基质金属蛋白酶抑制剂抑制兔晶状体后囊膜混浊的研究

目的 观察基质金属蛋白酶(MMP)抑制剂对兔晶状体后囊膜混浊的抑制作用和对眼内组织的毒性.方法 实验研究.选用新西兰白兔行超声乳化晶状体吸除术,用不同浓度的MMP抑制剂GM6001溶液(实验1组:100 μmol/L,实验2组:200 μmol/L,实验3组:500 μmol/L)和GM6001阴性对照液(500 μmol/L)进行术毕及术后隔日晶状体囊袋内灌注3次,观察术后第12周内后囊膜混浊情况,同时观察药物对眼前房反应、眼压、角膜内皮、虹膜、睫状体和视网膜的影响和毒性.采用四格表确切概率法分析使用GM6001后前房反应和对后囊膜混浊的抑制作用;采用单因素方差分析法分析GM6001对眼压的影响.结果 裂隙灯显微镜下观察,可见术后12周对照组后囊膜混浊明显,实验1组后囊膜混浊较对照组轻,实验2组和3组均无后囊膜混浊(P=0.007);病理学结果显示:对照组和实验1组后囊膜表面有多层排列紊乱的上皮细胞和成纤维细胞,而实验2组和3组后囊膜表面几乎无细胞生长;前房反应轻:用药2 d实验组和对照组兔眼前房闪光情况比较,差异无统计学意义(P=0.380);对眼压的影响:实验组与对照组用药2 d(F=0.642,P=0.597)、7 d(F=0.179,P=0.909)眼压比较,差异均无统计学意义;用药7 d,实验3组角膜内皮细胞呈规则的六边形,无变形脱落,与对照组眼角膜内皮细胞形态无明显差别;光镜观察发现对虹膜、睫状体和视网膜均无明显毒性.结论 MMP抑制剂可明显抑制兔眼超声乳化晶状体吸除术后晶状体后囊膜混浊的发生,对眼内组织无明显毒性,安全有效.

Abstract：

Objective To determine whether matrix metalloproteinase (MMP) inhibitor can provide therapeutic effects for rabbits posterior capsule opacification in vivo and to observe the side effects of this drug on surrounding intraocular structures. Methods Experimental research. New Zealand white rabbits were undertaken phacoemulsification operation. GM6001 at different concentrations ( 100,200 and 500 μmol/L)and GM6001 negative control liqueur were infused into the capsule bags of the rabbits at the end of operation and two days after the operation. The incidence of posterior capsule opacification was assessed and the histological sections of posterior capsules were observed under microscope 12 weeks after the surgery. The anterior chamber response was observed on day 2 post-operatively. The changes of intraocular pressure were measured by day 2 and day 7. Corneal endothelial cells were observed under scanning electron microscopeand iris, ciliary body and retina were observed under microscope on day 7. Results GM6001 significantly prevented posterior capsule opacification (P=0. 007 ). No opacification occurred on the rabbit posterior capsule in eyes with 200 and 500μmol/L GM6001 on week 12 post-operatively in vivo. No cells were found on posterior capsule in 500 μmol/L group, whereas lens epithelial cells and fibroblasts were found in the controls under microscope. No difference of anterior chamber flare between the eyes with GM6001 at different concentrations and the control group (P=0. 380) by day 2 after the operation. The intraocular pressure in eyes with GM6001 was the same as that in the control 2-days ( F = 0. 642, P = 0. 597 ) and 7-days ( F =0. 179 ,P =0. 909) post-operation. The corneal endothelial cells in eyes with 500 μ mol/L GM6001 arranged regularly and did not show any difference from that in the control eyes under scanning electron microscope 7-day after the operation. The iris, ciliary body and retina in eyes with 500 μmol/L GM6001 were normal in appearance 7-day after the operation. Conclusions MMP inhibitor can prevent posterior capsule opacification effectively in rabbits in vivo and does not cause damage to surrounding intraocular structures,suggesting that MMP inhibitor may become a medication used for the prevention of lens posterior capsule opacification.     

基质金属蛋白酶抑制剂抑制兔晶状体后囊膜混浊的研究

Objective To determine whether matrix metalloproteinase (MMP) inhibitor can provide therapeutic effects for rabbits posterior capsule opacification in vivo and to observe the side effects of this drug on surrounding intraocular structures. Methods Experimental research. New Zealand white rabbits were undertaken phacoemulsification operation. GM6001 at different concentrations ( 100,200 and 500 μmol/L)and GM6001 negative control liqueur were infused into the capsule bags of the rabbits at the end of operation and two days after the operation. The incidence of posterior capsule opacification was assessed and the histological sections of posterior capsules were observed under microscope 12 weeks after the surgery. The anterior chamber response was observed on day 2 post-operatively. The changes of intraocular pressure were measured by day 2 and day 7. Corneal endothelial cells were observed under scanning electron microscopeand iris, ciliary body and retina were observed under microscope on day 7. Results GM6001 significantly prevented posterior capsule opacification (P=0. 007 ). No opacification occurred on the rabbit posterior capsule in eyes with 200 and 500μmol/L GM6001 on week 12 post-operatively in vivo. No cells were found on posterior capsule in 500 μmol/L group, whereas lens epithelial cells and fibroblasts were found in the controls under microscope. No difference of anterior chamber flare between the eyes with GM6001 at different concentrations and the control group (P=0. 380) by day 2 after the operation. The intraocular pressure in eyes with GM6001 was the same as that in the control 2-days ( F = 0. 642, P = 0. 597 ) and 7-days ( F =0. 179 ,P =0. 909) post-operation. The corneal endothelial cells in eyes with 500 μ mol/L GM6001 arranged regularly and did not show any difference from that in the control eyes under scanning electron microscope 7-day after the operation. The iris, ciliary body and retina in eyes with 500 μmol/L GM6001 were normal in appearance 7-day after the operation. Conclusions MMP inhibitor can prevent posterior capsule opacification effectively in rabbits in vivo and does not cause damage to surrounding intraocular structures,suggesting that MMP inhibitor may become a medication used for the prevention of lens posterior capsule opacification.     

基质金属蛋白酶抑制剂抑制兔晶状体后囊膜混浊的研究

Objective To determine whether matrix metalloproteinase (MMP) inhibitor can provide therapeutic effects for rabbits posterior capsule opacification in vivo and to observe the side effects of this drug on surrounding intraocular structures. Methods Experimental research. New Zealand white rabbits were undertaken phacoemulsification operation. GM6001 at different concentrations ( 100,200 and 500 μmol/L)and GM6001 negative control liqueur were infused into the capsule bags of the rabbits at the end of operation and two days after the operation. The incidence of posterior capsule opacification was assessed and the histological sections of posterior capsules were observed under microscope 12 weeks after the surgery. The anterior chamber response was observed on day 2 post-operatively. The changes of intraocular pressure were measured by day 2 and day 7. Corneal endothelial cells were observed under scanning electron microscopeand iris, ciliary body and retina were observed under microscope on day 7. Results GM6001 significantly prevented posterior capsule opacification (P=0. 007 ). No opacification occurred on the rabbit posterior capsule in eyes with 200 and 500μmol/L GM6001 on week 12 post-operatively in vivo. No cells were found on posterior capsule in 500 μmol/L group, whereas lens epithelial cells and fibroblasts were found in the controls under microscope. No difference of anterior chamber flare between the eyes with GM6001 at different concentrations and the control group (P=0. 380) by day 2 after the operation. The intraocular pressure in eyes with GM6001 was the same as that in the control 2-days ( F = 0. 642, P = 0. 597 ) and 7-days ( F =0. 179 ,P =0. 909) post-operation. The corneal endothelial cells in eyes with 500 μ mol/L GM6001 arranged regularly and did not show any difference from that in the control eyes under scanning electron microscope 7-day after the operation. The iris, ciliary body and retina in eyes with 500 μmol/L GM6001 were normal in appearance 7-day after the operation. Conclusions MMP inhibitor can prevent posterior capsule opacification effectively in rabbits in vivo and does not cause damage to surrounding intraocular structures,suggesting that MMP inhibitor may become a medication used for the prevention of lens posterior capsule opacification.     

基质金属蛋白酶及其抑制剂与角膜

基质金属蛋白酶（ＭＭＰｓ）是降解细胞外基质成分的主要酶簇,其活性及过度表达与多种角膜疾病有关。本文综述了ＭＭＰｓ的分类、特性、各种角膜疾病中的表达,以及表达与活性调节机制,并总结了各种抑制剂在体内及体外对ＭＭＰｓ的抑制效果。     

基质金属蛋白酶抑制剂治疗角膜新生血管的实验研究

目的：观察人工合成基质金属蛋白酶抑制剂点眼对角膜新生血管的影响。方法：15只新西兰白兔双眼角膜植入脂多糖-醋酸乙烯聚合膜造成角膜新生血管模型后,治疗眼点基质金属蛋白酶抑制剂GM6001,对照眼点HEPES缓冲液,连续用药14日,处死动物摘下角膜做光、电镜观察。结果：GM6001点眼显著地抑制角膜新生血管的生长并减轻角膜的炎症反应。组织病理学检查显示新生血管化的角膜实质内有大量炎性白细胞浸润。结论：提示局部应用人工合成基质金属蛋白酶抑制剂对角膜新生血管有一定疗效,但治疗机制有待进一步研究。     

基质金属蛋白酶抑制剂在角膜疾病中的应用

基质金属蛋白酶是一类锌依赖性内肽酶,它能特异性降解细胞外基质和基底膜,导致角膜结构的破坏,而其抑制剂可以抑制其活性。近期研究较多的基质金属蛋白酶抑制剂有四环素类抗生素、组织金属基质蛋白酶抑制剂、合成的基质金属蛋白酶抑制剂、转化生长因子-β等。     

羊膜移植治疗急性角膜碱烧伤的实验研究--基质金属蛋白酶及其抑制剂表达的测定

目的 探讨新鲜羊膜移植术在早期角膜碱烧伤治疗中的作用机制。方法36只新西兰大白兔制作角膜碱烧伤模型，分为新鲜羊膜移植组、保存羊膜移植组和对照组。术后每日观察新生血管生长情况，并于术后7天、14天应用计算机图像分析系统对角膜表达基质金属蛋白酶(MMPs)和基质金属蛋白酶抑制剂-1(TIMP-1)进行半定量测定。结果术后新鲜羊膜移植组角膜新生血管发展缓慢，MMFs角膜表达降低而TIMP-1表达升高。结论羊膜移植可通过提高角膜表达基质金属蛋白酶抑制剂-1的水平来抑制基质金属蛋白酶的活性，从而在早期角膜碱烧伤的治疗中起抑制角膜溃疡和新生血管形成的作用，且这一作用新鲜羊膜要明显优于保存羊膜。     

基质金属蛋白酶抑制剂GM-6001对大鼠角膜碱烧伤后新生血管的抑制作用

目的:研究基质金属蛋白酶抑制剂GM-6001对大鼠角膜碱性烧伤后角膜新生血管的抑制作用。方法:取健康成年Wistar大鼠20只,随机分成实验组和对照组,每组10只。两组均建立大鼠角膜碱性烧伤模型。实验组滴用GM-6001滴眼液、氧氟沙星滴眼液和硫酸软骨素滴眼液;对照组滴用氧氟沙星滴眼液和硫酸软骨素滴眼液;各种滴眼液每日点眼4次,共7d。裂隙灯下观察角膜溃疡和角膜新生血管生长情况。结果:碱烧伤后实验组和对照组出现新生血管的时间无显著差异(P>0.05)。新生血管的生长长度与生长面积,在伤后1d和3d,实验组和对照组无显著差异(P>0.05);在伤后5d和7d,实验组和对照组有显著差异(P<0.05)。结论:基质金属蛋白酶抑制剂GM-6001点眼对角膜新生血管的生长有抑制作用。     

基质金属蛋白酶与角膜新生血管

基质金属蛋白酶是一族锌离子依赖性内源性蛋白水解酶，以水解细胞外基质为主要功能，在角膜新生血管生成的过程中发挥着举足轻重的作用。近年来对基质金属蛋白酶的研究逐渐受到重视，而对基质金属蛋白酶活性表达的干扰更为角膜新生血管的治疗提供了一个有着广阔前景的途径。现对基质金属蛋白酶家族及其作用机制、调节做一综述。     

羊膜移植对大鼠角膜碱烧伤后基质金属蛋白酶的影响

目的探讨羊膜移植对大鼠角膜中度碱烧伤后角膜上皮细胞和基质成纤维细胞中基质金属蛋白酶(matrix metalloproteinase，MMP)变化的影响。方法将12只SD大鼠随机分成2组，每组6只，分别作为碱烧伤后1d组和14d组。在2组中，所有大鼠角膜建立中度碱烧伤模型，左眼行羊膜移植，右眼作为对照。应用免疫组化法，分别观察碱烧伤后1d和14d实验组与对照组中MMP-9和MMP-2表达的变化。结果碱烧伤后1d，实验组与对照组中，角膜上皮细胞内的MMP-9和MMP-2的表达与正常角膜上皮细胞内的MMP-9和MMP-2的表达相比明显升高，但两组间的表达差异无显著性；而2组成纤维细胞内的MMP-9和MMP-2的表达与正常成纤维细胞内的MMP-9和MMP-2的表达相比明显升高，两组间的表达差异无显著性。碱烧伤后14d，2组中角膜上皮细胞内的MMP-9和MMP-2的表达与碱烧伤后1d情况相似，两组间的表达差异无显著性；2组成纤维细胞内的MMP-9和MMP-2的表达与碱烧伤后1d组相比明显升高，并且实验组中的MMP-9和MMP-2的表达与对照组相比也有明显升高。结论碱烧伤后大鼠角膜上皮细胞和基质成纤维细胞中的MMP-9和MMP-2的表达都有升高。羊膜移植能增强MMP-9和MMP-2在成纤维细胞中的表达，提示羊膜在加快角膜碱烧伤后的重塑中起一定作用。     

Experimental study on the treatment of rabbit corneal melting after alkali burn with Collagen cross-linking

AIM: To evaluate the effect of Collagen cross-linking on the prevention of melting in rabbit corneas after alkali burn. METHODS: Twenty New Zealand white rabbits were randomly divided into model control group and collagen cross-linking treatment group. The second group of rabbits received collagen cross linked treatment. Both groups were applied with antibiotic eye drops to prevent infection. The corneas were evaluated for melting, opacity, pathological and immunohistochemistry, record the changes when 28 days after the animals were killed. RESULTS: In the control group, 6 out of 8 rabbits showed corneal melting after injury (14±4) days, while two corneal perforated. In collagen cross-linking treatment group, one rabbit showed corneal melting after injury 23 days, without corneal perforation; corneal dissolution rate between the two groups was significantly different (P <0.05). Pathological examination suggested that in the treatment group, mild corneal edema, mild damage to collagen fibers, inflammatory cell infiltration was significantly less than the control group. Immunohistochemistry showed that corneal collagen fibers arranged in neat rows in the control group. CONCLUSION: Collagen cross-linking treatment not only can prevent and delay the corneal melting after alkali burn, but also can reduce the destruction of corneal collagen fibers and infiltration of inflammatory cells in the corneal tissue.     

碱烧伤后角膜新生淋巴管与炎症反应指数间的关联

目的 探讨角膜碱烧伤后的角膜新生淋巴管与炎症反应指数间的关联.方法 实验研究.制备大鼠角膜碱烧伤模型.采用5'核苷酸酶-碱性磷酸酶(5'-NA-ALP)双重酶组织化学染色及全角膜免疫荧光法分别检测碱烧伤后1、3 d,1、2、3、4、5、6、7及8周的角膜新生淋巴管和血管的动态变化,并进行淋巴管计数(LVC)和血管计数(BVC).同时,于裂隙灯显微镜下观察角膜炎症反应的变化,记录炎症反应指数(IF),并比较LVC和IF之间的关联.11例人角膜取自碱烧伤后行角膜移植的11例患者.淋巴管内皮细胞受体(LYVE-1)免疫组织化学染色法标记人角膜中的新生淋巴管,LVC和IF之间的关联运用Pearson's相关分析,采用配对t检验比较角膜中存在淋巴管和不存在淋巴管的患者之间IF、炎性细胞计数、碱烧伤病史、年龄的差异.结果 碱烧伤后,角膜基质层存在着新生淋巴管.碱烧伤后3 d时出现角膜新生淋巴管,2周末达到高峰,5周末消退.新生淋巴管的出现滞后于炎症反应,但先于炎症反应和新生血管而消退.LVC与IF之间呈正相关(r=0.572,P＜0.01).11例患者中3例存在着角膜新生淋巴管.与另8例角膜中无新生淋巴管的患者相比,前者IF显著性升高(t=3.28,P＜0.05)、炎性细胞计数显著性增加(t=2.42,P＜0.05),年龄显著性下降(t=2.62,P＜0.05),而碱烧伤病史无显著性差异(t=1.28,P＞0.05).结论 角膜碱烧伤后有淋巴管生成,角膜新生淋巴管和炎症反应指数之间存在着密切的关联.     

GM6001对兔LASEK术后角膜上皮下雾状混浊形成的影响

背景近年来基质金属蛋白酶（MMPs）在准分子激光术后创伤修复过程中的作用越来越受到学者们的关注。目的探讨MMPs抑制剂GM6001对兔准分子激光角膜上皮下磨镶术（LASEK）术后角膜上皮下雾状混浊（haze）形成的影响。方法27只新西兰白兔双眼行一10．00D激光切削的LASEK,手术后动物被随机分为GM6001组、氟米龙组和阴性对照组,术后分别用150Ixmol／L的GM6001滴眼液、质量分数0．1％氟米龙和氧氟沙星滴眼液点眼。每天在裂隙灯下对兔LASEK术后角膜上皮下haze进行观察和分级。分别于术后2、4、8周各组随机选取6只眼行角膜共焦显微镜检查,制备角膜组织切片行组织病理学检查,在透射电子显微镜下行角膜组织的超微结构检查。结果LASEK术后2周和4周,阴性对照组haze分级较高的眼数多于GM6001组和氟米龙组,差异均有统计学意义（P〈0．05）,GM6001组和氟米龙组haze分级水平均明显低于阴性对照组（P〈0．01）,但GM6001组和氟米龙组相比,差异无统计学意义（P〉0．05）;术后8周组3个组间haze分级的总体比较差异无统计学意义（P〉0．05）。术后2、4、8周GM6001组术区前部基质内角膜成纤维细胞数均较对照组和氟米龙组减少,差异均有统计学意义（P〈0．05）,各时间点对照组和氟米龙组差异无统计学意义（P〉0．05）。LASEK术后GM6001组和氟米龙组兔角膜上皮细胞的形态改变、胶原纤维排列的紊乱情况均轻于阴性对照组。结论GM6001通过抑制LASEK术后MMPs对角膜基质的降解,从而抑制角膜基质成纤维细胞的增生及胶原纤维的合成,减少haze的形成,其疗效与氟米龙相似。     

板层角膜移植时间对角膜碱烧伤后血清特异性抗体的影响

目的 通过动物角膜碱烧伤模型,观察烧伤后不同时期和烧伤后不同时间行板层角膜移植手术的新西兰白兔血清特异性抗体水平与组织病理的变化。方法 新西兰白兔20只,制作单侧眼角膜中央部中度碱烧伤模型并完全随机分为5组：烧伤组、早期移植组两组(即3d移植组、7d移植组)、中晚期移植组两组(即2周移植组、5周移植组)。制备正常及碱烧伤角膜蛋白提取液,用酶联免疫吸附试验(ELISA)检测每组兔不同时期血清抗角膜变性蛋白抗体水平,并取不同时期的角膜做光镜、电镜观察。结果 角膜碱烧伤后机体产生特异性抗体,2周时升高明显,5～6周达高峰,之后下降,8周时再次烧伤对侧眼角膜,抗体生成明显。早期移植组抗体升高不显著,而中晚期移植组抗体变化趋势与烧伤组基本相似。光、电镜结果显示：移植组与烧伤组比较,上皮愈合好,基质纤维排列整齐,炎细胞浸润轻,新生血管少;早期移植组比晚期移植组恢复更好。结论 早期板层角膜移植治疗角膜碱烧伤可阻断机体针对碱烧伤后角膜变性蛋白的体液免疫反应过程。     

缺氧诱导因子1α在碱烧伤后兔角膜新生血管形成中的作用

目的 观察碱烧伤后兔角膜新生血管形成的不同时期缺氧诱导因子1α(HIF-1α)在角膜内的表达,探讨HIF-1α对角膜新生血管形成的影响.方法 实验研究.取30只健康家兔,采用随机数字表法分成5组,每组各6只兔,右眼采用1 mol/L氢氧化钠溶液建立角膜碱烧伤模型,左眼作为自身对照.分别于碱烧伤前和碱烧伤后1、3、5、7、14 d,在裂隙灯显微镜下观察家兔角膜新生血管增生情况,HE染色观察角膜组织病理学特征,并采用免疫组织化学法检验角膜组织中HIF-1α的表达,计算炎性细胞(多形核白细胞和淋巴细胞)和HIF-1α阳性细胞核数,对其结果行单因素方差分析及相关分析.结果 角膜碱烧伤后,HIF-1α主要表达在角膜基质中的炎性细胞、血管内皮细胞的细胞核中.随着时间的增加,炎性细胞表达增强,HIF-1α表达量也相应增加,并于碱烧伤后5 d达到高峰,以后逐渐减少.碱烧伤后1、3、5、7、14 d,角膜组织中炎性细胞和HIF-1α表达水平的差异均有统计学意义(F=422.086,437.555;P均＜0.05),且HIF-1α的表达与新生血管的形成在时空上一致.经相关分析,角膜中炎性细胞和HIF-1α阳性细胞表达呈正相关(r=0.860,P＜0.05).结论 碱烧伤后炎症反应能诱导HIF-1α的表达,而HIF-1α能促进角膜新生血管的形成.     

GM6001对碱烧伤角膜组织中基质金属蛋白酶表达及活性的影响

目的 检测正常和碱烧伤后不同时间角膜组织中明胶酶(MMP-2，MMP-9)和胶原酶(MMP-1)的表达，探讨在角膜融解发生中的作用．方法 兔角膜碱烧伤20眼，分为对照组和GM600l治疗组，于伤后12、24、48、72h，1、2周和1个月取材，酶谱法检测角膜组织中明胶酶MMP-2、MMP-9的表达，Western blot检测胶原酶MMP-1的表达。结果 在正常兔角膜中，仅检测到微弱的明胶酶原MMP-2，碱烧伤后1周后开始明显升高，至烧伤后1个月维持较高水平，并在2周时出现MMP-2活性酶的表达，并持续至烧伤后1个月。明胶酶MMP-9在正常角膜组织中检测不到，但烧伤后24h开始表达，于烧伤后1周达到最高，然后逐渐下降，至伤后1个月已检测不到。胶原酶MMP-1在正常组织中检测为阴性，从伤后24h开始升高，1个月内无下降。GM6001治疗组角膜组织MMP-2、MMP-9及MMP-1的表达均明显低于对照组。结论 基质金属蛋白酶参与碱烧伤角膜组织的融解，GM6001可抑制MMPs的活性，进而抑制角膜融解的发生。     

碱烧伤后角膜新生淋巴管的实验研究

目的动态检测大鼠角膜碱烧伤后的角膜新生淋巴管和血管的变化,并阐明二者之间的关联。方法制备大鼠角膜碱烧伤模型,于碱烧伤后1周、2周行角膜组织电镜检查,检测角膜新生淋巴管与新生血管。5’核苷酸酶-碱性磷酸酶(5’-nase-alkaline phos-phatase,5’-NA-ALP)双重酶组织化学染色及全角膜免疫荧光染色分别检测碱烧伤后6h、1d、3d、1周、2周、3周、4周、5周、6周、7周、8周的角膜新生淋巴管和新生血管的动态变化,并进行淋巴管计数(lymphatic vessels counting,LVC)和血管计数(blood vessels counting,BVC)比较。结果电镜观察结果:角膜碱烧伤后1周,角膜基质层出现新生血管,未见淋巴管;碱烧伤后2周,新生血管和新生淋巴管均出现。酶组织化学染色结果显示:碱烧伤后6h有新生血管,1周时角膜基质层存在新生淋巴管,2周时LVC和BVC均达到高峰,分别为(16.41±1.00)个和(50.40±1.56)个;以后逐渐下降,5周时LVC为(0.33±0.50)个,BVC为(12.52±2.51)个;8周时均为0。碱烧伤后,新生淋巴管和新生血管呈显著性正...     

人工角膜在治疗严重化学烧伤眼中的研究

目的探讨严重化学烧伤性角膜混浊患者行人工角膜植入术的临床效果和并发症等。方法选择2000年10月至2006年3月于解放军总医院眼科就治的28例因严重化学烧伤导致双眼盲目患者的单侧眼,术前视力14只眼为手动,14只眼为光感,并且角膜混浊病变无法采用常规角膜移植手术达到复明目的。其中严重碱烧伤20只眼,严重酸烧伤8只眼。人工角膜植入术分两期：Ⅰ期手术将人工角膜支架植入角膜层间,所选患眼行角膜表面或层间加固性手术。3个月后行Ⅱ期手术,植入带螺纹的人工角膜光学部。常规行晶状体、部分虹膜及前部玻璃体切除术,将外1／3上、下睑缘做永久性缝合。对完全睑球粘连者,用上、下睑皮肤覆盖角膜表面,仅暴露人工角膜光学部。结果Ⅱ期术后观察3—65个月,平均22．6个月,28只眼中有21只眼裸眼视力≥0．05（75％）,其中2只眼裸眼视力≥1．0。经镜片矫正后,11只眼（39％）视力为0．6—1．2;1只眼（4％）0．3～0．5;5只眼（18％）0．05—0．25;3只眼（11％）手动;3只眼（11％）光感;1只眼（4％）无光感。手术并发症包括分离角膜板层时穿人前房,晶状体皮质残留,继发性青光眼,镜柱前表面组织或上皮增生遮盖,镜柱后壁沉着物,角膜溶解,眼内炎,视网膜脱离。结论人工角膜是目前对严重角膜瘢痕、血管化的双眼化学烧伤患者有效的复明手段。该术式结合自体结膜遮盖、自体骨膜移植加固及睑裂部分缝合等,有利于人工角膜的长期存留。术后定期复查、积极预防并发症是保持视力的有效手段。     

角膜碱烧伤后VEGF与新生血管渗漏性的相关性实验研究

目的 研究大鼠角膜碱烧伤后新生血管渗透率的变化并探讨血管内皮细胞生长因子(vascular endothelial growth factor,VEGF)对渗透率的影响.方法 建立大鼠角膜碱烧伤模型,于术后1 d、2 d、3 d、5 d、7 d、10d伊文兰示踪法检测新生血管渗透率,PCR法检测角膜组织中VEGF-RNA的表达.以正常大鼠角膜作为对照.结果 正常及碱烧伤后1 d、2 d、3 d、5 d、7 d、10 d大鼠角膜新生血管渗透率依次为0 mg·L-1·mm-2(1.14±0.17)mg·L-1·mm-2,(0.24±0.08)mg·L-1·mm-2,(0.29±0.16)mg·L-1·mm-2,(0.14±0.10)mg·L-1·mm-2,(0.09±0.06)mg·L-1·mm-2和(0.05±0.04)mg·L-1·mm-2;角膜组织中VEGF-RNA水平依次为(1.09±0.31)×106拷贝·μg-1总RNA,(7.01±1.99)×106拷贝·μg-1总RNA,(1.01±0.59)×106拷贝·μg-1总RNA,(2.43±0.43)×106拷贝·μg-1总RNA,(0.99±1.31)×106拷贝·μg-1总RNA,(0.95±0.03)×106拷贝·μg-1总RNA和(0.17±0.15)×106拷贝·μg-1总RNA,其中7 d和10 d的VEGF-RNA低于正常水平(P7=0.011,P10=0.006).经Pearson相关分析,新生血管渗透率和VEGF-RNA水平呈正相关改变(r=0.866,P＜0.01).结论 VEGF在新生血管渗漏的调节机制中起着重要作用;大鼠角膜碱烧伤后期,新生血管渗漏性增高难以应用VEGF机制进行解释的现象,提示可能存在其他的新生血管渗漏调节机制.[眼科新进展 2009;29(1):18-20]