t—PA前房注射治疗人工晶体植入术后纤维蛋白性膜

目的探讨组织型纤溶酶原激活剂（ｔｉｓｕｅｐｌａｓｍｉｎｏｇｅｎａｃｔｉｖａｔｏｒ,ｔＰＡ）治疗人工晶体植入术后晶体前机化膜的合理方法,并评价其临床效果。方法将４３例（５８只眼）各类白内障术后眼分为３组,分别于人工晶体植入术后不同时间,前房内注射ｔＰＡ,或联合ＹＡＧ激光治疗,对比观察各组疗效。第１组２６只眼,在手术结束时立即前房内注入４μｇｔＰＡ。第２组２２只眼,在术后５～７天前房内形成纤维蛋白膜时,于前房内注射４μｇｔＰＡ。第３组１０只眼,术后形成较厚的纤维蛋白膜,在术后５～９天时先用ＹＡＧ激光切开纤维膜,再向前房内注射４μｇｔＰＡ。结果第１组患者中,４只眼发生前房内出血,８只眼形成瞳孔区纤维蛋白膜,于术后３～５天时再次前房内注射ｔＰＡ后全部溶解。第２组患者中,２０只眼内的纤维蛋白膜２４小时内全部溶解,无前房出血。第３组患者,４～２４小时内瞳孔区的纤维蛋白膜全部吸收,无前房内出血。结论在术后约１周时,前房炎症稳定的情况下,小剂量ｔＰＡ前房内注射治疗晶体前纤维蛋白性机化膜十分有效,ＹＡＧ激光联合治疗的作用更加明显。     

5—氟尿嘧啶多相脂质体对实验性青光眼滤过术瘢痕形成的影响

目的 为研究５－氟尿嘧啶（５－Ｆｌｕｏｒｏｕｒａｃｉｌ，５－Ｆｕ）多相脂质体和５－Ｆｕ预防滤过术瘢痕形成的作用。方法 对２０只新西兰长耳兔双眼行小梁切除术。术后将兔分为２组，每组１０只，每组按随机规定一眼为用药眼，对侧眼为对照眼。第１组：用药眼术后每日结膜下注射５－Ｆｕ（水针剂）０．２ｍｌ（５ｍｇ），对照眼结膜下注射等量生理盐水。第２组：用药眼术后每隔３日结膜下注射５－Ｆｕ多相脂质体０．２ｍｌ（５     

5—氟尿嘧啶高分子缓释剂在兔眼滤过术后抗瘢痕形成的研究

目的研究５－氟尿嘧啶（５－ｆｌｕｏｒｏｕｒａｃｉｌ，５－Ｆｕ）缓释剂在兔眼滤过术后抗瘢痕形成的疗效及毒性。方法对２３只家兔双眼行巩膜后唇咬切术，术后次日第１组结膜下注射２．５％５－Ｆｕ缓释剂１０ｍｇ，第２组结膜下注射２．５％５－Ｆｕ注射液１０ｍｇ。术后第１周隔日用药１次，连续３次；第２周隔２日用药１次，连续３次。第３组用同法注射等体积的空白缓释剂。结果空白缓释剂组的滤过泡在术后７天内失败，５－Ｆｕ注射液组的滤过泡在术后２０～３０天失败，５－Ｆｕ缓释剂组的滤过泡持续至实验全程。术后７～３０天，５－Ｆｕ缓释剂组巩膜瘘道的阻塞率为６．７％，５－Ｆｕ注射液组为４１．７％，空白缓释剂组为１００．０％。５－Ｆｕ缓释剂组３只眼，５－Ｆｕ注射液组８只眼及空白缓释剂组２只眼出现角膜上皮缺损。结论本研究结果显示，５－Ｆｕ缓释剂可有效防止滤过泡瘢痕化及巩膜瘘道阻塞，提高兔眼滤过术的成功率，并降低５－Ｆｕ注射液的毒性，有临床应用价值。     

曲安奈德对年龄相关性白内障术后前葡萄膜炎的疗效及其对炎症因子的影响

目的　观察曲安奈德对年龄相关性白内障术后前葡萄膜炎的临床疗效及其对相关炎症因子的影响。方法　选择２０１０年２月至２０１２年６月间我科收治的年龄相关性白内障患者１６８例（１６８眼）为研究对象,按照治疗方式的不同分为对照组和曲安奈德组,每组各８４例（８４眼）。对照组予以术后结膜下注射地塞米松,而曲安奈德组给予前房注射２ｍｇ曲安奈德,对比两组患者术后第１天、第３天和第５天的最佳矫正视力、眼压、前房细胞数、房水闪辉情况,并于术后第５天测肿瘤坏死因子-α（ｔｕｍｏｒｎｅｃｒｏｓｉｓｆａｃｔｏｒ-α,ＴＮＦ-α）、干扰素-γ（ｉｎｔｅｒｆｅｒｏｎ-γ,ＩＦＮ-γ）和白细胞介素-１０（ｉｎｔｅｒｌｅｕｋｉｎ-１０,ＩＬ-１０）的含量变化。结果　曲安奈德组患者的最佳矫正视力在术后第３天已有明显改善,显著优于对照组（Ｐ＜０．０５）。且两组间前房细胞数及房水闪辉比较发现,术后第３天和第５天,两组差异均具有统计学意义（均为Ｐ＜０．０５）。术后第５天曲安奈德组的ＴＮＦ-α和ＩＦＮ-γ的表达水平分别为（１９．６±８．９）ｐｇ?Ｌ－１、（１４．４±７．８）ｐｇ?Ｌ－１,显著低于对照组（２９．５±１４．２）ｐｇ?Ｌ－１、（３９．８±１０．３）ｐｇ?Ｌ－１,差异均有统计学意义（均为Ｐ＜０．０５）,而ＩＬ-１０含量两组间比较差异却无统计学意义（Ｐ＞０．０５）。结论　年龄相关性白内障手术中前房注射曲安奈德可有效抑制术后前葡萄膜炎,减少前房反应,且抗炎效果良好。     

碱性成纤维细胞生长因子和胰岛素样生长因子—Ⅰ及其协同作用对？…

目的 研究碱性成纤维细胞生长因子（ｂａｓｉｃ ｆｉｂｒｏｂｌａｓｔ ｇｒｏｗｔｈ ｆａｃｔｏｒ,ｂＦＧＦ）、胰岛素样生长因子－１（ｉｎｓｕｌｉｎ－ｌｉｋｅ ｇｒｏｗｔｈ ｆａｃｔｏｒ－１,ＩＧＦ－１）及二者的共同作用对体外牛晶体上皮细胞（ｂｏｖｉｎｅ ｌｅｎｓｅｐｉｔｈｅｌｉａｌ ｃｅｌｌ,ＢＬＥＣ）增殖的影响。方法 ＢＬＥＣ原代培养,取第４例细胞种入２４孔板,加入不同浓度的ｂＦＧＦ、ＩＧＦ－１,     

普拉洛芬滴眼液不同用药时间对干眼症疗效的影响

目的　探讨普拉洛芬滴眼液不同用药时间对干眼症疗效的影响。方法　选取我院眼科门诊诊断为双眼干眼症的患者１１７例,按照随机数字表法将患者分成普拉洛芬１４ｄ组（３９例）、普拉洛芬３０ｄ组（４０例）和对照组（３８例）。普拉洛芬１４ｄ组给予１ｇ·Ｌ－１普拉洛芬滴眼液（１４ｄ）联合１ｇ·Ｌ－１玻璃酸钠滴眼液（３０ｄ）;普拉洛芬３０ｄ组给予１ｇ·Ｌ－１普拉洛芬滴眼液（３０ｄ）联合１ｇ·Ｌ－１玻璃酸钠滴眼液（３０ｄ）,对照组仅给予１ｇ·Ｌ－１玻璃酸钠滴眼液（３０ｄ）。给药方法均为局部滴双眼,每次１滴,每天４次。分别于治疗前后检测３组患者的泪液分泌试验Ｉ（ＳｃｈｉｒｍｅｒＩｔｅｓｔ,ＳＩｔ）、泪膜破裂时间（ｔｅａｒｂｒｅａｋ-ｕｐｔｉｍｅ,ＢＵＴ）和角膜荧光素染色（ｃｏｒｎｅａｌｆｌｕｏｒｅｓｃｅｎｔｓｔａｉｎｉｎｇ,ＦＬ）评分。结果　治疗前３组患者人口基线特征比较差异均无统计学意义（均为Ｐ＞０．０５）。治疗后普拉洛芬１４ｄ组ＳＩｔ（７．１１±１．３６）ｍｍ和ＢＵＴ（８．４２±０．７９）ｓ均高于对照组ＳＩｔ（５．１９±０．８５）ｍｍ和ＢＵＴ（５．９２±１．２４）ｓ;ＦＬ评分（０．７３±０．７２）显著低于对照组（１．８８±０．７１）,差异均有统计学意义（ｔＳＩｔ＝８．０００,Ｐ＜０．００１;ｔＢＵＴ ＝１０．８７０,Ｐ＜０．００１;ｔＦＬ＝－７．６６７,Ｐ＜０．００１）;治疗后普拉洛芬３０ｄ组ＳＩｔ（７．３８±１．０１）ｍｍ和ＢＵＴ（８．１２±１．００）ｓ均高于对照组,ＦＬ评分（０．８８±０．６８）显著低于对照组,差异均有统计学意义（ｔＳＩｔ＝９．１２５,Ｐ＜０．００１;ｔＢＵＴ＝９．５６５,Ｐ＜０．００１;ｔＦＬ ＝－６．６６７,Ｐ＜０．００１）;但治疗后普拉洛芬１４ｄ组与普拉洛芬３０ｄ组的ＳＩｔ、ＢＵＴ和ＦＬ评分差异均无统计学意义（ｔＳＩｔ＝－１．１２５,０．４＞Ｐ＞０．２;ｔＢＵＴ＝１．３０４,０．２＞Ｐ＞０．１;ｔＦＬ＝－１．０００,０．４＞Ｐ＞０．２）。结论　短期应用１ｇ·Ｌ－１普拉洛芬滴眼液治疗干眼症即可达到较好的疗效,它是辅助治疗干眼症的有效药物。     

荷载Zebularine的聚合物胶束复合体纳米颗粒对兔眼晶状体后囊膜混浊的预防作用

目的　研究荷载Ｚｅｂｕｌａｒｉｎｅ（Ｚｅｂ）的聚合物胶束复合体（ＭｅＰＥＧ-ＰＣＬ）纳米颗粒（ｎａｎｏｐａｒｔｉｃｌｅｓ,ＮＰｓ）对兔晶状体后囊膜混浊（ｐｏｓｔｅｒｉｏｒｃａｐｓｕｌｅｏｐａｃｉｆｉｃａｔｉｏｎ,ＰＣＯ）的预防作用。方法　选取３２只新西兰白兔随机分为生理盐水对照组（Ｃ组）、游离Ｚｅｂ组（ＺｅｂＦ组）、荷载Ｚｅｂ的ＭｅＰＥＧ-ＰＣＬＮＰｓ组（ＺｅｂＮＰｓ组）、ＭｅＰＥＧ-ＰＣＬ空载颗粒组（ＮＰｓ组）,所有动物行晶状体摘出＋人工晶状体植入术,Ｃ组术毕球结膜下注射生理盐水０．１ｍＬ,ＺｅｂＦ组注射０．４ｇ·Ｌ－１的游离Ｚｅｂ０．１ｍＬ,ＺｅｂＮＰｓ组注射０．４ｇ·Ｌ－１荷载Ｚｅｂ的ＭｅＰＥＧ-ＰＣＬＮＰｓ０．１ｍＬ,ＮＰｓ组注射ＭｅＰＥＧ-ＰＣＬ空载颗粒０．１ｍＬ。术后采用裂隙灯观察前房反应和ＰＣＯ分级,动态测量眼压,高效液相色谱法测定房水中Ｚｅｂ浓度。结果　术后１ｄ、３ｄ各组间前房反应差异无统计学意义（Ｈ＝５．２１,Ｐ＝０．５９）。术后各组间对应时间点眼压差异均无统计学意义（均为Ｐ＞０．０５）。术后１ｄ、２ｄＺｅｂＮＰｓ组房水中Ｚｅｂ含量显著高于ＺｅｂＦ组（均为Ｐ＜０．０１）,术后３ｄＺｅｂＦ组房水中已经检测不到Ｚｅｂ,术后２ｄＺｅｂＮＰｓ组房水中药物含量最高,随后降低。术后１０周ＺｅｂＦ组、ＮＰｓ组、Ｃ组均发生了明显的ＰＣＯ,ＺｅｂＮＰｓ组ＰＣＯ较ＺｅｂＦ组显著减轻（Ｈ＝９．９１,Ｐ＜０．０５）。结论　荷载Ｚｅｂ的ＭｅＰＥＧ-ＰＣＬＮＰｓ可通过增高房水中Ｚｅｂ浓度有效减轻兔眼晶状体摘出术后ＰＣＯ程度。     

高三尖杉酯碱脂质体及高三尖彬酯碱注射液对兔滤过术的作用

目的 研究高三尖杉酯碱（ＨＨＴ）脂质体及高三尖杉酯碱注射液对兔滤过术后抗瘢痕形成的疗效及毒性。方法 对４０只家兔双眼行巩膜后唇咬切术，自术后次日起，第１组结膜下注射ＨＨＴ脂质体，第２组结膜下注射空白脂质体（对照组），第３组结膜下注射低剂量ＨＨＴ注射液，第４组结膜下注射生理盐水（对照组），第５组结膜下注射高剂量ＨＨＴ注射液。结果 ２个对照组的滤过泡在术后７天失败，低剂量ＨＨＴ的滤过泡在术后９天失败，     

玻璃体内注射雷珠单抗治疗病理性近视合并脉络膜新生血管疗效观察

目的　观察玻璃体内注射雷珠单抗治疗病理性近视合并脉络膜新生血管（ｃｈｏｒｏｉｄａｌｎｅｏｖａｓｃｕｌａｒｉｚａｔｉｏｎ,ＣＮＶ）的临床疗效及安全性。方法　回顾性分析１８例１８眼病理性近视患者的临床资料。玻璃体内注射雷珠单抗０．５ｍｇ（０．０５ｍＬ）,术后每个月随访时行最佳矫正视力（ｂｅｓｔｃｏｒｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ,ＢＣＶＡ）、眼底彩照、光学相干断层扫描（ｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏｇｒａｐｈｙ,ＯＣＴ）检查,术后１个月、３个月、６个月随访时行眼底荧光血管造影（ｆｌｕｏｒｅｓｃｅｎｃｅｆｕｎｄｕｓａｎｇｉｏｇｒａｐｈｙ,ＦＦＡ）检查。随访过程中发现ＣＮＶ部分闭合或持续渗漏者则再次予以玻璃体内注射雷珠单抗。比较治疗前后ＢＣＶＡ、ＯＣＴ、眼底彩照及ＦＦＡ检查结果,观察其临床疗效及安全性。结果　术后１个月、３个月、６个月随访时,ＢＣＶＡ均较术前明显提高（Ｆ＝１１．３５４,Ｐ＜０．０５）;黄斑中心凹厚度均较术前明显降低（Ｆ＝４．２４２,Ｐ＜０．０５）。术后６个月随访时,１６眼视力提高２行以上,２眼视力稳定;眼底彩照示所有患眼黄斑区出血吸收,ＦＦＡ检查示１４眼ＣＮＶ完全闭合,４眼大部分闭合。玻璃体内注射雷珠单抗平均次数为２．５６次,其中３眼行１次,８眼行２次,５眼行３次,２眼行４次。随访期间所有患者均未出现眼部及全身并发症。结论　玻璃体内注射雷珠单抗治疗病理性近视合并ＣＮＶ是安全有效的。     

5—氟尿嘧啶联合皮质类固醇防治人工晶体植入术后后囊混浊的疗效观察

目的探讨简单易行的白内障囊外摘除（ｅｘｔｒａｃａｐｓｕｌａｒｃａｔａｒａｃｔｅｘｔｒａｃｔｉｏｎ，ＥＣＣＥ）加后房型人工晶体植入术后远期（半年至２年）后囊混浊（ｐｏｓｔｅｒｉｏｒｃａｐｓｕｌａｒｏｐａｃｉｔｙ，ＰＣＯ）的防治措施。方法对２８例（３１眼），其中外伤性白内障１６例（１６眼），并发性白内障６例（８眼），老年性白内障６例（７眼），行后房型人工晶体植入，术后第７天开始用５－氟尿嘧啶（５－ｆｌｕｏｒｏｕｒａｃｉｌ，５－Ｆｕ）结膜下注射，全程用５－Ｆｕ（４５ｍｇ），半年后随诊，按后囊混浊分级标准对疗效进行评价。结果本组３１只眼中０级（后囊透明）者２９眼占９３．５５％，Ⅰ级和Ⅱ级（后囊混浊）各１眼占６．４５％，即后囊混浊的发生率为６．４５％，明显低于其它报道（４０～５０％），而且所发生的２例后囊混浊未引起明显的视力下降，故有效防治率达１００％。结论５－Ｆｕ联合皮质类固醇局部应用是一种简便易行，安全有效的防治白内障术后后囊混浊的方法。     

高三尖杉酯碱脂质体及高三尖杉酯碱 注射液对兔滤过术的作用

目的研究高三尖杉酯碱（ｈｏｍｏｈａｒｉｎｇｔｏｎｉｎｅ,ＨＨＴ）脂质体及高三尖杉酯碱注射液对兔滤过术后抗瘢痕形成的疗效及毒性。方法对４０只家兔双眼行巩膜后唇咬切术,自术后次日起,第１组结膜下注射ＨＨＴ脂质体,第２组结膜下注射空白脂质体（对照组）,第３组结膜下注射低剂量ＨＨＴ注射液,第４组结膜下注射生理盐水（对照组）,第５组结膜下注射高剂量ＨＨＴ注射液。结果２个对照组的滤过泡在术后７天失败,低剂量ＨＨＴ组的滤过泡在术后９天失败,ＨＨＴ脂质体组的滤过泡在术后１２天失败,高剂量ＨＨＴ组的滤过泡在术后１５天失败。术后５～１０天,高剂量ＨＨＴ组的巩膜瘘道阻塞率为３７５％,其余４组的阻塞率均为１０００％;术后１５～３０天,５组的巩膜瘘道阻塞率均为１０００％。高剂量ＨＨＴ组中６３０％的眼出现中至重度角膜水肿及角膜血管翳。结论对兔眼滤过术后应用ＨＨＴ脂质体和低剂量ＨＨＴ注射液不能明显提高兔眼滤过术的成功率。应用高剂量ＨＨＴ注射液可暂时提高兔眼滤过术的成功率,但副作用亦明显增加。     

丝裂霉素C辅助兔青光眼滤过手术的电镜观察

目的 观察兔眼滤过手术中一次性应用丝裂霉素C(MMC)后滤过泡处结膜组织的电镜改变。方法 6只白兔行全层巩膜切除滤过手术并进行观察。分为实验组(术中用0．2mg／ml MMC)、生理盐水空白对照组和阳性对照组(术后用5-Fu)。术后2周分别对滤过泡处结膜组织做透射电镜和扫描电镜检查。结果电镜显示所有组结膜上皮分离破坏，MMC和5-Fu治疗组局限性胶原纤维减少变细紊乱，结膜下可见大小不等、形态各异的腔隙存在。结论 青光眼术中一次性结膜下应用MMC可提高兔青光眼滤过手术的成功率。     

The effect of topical povidone-iodine, intraocular vancomycin, or both on aqueous humor cultures at the time of cataract surgery

PURPOSE: To investigate whether the use of topical povidone-iodine before surgery, the addition of vancomycin to the irrigating solutions during phacoemulsification, or both reduces the frequency of positive intraocular cultures at the end of surgery. METHODS: A two-part, clinical study was performed. In the preliminary study, intracameral antibiotic concentrations were measured immediately after surgery (in 11 eyes) and 2 hours after surgery (in 11 eyes) in patients treated with vancomycin. In the primary study, 400(1) patients were divided into four groups composed of 100 eyes each. The first and the second groups received vancomycin (20 microg/ml) in the irrigating fluid. The third and the fourth groups received irrigating fluid only without antibiotics. The first and third groups received a topical 5% povidone-iodine solution 10 and 5 minutes before surgery; a topical placebo solution was used in the second and the fourth groups. All patients in the primary study underwent anterior chamber aspiration after surgery, and culturing was performed 2 hours later. Identification and quantification of positive cultures in thioglycolate broth and chocolate agar were performed. RESULTS: In the preliminary study, the half-life of intraocular vancomycin was less than 2 hours. In the primary study, intraocular aspirates yielded positive cultures in two (2%), five (5%), 11 (11%), and 13 (13%) specimens from the first, second, third, and fourth groups, respectively. CONCLUSIONS: We found a lower rate of positive cultures in the group that received vancomycin in the irrigating fluid; 2 hours of contact between the antibiotic solution and bacteria produced results that reached statistical significance (P = 0.032).     

结膜下注射CTGF抗体对兔青光眼滤过手术后眼压和滤过泡面积的影响

目的:探讨结缔组织生长因子(connective tissue growth factor,CTGF)抗体对兔青光眼滤过手术后滤过泡瘢痕化的抑制作用。方法:家兔5只双眼制作青光眼滤过手术模型。随机选取家兔一眼作为抗体组,分别于手术完成当时和术后5d结膜下注射0.1mL浓度为50mg/L的CTGF抗体;另一眼作为对照组在相同时间点结膜下注射0.1mL磷酸盐缓冲液。术后1,3,5,7,10,14d分别观察滤过泡形态并测量其面积和眼压值。结果:术后7,10和14d抗体组滤过泡面积均大于对照组(P<0.05),眼压均小于对照组(P<0.05)。结论:结膜下注射CTGF抗体可维持兔眼滤过手术后较大的滤过泡面积和较低的眼压。     

青光眼术后5-Fu抗瘢痕形成的实验动物研究(兔眼房水的5-Fu药代动力学研究)

6只新西兰纯种白兔右眼行巩膜咬切术后,第三天球结膜下注射0.5%5～Fu 3mg。采用微量进样器对同一兔眼注射5-Fu前(0点)、注射后0.25、0.5、1、1.5、2、3、4、6、8、12小时不同时点多次采用作房水的5-Fu药代动力学研究。结果:注射后平均40分钟房水中5-Fu浓度吸收达高峰,高峰浓度平均为21.94μg/ml,半衰期平均为28.20分钟,4小时后5-Fu在房水中基本消除。     

Decorin modulates wound healing in experimental glaucoma filtration surgery: a pilot study

PURPOSE: To analyze the effect of perioperative decorin in an experimental setting of glaucoma filtration surgery. METHODS: Glaucoma filtration surgery, similar to that performed in clinical practice, was performed on 35 chinchilla rabbits (ChBB:CH). The animals received a unilateral subconjunctival injection of decorin (40-100 microg) or the vehicle alone before surgery and at different time intervals thereafter. Antifibrotic efficacy was established by clinical response and histologic examination. The animals were killed on day 14, and the eyes processed for histology. RESULTS: Both the vehicle and the decorin solution were well tolerated. No adverse effects such as inflammation or blurring of the optical media were observed. Conjunctival scarification occurred within 1 week in the control groups but was suppressed in the experimental groups. The intraocular pressure correlated with the fibrotic process and reached normal levels within 7 days after surgery in control animals, but remained significantly (P <0.001) reduced in the experimental groups. Histologic examination of the surgical area 14 days after surgery disclosed massive fibrosis in the control animals, but little deposition of extracellular matrix in the experimental groups. CONCLUSIONS: The data of this pilot study suggest that perioperative subconjunctival decorin applications significantly affect conjunctival scarring and surgical outcome of glaucoma filtration treatments in rabbits.     

Lack of Corneal Toxicity of Interferon Alpha—2b Administered Subconjunctivally after Sclerectomy

Purpose: To evaluate the corneal toxicity of subconjunctival injection interferon α-2bat filtering bleb after sclerectomy in white rabbits.Methods: Eight rabbits which had been performed sclerectomy were randomlydivided into two groups. Each group consisted of four rabbits. Eight eyes in group 1were subconjunctivally received interferon α-2b 5 × 105IU/0. 2ml into filtering blebfrom the edge of the filtering site immediately after operation and every postoperativeday. The other eight eyes in group 2 were injected with 0. 2ml normal saline. All ofthe eyes underwent daily examination by slip-lamp microscopy and directophthalmoloscopy. Sodium fluorescein was used to assess corneal epithelial integrity.On day 3,4,7 and 14, every two rabbits (group 1 and 2 each, respectively) werekilled and removed cornea immediately to take examination of the viability of cornealendothelium by dual staining with typan blue and alizanin red S.Results: No sign of toxicity in corneal epithelium and endothelium were foundfoll     

比较5-Fu和MMC缓释膜在青光眼滤过手术中应用的实验研究

目的 评估生物缓释膜在青光眼滤过手术中的安全性和作用,比较5-氟尿嘧啶(5-Fu)和丝裂霉素(MMC)缓释膜在青光眼滤过手术中的抗增殖的疗效.方法 以5-Fu和MMC作为模型药物,壳聚糖作为载体,溶剂挥发法成膜;通过共价交联的方式将12μg的5-Fu或MMC结合到生物缓释膜上.未植入缓释膜作为对照组,其余3组植入空白、5-Fu和MMC缓释膜.四组均行青光眼滤过手术,静脉留置针作为引流管,空白缓释膜、5-Fu缓释膜、MMC缓释膜缝于巩膜瓣下.滤过手术前和手术后1、3、5、714、21和28d,以Tonopen眼压计记录兔眼压,以裂隙灯观察滤过泡大小和眼前节的变化并照相;分别于术后28d每组处死两只兔,总共8只眼标本行病理组织学检查;用扫描电子显微镜检测每组术后28d的角膜和晶状体标本.结果 术前各组平均眼压无差异,MMC组手术前和手术后28d内比较差异有统计学意义(F值为26.866 P＜0.01),5-Fu组和单纯引流管组手术前和手术后14d内比较差异有统计学意义,(F值分别为13.467,6.567 P＜0.01),空白缓释膜组手术前和手术后7d内比较差异有统计学意义(F值分别为11.426 P＜0.01);MMC、5-Fu组滤过泡生存时间优于单纯引流管组、空白缓释膜组.5-Fu和MMC组,术后28d角膜内皮细胞和晶状体前囊无异常改变.结论 5-Fu和MMC生物缓释膜能明显提高滤过手术成功率并且是安全的,在降低眼内压和延长滤过泡减少眼前节并发症方面,MMC缓释膜比5-Fu缓释膜能更有效地提高滤过手术成功率.     

Injectable microspheres with controlled drug release for glaucoma filtering surgery.

The authors evaluated the effects of biodegradable poly (lactic acid) microspheres that provided the controlled release of the antimetabolic agent adriamycin (ADR) to prevent post surgical fibrosis after glaucoma filtering surgery. Fifty six eyes of 28 rabbits underwent posterior lip sclerotomy and received a 0.2 ml subconjunctival injection that contained microspheres 90 degrees from the filtering site immediately after surgery. Microspheres containing ADR (100 or 200 micrograms) were randomly administered to one eye. The fellow eyes served as controls and received microspheres without the drug. Intraocular pressure in the eyes treated with the microspheres that contained the drug was significantly lower than that in the control eyes from days 7-12 in the 100 micrograms group and from days 6-16 in the 200 micrograms group (P < .05). Eyes that received ADR had a significantly longer patent filtering bleb compared with the control eyes (P < .05). No corneal complications were observed in the eyes treated with 100 micrograms of ADR and the control eyes. Peripheral corneal opacities (25%) and epithelial erosion (17%) were observed in the eyes that received the 200 micrograms dose, but the cornea returned to normal after 4 wk. These results suggest that controlled-drug-release microspheres with an antimetabolic agent may be promising for preventing fibrosis after surgery.     

Clinical and electrophysiologic results after intracameral lidocaine 1% anesthesia: a prospective randomized study.

OBJECTIVE: To evaluate the efficacy and safety of intracameral lidocaine in cataract surgery compared to peribulbar anesthesia. DESIGN: A prospective, randomized, controlled study. PARTICIPANTS: A total of 200 consecutive cataract patients (200 eyes) participated. INTERVENTION: Eyes were randomly assigned to two groups: one group received 0.15 ml intracameral 1% unpreserved lidocaine combined with topical anesthesia (oxybuprocaine); the other group received 6 ml prilocaine peribulbar before phacoemulsification with sclerocorneal tunnel incision. MAIN OUTCOME MEASURES: Duration of surgery was measured; implicit time and amplitudes of the b-waves of the photopic electroretinogram (ERG) potentials (single-flash ERG and the 30-Hz flicker ERG) were recorded; frequencies of intraoperative problems, complications, intraoperative, and postoperative pain were evaluated. RESULTS: After lidocaine anesthesia combined with topical anesthesia, similar complications were found, longer operation time (P < 0.001), and significantly better visual acuity immediately after surgery (P < 0.001). The ERG amplitudes were not significantly reduced after 0.15-ml intracameral lidocaine half an hour after surgery (P > 0.05). CONCLUSION: Intracameral lidocaine 1% combined with topical anesthesia can be recommended as an alternative procedure to peribulbar anesthesia in cataract surgery with corneoscleral tunnel incision.