. Very few cases were associated with inadvertent intraoperative cyclodialysis, but there are no cases of prolonged hypotony with ciliochoroidal effusion with cyclodialysis. In our case, associated transient intraoperative and postoperative hypotony with a history of chronically high pressure along with the possible contribution of low-grade postoperative inflammation may have precipitated the ciliochoroidal effusion with prolonged hypotony associated with cyclodialysis.     

睫状体脉络膜上腔分离术联合硅胶带植入术对兔眼房水引流的影响

目的:研究睫状体脉络膜上腔分离术联合硅胶带植入术对兔眼房水引流的影响。方法:新西兰大白兔12只,随机分为2组,每组6只,一组右眼行睫状体脉络膜上腔分离术联合硅胶带植入术,另一组右眼行标准小梁切除术,观察术后10,21,42d眼压及房水流畅系数的变化。结果:睫状体脉络膜上腔分离术联合硅胶带植入术组术后10d眼压下降(33.7±3.7)%,与小梁切除术组降压(32.2±3.8)%幅度一致(P=0.501);术后21d眼压下降(14.7±1.6)%,较小梁切除术组(2.3±9.1)%大(P=0.013),标准小梁切除术组21d左右眼压即恢复正常;术后42d眼压下降(0.3±7.9)%,与小梁切除术组(3.5±6.3)%无统计学差异(P=0.461)。房水流畅系数硅胶带植入术组术后10d为0.38±0.03,与小梁切除术组(0.35±0.03)无统计学差异(P=0.16);术后21d为0.26±0.03,较小梁切除术组(0.21±0.02)大(P=0.006);术后42d为0.18±0.02,与小梁切除术组(0.19±0.03)无统计学差异(P=0.765)。结论:兔眼睫状体脉络膜上腔分离术联合硅胶带植入术可有效降低兔眼眼压,增大兔眼房水流畅系数。     

Uveoscleral outflow: diffusion or flow?

Shallow peripheral ciliochoroidal detachments with 10(-4) M fluorescein isothiocyanate dextran 70 were created in cynomolgus monkey eyes. Anterior chamber fluorophotometric readings were taken for 6 hr. From the anterior chamber fluorescence values, the rate of tracer movement from the supraciliary space into the anterior chamber was calculated. The rate of movement was 0.003 microliter/min, expressed in equivalent volumes of tracer solution. This value is more than 200 times lower than the rate of tracer movement from the anterior chamber to the supraciliary space. It is concluded that tracer movement from the anterior chamber to the supraciliary space (uveoscleral route) results from fluid flow rather than diffusion.     

Influence of indomethacin on PGE2 in rabbit aqueous humor after YAG laser photodisruption of the iris

In an experimental study with rabbits, the influence of indomethacin on the postoperative PGE₂ level in the aqueous humor was investigated, following YAG laser traumatization of the iris. Indomethacin is a drug with an inhibitory effect on the synthesis of prostaglandins. Using albino rabbits, the right eye was treated with indomethacin eye drops three times daily for 3 days. On the 4th day, high-energy YAG laser was applied to the iris of both eyes (Q-switched Nd: YAG Laser, Model Cilco Lasertek PV 135; ten photodisruptive lesions, with 50 mJ to the midperiphery of the iris). Subsequently, the rabbits were subdivided into three groups. In group 1 the aqueous humor was removed from both eyes 12 h postoperatively; in group 2 the aqueous humor was tapped 36 h after the intervention; for group 3, it was 60 h afterwards. The results from 15 rabbits were evaluated. Local indomethacin treatment was continued until tapping of the aqueous humor. As a control, another group was used with 3 rabbits without treatment. Twelve hours after YAG laser treatment there was still a clearly significant difference in the PGE₂ concentrations between the eyes that had received indomethacin and the untreated eyes; 36 h postoperatively, the difference was no longer statistically significant, and after 60 h the PGE₂ concentrations of the treated and untreated eyes were the same.     

Ultrasound biomicroscopy in the diagnosis of supraciliochoroidal fluid after trabeculectomy.

PURPOSE: To report supraciliochoroidal effusion after trabeculectomy with the use of ultrasound biomicroscopy. METHODS: In a prospective study, 28 eyes of 19 patients with primary open-angle glaucoma that underwent trabeculectomy were evaluated preoperatively and postoperatively by ultrasound biomicroscopy. RESULTS: Four eyes showed a hypoechogenic suprachoroidal space that remained stable for 6 months postoperatively. These four eyes had intraocular pressures of 11 mm Hg or less on no antiglaucoma medications and without signs of choroidal detachment. CONCLUSION: Ultrasound biomicroscopy proved to be a useful method of detecting, after trabeculectomy, supraciliochoroidal fluid without clinically detectable choroidal detachment. This fluid may signify an iatrogenic cyclodialysis during surgery or, less likely, subclinical ciliochoroidal detachment.     

Suprachoroidal seton implantation in refractory glaucoma: a novel surgical technique

PURPOSE: To describe a new surgical technique in which aqueous humor is diverted from the anterior chamber to the suprachoroidal space for the augmentation of uveoscleral outflow in the management of refractory glaucoma. METHODS: Four painful-blind eyes of four consecutive patients were included in the study. Mean age of patients was 54.7+/- 9.2 years. Preoperative diagnosis was neovascular glaucoma complicating diabetic retinopathy in three cases and chronic angle-closure glaucoma in one case. Mean preoperative intraocular pressure of the patients receiving two medications was 58.5 +/- 9.2 mm Hg. A modified Krupin eye valve with disk was implanted into the suprachoroidal space. The anterior tube part of the Seton device was placed into the anterior chamber through the long scleral tunnel for draining the aqueous humor from the anterior chamber to the suprachoroidal space. RESULTS: The placement of modified Krupin eye valve with disk to the suprachoroidal space was achieved in all cases. While mean preoperative intraocular pressure was 58.5 +/- 9.2 mm Hg, it was 14.2 +/- 4.7 mm Hg at postoperative one week. It was 13.5 +/- 4.6 mm Hg and 15 +/- 4.9 mm Hg at one and three months respectively. At the last follow-up visit, mean intraocular pressure was 17.25 +/- 5.37 mm Hg ranging from 12 to 24 mm Hg. Choroidal detachment was developed in one case and regressed in six weeks. Rubeosis irides regressed at third month in three cases. None of the eyes developed suprachoroidal hemorrhage, retinal detachment, or phthisis bulbi. CONCLUSION: The drainage of aqueous humor from the anterior chamber to the suprachoroidal space with the implantation of the glaucoma Seton device is effective in lowering intraocular pressure in refractory glaucoma.     

The role of lysosomal enzymes in the pathogenesis of ciliochoroidal detachment

The paper discusses the role of lysosomal enzymes, in particular beta-galactosidase, as a starting mechanism in the development of ciliochoroidal detachment. The activity of beta-galactosidase was determined in the suprachoroidal fluid, the aqueous humor, in the blood serum before intraocular operation and in posterior sclerotomy. Ciliochoroidal detachment is shown to be accompanied by accumulation of beta-galactosidase in the suprachoroidal space, not correlating with the enzyme content in the blood serum. This allows to speak about a possible participation of this enzyme in the formation of ciliochoroidal detachment.     

Ciliochoroidal effusion induced by topical latanoprost in a patient with sturge-weber syndrome

BACKGROUND: To report drug-induced ciliochoroidal effusion in a patient with Sturge-Weber syndrome.CASE: A 17-year-old man presented with unilateral glaucoma associated with Sturge-Weber syndrome.OBSERVATIONS: His corrected visual acuity was RE 20/20 and LE 40/60. Intraocular pressure readings by Goldmann applanation tonometry were RE 32 mm Hg and LE 12 mm Hg. Fundus examination showed marked glaucomatous disc cupping in his right eye and normal finding in his left. The patient had a port-wine stain on his right upper eyelid ipsilateral to the glaucomatous eye. Antiglaucomatous medications were begun, including topical latanoprost, with a diagnosis of juvenile onset glaucoma associated with Sturge-Weber syndrome. Ultrasound biomicroscopy showed a 360 degrees circumference ciliochoroidal effusion. Forty days after starting medication, latanoprost treatment was discontinued. Ten days later, ultrasound biomicroscopy showed a total disappearance of the ciliochoroidal effusion.CONCLUSION: Interaction of the enhanced uveoscleral outflow with latanoprost in conjunction with elevated episcleral venous pressure may have caused the congestion of the aqueous humor in the supraciliary-choroidal space, resulting in the ciliochoroidal effusion.     

Absence of an effect of topical dexamethasone on endothelial permeability and flow of aqueous humor

Twenty-four normal human subjects were studied before and after one week of treatment with 0.1% topical dexamethasone. Intraocular pressure, corneal thickness and endothelial cell size were measured. The flow of aqueous humor and the endothelial permeability to fluorescein were determined using fluorophotometry. In addition, the relationship between the initial location of an iontophoretic depot of fluorescein and its kinetics was studied. There was a small and significant increase in intraocular pressure in the eyes treated with dexamethasone but no significant change in corneal thickness, endothelial permeability or the rate of aqueous humor flow. The elimination of fluorescein from the eye was slightly higher when the fluorescein depot was placed adjacent to the superior limbus than when the depot was placed in the central cornea. Smaller right to left differences were observed when fluorescein was placed peripherally than when it was placed centrally. The increased precision with peripheral placement is probably due to the improved signal-to-noise ratio for fluorescence measurements of the anterior chamber through the unstained cornea.     

兔眼超声乳化吸出术后非手术眼房水及血清中TNF-α、IL-1β表达变化与该眼角膜知觉敏感度变化之间的关系

目的　探讨超声乳化吸出术后不同时间点兔非手术眼房水及血清中肿瘤坏死因子α（TNF-α）和白细胞介素-1β（IL-1β）表达变化与该眼角膜知觉敏感度变化之间的关系。方法　选取健康成年新西兰大白兔40只作为实验对象。采用随机数字表法将大白兔分为实验组与空白对照组,实验组25只,空白对照组15只。实验组:一眼行晶状体超声乳化吸出术,根据术后取材时间分为术后1 d、3 d、7 d、14 d、21 d共5组,每组5只动物。空白对照组:按照对应取材时间也分为5组,每组3只动物。术后观察并记录各组兔双眼的结膜充血、角膜混浊及前房炎症反应情况。实时定量PCR检测各组兔血清TNF-α mRNA和IL-1β mRNA表达水平,ELISA法检测房水中TNF-α、IL-1β蛋白浓度,角膜知觉计测量角膜知觉敏感度。结果　实验组非手术眼与空白对照组双眼在不同时间点,结膜充血、角膜混浊及前房炎症反应级别均为0级。术后1 d、3 d、7 d、14 d,实验组兔血清TNF-α mRNA和IL-1β mRNA表达水平均较基线值升高,术后7 d达高峰（TNF-α mRNA相对表达量为14.95±0.89,IL-1β mRNA相对表达量为7.56±>0.46）,之后逐渐下降,术后21 d降至术前水平。实验组各相邻取材时间点两两比较,血清TNF-α mRNA和IL-1β mRNA表达水平差异均有统计学意义(均为P<0.05)。术后1 d、3 d、7 d、14 d,非手术眼房水TNF-α和IL-1β蛋白浓度均较基线值升高,其中峰值出现于术后7 d［TNF-α蛋白浓度为（162.34±5.71） ng·L^-1,IL-1β蛋白浓度为（16.68±0.74）ng·L^-1］,之后逐渐下降,术后21 d降至术前水平。实验组相邻取材时间点两两比较,非手术眼房水TNF-α和IL-1β蛋白浓度差异均有统计学意义(均为P<0.05)。术后1 d、3 d、7 d、14 d,非手术眼角膜知觉敏感度较基线值升高,于术后7 d角膜知觉敏感度最高;之后角膜知觉敏感度逐渐下降,术后21 d基本恢复至基线水平。实验组非手术眼相邻时间点两两比较,角膜知觉敏感度差异均有统计学意义（均为P<0.05）。结论　实验兔第一眼晶状体超声乳化吸出术后早期,非手术眼角膜知觉敏感度升高,该变化可能与该眼房水及血清中TNF-α和IL-1β表达的动态变化相关。     

Comparative experimental morphological study of the impact of various drainages for cyclodialysis to the adjacent tissues

The investigation was made on 8 eyes (4 rabbits) undergone cyclodialysis with the hydrogen or collagenic drainage being introduced into the supraciliary cleft. Comparative pathohistological study indicated the evident advantages of a hydrogel implant ensuring the drainage function of the formed cyclodialysis cleft throughout the experiment (5 weeks). By contrast, subject to resolution, the collagenic drainage spurred the early development of young connective tissue in the cyclodialysis cleft just on day 14 after implantation. Complete atresia of the cyclodialysis cleft and cessation of its drainage function might be suggested by week 3. Moreover, hydrogel material has, in our opinion, a less noticeable irritating effect on the adjacent tissues and causes minimum inflammatory and fibroplastic reactions.     

A case of acute angle-closure glaucoma secondary to annular ciliochoroidal detachment after unsutured cataract surgery

BACKGROUND: We report a patient with acute angle-closure glaucoma secondary to annular ciliochoroidal detachment after unsutured cataract surgery. CASE: An 82-year-old man was diagnosed with bilateral shallow central anterior chamber depth, flat peripheral anterior chamber, and elevated intraocular pressure. One day previously he had undergone uncomplicated unsutured cataract surgery in the right eye and eight days previously, in the left eye. Ultrasound biomicroscopy revealed annular ciliochoroidal detachment in both eyes. Treatment with intravenous methyl prednisolone deepened the anterior chamber and reduced intraocular pressure. CONCLUSION: Annular ciliochoroidal detachment may lead to anterior rotation of the ciliary body and angle-closure. This clinical entity is indistinguishable from malignant glaucoma when the fundus cannot be visualized.     

更昔洛韦原位胶化滴眼液兔眼部药物动力学及生物利用度研究

目的比较0．2％更昔洛韦滴眼液及其原位胶化滴眼液给兔眼滴用后,更昔洛韦在兔眼泪液、房水以及角膜组织中的经时过程及其药物动力学行为。方法采用健康无眼疾白色家兔,按完全随机化方法分为试验组与对照组。试验组每眼结膜囊内单次给更昔洛韦原位胶化滴眼液50山,对照组动物每眼结膜囊单次给更昔洛韦一般滴眼液50μl。两种制剂滴眼后,在不同时间点分别取泪液、房水以及角膜组织,样品经处理后,采用高效液相色谱法（HPLC）测定不同时间的兔眼泪液、房水及角膜组织中更昔洛韦浓度,药物动力学参数采用非线性最小二乘法进行计算机拟合求得。结果在用药后120min内,试验组各时间点房水中和角膜组织中的药物浓度均明显高于对照组。泪液中在5—10min时试验组药物浓度明显高于对照组。试验组的泪液、房水和角膜药物浓度一时间曲线下面积分别是对照组的2．2、5．5和3．4倍,试验组和对照组药物在房水中的t1／2分别为59和43min,在角膜中分别为223和87min。试验组和对照组房水中药物达峰浓度分别为4．79和0．96μg／ml,达峰时间分别为60和45min。结论更昔洛韦原位胶化滴眼液同一般滴眼液相比,明显延长药物在眼部的滞留时间,增加角膜组织和房水中的药物浓度。显著提高更昔洛韦的眼部生物利用度。     

Heparin drug delivery system for prevention of posterior capsular opacification in rabbit eyes

BACKGROUND: The aim of this study was to investigate the safety and efficacy of a heparin drug delivery system (HEP DDS) for prevention of posterior capsular opacification (PCO) in rabbits. METHODS: Fifty New Zealand albino rabbits (50 eyes) undergoing phacoemulsification were equally divided into five groups receiving normal saline eye drops (group A), a carrier DDS implanted into the posterior chamber (group B), 5% heparin eye drops (group C), a HEP DDS implanted subconjunctivally (group D) and a HEP DDS implanted into the posterior chamber (group E). All the 50 eyes were examined by slit-lamp microscopy. The heparin levels in blood and aqueous humor were measured, and the wet posterior capsules were weighed. RESULTS: All eyes in groups A and B had PCO at 5-7 days, much earlier than in groups C, D and E. Two eyes in group C, three eyes in group D and six eyes in group E showed no signs of PCO throughout the 12-week study. The mean weight of wet posterior capsules from groups A-E was 157.919 mg, 160.091 mg, 81.114 mg, 71.827 mg and 19.984 mg respectively. The mean aqueous humor heparin level in groups C, D and E was 10.279 microg/ml, 13.246 microg/ml and 25.964 microg/ml respectively. Cell proliferation of the posterior capsules in group E was not active. The conjunctiva, cornea, iris, ciliary body and retina remained intact, and no significant toxic reactions were observed. No intraocular hemorrhage occurred during the follow-up. CONCLUSION: Implantation of a HEP DDS into the posterior chamber of experimental animals significantly maintained a higher heparin level in aqueous humor for a relatively long period of time. The findings indicate potential prevention of PCO with minimum toxic and side effects.     

外伤性视网膜脱离术后复发的临床特征分析

目的探讨外伤性视网膜脱离术后复发的临床特征。 方法收集2013年1月至2018年6月北京同仁眼科中心外伤性视网膜脱离术后复发视网膜脱离的77例(77只眼)病例资料,并进行回顾性分析。其中,男性67例(67只眼),女性10例(10只眼);年龄7~64岁,平均年龄(35.0±14.5)岁。根据致伤原因、复发视网膜脱离的时间、玻璃体的状态和视网膜脱离的范围将患者进行分组。采用均数±标准差描述患者年龄分布的情况;采用眼数和百分比描述不同分组的病例数量与病例分布的情况。采用卡方检验比较不同致伤原因导致复发视网膜脱离患者的百分比,以及不同玻璃体状态下,患者视网膜脱离的位置范围与视网膜脱离发生率的差异。 结果术后复发视网膜脱离的患者中,因眼内异物致伤的患者有16例(16只眼),占20.8%;闭合性眼外伤患者有19例(19只眼),占24.7%;除眼内异物伤以外的开放性眼外伤患者有42例(42只眼),占54.5%。经卡方检验,三组患者的差异有统计学意义(χ²＝10.37,P<0.05);进一步两两比较,闭合性眼外伤组患者和开放性眼外伤组患者与眼内异物伤组患者的差异有统计学意义(χ²＝9.80,7.01;P<0.05);闭合性眼外伤组与开放性眼外伤组的差异无统计学意义(χ²＝0.90,P>0.05)。患者复发视网膜脱离前的手术次数为1~6次,平均(2.4±0.9)次。视网膜脱离复发发生在前次手术后3个月内的有44例(44只眼),占57.1%;视网膜脱离复发发生在前次手术后12个月以上的有5例(5只眼),占6.5%。视网膜脱离复发前,行玻璃体手术的有72例(72只眼),占93.5%;行巩膜外加压术的有5例(5只眼),占6.5%。所有患者中,眼内硅油存留的有49例(49只眼),占63.6%;眼内房水填充的有24例(24只眼),占31.2%;下方视网膜再脱离的患者有34例(34只眼),占44.2%;视网膜全脱离的患者有26例(26只眼),占33.8%。硅油填充眼的患者中,视网膜全脱离的有13例(13只眼),占26.5%;下方视网膜脱离的有27例(27只眼),占55.1%。房水填充眼的患者中,视网膜全脱离的有13例(13只眼),54.2%;下方视网膜脱离的有6例(6只眼),占25.0%。经卡方检验,差异有统计学意义(χ²＝5.37,5.90;P<0.05)。硅油填充眼的患者中,鼻侧视网膜脱离的有4例(4只眼),占8.2%;房水填充眼的患者中,鼻侧视网膜脱离的有1例(1只眼),占4.2%;玻璃体无填充的患者中,鼻侧视网膜脱离的有2例(2只眼),占50.0%。经卡方检验,差异有统计学意义(χ²＝8.85,P<0.05)。所有患者中,视网膜前或视网膜下存在增生膜的有71例(71只眼),占92.2%。行再次手术的患者有74例(74只眼),占96.1%。其中,行玻璃体手术的有71例(71只眼),占96.0%;行硅油填充术的有67例(67只眼),占94.4%。术后3~24个月的随访结果显示,再次手术的患者中,视网膜复位的有35例(35只眼),占47.3%;行硅油填充术的患者中,硅油未取出的有26例(26只眼),占38.8%。 结论外伤性复发性视网膜脱离的主要原因为增生性玻璃体视网膜病变,玻璃体切除联合硅油填充术是主要的治疗方法,但患者预后不佳。     

眼调节对葡萄膜巩膜房水外流途径影响的形态学观察

目的　通过形态学观察探讨眼调节对葡萄膜巩膜房水外流途径的影响。方法　14只健康日本大耳白兔,10只（20眼）用于荧光显微镜观察,4只（8眼）用于光镜观察,按用药方法不同各分为调节状态组和非调节状态组。所有白兔双眼分别采用5 g·L^-1硝酸毛果芸香碱滴眼液和10 g·L^-1盐酸环喷托酯滴眼液模拟眼调节态和非调节态,测量滴眼前及末次滴眼后30 min的眼压,于滴眼后30 min将5 μL异硫氰酸荧光素标记牛血清白蛋白（FITC-BSA）注入前房,于前房注射后0.5 h、1.5 h、2.5 h、3.5 h、4.5 h各处死2只白兔,摘取双眼作冰冻切片,于荧光显微镜下观察调节态和非调节态葡萄膜巩膜途径的房水荧光强度及其分布形态;于滴眼后30 min处死4只白兔,摘取双眼通过HE染色和抗平滑肌抗体染色在普通光镜下观察兔眼睫状肌形态、肌间隙。结果　调节状态组基线眼压（19.13±1.75）mmHg（1 kPa=7.5 mmHg),毛果芸香碱模拟眼调节后眼压下降,滴眼后眼压为（16.56±1.67）mmHg,差异有统计学意义（t=9.37,P=0.00)。调节状态组睫状体、脉络膜上腔和前巩膜荧光强度较非调节状态组均显著减弱（均为P<0.05）,而两组间后巩膜、脉络膜差异均无统计学意义（均为P＞0.05）。光镜观察见非调节状态组放射肌区域有明显肌间隙,而在调节状态组未发现此间隙。结论　眼调节可通过收缩睫状肌从而减少房水从葡萄膜巩膜房水外流道排出。     

Delivery of fluorescein to the anterior chamber using the corneal collagen shield

Collagen corneal shields show promise as an alternative method of drug delivery to the eye. The authors quantified collagen shield delivery of sodium fluorescein to the aqueous humor in human volunteers using fluorophotometry. Collagen shields that had been immersed in 0.01% sodium fluorescein were applied to eyes of human volunteers. The shields delivered significantly more fluorescein to the aqueous humor at 2 and 4 hours compared with drops of the same concentration instilled every 30 minutes for 4 hours (P less than 0.0001 and P = 0.0003, respectively) or daily wear soft contact lenses presoaked in 0.01% fluorescein (P less than 0.0001 and P less than 0.0025, respectively). Collagen shields did not induce damage to the corneal epithelium over a 2-hour wearing period. These results suggest that the collagen shield may be superior to topical drops in delivering water-soluble compounds to the cornea and aqueous humor.     

低分子肝素下调房水bFGF含量抑制晶状体囊外摘除术后前房炎症

目的:观察房水中碱性成纤维细胞生长因子(basic fi-bro blast growth factor,bFGF)含量的变化,探讨低分子肝素(low molecular weight heparin,LMWH)抑制晶状体摘除术后前房炎症的机制。方法:家兔84只随机分为对照组和实验组,每组42只,行单眼透明晶状体囊外摘除术。实验组手术结束时用浓度为50kU/L的LMWH进行前房灌注。分别于术后1,3,6,15,30,45,60d每组各取6只家兔,裂隙灯显微镜下对角膜水肿、房水混浊及前房纤维蛋白渗出的程度进行观察和分级,然后处死动物,抽取房水用Elisa法测定bFGF的含量。另选6只健康家兔测定前房bFGF含量作为基线值。结果:术后1～6d,实验组角膜水肿、房水混浊及前房纤维蛋白渗出的程度明显轻于对照组(P<0.01),15d后两组比较无差异。术后实验组和对照组房水bFGF含量同时升高,实验组1d达峰值,而对照组6d达峰值;达峰值后两组bFGF含量均缓慢下降。术后1～30d对照组bFGF含量明显高于实验组(P<0.05),45d后两组比较无显著性差异。结论:应用浓度为50kU/L的LMWH前房灌注能显著降低兔眼晶状体囊外摘除术后前房炎症反应,其机制可能与房水中bFGF含量下调有关。     

LMWH inhibits anterior chamber inflammation after extra capsular lens extraction through down regulation of bFGF content in aqueous humor

AIM: To observe the changes of basic fibroblast growth factor (bFGF) content in anterior chamber before and after extra capsular lens extraction for investigating the mechanism of low molecular weight heparin (LMWH) inhibiting anterior chamber inflammation. METHODS: Eighty-four rabbits were randomly divided into control and experimental group, 42 rabbits in each group. Extra capsular lens extraction was done on unilateral eye in each rabbit. LMWH was perfused into anterior chamber by the concentration of 50U/mL at the end of operation in experimental group. The degrees of corneal edema, aqueous flare and fibrin were evaluated with slit lamp microscope on postoperative day 1, 3, 6, 15, 30, 45 and 60, respectively. Six eyes of each group were at each time point. Contents of bFGF in aqueous humor were determined by ELISA after animals were killed. Another six eyes were used for determining the base line level of bFGF in aqueous humor. RESULTS: The degrees of corneal edema, aqueous flare and fibrin in experimental group were significantly lighter than those in control group (P<0.01) on postoperative day 1, 3 and 6, respectively. No difference was showed between the two groups at other point time. Contents of bFGF in aqueous humor increased at the same time. bFGF content reached peak on postoperative day 1 in experimental group, while on postoperative day 6 in control group. Contents of bFGF in the two groups declined slowly after reaching peak. The bFGF content in control group were significantly higher than that in experimental group 1-30 days after surgery (P<0.05). No significant differences were shown between the two groups on postoperative day 45 and 60, respectively. CONCLUSION: Perfusion with LMWH by the concentration of 50U/mL can significantly reduce anterior chamber inflammation after extra capsular lens extraction in rabbits, which may be related to down regulation of bFGF content in aqueous humor.