人工晶状体表面改性抑制后发性白内障的研究进展

白内障是目前最主要的致盲性眼病,临床上通常采用超声乳化联合人工晶状体（IOL）植入对其进行治疗。该手术术后视力恢复良好。但是所植入的IOL是一种外来性异物,术后除了急性炎症反应之外,存在着远期的体内生物相容性问题,即后发性白内障,严重影响术后的视觉质量。虽然手术方式改进、IOL设计加工改良等能降低后发性白内障的发生率,但由于材料本身的相容性问题并未获得改善,仍能导致后发性白内障的发生。笔者从材料学的角度对材料表面性能改性抑制后发性白内障作一综述。     

后发性白内障与人工晶状体材料的关系

目的 :探讨后发性白内障与人工晶状体材料之间的关系。方法 :6只科研兔 (体重 2 .5～ 4kg ,由大连医科大学动物中心提供 )共 1 2只眼 ,随机分为 2组 ,每组 6只眼。麻醉后行透明晶状体囊外摘除术 ,并分别植入相同设计的PM MA及硅胶人工晶状体。术后 6个月 ,取出晶状体后囊 ,行免疫组织化学法染色 ,用医用多功能图像分析软件对晶状体后囊表面的增殖细胞核抗原 (proliferitingcellnuclearantigen ,PC NA)进行定量检测 ,用SPSS统计软件分析结果。结果 :植入硅胶人工晶状体组PCNA平均值为 8.50± 1 .6 4,植入PMMA人工晶状体组PCNA平均值为 6 .1 7± 1 .4 7,二者差异有显著性 (P <0 .0 5)。结论 :后发性白内障与人工晶状体的材料有关 ,硅胶人工晶状体较PMMA人工晶状体更能显著降低后发性白内障的发生率。     

阿霉素药物缓释系统抑制人工晶状体植入术后后囊膜混浊的实验研究

目的 探讨阿霉素药物缓释系统(ADM-DDS)对兔眼人工晶状体植入术后后囊膜混浊(PCO)的抑制作用及其毒副作用,为临床应用提供实验依据。方法 自制聚乳酸(PLA)为载体的眼内植入型ADM-DDS,内含ADM 22μg。采用兔眼晶状体囊外摘出联合人工晶状体植入术的动物模型,术中将ADM-DDS植入15只兔眼晶状体囊袋内。术后临床常规检查,第4周行病理组织学及电镜检查。结果 实验组与对照组比较,晶状体后囊膜混浊减轻(t=2,P<0.01),Soemmering环面积减小(t=20.51,P<0.01),兔眼晶状体上皮细胞(RLECs)细胞核固缩坏死,胞浆凝集、空泡变性。两组之间的眼压、角膜内皮细胞形态及密度以及光镜下角膜、虹膜、睫状体、视网膜组织均无差异。结论 兔眼内植入ADM-DDS通过ADM缓释作用抑制了人工晶状体植入术后RLECs的增殖。ADM-DDS对兔眼角膜、虹膜、睫状体及视网膜无明显毒性。以PLA为载体的DDS将有可能成为临床上药物预防PCO的一种有效而安全的给药途径。     

AcrySof和PMMA人工晶状体植入致后发性白内障发生率的比较

目的：评价植入聚甲基丙烯酸甲酯（PMMA）人工晶状体和软性人工晶状体（AcroSof）致后发性白内障的严重程度。方法：总共100人（110眼）进行了人工晶状体植入术，随机分为两组植入不同类型的晶状体。组Ⅰ：AcrySof（SA60AT）人工晶状体，组Ⅱ：PMMA（LXIOBD）人工晶状体。分别在术后3，6，12和18mo，通过测定最佳矫正视力和数码照片拍摄评价后囊膜浑浊的密度。结果：术后3mo，PMMA组后囊膜浑浊的密度明显增加（3．6％），而Acrylic组并未发现增加。术后18mo，显著后囊膜浑浊两组的发生率相比较，Acrylic组（14．5％）较PMMA组（34．5％）低。由于PMMA人工晶状体比AcrySof人工晶状体所致后囊膜浑浊的范围广，故其导致更严重的视力降低。结论：与PMMA人工晶状体相比较，植入AcrySof人工晶状体在一定程度上有助于降低后发性白内障的发生率。     

人工晶状体嵌塞植入术预防后发性白内障的意义

目的 探讨人工晶状体嵌塞植入术的可行性及其预防后发性白内障发生的意义。方法 利用环行撕囊口嵌塞人工晶状体29例（29眼）,其中Ⅱ期人工晶状体植入26眼,Ⅰ期后囊破裂者3眼。结果 本组29眼人工晶状体嵌塞手术成功,无发生后发性白内障者,无人工晶状体偏位者,而且均固定良好。结论 利用撕囊口嵌塞法植入人工晶状体可以避免后发性白内障的发生,是囊袋及睫状沟人工晶状体植入的补充,临床效果良好。     

人工晶状体袢的角度与后发性白内障相关性研究

目的　探讨后发性白内障与人工晶状体袢角度之间的关系。方法　 9只科研兔随机分为 3组 ,每组 6眼。麻醉后 ,行透明晶状体囊外摘出术 ,并分别植入袢角度不同的PMMA人工晶状体 ,第 1组植入 0°袢人工晶状体 ,第 2组植入 5°袢人工晶状体 ,第 3组植入 10°袢人工晶状体。术后 6个月 ,裂隙灯下观察晶状体后囊混浊情况并分级 ,取出晶状体后囊 ,行光镜及透射电镜检查 ,并采用免疫组化法对晶状体后囊染色 ,然后采用医用多功能图像分析软件对晶状体后囊表面及赤道部的增殖细胞核抗原 (proliferatingcellnucle arantigen ,PCNA)进行定量检测 ,用SPSS统计软件分析结果。结果　裂隙灯下可见术后随着人工晶状体袢角度的增加 ,发生后发性白内障的例数及等级均呈下降趋势。光镜及透射电镜扫描可见发生后发性白内障的晶状体后囊表面有一层或多层晶状体上皮细胞生长 ,未发生后发性白内障的晶状体后囊表面无晶状体上皮细胞生长 ,赤道部均可见多层晶状体上皮细胞生长。PCNA定量结果 :植入 0°袢人工晶状体组与植入 5°袢人工晶状体组之间后囊表面及赤道部PCNA阳性率 (分别为 10 .5 0 0±2 2 5 8,9.16 7± 2 .2 2 9)无明显差异 (P >0 .0 5 ) ,而植入 10°袢人工晶状体组 (4.5 0 0± 1.871)与植入 0°袢人工晶状体组及植入     

糖尿病性白内障人工晶状体植入术

糖尿病性白内障摘出加人工晶状体植入术的报道很多,一般认为术后并发症高于非糖尿病眼,视力恢复低于非糖尿病眼,主张术前血糖应控制在８３ｍｍｏｌ·Ｌ－１以下,慎重选择手术。我们通过对７例１０眼病例手术,血糖均在较高水平,术后无１例严重并发症发生,视力恢复满意,现报告如下。１　临床资料１－１　一般资料　本组病人７例１０眼,男４例,女３例,年龄５３～７３ａ,病程１～１０ａ,血糖７－７６～１５－７４ｍｍｏｌ·Ｌ－１。其中３例因其它疾病而发现,无正规服用收稿　１９９９０８０６本文编辑　张知达作者单位　５…     

儿童白内障人工晶状体植入后发障刺开术临床探讨

目的：评价儿童白内障人工晶状体植入后发障刺开术的应用价值。应用：对26例儿童白内障人工晶状体植入后发障，在睫状体平坦部插入载囊针对后发障进行刺开术治疗。结果：视力明显提高，5米以上数指3例，0．1－0．3的12例，0．4－0．6的8例，0．8以上3例，结论：后发障刺开术操作简便，易合患者接受，效果好，并发症少，值得推广。     

儿童人工晶状体眼后发性白内障的手术治疗

目的探讨透明角膜切口插管灌注、睫状体扁平部后发性白内障切除术治疗儿童人工晶状体眼后发性白内障的手术技巧和疗效。方法对51例(57只眼)人工晶状体植入术后后发性白内障儿童患者行透明角膜切口插管灌注、睫状体扁平部后发性白内障切除术。术后随访记录视力、眼压及角膜内皮细胞密度,观察前房反应和并发症的发生情况。平均随访时间为30个月。结果全部术眼晶状体后囊膜中央均形成直径约3～4mm的圆形透明区,后发性白内障切除术的成功率为100％;术中前房稳定,人工晶状体无损伤。术后可配合视力检查的患者最佳矫正视力均恢复至后发性白内障发生前的最佳水平,且部分患者超过最佳水平;其中术后1周和3个月的最佳矫正视力≥0．3的术眼分别占44．4％和51．9％,随访期间无切口渗漏、角膜水肿、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。结论透明角膜切口插管灌注、睫状体扁平部后发性白内障切除术可安全、有效、便捷治疗儿童人工晶状体植入术后的后发性白内障。     

维甲酸修饰人工晶状体植入对兔后囊混浊的抑制作用

目的 :观察维甲酸修饰人工晶状体 (intraocularlens ,IOL)植入对兔残留晶状体上皮细胞 (residuallensepithe lialcells,RLECs)V型胶原合成的抑制作用 ,探讨其防治后囊混浊的作用机制。方法 :48只新西兰白兔被随机分为 3组 ,对照组植入未经修饰的PMMAIOL ,实验组植入经 5 μg、10 μg维甲酸修饰的IOL ,术后第 2天、第 7天、第 14天、第 30天采用高效液相色谱法动态检测房水中的药物浓度变化 ,采用SABC免疫组织化学法检测RLECs中V型胶原的表达情况。结果 :实验组于植入术后 7～ 14d内保持稳定的房水药物浓度 ,RLECs中V型胶原表达的程度显著低于对照组 (P <0 .0 1)。结论 :维甲酸修饰人工晶状体植入可显著抑制RLECs中V型胶原的合成 ,有可能成为防治后囊混浊的有效方法     

Comparative incidence of posterior capsular opacification in AcrySof and PMMA intraocular lenses

AIM: To evaluate the extent of significant posterior capsular opacification (PCO) after implanting polyme-thylmethacrylate (PMMA) and soft acrylic intraocular lenses. METHODS: A total of one hundred patients (110 eyes) undergoingintraocular lens(IOL) implant surgerywererandomly divided into two groups based on the type of IOL implanted: Group I: AcrySof (SA60AT) and Group II: PMMA (LX10BD). The density of posterior capsular opacification (PCO) was assessed 3, 6, 12 and 18 months after surgery by taking best corrected visual acuity (BCVA) and the digital photographs. RESULTS: At the end of 3 months postoperatively, the PCO density in the Group I (PMMA) increased significantly (3.6%) while no increase was found in the Group II (Acrylic). By the end of 18 months follow-up, the incidence of significant PCO was found to be less in the acrylic group (14.5%) as compared to the PMMA group (34.5%).On the basis of density, the PCO was more extensive with the PMMA lens than the AcrySof lens, which led to more severe visual loss. CONCLUSION: The intraocular implantation of the AcrySof IOL helps to reduce the incidence of PCO to a greater degree as compared to the PMMA IOL.     

Selenium functionalized intraocular lenses inhibit posterior capsule opacification in an ex vivo canine lens capsular bag assay

The purpose of this study was to determine the inhibitory effect of selenocystamine coated intraocular lenses (IOLs) on the formation of posterior capsule opacification (PCO) in an ex vivo canine lens capsular bag assay. Selenocystamine was covalently bound to the surface of poly(2-hydroxyethyl methacrylate) (poly(HEMA)) discs. Three groups of canine lens capsules (6 coated IOLs (SeIOLs), 7 non-coated control IOLs and 8 empty capsules) were cultured for 10 days. During the culture period PCO was scored based on visual inspection of the capsules using phase contrast microscopy. On day 10 all the capsules were prepared for light microscopic examination and lens epithelial cells (LECs) were quantified. Proliferating cell nuclear antigen (PCNA), α-smooth muscle actin (α-SMA) and cleaved caspase-3 were examined by immunohistochemistry. Additionally, cell viability assays were performed on LECs cultured in tissue culture medium pre-incubated with either a SeIOL or control IOL. The viability assays demonstrated that no detectable cytotoxic leachables were associated with the functionalized IOLs. The central posterior capsule was free of cells underneath all SeIOLs, although large numbers of LECs populated the capsular periphery. Apoptotic cells were observed underneath the periphery of some SeIOLs. Both the PCO scores and LEC counts of SeIOL containing capsules were significantly lower than those of control group capsules (p < 0.01 and p = 0.0004, respectively).The use of selenium functionalized IOLs resulted in a significant reduction of PCO in this ex vivo model. Binding of selenocystamine to a foldable IOL may provide an effective method to prevent population of the central posterior capsule with LECs.     

人工晶状体混浊及其类型

人工晶状体混浊是白内障术后罕见的并发症之一,患者主要表现为视力下降和对比敏感度降低。多种材料的人工晶状体均可发生混浊,混浊类型主要有表面型、内部型和混合型3种。其成因可能为羟基磷灰石沉着。通过人工晶状体置换术可获得较为满意的疗效。     

前后囊不完整人工晶状体的双囊夹持植入法

目的观察白内障手术中前后囊不完整病例双囊夹持人工晶状体植入法的临床效果。方法对白内障手术中前后囊不完整的白内障63例（63眼）施行一期前后囊互补夹持法植入后房人工晶状体，术后观察视力、人工晶状体的位置、囊的浑浊情况及并发症。术后随访6～48月。结果52眼（82．54％）术后1周最佳矫正视力〉0．5，人工晶状体位置稳定，无后发性白内障、视网膜脱离或继发性青光眼等并发症的发生。结论对于白内障手术中前后囊不完整者在术中采用双囊互补夹持法植入后房人工晶状体效果良好。     

Comparison of posterior capsular opacification in heparin-surface-modified hydrophilic acrylic and hydrophobic acrylic intraocular lenses

Purpose  To compare posterior capsular opacification (PCO) in a heparin-surface-modified (HSM) hydrophilic acrylic intraocular lens (IOL) and a hydrophobic acrylic IOL. Methods  Seventy-eight patients with simple cataract were randomized to receive either the BioVue 3 HSM hydrophilic acrylic IOL (Ophthalmic Innovations International, Ontario, CA, USA) (n = 38) or the Sensar AR40e hydrophobic acrylic IOL (AMO, Santa Ana, CA, USA) (n = 40). Another 99 patients with complicated cataract received either the BioVue 3 (n = 49) or the Sensar AR40e IOL (n = 50). Twelve months after surgery, POCOman software was used to analyze digital retroillumination photographs of the PCO. Results  In the simple cataract group, the respective PCO areas, expressed as a percentage and PCO severity scores at 12 months were 6.12% and 0.081 in the BioVue 3 group and 5.91% and 0.075 in the Sensar AR40e group. There was no statistically significant difference in the PCO area or the PCO severity score between the two IOLs (P = 0.631, P = 0.495, respectively). In the complicated cataract group, the respective PCO areas and PCO severity scores were 35.80% and 0.181 in the BioVue 3 group and 27.17% and 0.110 in the Sensar AR40e group. There was no statistically significant difference between the two IOLs (P = 0.147, P = 0.162). Conclusion  There was no difference in the degree or severity of PCO between the HSM hydrophilic acrylic IOL and the hydrophobic acrylic IOL groups.     

折叠人工晶状体与非折叠人工晶状体植入术后晶状体后囊膜混浊的临床观察

目的评估植入不同人工晶状体术后发生后囊膜混浊(posterior capsular opacification,PCO)的临床意义. 方法将折叠人工晶状体与非折叠人工晶状体植入患者分为两组,观察术后6个月PCO的发生情况,并进行相应统计分析. 结果折叠人工晶状体组患者术后发生PCO的可能性较小,而且在发生不同程度的PCO患者中,折叠人工晶状体组发生PCO的程度较轻. 结论行折叠人工晶状体植入术治疗白内障对减少发生PCO有一定临床意义.