青光眼滤过术后结膜下注射5—氟尿嘧啶防止瘢痕形成疗效观察

本文总结对20例22只眼闭角型青光眼患者施行了抗青光眼手术，手术方式；作以穹隆部为基底球结膜瓣，剥离成3×6mml／2厚度巩膜瓣，用巩膜咬切器切除小梁组织约2．smm，虹膜作12点时位根切除，巩膜瓣作两对角处缝合，球结膜作连续缝合．术后随机分为；5一氟尿嘧啶组10例11只眼球结膜下注射5-氟尿嘧啶3mg，对照组10例11只眼，术后不注射5-氟尿嘧啶．观察结果5-氟尿嘧啶组术后12个月功能性滤过泡占总数92％，对照组为刀％（P（005）．5一氟尿呼唤组眼压控制率为97％，对照组为78％，二者有显著差异（P（0．05）．讨论：5一氟尿吨院是抗癌药物…     

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     

青光眼滤过术后抗瘢痕形成药物的研究新进展

青光眼滤过术是目前抗青光眼药物及激光治疗无法控制眼压时的首选手术方式,其术后滤过泡瘢痕形成是导致手术失败的重要原因。目前在抗青光眼术后瘢痕的基础及临床研究上有一定的进展,但寻求一种高效、安全、稳定的药物治疗青光眼滤过术后瘢痕形成仍是一个需要继续努力解决的问题。本文就近3a所发表的关于青光眼滤过术后抗瘢痕形成的相关药物研究作一综述。     

青光眼滤过术后抗瘢痕形成药物的研究现状

青光眼滤过术失败的主要原因是成纤维细胞增殖，胶原沉积，滤过泡瘢痕形成。在滤过术后应用抗瘢痕形成药物能提高青光眼滤过术的成功率。如；抗代谢药物，干扰素，肝素等已用于滤过术后的实验及临床研究。正确评价和选择更有效的药物释放系统是研究的重要课题。     

5—氟尿嘧啶联合眼球按摩在小梁切除术后防治瘢痕形成的探讨

目的：为研究5-氟尿嘧啶（5－Fluorouracil,5－FU）联合眼球按摩在小梁切除术后防治瘢痕形成中的作用。方法：将54例（54只眼）小梁切除术后眼压失控的青光眼随机分5－FU联合眼球按摩组34只眼和对照组20只眼，5－FU联合眼球按摩组术后结膜下注射5－FU5mg并行眼球按摩2～3分钟。对照组Ⅰ10只眼术后结膜下注射5－FU5mg，对照组Ⅱ10只眼行眼球按摩。追踪观察10个月～3年，平均2年。结果：5－FU联合眼球按摩组术前平均眼压为4．54kPa（1kPa=7．5mmHg），术后平均眼压为2．23kPa，成功率为97％。对照组Ⅰ术前平均眼压为4．43kPa，术后平均眼压为3．43kPa，成功率为60％，对照组Ⅱ术前平均眼压为4．34kPa，术后平均眼压为4．04kPa，成功率为50％，P＜0．0001。治疗组2只眼出现角膜混浊，1只眼出现低限压。对照组未见角膜损害及伤口渗漏。结论：5－FU联合眼球按摩在青光眼小梁切除术后能起到防治瘢痕形成的作用。     

青光眼滤过术后瘢痕形成机制及抗瘢痕化研究进展

青光眼滤过性手术失败最主要的原因是瘢痕化造成的滤过通道堵塞。增生的瘢痕中,Tenon囊成纤维细胞转化为肌成纤维细胞持续存在,并且分泌大量的细胞外基质,胶原纤维排列紊乱。国内外学者对青光眼滤过性手术后抗瘢痕治疗进行了大量的研究,现将青光眼滤过手术后瘢痕形成机制及对应的研究进展进行综述。     

蛇毒制剂对兔眼滤过术的影响

目的评价蛇毒制剂在兔眼滤过术后抗瘢痕形成的效果和眼毒性.方法对10只兔双眼行巩膜全层咬切术,术后实验组球结膜下注射5×10-2U/ml的蛇毒制剂0.5ml,对照组注射等量生理盐水,裂隙灯观察眼前段.术后第21天,用鼠尾胶原作为房水外流示踪剂行前房恒压灌注及原位固定,对手术区组织行功能及组织形态学检查.结果术后14,21天,实验组有5眼、3眼可见滤过泡,对照组无1眼有滤过泡.滤过泡消失眼的滤过口被瘢痕组织封闭,手术区结膜下纤维组织明显增生.有滤过泡眼的滤过口仍显开放,房水示踪剂经此开口流入滤过泡.结论蛇毒制剂能抑制兔眼滤过术后结膜下过分瘢痕化,延长滤过泡的存在时间和功能,其眼毒性不明显.     

大蒜素对青光眼滤过术后兔眼滤过泡瘢痕化的抑制作用

目的　探讨大蒜素对青光眼滤过术后兔眼滤过泡瘢痕化的抑制作用。方法　取健康同品系大白兔36只72眼,随机分成大蒜素组、丝裂霉素组、生理盐水组,每组24眼,均行小梁切除术。各组分别将浸有大蒜素（1.112 kg·L^-1）、丝裂霉素（0.3 g·L^-1）、生理盐水的棉片放置于结膜囊-巩膜瓣-巩膜床层间,5 min后完全取出棉片,充分冲洗。术后各组分别测眼压,观察滤过泡的形态,计算滤过泡面积并行眼前节照相。术后28 d处死各组兔,行HE染色及Masson染色对比观察各组结膜下瘢痕增生情况。结果　术后第1天3组眼压较术前降低,随后眼压逐渐回升。各组不同时间内的眼压差异均有统计学意义（均为P<0.05）。术前及术后1 d、4 d、7 d、14 d两两比较中除术后4 d丝裂霉素组眼压比生理盐水组低（P=0.025）外,其余各时间眼压两两比较,差异均无统计学意义（均为P>0.05）。术后28 d生理盐水组眼压高于大蒜素组和丝裂霉素组（均为P<0.05）,大蒜素组和丝裂霉素组相比差异无统计学意义（P>0.05）。术后1~4 d 3组滤过泡面积分别达到最大值,之后滤过泡面积逐渐减小。统计学分析结果示3组滤过泡面积减小量在不同的时间点上是不同的（P<0.05）。不同分组之间的滤过泡面积减小量有明显差异（P<0.05）。术后大蒜素组与丝裂霉素组滤过泡面积减小幅度相同,差异无统计学意义（P>0.05）,生理盐水组比大蒜素组和丝裂霉素组的滤过泡面积减小速度更快,差异均有统计学意义（均为P<0.05）。术后28 d各组结膜上皮均完整无破损及增厚。HE染色显示大蒜素组和丝裂霉素组兔眼瘢痕组织较少,滤过通道较宽;生理盐水组兔眼瘢痕组织较多,滤过通道狭窄。Masson染色显示大蒜素组和丝裂霉素组可见少量炎性细胞浸润,滤过区成纤维细胞及胶原纤维疏松,结膜及巩膜间隙较宽;生理盐水组可见大量炎性细胞浸润,滤过区成纤维细胞及胶原纤维致密,结膜及巩膜间隙较窄,形成大量的瘢痕组织。术后 28 d 根据胶原纤维占整个结膜和巩膜空间总面积的百分比分析,大蒜素组［（58.13±5.33）%］比丝裂霉素组［（62.42±2.95）%］胶原纤维少,差异有统计学意义（P<0.05）,大蒜素组和丝裂霉素组均比生理盐水组［（89.75±3.91）%］胶原纤维少,差异均有统计学意义（均为P<0.05）。结论　大蒜素和丝裂霉素有着相同的功效,可通过抑制小梁切除术后滤过泡瘢痕化,对功能性滤过泡有一定的维持作用。     

青光眼滤过术后抗瘢痕药物研究进展

青光眼是临床常见致盲眼病,目前以手术治疗为主,但术后复发率较高,主要原因是术区成纤维细胞增生,致瘢痕形成阻塞滤过道。为提高手术成功率,一些抗瘢痕形成的药物被越来越多的应用于青光眼滤过手术的实验与临床研究中,但这些药物也有一定的并发症及毒副作用。随着医疗技术的进步,人们正在寻找更为安全有效的给药方式和新的抑制瘢痕形成的药物。      

Glaucoma filtration surgery in rabbits using bioerodible polymers and 5-fluorouracil

A prospective, randomized, double-masked, and placebo-controlled study was performed to examine the effect of a localized and sustained delivery of 5-fluorouracil (5-FU) on the success of glaucoma filtration surgery in 18 rabbits. A bioerodible polyanhydride composed of bis (p-carboxyphenoxy) hexane (PCPH) and sebacic acid (SA) was used as the drug carrier. The polymer and 5-FU (10% by weight) were molded into 4-mm long cylinders by a 15-gauge needle. These implants, with and without the therapeutic agent, were placed at the site of filtration surgery intraoperatively. The results showed that intraocular pressures (IOPs) were lower in the experimental eyes during the second postoperative week, but eventually both experimental and control eyes returned to preoperative levels. Filtration blebs lasted longer in experimental eyes and bleb failure occurred before IOP failure in both experimental and control eyes. Implant disappearance occurred after IOP and bleb failure. Experimental eyes had more postoperative complications than control eyes. Eventually, the filtration surgery failed in both the experimental and control rabbit eyes.     

The use of bioerodible polymers and 5-fluorouracil in glaucoma filtration surgery

A study was performed to examine the effect of a localized and sustained delivery of 5-fluorouracil (5-FU) on the success of glaucoma filtration surgery in 18 rabbits in a prospective, randomized, double-masked and placebo-controlled fashion. A bioerodible polyanhydride composed of bis (p-carboxyphenoxy) propane and sebacic acid was used as the drug carrier. The polymer and 5-FU (20% by weight) were compressed into 3 mm diameter discs, 1 mm thick. The polymer with the 5-FU was randomized to one eye and the fellow eye received the blank polymer. The results showed that intraocular pressures (IOP) were lower in the experimental eyes during the 5th through 17th postoperative days, but eventually both experimental and control eyes returned to preoperative levels. Filtration blebs lasted longer in experimental eyes when compared to control eyes. Implant disappearance occurred after IOP elevations and bleb failure. Eventually, the filtration surgery failed in both the experimental and control rabbit eyes.     

Use of bioerodible polymers impregnated with mitomycin in glaucoma filtration surgery in rabbits

A prospective, randomized, double-masked, and placebo-controlled study was performed to evaluate the effects of a localized and sustained release of mitomycin on the success of glaucoma filtration surgery in rabbits. A bioerodible polymer was used as the drug carrier. Full-thickness filtration surgeries were performed and data from 22 rabbits were collected. One eye received a polymer impregnated with mitomycin (0.02 mg or 0.06 mg), while the fellow eye received a drug-free polymer. Intraocular pressure, bleb survival, and postoperative complications were investigated. Intraocular pressures remained lower for a longer period of time (P less than 0.004) and filtration blebs lasted longer (P less than 0.05) in experimental eyes than in control eyes. Conjunctivitis and sectorial corneal haze occurred more frequently in eyes treated with the higher dosage mitomycin compared with control eyes. The use of mitomycin-C in a polymer delivery system appeared to promote the success of glaucoma filtration surgery in rabbits. With the lower dosage of mitomycin, clinically significant ocular toxicity was not noted.     

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。     

可降解聚合微球持续释放5-氟脲嘧啶作为滤过手术的辅助治疗

目的:研究 5 Fu高分子微球对实验性质滤过术后瘢痕形成的疗效及毒性。方法 :对 40只兔行巩膜后唇咬切术 ,实验组术中结膜下注射 1ml 5 Fu微球 ,对照组术中结膜下注射 2 5 % 5 Fu注射液 10mg。结果 :术后实验组和对照组眼内压和滤过泡的存留有显著性差异。 5 Fu微球药物浓度变化范围 2 6 47～ 9 872ug/ml,持续 14天 ,可降低它的毒性 ,组织学显示两组纤维增生有显著差异。结论 :PTL EO PLA聚合微球通过释放 5 Fu ,防止瘢痕增殖引起的滤过不畅 ,降低 5 Fu的毒性 ,提高兔眼滤过术的成功率 ,有临床应用价值     

Combined trabeculotomy-trabeculectomy augmented with 5-fluorouracil in paediatric glaucoma

Background: To describe our experience of combined trabeculotomy–trabeculectomy in paediatric glaucomas with a special emphasis on the use of 5‐fluorouracil and releasable sutures. Design: Retrospective review carried out at Manchester Royal Eye Hospital, UK, a tertiary referral centre. Participants: Twenty‐nine eyes of 21 consecutive patients with congenital glaucoma undergoing combined trabeculotomy–trabeculectomy augmented with 5‐fluorouracil. Methods: 5‐Fluorouracil augmented combined trabeculotomy–trabeculectomy was carried out with intense postoperative management and suture adjustment of releasable sutures within the first 3 weeks after surgery. Peribleb 5‐fluorouracil injections were given repeatedly if there were signs of aggressive bleb scarring. Main Outcome Measures: Absolute success was defined as intraocular pressure of 21 mmHg or less, clear cornea and absence of progressive glaucomatous optic disc changes at last follow up, whereas qualified success was defined as these endpoints with anti‐glaucoma medication. Results: Absolute success was achieved in 19 out of 29 eyes (65.5%), and a further 4 (13.8%) had qualified success. There was no difference in the surgical outcomes of primary infantile glaucoma and secondary causes of paediatric glaucoma such as anterior segment dysgenesis. Combined trabeculotomy–trabeculectomy had a significantly greater success rate as a secondary procedure rather than as a primary procedure. Conclusion: 5‐Fluorouracil‐enhanced combined trabeculotomy–trabeculectomy with releasable sutures appears to be an effective procedure for congenital glaucoma refractory to goniotomy. It is less effective as a primary procedure when severe corneal haze prevents goniotomy in newborn congenital glaucoma. Intense postoperative monitoring including active bleb manipulation with needling and 5‐fluorouracil injections may increase the success of the procedure.     

非穿透性滤过手术联合羊膜移植的实验研究

探讨羊膜移植在兔眼非穿透性滤过手术中的抗瘢痕化作用及其毒副作用。方法 :选取新西兰白兔 15只 ,双眼行非穿透性滤过手术 ,术中随机选取一眼联合羊膜移植。术后观察术眼眼内反应、滤过泡形态和功能 ,并行角膜内皮活性染色、眼球组织切片及滤过区组织学检查。结果 :实验组术后第 10天时 ,全部术眼可见弥散隆起的滤过泡 ,第 14天时 ,滤过泡存留有 6眼 ;对照组术后 5～ 7天开始出现滤过区局限 ,第 10天时仅有 3眼存留滤过泡 ,第 14天仅有 1眼 ,差异有统计学意义。实验组组织学检查显示滤过区纤维组织形成少 ,但局部有炎症细胞浸润。对照组滤过区见大量纤维瘢痕组织形成。所有术眼前房反应轻微 ,角膜内皮活性染色及眼球组织切片未见异常。结论 :羊膜组织对兔眼非穿透性滤过手术有抗瘢痕形成作用 ,且对兔眼组织无毒副反应。     

干扰素α-2b与实验性滤过性手术

为探讨干扰素α-2b(interferon-alpha2b,IFNα-2b)在不同给药方法及不同剂量下对兔眼抗青光眼术后滤过泡的影响,选取新西兰纯种白兔20只,全部行标准统一的巩膜咬切术,采用湿棉片敷贴给药和结膜下注射的方法,与对照组相比,观察术后的疗效,包括滤过泡存留情况、滤过区组织学检查、成纤维细胞计数和术后并发症.结果湿棉片敷贴5×105IU/ml或1×106IU/mlIFNα-2b5分钟,与对照组相比,疗效均无明显差别;结膜下注射5×105IU或1×105IU能有效减少滤过区疤痕组织增生,且5×105IU效果比1×105IU好;实验条件下,未引起明显的眼部并发症.     

抗青光眼术在无晶体眼和人工晶体眼的疗效

探讨发生于无晶体眼和人工晶体眼的青光眼的有效的手术治疗方法。方法：回顾分析１９９２年１１月～１９９７年６月我院４５例４５眼发生于无晶体眼和人工晶体眼的青光眼的住院病例的临床资料。手术方法包括小梁切除术、睫状体冷冻术、青光眼减压阀植入引流术以及其他手术。结果：青光眼减压阀植入引流术控制眼内压优于睫状体冷冻术和小梁切除术,术后合并使用降眼压药物少于睫状体冷冻术后。结论：发生于无晶体眼和人工晶体眼的青光眼的治疗需根据临床情况考虑,青光眼减压阀植入引流术有较好的疗效     

细胞因子对青光眼滤过手术瘢痕化调控的研究进展

手术后瘢痕化是导致青光眼滤过手术失败的主要原因。多种细胞因子,如转化生长因子β（TGF-β）、血管内皮生长因子（VEGF）、结缔组织生长因子（CTGF）、白细胞介素（IL-1）和干扰素（INF）等参与青光眼滤过手术瘢痕化过程的调控。目前已研制出多种针对这些细胞因子的治疗性干预措施,在预防青光眼手术滤过通道瘢痕化方面具有很好的应用前景。本文对参与调控青光眼滤过手术瘢痕化的细胞因子以及针对性治疗措施进行综述。