The effect of total-body irradiation on corneal neovascularization in the Fischer 344 rat after chemical cauterization.

Previous investigations of corneal neovascularization after irradiation yielded discordant results. Most studies indicated that new blood vessel formation in the cornea is inhibited by irradiation. However, others reported that angiogenesis after corneal cauterization is similar in both irradiated and nonirradiated animals. To assess the effect of total-body irradiation on neovascularization further, the amount of angiogenesis was determined in irradiated rats after chemically induced corneal injury. Corneal tissue was evaluated quantitatively with computerized image analysis 2, 3, or 4 days postcautery in rats perfused with India ink and gelatin immediately after death. The rats were exposed to a single dose (9 Gy) of total-body irradiation 6 days before corneal cauterization. In both the nonirradiated and irradiated rats, neovascularization increased with the duration of the postcautery interval. The amount of corneal neovascularization was not significantly different in the irradiated and nonirradiated rats at any of the postcautery intervals studied. This investigation suggests that endothelial cell migration plays a more important role than cell replication in the pathogenesis of corneal angiogenesis in the Fischer 344 rat. Moreover, the suppression of corneal angiogenesis by irradiation may be dependent on the experimental conditions and species examined.     

Specular microscopic study of X-ray-irradiated rabbit cornea

PURPOSE: To investigate the influence of ionizing radiation on the corneal epithelium and endothelium of rabbit eyes. METHODS: Five healthy mature albino rabbits were unilaterally irradiated with 20 Gy of X-rays (250 kV, 12 mA). Slit-lamp biomicroscopic observation and specular microscopic examination of the corneal epithelium and endothelium were carried out before and 1, 4, 8, 12, 16, 20, 24, and 36 weeks after irradiation. We evaluated mean area of the superficial corneal epithelial cells, mean area and the percentage of hexagonal cells of the corneal endothelial cells, and corneal thickness. The statistical difference between the irradiated and control eyes was assessed using paired t-test. RESULTS: All animals developed cataract within 24 weeks. Slit-lamp biomicroscopy showed no apparent corneal abnormalities over the 36-week follow-up period. Specular microscopy revealed a significant enlargement of the superficial corneal epithelial cells from 4 to 12 weeks after irradiation (P<0.01), which disappeared at 16 weeks post-irradiation. Specular microscopy of the corneal endothelium showed enlargement and morphological alterations of the cells beginning 8 weeks after irradiation (P<0.05). These changes persisted throughout the study period. There were no statistically significant changes in corneal thickness. CONCLUSION: After X-ray radiation of 20 Gy, transient damage occurred in the corneal epithelium, while delayed and irreversible changes were seen in the endothelium.     

Effect of focal X-ray irradiation on experimental choroidal neovascularization.

PURPOSE: Radiation therapy has been used to treat choroidal neovascularization (CNV) in patients with age-related macular degeneration. The in vivo effect of applying focal x-ray irradiation to the eye of rabbits with experimental CNV was investigated. METHODS: CNV was induced in the rabbit eyes by subretinal implantation of gelatin hydrogel microspheres impregnated with basic fibroblast growth factor. Three weeks after implantation, 17 of 34 eyes with CNV lesions accompanied by fluorescein leakage were irradiated with a single dose of 20 Gy; the other 17 eyes were not irradiated and served as the controls. The eyes were examined before irradiation and 1, 2, and 4 weeks after irradiation, by indirect ophthalmoscopy and fluorescein angiography. The degree of a decreasing amount of fluorescein leakage from the CNV lesions after irradiation was graded using a computerized image analysis system and was compared in the irradiated and nonirradiated eyes. These eyes were also examined histologically and immunohistochemically. RESULTS: Fluorescein leakage from the CNV lesions had significantly decreased in the eyes irradiated with 20 Gy compared with the control eyes, throughout the study period (P < 0.05). Histologic and immunohistochemical studies at 4 weeks after irradiation demonstrated that the degree of vascular formation and the number of vascular endothelial cells in the subretinal membrane of the irradiated eyes were less than those of the control eyes. CONCLUSIONS: Focal x-ray irradiation at the ocular region effectively reduced experimental CNV activity. These results support the possibility that radiation therapy may be beneficial in treating CNV.     

Experimental corneal neovascularization by basic fibroblast growth factor incorporated into gelatin hydrogel

The study was designed to investigate the feasibility of using an acidic gelatin hydrogel as a biodegradable vehicle for basic fibroblast growth factor (bFGF). bFGF was incorporated by polyion complexation into a biodegradable hydrogel prepared by cross-linking acidic gelatin with the isoelectric point of 4.9. The dried hydrogel (sized to 2x1 mm) was hydrated with bFGF aqueous solution including different doses of bFGF (20, 50, 125, 250 and 500 ng) and implanted into a rabbit corneal pocket (2.5x2 mm). As a control group, the gelatin hydrogel without bFGF or bFGF alone (500 ng) was used. Corneal angiogenesis was evaluated by biomicroscopy, corneal fluorescein angiography and histology for 21 days. Photographs were taken and corneal angiogenesis was evaluated by image analysis. The hydrogel degraded with time after its implantation into the corneal pocket. Experimental eyes receiving the hydrogel containing more than 50 ng of bFGF demonstrated significant corneal angiogenesis. Control eyes and eyes receiving the hydrogel containing 20 ng of bFGF showed no corneal angiogenesis. Corneal angiogenesis, which occurred on the 3rd or 4th day after implantation, reached maximal growth on about day 7 and regressed from day 10 after implantation. The area of angiogenesis showed a dose-dependency on bFGF. The gelatin hydrogel itself induced neither angiogenesis nor inflammation. These results suggested that acidic gelatin hydrogel releases bioactive bFGF with its biodegradation, resulting in corneal neovascularization.     

电离辐射对角膜新生血管形成的抑制作用

背景 角膜新生血管(CNV)可发生在多种跟表疾病中,常可加重病情,但有效的临床治疗方法仍在探索中. 目的 探讨电离辐射对角膜碱烧伤后新生血管的抑制作用.方法 76只清洁级Wistar纯系大鼠中70只用角膜碱烧伤的方法建立大鼠右眼CNV模型,然后按照随机数字表法将造模动物分为β射线10 Gy一次性照射组2只、β射线7 Gy分次照射组17只、β射线10 Gy分次照射组17只、质量分数1％环孢素A(CsA)点眼组17只和角膜碱烧伤模型组17只,6只正常兔6只眼(均取右眼)作为正常对照组.用90 Sr-90Y眼科敷贴器于右眼角膜碱烧伤后第1天开始沿角膜缘进行β射线照射,1％ CsA点眼组用药时间与照射时间相同.实验后每日行裂隙灯检查并计算CNV长度和面积.于角膜碱烧伤后3、5、7d制备角膜组织石蜡切片和匀浆,采用免疫组织化学法检测各组大鼠角膜组织中bcl-2、bax、血管内皮生长因子(VEGF)的表达,分别采用Western blot和逆转录聚合酶链反应(RT-PCR)检测各组大鼠角膜组织中VEGF蛋白及mRNA表达的变化.结果 角膜碱烧伤后7d,裂隙灯下可见β射线10 Gy一次性照射组、β射线10 Gy分次照射组均出现角膜溃疡,角膜碱烧伤模型组可见大量CNV生成,而β射线7 Gy分次照射组和1％CsA点眼组CNV明显较少.角膜碱烧伤后7d,β射线7 Gy分次照射组、1％ CsA点眼组CNV长度和面积均明显小于角膜碱烧伤模型组,差异均有统计学意义(长度:q=14.40、24.20,P＜0.01;面积:q=17.80、14.00,P＜0.01).免疫组织化学检测表明,与角膜碱烧伤模型组比较,β射线7Gy分次照射组、1％CsA点眼组大鼠角膜中bcl-2和VEGF蛋白表达均减弱,而bax蛋白表达均增强.RT-PCR检测表明,β射线7 Gy分次照射组、β射线10 Gy分次照射组、1％CsA点眼组VEGF mRNA表达强度明显低于角膜碱烧伤模型组,Western blot检测发现VEGF蛋白的表达与VEGFmRNA的表达遵循同样的规律.结论 90Sr-90Y跟科敷贴器小剂量分次放射治疗可明显抑制角膜碱烧伤后CNV的生长,并且以β射线7 Gy分次照射作用效果最佳.     

Oedematous corneal response of the fellow control eye to lotrafilcon a and vifilcon a hydrogel contact lenses in the rabbit

PURPOSE: To compare central corneal swelling after 24 h in eyes wearing Lotrafilcon A (high Dk silicone hydrogel) and Vifilcon A (low Dk hydrogel) lenses and the fellow control eyes of rabbits. METHODS: 24 New Zealand albino rabbits, free of corneal and conjunctival disease, were anaesthetised with ketamine and xylazin. In 12 rabbits, the right eye was fit with the high Dk Lotrafilcon A silicone hydrogel lens. In the other 12 rabbits, the right eye was fit with the low Dk Vifilcon A hydrogel lens, whereas the left eyes were kept as control eyes. Thereafter, the lens-fitted eyes had partial tarsorrhaphy that left a central gap of approximately 4 mm in length. After 24 h the eyelids were opened and the lenses removed. Central corneal thickness was measured using an ultrasonic pachymeter (Mentor O&O-Advent). RESULTS: Central corneal oedema induced by Vifilcon A lens was significantly higher than that with the Lotrafilcon A lens (p < 0.0001). The oedema of the fellow eyes paired with the Vifilcon A lens-wearing eyes was also higher than that of the fellow eyes paired with the Lotrafilcon A lens-wearing eyes (p < 0.01). CONCLUSIONS: The Lotrafilcon A lens induced significantly less corneal oedema than the Vifilcon A lens. Corneal oedema of the fellow eyes appears to be influenced by the swelling of the contralateral lens-wearing eyes. The oedema of the fellow control eye was significantly lower when there was less oedema in the contralateral eye wearing a high Dk silicone hydrogel lens. This may be a sympathetic physiological response. The presence of silicone in the high Dk hydrogel lens may suppress corneal oedema in the lens-wearing eye, thus affecting the fellow eye.     

Potential Inhibitory Effect of LASSBio-596, a New Thalidomide Hybrid, on Inflammatory Corneal Angiogenesis in Rabbits

Aims: Evaluate the effect of LASSBio-596, structurally designed as a new hybrid of thalidomide, on inflammatory corneal angiogenesis. Methods: Eighteen rabbits were submitted to an alkaline cauterization in the right cornea. The animals were randomly allocated to three groups: vehicle, dexamethasone and LASSBio-596. Drugs were administered by eyedrops 3 times a day for 21 days. Evaluations were performed on days 3, 6, 9, 12, 15, 18 and 21 after cauterization. At these time points, digital images of the cornea were captured in a standard fashion. The angiogenic response was measured using software that was developed specifically for this purpose. It calculated the following parameters: neovascularization area (NA), total vascular length (TVL) and blood vessel number (BVN). Results: It was observed that dexamethasone significantly decreased NA, TVL and BVN during all assessments. From the NA the angiogenesis rate (AR) was calculated in each group. Therefore, dexamethasone completely inhibited the inflammatory corneal angiogenesis with an AR of -0.001 ± 0.006 mm(2)/day, which was significantly lower (p < 0.001) than that observed after treatment with vehicle (0.078 ± 0.024 mm(2)/day) and LASSBio-596 (0.054 ± 0.012 mm(2)/day). Although LASSBio-596 reduced angiogenesis in relation to vehicle, according to NA, TVL and BVN values, this difference was not statistically significant. However, it was found that the AR as measured in the LASSBio-596 group was significantly lower (p < 0.05) than that seen in control animals, indicating a potential antiangiogenic effect. Conclusion: We conclude that topical application of LASSBio-596 at 1.0% has a potential inhibitory effect on inflammatory corneal angiogenesis in rabbits.     

实验性角膜新生血管的形态观察

目的观察兔角膜新生血管的形态特点,探讨其发生机制及治疗效果.方法将16只新西兰兔随机分为实验和对照两组,均以75%硝酸银液烧灼兔角膜,实验组于硝酸银烧灼后行β射线照射,观察两组角膜新生血管的生长规律;选期制做新生血管铸型,扫描电镜下比较两组间新生血管形态差异.结果角膜新生血管以典型的芽生方式发生和增殖,经β射线照射后的血管芽形成受到明显的抑制和破坏,新生的血管支干发生萎缩、坏死.结论阻断新生血管的芽生过程可抑制角膜新生血管的形成和发展.     

Subclinical experimental optic neuropathy after accelerated proton beam irradiation

BACKGROUND: Accelerated proton beam irradiation has been used for several years to treat intraocular tumors. The pathophysiology of proton-beam-induced retinopathy and neuropathy has not been characterized to date. The present study investigates the early effects of irradiation with an accelerated proton beam on the optic nerve of the rabbit. MATERIALS AND METHODS: The optic nerve head of Albino New Zealand rabbits (n = 14) was irradiated with a narrow beam of accelerated protons using the total dose of 60 and 43 Gy, respectively. This dose was split up into 4 equal sessions taking place on 4 consecutive days. Ophthalmoscopic examination was performed regularly, and the rabbits were sacrificed at 1, 3 and 8 months after irradiation. The eyes were enucleated and processed for light and electron microscopy. RESULTS: Despite the absence of ophthalmoscopically detectable optic neuropathy in all 14 rabbits irrespective of the dose of irradiation, light and electron microscopy of the optic nerve showed a glial and fibrotic perivascular scar made up predominantly of altered astrocytes. This scar formation was seen as early as 1 month after irradiation and was at times accompanied by infiltration with inflammatory cells perivascularly both outside and within the optic nerve. In contrast to the astrocytes, oligodendrocytes did not show degenerative cellular alterations. During the 8-month follow-up, no signs of vascular occlusion were found. CONCLUSIONS: The observed lesions in the glial tissues with consecutive fibrosis appear to stem from a direct effect of irradiation. This may represent the initial mechanism of early subclinical irradiation-induced damage to the optic nerve before vascular occlusions may occur at a later stage, which may lead to more severe damage.     

Experimental external irradiation of corneal neovascularization

The clinical effect of ionidizing radiation on ocular neovascularizations is controversial not only because of the variety of treatment modalities. The aim of our study was to investigate an experimental model which allows to evaluate radiation parameters and to study the mechanism of the inhibitory effect on neoangiogenesis. METHODS: Corneal angiogenesis was induced by use of a micropocket assay in NZW rabbits. Pellets with 500 ng bFGF in 2% methylecellulose were implanted into the stroma 2.0 mm from the limbus. Initiation of vessel growth occurred on day 3. At this time radiation was performed with different doses (single dose of 15 to 30 Gy or fractionated 5 x 5 Gy) using a 6 MeV linear accelerator. Vascular growth was quantified. RESULTS: Irradiation with a total dose of 25 Gy applied in a fractionated regimen or as single-dose irradiation on the day of surgery or on day 6 after surgery did not significantly reduce neovascular growth. In contrast, postoperative radiation therapy on day 3 was able to reduce the area of ingrowing vessels significantly (P < 0.01). In spite of the relatively high dose there were no significant side effects during the observation period of 8 weeks. CONCLUSION: Our results show that single-dose radiation (> or = 25 Gy) is sufficient to inhibit the growth of corneal neovascularizations. With this model it might be possible to investigate parameters for therapy of ocular neovascularizations as well as the underlying mechanisms.     

Intracorneal bovine albumin: an immunologic model of corneal angiogenesis

Background: We characterized the neovascularization that follows the intracorneal injection of bovine albumin (BA) in rabbits as a model of corneal angiogenesis. Methods: New Zealand white rabbits received intracorneal injections of phosphate-buffered saline with and without various amounts of BA. The rabbits were co-sensitized or presensitized by intramuscular BA or were not sensitized. The corneal vascular response was quantified by ranking photographs taken periodically after the injection. Results: In pre-sensitized animals, blood vessels were apparent within 4 days and reached maximum intensity 14 days after the intracorneal injection. Corneas also vascularized in nonsensitized rabbits, but a larger dose (>0.2 mg BA) was required than in pre-sensitized animals (>0.02 mg BA). Vascularization began later in non-sensitized animals and was less extensive than in pre-sensitized animals. Conclusion: The intracorneal injection of BA is a reproducible model of corneal angiogenesis in rabbits and should allow the involved immunological mechanisms to be elucidated.     

Immunohistochemical study of localization of extracellular matrix after holmium YAG laser irradiation in rat cornea

PURPOSE: To better understand the corneal responses to holmium YAG (Ho:YAG) laser irradiation, we used immunofluorescent microscopy to examine changes in the localization of the extracellular matrix components, which play important roles in the maintenance of corneal morphology and functions. METHODS: Rats were irradiated with a Ho:YAG laser. On days 1, 3, and 7 after irradiation, the eyes were enucleated and frozen. Cryosections were made with a cryostat and were stained with antibodies against type I collagen, fibronectin, type IV collagen, or laminin for immunohistochemical study. RESULTS: One day after Ho:YAG laser irradiation, contraction of the stromal collagen fibrils was observed. Keratocytes could not be observed at the irradiated stromal region on day 1 after irradiation. One week later, however, keratocytes returned to the irradiated area. Although the stromal collagen fibrils had contracted, they were stained by an antibody against type I collagen. Dense fluorescence for fibronectin was observed at the margin of the stromal acellular zone. Both laminin and type IV collagen were observed at the basement membrane under the corneal epithelium, regardless of whether or not the corneas had been irradiated. CONCLUSION: These results suggest that Ho:YAG laser irradiation might be useful for the collagen contraction of stroma, without causing serious damage to the corneal epithelium and the basement membrane.     

Effect of irradiation on vascularization of corneas grafted onto chorioallantoic membranes

Several studies have shown that total body irradiation decreases the angiogenic response to corneal cauterization. This inhibition could be due to alterations in angiogenic stimuli within injured corneas and/or to a decreased ability of irradiated animals to respond to such stimuli. To determine whether total body irradiation specifically affects angiogenic stimuli within injured corneal tissue, cauterized corneas from mice exposed to 900 rads of total body irradiation and from non-irradiated controls were grafted onto the chorioallantoic membranes (CAM) of chick embryos and their abilities to stimulate the ingrowth of healthy embryonic blood vessels were compared. Cauterized corneas incorporated into CAM mesenchymal tissue were invaded by blood vessels in 34.6% of the irradiated group and in 75% of the non-irradiated controls. This difference in the two groups was statistically significant (P less than 0.03). Total body irradiation significantly decreased the frequency of vascular invasion of cauterized corneal tissues by healthy CAM blood vessels. This finding suggests that total body irradiation can specifically affect the stimulus for angiogenesis within cauterized corneas.     

αB-crystallin malondialdehyde,superoxide dismutase, and lutathione peroxidase changes in X-ray irradiated rat lens

AIM: To evaluate αB-crystallin malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GPx) changes in X-ray irradiated rat lens. METHODS: Eight-week-old Sprague-Dawley male rats received X-ray irradiation to the head with rest of the body protected. The exposure dose ranged from 2 to 25 Grays (Gy). The cataract status were examined by slit lamp and rated with "four-grade systems" post-irradiation. The lens MDA level, and the activities of SOD and GPx were measured in a short-term experiment post-irradiation, and αB-crystallin protein levels were quantified. RESULTS: The lenses of normal control and the X-ray irradiated groups with the dose up to 10 Gy remained transparent throughout the experiment. The lens first appeared tiny scatters, and even lamellar opacities in the posterior capsule 45 days post-irradiation with the dose of 15 Gy, and progressed slowly to the advance stage of cataract; while, for the higher dose (25 Gy), the opacity of lens appeared much earlier, and progressed more rapidly to mature stage of cataract within 1 month. At the end of the observation (90 days post-irradiation), almost all lenses became complete opacity with the higher dose (25 Gy). The degree of lens opacity was rated accordingly. The lens MDA level was increased, and SOD and GPx activities were decreased with a dose-dependent manner post-irradiation. The αB-crystallin protein level was decreased dose-dependently at the end point of observation. CONCLUSION: Oxidative events and αB-crystallin may play important roles in the pathogenesis of cataract in X-ray irradiated rat lens.     

The influence of hyperbaric oxygen therapy and irradiation on hydroxyapatite ocular implant exposure and fibrovascular ingrowth in New Zealand white rabbits

PURPOSE: Lack of adequate fibrovascular ingrowth has been implicated as a cause of exposure of hydroxyapatite (HA) implants in anophthalmic sockets. We investigated the vasculopathic effects of external beam irradiation, and the fibrovascular-enhancement effects of hyperbaric oxygen (HBO), on HA implant exposure and fibrovascular ingrowth in a rabbit model. METHODS: Eighteen rabbits underwent enucleation with implantation of a 12-mm HA sphere. Six rabbits received 20 Gy of external beam orbital irradiation prior to enucleation. Three irradiated and 6 nonirradiated rabbits received postoperative HBO. Three weeks postoperatively, all rabbits were evaluated clinically for evidence of implant exposure. Implants were then removed, and histopathologic analysis of fibrovascular ingrowth was performed. RESULTS: The amount of vascularization as measured by the depth of ingrowth was greater for nonirradiated (89% ingrowth) than for irradiated (71% ingrowth) animals. HA implant exposure occurred in 1 of 12 (8%) of the nonirradiated, and 4 of 6 (67%) of the irradiated rabbit orbits. HBO did not protect irradiated rabbits from exposure, but did enhance fibrovascular ingrowth in nonirradiated rabbits (100% ingrowth vs. 77% ingrowth). CONCLUSION: Impaired orbital vascularization from prior irradiation appears to retard fibrovascular ingrowth into HA implants, and is associated with an increased incidence of exposure. While HBO did not diminish the likelihood of exposure in irradiated sockets, HA fibrovascular ingrowth in normal orbits appeared to increase with HBO. This may have beneficial clinical application in cases of exposure in nonirradiated orbits.     

Bevacizumab inhibits corneal neovascularization in an alkali burn induced model of corneal angiogenesis

BACKGROUND: New and uncontrolled blood vessel development in the cornea is a pivotal process in the pathogenesis of several corneal diseases. These corneal diseases may finally cause blindness and managing them therapeutically is problematic. The data supporting a causal role for vascular endothelial growth factor in corneal neovascularization are extensive. This study aimed to evaluate the effect of subconjunctival bevacizumab (Avastin) on experimental corneal neovascularization in rabbits. METHODS: Chemical cauterization of the cornea was performed by touching central cornea with a 5-mm-diameter NaOH-soaked cotton applicator for 10 s in 20 eyes of 20 White New Zealand rabbits. The rabbits were then divided randomly into two equal groups. Bevacizumab (2.5 mg) was administered to 10 eyes (group 1) by a subconjunctival injection immediately after chemical cauterization of corneal surface. As a control, 10 eyes (group 2) received an injection of distilled water. Rabbits were examined daily for detection of the first signs of neovascularization. Three weeks later, the extent of corneal neovascularization was evaluated by direct examination and photograph analyses. Total corneal neovascularization area, degree of circumference involved and longest neovascular pedicle length were assessed. RESULTS: Bevacizumab significantly decreased the total neovascularization area (P < 0.009), the circumference involved (P < 0.011) and the longest neovascular pedicle length (P < 0.023). CONCLUSION: Local injection of bevacizumab has a significant effect on inhibition of alkali burn-induced corneal neovascularization. This shows the potential value of bevacizumab in the treatment of corneal neovascularization.     

Inhibiting the effect of 90Sr-90Y ophthalmic applicators on rat corneal neovascularization induced by sutures

AIM: To investigate a practical technique used to inhibit corneal angiogenesis with a 90Sr-90Y ophthalmic applicator. METHODS: A 90Sr-90Y ophthalmic applicator was detected with a radioactive nuclide application treatment healthy protection standard. The applicator used was produced through medical dosimetry research; it had a concave applicator add measured the applicator temperature, serviceable humidity range, applicator appearance status, applicator radiation homogeneity, radioautography, and radiological safety of the original applicator surface. A vessel model was established using newborn rats, with sutures around the corneal limbus. Corneal neovascularization (CNV) were observed with a slit lamp. The new vessel length and response area were measured. RESULTS: Low-dose radiation can inhibit CNV after corneal sutures. The absorbed dose of the applicator (0.046 Gy/s) was safe for the treatment of it. The lengths of new vessels and the areas of new vessels were lower than the new born vessel rat group (P<0.01). CONCLUSION: The optimal radiation dose emitting from the applicator can be safe and potentially used in humans.     

结膜下注射贝伐单抗对兔角膜新生血管的抑制作用

目的 观察碱烧伤后不同时间结膜下注射贝伐单抗（Bevacizumab）角膜新生血管（CNV）的形成与转归.方法 新西兰白兔54只,制成单眼碱烧伤模型,随机分为3组,每组18只眼,A组碱烧伤后结膜下立即注射贝伐单抗2.5 mg（0.1 ml）,B组碱烧伤后3d结膜下注射贝伐单抗2.5 mg（0.1 ml）,C组结膜下注射生理盐水0.1ml,为对照组.共观察28 d.裂隙灯显微镜下观察角膜新生血管生长情况,行眼前段照相并计算其面积,伤后7、14、28 d各组随机取6例角膜行共焦显微镜检查,观察角膜组织炎性细胞浸润情况及角膜新生血管形态学变化.结果 A、B及C组角膜新生血管开始出现的时间分别为（5.9＋0.8）d、（3.5＋0.6）d及（3.4＋1.1）d,其中A组明显较C组延长（P＜0.05）,B组与C组差异无统计学意义（P =0.068）.伤后各时间点A、B组角膜新生血管的生长面积均明显较C组减少（P＜0.05）,A组与B组角膜新生血管面积比较,差异有统计学意义（P＜0.05）.共焦显微镜检查可见C组烧伤区大量炎性细胞浸润及新生血管形成,而A组角膜炎性细胞较少,烧伤区无新生血管形成,B组见少量新生血管侵入烧伤区.3组基质层均可见纤维及瘢痕组织增生,其中治疗组纤维增生程度与瘢痕组织均较对照组轻.结论 结膜下注射贝伐单抗可抑制角膜炎性细胞形成,改善损伤角膜基质,促进角膜愈合,从而减少碱烧伤引起的角膜新生血管的生长,在早期注射能取得更好的疗效.     

Ocular surface reconstruction by tissue engineering

Ocular surface reconstruction by tissue engineering using somatic stem cells is a second-generation modality. In order to treat bilaterally affected, severe ocular surface disorders, we investigated the transplantation of two types of cultivated mucosal epithelia: allogenic corneal epithelial stem cells, and autologous oral mucosal epithelial cells. For this, first, we summarized the clinical results of allogenic keratoepithelioplasty and limbal transplantation. In addition, we showed that the immunological shift from Th1 to Th2 by using keyhole limpet hemocyanin was effective in suppressing the incidence of immunological rejection. Second, we investigated the transplantation of cultivated human corneal epithelial stem cells onto amniotic membrane. The cultivated sheet was created by co-culture with 3T3 fibroblasts, using the air-lift method, in cultivating the corneal epithelial stem cell on the amniotic membrane. These cultivated cells demonstrated positive keratin 3 and 12 specific to in vivo corneal epithelium, tight junction related proteins, and telomerase activity. The transplanted allogenic human corneal epithelial sheet survived on the corneal surface in all cases, and was quite effective for achieving ocular surface stability in the acute phase of Stevens-Johnson syndrome, ocular cicatricial pemphigoid, or chemical injury. However, a few cases developed immunological rejection or opportunistic infection. Third, to establish the transplantation of the autologous cultivated oral mucosal epithelial sheet, we performed animal experiments using rabbits. In vitro oral mucosal epithelial sheet showed histology similar to that of in vivo corneal epithelial sheet. It expressed positive keratin 3 as well. Since the autologous transplantation of this sheet survived on the ocular surface with the recovery of corneal transparency, a cultivated oral mucosal epithelium may become a substitute for corneal epithelium. Fourth, we created a cultivated human corneal endothelial cell sheet on amniotic membrane using a similar technique, and transplanted it to a rabbit eye as a xenograft. The transplanted corneal endothelial cell density was over 3,000 cells/mm2, and it was actively functioning even after the transplantation. Lastly, to explore cell markers for corneal epithelial stem cells, we established a technique using laser micro-capture, and introduced amplified fragment length polymorphism (AFLP), identifying several candidate molecules as stem cell markers.     

Sutureless amniotic membrane fixation using fibrin glue for ocular surface reconstruction in a rabbit model

PURPOSE: Amniotic membrane transplantation has become an important treatment option for corneal surface reconstruction. However, suture fixation of the transplant has various disadvantages like corneal irritation, scarring, graft loss due to membrane shrinkage, and the need for subsequent suture removal. Replacement of sutures by bioadhesives might be an advantageous alternative. This controlled study was designed to evaluate a new sutureless technique for amniotic membrane fixation onto the corneal surface by using fibrin glue. METHODS: Standardized disks of cryopreserved amniotic membranes were transplanted onto the deepithelialized cornea of 12 rabbits using either conventional suture fixation or a new fibrin glue technique. The rabbits were followed-up with slit-lamp examination and fluorescein staining until epithelialization was completed. Consecutively, the rabbits were killed and the eyes processed for histology and immunohistochemistry for cytokeratin-3. RESULTS: All membranes of both groups stayed in place throughout the follow-up time and showed a progressive graft epithelialization that was completed after 12 days. Whereas suture-fixated membranes showed progressive tissue shrinkage, fibrin-glued sheets remained unaltered. In the bioadhesive group, histology revealed a smooth fibrin layer in the graft-host interface and a continuous, stratified layer of cytokeratin-3 expressing corneal epithelial cells on the membrane surface. In contrast, suture-fixated membranes showed contracted and prominent membrane edges with epithelial ingrowth into the submembrane interface. CONCLUSION: Our results demonstrate the general feasibility of reproducible and reliable sutureless amniotic membrane fixation onto the corneal surface in rabbits. Stable adherence is maintained until epithelialization is completed. The sutureless technique gives sufficient manipulation time for the sheet before the final cross-linking process is completed. Furthermore, several advantageous characteristics could be demonstrated as increased biocompatibility, better epithelialization pattern and the lack of membrane shrinkage.