白内障术后后囊膜混浊的基因治疗进展

基因治疗作为阻止晶状体后囊膜混浊的一种全新的治疗方法日益受到关注,本文从自杀基因、细胞周期基因、凋亡基因等方面就后囊膜混浊的基因治疗研究进展进行综述。     

眼内应用丝裂霉素C抑制后囊膜混浊的组织病理学研究

目的：研究兔晶状体超声乳化术中眼内应用0．2mg／ml的丝裂霉素C(mitomycin-C，MMC)对术后后囊膜混浊的抑制作用，并比较不同给药方式对眼毒性的差异。方法：将32只新西兰白化兔随机分为A、B、C、D4组，进行晶状体超声乳化摘除术。A组为空白对照组，B组用0．2mg／ml的MMC溶液在环形撕囊后作水分离，C组在术中将混有MMC(0．2mg／ml)的粘弹剂注入空的囊袋中，D组将MMC(0．2mg／ml)溶于配好的灌注液中，在手术中应用。术后1个月对术眼进行组织病理学检查。结果：术后1个月时光镜下A组中赤道部及中央后囊膜均可见晶状体上皮细胞的明显增生、移行及大量排列紊乱的成纤维细胞和胶原纤维。B、C、D三组中可见赤道部少量残留的晶状体上皮细胞及皮质，中央后囊的表面未见品状体上皮细胞、成纤维细胞或珍珠样小体。透射电镜下，D组中虹膜上皮、睫状体上皮及视网膜各层均发生了不同程度超微结构的损伤，A、B、C三组间未见明显异常。结论：眼内应用0．2mg／ml的MMC明显抑制后囊膜混浊的发展。尽管眼内应用0．2mg／ml的MMC可以导致眼内组织的毒性，但通过改进用药方法和加强保护措施，可有效地避免或减少药物的眼毒性。在应用于临床之前，仍需进一步动物实验研究。     

外伤性白内障防止术后后囊浑浊的研究--二次撕囊联合后囊撕囊的效果分析

目的 评价二次撕囊联合后囊撕囊手术防止外伤性白内障术后后囊浑浊的效果。方法 将在外伤性白内障手术过程中行二次撕囊联合后囊撕囊的62例（62眼）定为观察组；随机抽取62例（62眼）在手术过程中未行二次撕囊联合后囊撕囊的定为对照组。将两组在术后随访过程中观察记录的晶状体后囊中央部浑浊程度进行统计学分析。结果 术后随访发现在两组后囊中央部浑浊同级别比较中，观察组：对照组：0级者为37：8（x^2=29．334，P〈0．01），1级者为17：30（x^2=5．791，P=0．016），2级者为5：13（x^2=4．159，P=0．041），3级和4级者为3：11（x^2=5．153，P=0．023），观察组后囊无浑浊的例数明显增多，各级后囊浑浊例数均明显少于对照组。结论 二次撕囊联合后囊撕嵌在外伤性白内障手术中应用，晶状体后囊中央部浑浊程度在一定时间内明显减轻。     

Pharmacological attempts to reduce posterior capsule opacification after cataract surgery – a review

Reduction of posterior capsule opacification (PCO) after cataract surgery has been achieved since the general acceptance of posterior chamber intraocular lens implantation 30 years ago. Attention to surgical technique on the one hand and changes in lens design and materials on the other have synergistically reduced the incidence of PCO to less than 5% at 5 years. But lens epithelial cells still proliferate and pharmacological prevention has been largely unsuccessful so far. Any agent must be toxic to these lens epithelial cells without being toxic to the corneal endothelium. This review looks at many substances that have been tried and a few that have been partly successful without yet entering clinical practice. Possibilities for future clinical research are canvassed.     

白内障术后后囊膜混浊的发生因素

晶状体后囊膜混浊是白内障摘除联合后房型人工晶状体植入术后最常见的并发症,其发生率与人工晶状体的材料、镜片的式样,手术技术等因素均有关。新型的亲水丙烯酸和疏水丙烯酸AcrysofTM人工晶状体由于材料有良好的生物相容性及粘附性能,从而降低了后囊膜混浊的发生率。后凸型的人工晶状体、矩形锐利直角的光学边缘的人工晶状体、小切口白内障超声乳化摘除术、连续环形撕囊可以减少后囊膜混浊的发生率。     

曲安奈德抑制糖尿病白内障后囊混浊的研究

目的:研究曲安奈德预防糖尿病性白内障术后后囊膜混浊的疗效和安全性。方法:收集2007-03/2011-09在我院行白内障超声乳化+人工晶状体植入术的糖尿病患者173例296眼随机分为3组。A组（102眼）使用平衡盐液进行水分离,B组（93眼）使用稀释的曲安奈德液进行水分离,C组（101眼）使用稀释的曲安奈德液进行水分离联合前房冲洗。分别于术后1wk;1,3,6,12mo观察患者最佳矫正视力、晶状体后囊膜混浊（posterior capsular opacity,PCO）分级情况。结果:术后1wk时A组与B,C组,最佳矫正视力之间的差异有统计学意义（P＜0.05）。其余各时间点A,B,C组之间的差异无统计学意义（P>0.05）。术后A组与B,C组PCO分级差异有统计学意义（P＜0.01）。结论:曲安奈德进行水分离联合前房冲洗能有效降低糖尿病性白内障术后后囊膜混浊的发生率,且眼内使用较为安全。     

Cyclosporin effectively inhibits posterior capsule opacification after phacoemulsification in rabbits: a preliminary study

Purpose: To evaluate whether cyclosporin A prevents or reduce posterior capsule opacification after phacoemulsification surgery in rabbit eyes. Methods: Twenty rabbits underwent cataract surgery in their right eyes were randomized into two groups. In group 1, 0.1 mL cyclosporin A (0.5 mg/mL) was given into the capsular bag after phacoemulsification and 0.1 mL cyclosporin A (0.5 mg/mL) was injected subconjunctivally once every 3 days for 1 week. Group 2 served as a control group. The development of posterior capsule opacification was assessed weekly, its density was graded clinically, and the proliferation of lens epithelial cells was evaluated histologically. Results: On clinical assessment, cyclosporin A was significantly effective in preventing posterior capsule opacification compared with controls (P = 0.0045). On histological analysis, there was significantly reduced proliferative activity on posterior capsules in the treatment group, in contrast to multilayer lens epithelial cells proliferation in the control group. Conclusion: The preliminary results indicate that cyclosporin A is effective in suppressing posterior capsule opacification in rabbits, yet requires further investigation.     

直角边缘囊袋张力环预防兔后囊膜混浊的实验研究

目的:探讨直角边缘囊袋张力环(capsule tension ring,CTR)预防兔后囊膜混浊(posterior capsule opacification,PCO)的作用。方法:新西兰兔20只随机分为两组,进行超声乳化晶状体摘除术后,实验组植入CTR和CraneOV-55C人工晶状体(intraocular lens,IOL),对照组只植入CraneOV-55CIOL。观察术后并发症和PCO情况。术后3mo行光镜和透射电镜检查,观察晶状体后囊膜的形态学变化。结果:术后3mo实验组和对照组都发生了明显的PCO(P>0.05),各组Soemmering环形成程度无统计学差异(P>0.05)。病理学检查发现,两组兔赤道部晶状体上皮细胞增生形成了巨大的Soemmering环,大量晶状体上皮细胞移行至后囊膜。结论:直角边缘CTR未能预防兔PCO的发生,有必要对其进一步改进。     

Square-edge polymethylmethacrylate intraocular lens design for reducing posterior capsule opacification following paediatric cataract surgery: initial experience

Purpose: To compare the incidence and severity of development of posterior capsule opacification (PCO) following implantation of square‐edged polymethylmethacrylate (PMMA) or hydrophobic acrylic intraocular lenses (IOLs) following paediatric cataract surgery. Design: Prospective, consecutive, interventional, comparative, randomized and cross‐sectional study of 40 eyes of 32 children aged between 4 and 12 years who underwent phacoemulsification and posterior chamber IOL implantation. Methods: The patients were randomized into two groups of 20 eyes each. Group 1 eyes received a square‐edge hydrophobic acrylic IOL (Acrysof SA 60 AT, Alcon Surgical, Fort Worth, Texas), and Group 2 eyes received a square‐edge single‐piece PMMA lens (Aurolab SQ 3600 Aurolab IOL Division, Madurai, India) in the capsular bag. No eye underwent a primary posterior capsulotomy. The PCO density was evaluated on slitlamp retroillumination photographs by using POCOman software at 3, 6, 9 and 12 months post surgery. Results: The average percentage PCO on POCOman analysis was 51.23 for Group 1 and 49.49 for Group 2 (P = 0.09), and the average PCO severity grade was 1.34 in Group 1 and 1.12 in Group 2 (P = 0.08). Visual axis remained clear in 14 of 20 eyes with the acrylic lens as compared with 13 of 20 eyes with the PMMA lens. (P = 0.32). Conclusions: Square‐edge PMMA IOLs offer a significant cost advantage over acrylic lenses at similar rates of PCO formation following paediatric cataract surgery, which is of significant value in developing countries.     

生长抑素8肽抑制后发性白内障的动物实验

目的 研究生长抑素8肽（SS－8肽）对兔后囊混浊的影响,探讨防治后囊混浊的药物。方法 选择新西兰大白兔29只,随机分为4组,对照组、SS－8肽10^-6mol/L组、10^-7mol/L组、10^-8mol/L组,均行常规的白内障囊外摘出联合后房型人工晶状体植入术,实验组灌注液中分别加入不同浓度的SS－8肽,术后随访3个月,观察后囊混浊、角膜内皮及切口愈合情况。结果 SS－8肽10^-6mol/L组、10^-7mol/L组与对照组相比,均能显著降低兔后囊混浊的发生率,对切口愈合无明显影响,可引起个别角膜内皮细胞增大。结论 SS－8肽可用于防治后囊混浊。     

人工晶状体的设计对后囊膜混浊的影响

后囊膜混浊是白内障囊外摘除术后最主要的并发症之一。后囊膜混浊的发生是多因素参与的结果,手术方式的改进、人工晶状体的改良、术后炎症反应的控制都可以减少后囊膜混浊的发生。本文就人工晶状体的设计对后囊膜混浊的影响作一综述。     

后发性白内障相关因素的临床研究

目的观察超声乳化白内障吸除联合折叠人工晶状体植入术后后发性白内障(posteriorcapsuleopacification,PCO)发生的相关因素及其特点。方法随访观察394例(440只眼)白内障患者超声乳化白内障吸除联合囊袋内折叠人工晶状体植入术后的视力,用内置数码摄像头Zeiss120裂隙灯进行眼底后反光裂隙照相,转化成数码图像输入计算机,观察人工晶状体位置、连续环形撕囊和后囊膜混浊等情况。随访时间2～58个月,平均14个月。按照晶状体类型共分为6组Sensar组113例(123只眼),Acrysof三片组129例(157只眼),Acrysof一片组79例(84只眼),SC60B组23例(26只眼),硅凝胶组50例(50只眼)。获得的照片使用德国EPCO2000软件分析,对PCO程度进行评分并将各组进行比较分析。结果完全没有PCO的有19只眼(占4.32%),存在PCO的有421只眼(占95.68%),PCO波及瞳孔中央3mm的有274只眼(占62.27%)。按人工晶状体光学面材料分组的两组中,对应PCO数值进行比较,总分差异无显著性(t=1.470,P=0.143);按照襻的成角分组的四组中,所对应的PCO数值中1级混浊的数值比较,差异有显著性(F=4.054,P=0.007);按边缘设计不同分组的两组中,对应PCO数值比较,总分差异有显著性(t=3.763,P=0.0001);根据连续环形撕囊分组的3组中,所对应的PCO数值比较,总分差异有显著性(F=3.689,P=0.026)。结论后囊膜混浊的发生与人工晶状体材料无相关性;襻与光学面成角为10°的人工晶状体对PCO的早期形成有抑制作用;直角边缘设计可以减少PCO的形成;连续环形撕囊口完全覆盖人工晶状体光学面抑制了后囊膜混浊的发生几率。     

胰蛋白酶复合黏弹剂对后发性白内障的预防作用

目的探讨胰蛋白酶复合黏弹剂预防后发性白内障（PCO）的有效性及安全性。方法将25只新西兰白兔50只眼平均分为5组,每组10只眼。所有实验眼均行白内障超声乳化手术,在晶状体囊袋内分别注入普通黏弹剂、质量分数0.5%胰蛋白酶复合黏弹剂＋血清复合黏弹剂、0.75%胰蛋白酶复合黏弹剂＋血清复合黏弹剂、1%胰蛋白酶复合黏弹剂＋血清复合黏弹剂或1%胰蛋白酶复合黏弹剂并在囊袋内保留3min。摘除实验眼并制备常规固定切片,行苏木精-伊红染色,光镜下观察各组兔晶状体上皮细胞（LECs）和角膜内皮细胞（CECs）的形态学变化。结果 LECs计数随着胰蛋白酶剂量的增加而逐渐减少,4个实验组LECs计数的差异有统计学意义（H=36.696,P=0.00）。1%胰蛋白酶复合黏弹剂＋血清复合黏弹剂组的CECs计数为（34.0±2.6）个,而1%胰蛋白酶复合黏弹剂组为（27.0±4.7）个,2组差异有统计学意义（Z=-3.792,P=0.00）。组织学检查表明,光学显微镜下普通黏弹剂组LECs结构和排列正常;0.5%胰蛋白酶复合黏弹剂＋血清复合黏弹剂组和0.75%胰蛋白酶复合黏弹剂＋血清复合黏弹剂组可见部分LECs脱落,眼内其他组织形态无明显异常;1%胰蛋白酶复合黏弹剂＋血清复合黏弹剂组LECs完全脱落,但CECs及眼内其他组织形态无明显异常;1%胰蛋白酶复合黏弹剂组LECs完全脱落,伴有CECs的小片状脱落。结论白内障术中运用1%胰蛋白酶复合黏弹剂配合血清复合黏弹剂能安全有效地去除LECs,为PCO的预防提供了一个新的治疗途径。     

柔红霉素预防后囊膜混浊的临床研究

目的　观察柔红霉素预防后囊膜混浊的临床效果。方法　对62只患白内障眼行白内障囊外摘出术及白内障囊外摘出并后房型人工晶状体植入术,分为实验组和对照组,实验组28眼,术中前房灌注液加入柔红霉素(7.5mg     

25G后囊膜切开联合前段玻璃体切除术治疗后发性白内障

目的：探讨25G后囊膜切开联合前段玻璃体切除手术治疗后发性白内障的疗效及并发症。

方法：对48例68眼后发性白内障患者以TSV 25G玻璃体手术系统经扁平部行后囊膜切开联合前段玻璃体切除手术。术后平均随访24mo,观察视力、眼压、前房反应和并发症的发生情况。

结果：所有术眼晶状体后囊膜中央均形成直径约4mm的圆形透明区,术中前房稳定,人工晶状体无损伤。术后第1d,裸眼视力(uncorrected visual acuity,UCVA)为0.70±0.12(0.5～1.0),最佳矫正视力(best corrected visual acuity,BCVA)为0.73±0.10(0.6～1.0)。术后3mo,UCVA为0.72±0.12(0.5～1.0),BCVA为0.74±0.10(0.6～1.0)。术后3mo UCVA与术前UCVA比较,差异有统计学意义(t=-45.902,P=0.000)。随访期间无切口渗漏、角膜水肿、眼内炎、瞳孔区玻璃体疝、人工晶状体损伤、视网膜脱离、高眼压及晶状体后囊膜切开区再次混浊等并发症。

结论：25G后囊膜切开联合前段玻璃体切除手术去除后囊膜混浊效果稳定、眼底并发症少,可以作为治疗后发性白内障的一种选择。     

白内障术后晶状体后囊膜混浊及远期视力下降影响因素分析

目的探讨白内障术后晶状体后囊膜混浊(posterior capsular opacification,PCO)发生及术后远期视力下降的影响因素。方法收集行白内障超声乳化摘出联合人工晶状体植入术的年龄相关性白内障患者37例(47眼),记录患者术前、术后的眼部检查情况及是否行后囊膜抛光处理等术中情况,于术后2a对PCO进行分级评价。结果 47眼中,有25眼在术后2a发生了PCO,其中18眼混浊已累及中心3mm区,4眼已行YAG激光后囊膜切开术,后囊膜切开率8.5%。统计分析显示,PCO和混浊累及中心3mm区的发生率在是否行后囊膜抛光眼之间的差异均有统计学意义(均为P<0.05)。在各因素中,行后囊膜抛光是发生PCO以及混浊累及中心3mm区仅有的保护性因素。累及中心3mm区的PCO、眼底疾病和黄斑病变与术后2a视力变化之间的关联均有统计学意义(均为P<0.05)。结论白内障术后发生累及中心3mm区的PCO可导致术后远期视力下降;术中行后囊膜抛光处理可显著降低PCO的发生率和严重程度。     

丝裂霉素C对后囊混浊防治作用的实验研究

目的 通过兔眼透明晶状体囊外摘出,术中囊袋内灌注药物,观察丝裂霉素C（mitomycin C,MMC）对后囊混浊（posterior capsule opacification,PCO）的影响,并观察其对眼内组织的副作用.方法 将8只大白兔随机分为2组,每组4只（8眼）.行透明晶状体囊外摘出术,术中前房内注入透明质酸钠,囊袋内分别灌注生理盐水（A组,对照组）、MMC（B组,实验组,0.1 g·L^-1）各0.2 mL,保留3 min,然后环形撕囊,囊外摘出晶状体.术后每日观察并记录早期炎性反应情况,PCO出现的时间及程度;3月后处死动物,抽取房水,测房水细胞及蛋白含量;取下眼球,行HE染色,观察晶状体上皮细胞增殖及眼内组织炎性反应情况.结果 术后第1天A、B组结膜充血及前房渗出均较明显,以后逐渐消退,结膜充血平均消退时间分别为（9.25±0.89）d、（9.88±1.13）d,前房渗出时间分别为（6.38±0.92）d、（6.88±1.36）d,2组间无显著性差异（P＞0.05）.PCO出现时间、混浊程度,2组之间均有显著性差异（P＜0.01）.术后3个月2组房水蛋白含量均较术前明显增高（P＜0.01）,但无显著性差异.HE染色结果显示2组眼内组织均无炎性细胞浸润.结论 晶状体摘除手术可以造成血-房水屏障的破坏,术后3个月仍未完全恢复.MMC在0.1 g·L^-1能够有效抑制PCO发生,但并不增加对血-房水屏障的影响.     

A long-term follow-up study of different irrigation/aspiration techniques on formation of posterior capsule opacification

BACKGROUND: This study was designed to determine the effect of 2 different irrigation/aspiration techniques on the formation of posterior capsule opacification (PCO) after cataract surgery in which CeeON Edge 911A (Pharmacia, Sweden) sharp-edged silicone lenses were implanted. METHODS: In this prospective study, 60 eyes from 39 patients, average age 65 (range: 46-85) years, were analyzed. Lens extraction was performed by phacoemulsification, and CeeON Edge 911A intraocular lenses were implanted. Two different irrigation/aspiration techniques were used in which the cortex of 32 eyes was removed by coaxial irrigation/aspiration (this group was designated group I) and the cortex of 28 eyes was removed by bimanual irrigation/aspiration (this group was designated group II). Secondary cataract formation and visual acuity were evaluated and compared in both groups. RESULTS: The average follow-up time was 44 (SD 11) months. In group I, secondary cataract formation causing 2 lines of decrease on visual acuity was observed in 1 eye 8 months after the operation. The secondary cataract developed in the form of cortex migration. This patient was treated with laser (Neodymium: Yttrium Aluminum Garnet [Carl Zeiss Meditech, Germany]) capsulotomy at the time of detection. Best corrected visual acuity for all eyes was 0.5 and higher; postoperative refractive error ranged between +1.0 and -2.0 diopters. INTERPRETATION: Although CeeON Edge 911A silicone lenses with sharp edge prevent formation of PCO very effectively, in 1 eye in the coaxial irrigation/aspiration group, 2 lines of decrease on visual acuity were observed due to PCO. However, we did not find any significant difference between the 2 irrigation/aspiration techniques with respect to PCO formation. In terms of complete removal of the cortical material, the bimanual irrigation/aspiration technique was found to be superior to the coaxial irrigation/aspiration technique because of the better accessibility to all areas of the capsular bag.     

丝裂霉素抑制后囊膜混浊的实验研究

目的 探讨丝裂霉素抑制后囊膜混浊的有效浓度及可能造成的眼损害和临床应用的可行性。方法 大耳白兔30只,随机分为6组,每组5只,施行晶状体囊外摘出术。对照组用BSS 0．3ml注入囊袋内进行水分离,实验组分别给予0．01％,0．02％,0．03％,0．04％,0．05％丝裂霉素0．3ml注入囊袋内进行水分离。术中均用玻璃酸钠先行保护角膜。随访3个月,处死动物,手术显微镜及光镜观察后囊膜混浊情况、角膜透明度及炎症反应。结果 随访3个月发现,后囊膜混浊多见于术后2个月,时间越长,混浊范围越大。随用药质量浓度增加,后囊膜混浊发生率及严重程度下降,未发现角膜、虹膜及睫状体损伤。结论 囊袋内应用丝裂霉素,并用玻璃酸钠保护角膜内皮,可减少后囊膜混浊发生率且无邻近眼组织损伤。     

染料木黄酮对实验性后发性白内障形成的影响

目的研究染料木黄酮对兔眼白内障术后后囊膜混浊形成的抑制作用。方法建立24眼兔眼白内障术后模型，分为对照组12眼和实验组12眼，实验组术中灌注液加入染料木黄酮。观察术后兔眼角膜、前房、后囊膜情况，术后2个月处死实验动物．行免疫组化检查。结果实验组与对照组术后裂隙灯下角膜、虹膜等组织无明显差异，术后2个月对照组6只兔眼出现不同程度周边部后囊膜混浊，3只兔眼出现瞳孔中央部后囊膜混浊；实验组2只兔眼出现周边部后囊膜混浊，2只兔眼出现瞳孔中央部后囊膜混浊。后囊膜PCNA染色阳性率实验组明显少于对照组（t=3．5，P〈0．01）。结论染料木黄酮对兔眼白内障术后后发障具有一定抑制作用。