锰离子滴眼液局部应用对眼前节组织的毒性作用

背景 锰离子滴眼液用于活体视觉传导通路的示踪观察方法已有研究,但锰离子局部点眼对眼前节组织的毒性作用尚无深入研究. 目的 研究不同质量浓度锰离子滴眼液对兔眼眼前节组织的毒性作用.方法 选取32只清洁级新西兰白兔,按照随机数字表法随机分为1.00 mol/L MnCl2组、0.50 mol/LMnCl2组、0.25 mol/L MnCl2组以及对照组,每组8只.采用抽签法随机选择动物一侧眼为实验眼,按照分组情况分别用1.00、0.50、0.25 mol/L锰离子滴眼液及生理盐水各1滴点于结膜囊中,分别于点眼后2h及1、3、7、14、21和28 d时在裂隙灯显微镜下观察眼局部刺激反应;用角膜荧光素染色法观察角膜上皮损伤情况并进行评分;采用角膜内皮镜观察角膜内皮细胞密度(ECD)和角膜厚度,并于点眼后3、7、14、28 d行苏木精-伊红染色,检查结膜、角膜、小梁网及睫状体的组织病理学变化.结果 1.00 mol/L MnCl2组和0.50 mol/L MnCl2组兔眼均出现睑结膜充血、水肿及大量分泌物等刺激症状,1.00 mol/L MnCl2组兔眼于点眼后1d刺激反应最强,点眼后7d反应消失;0.50 mol/L MnCl2组兔眼眼表刺激反应程度轻于1.00 mol/L MnCl2组,持续到点眼后3 d;0.25 mol/L MnCl2组兔眼点眼后未见明显的眼表刺激反应.点眼后2h、1d、3d及7d,各组兔眼角膜上皮荧光素染色评分总体比较差异均有统计学意义(x2=17.350、19.200、12.200、10.140,均P＜0.05).各组兔眼点眼后不同时间点ECD总体比较差异无统计学意义(F分组=0.38,P＞0.05;F时间=1.79,P＞0.05).各组兔眼点眼后不同时间点角膜厚度总体比较差异有统计学意义(F分组=18.22,P＜0.05;F时间=116.75,P＜0.05)点眼后2h～3d,1.00 mol/L MnCl2组兔眼角膜厚度值明显增加,但点眼后7～28 d,各组兔眼角膜厚度值接近,点眼后2h～14d角膜厚度值均明显高于点眼后28 d,0.50 mol/L MnCl2组兔点眼后2h～1d角膜厚度值明显高于点眼后28 d,差异均有统计学意义(均P＜0.05).组织病理学检查结果显示,1.00 mol/L MnCl2组兔眼于点眼后3d和7d可见结膜、小梁网和睫状体的炎性细胞浸润及角膜基质水肿,0.50 mol/L MnCl2组于点眼后3d可见结膜炎性细胞浸润,但角膜、小梁网和睫状体组织未见明显异常,而0.25 mol/L MnCl2组兔眼点眼后结膜、角膜、小梁网和睫状体均未见明显异常.结论 1.00 mol/L锰离子滴眼液对兔眼眼前节有明显毒性作用,0.50 mol/L锰离子滴眼液的毒性则明显降低,0.25 mol/L锰离子滴眼液对兔眼眼前节无明显的毒性作用.     

干眼患者使用表面麻醉剂后泪河形态的改变

目的：探讨干眼患者使用表面麻醉剂后泪河的变化。
　　方法：随机选取干眼患者50例。随机选取一眼滴用表面麻醉剂纳入试验组,另一眼用9g/L生理盐水点眼纳入对照组,点药15 min 后通过眼前节相干光学断层扫描仪( anterior segment optical coherence tomography,AS-OCT)记录并比较两组的泪河高度( tear meniscus height,TMH)、泪河深度( tear meniscus depth,TMD)以及泪河横截面面积( tear meniscus area,TMA)。
　　结果：表面麻醉剂使用后TMH为0.173±0.040mm,TMD为0.166±0.019mm,TMA为0.049±0.013mm2,与点药前相比,差异均有统计学意义( tTMH=2.78,P<0.01;tTMD=2.31,P<0.01;tTMA=2.69,P<0.01),点药后两组相比,差异均有统计学意义(tTMH=5.87,P<0.01;tTMD=2.04,P<0.05;tTMA=4.63,P<0.01)。
　　结论：表面麻醉剂减少干眼患者泪液分泌量,临床工作中应加强预防和干预。     

环孢素A双连续型微乳在大鼠皮肤中的药物滞留量考察

目的考察环孢素A双连续型微乳经大鼠皮肤给药的可行性及对药物体内分布的影响,并与大鼠灌胃给予新山地明比较。方法将环孢素A双连续型微乳非封闭的应用于大鼠皮肤,给药皮肤用胶带剥离法分离角质层,得到的全血、肾脏、肝脏、皮肤(除去角质层)经提取后用RP-HPLC法测定药物的含量,观察药物在血液中质量浓度的经时变化以及在肾脏、肝脏和皮肤的分布状况。结果与灌胃给予同剂量新山地明的体内行为相比,微乳经皮给药后皮肤中药物的含量显著高于口服组(P<0.01),而血液及肝脏、肾脏中药物的含量明显低于口服组。结论双连续型微乳能够有效的提高环孢素A在大鼠皮肤中的滞留量,同时可以降低药物在肝肾的蓄积。     

Solid lipid nanocarriers in drug delivery: characterization and design

Introduction: Solid lipid nanoparticles are promising drug carriers for systemic circulations as well as local applications. One of the major challenges for drug delivery is designing nanocarriers for efficient delivery of active substances to the target site and facilitating drug absorption.

Areas covered: In this article, the effects of excipients and particle preparation methods on the properties of solid lipid nanocarriers (SLNCs) and their impact on drug absorption and efficacies related to different administration routes are reviewed and discussed.

Expert opinion: SLNCs have special characteristics, making them attractive as drug delivery systems, for parenteral and oral delivery for systemic effects, or ocular, pulmonary and topical delivery to enhance local treatment efficacy and reducing systemic side effects. Both excipients and fabrication methods are crucial for the function and size of nanoparticles and should be considered simultaneously in designing particles to obtain the optimal drug absorption and efficacy, especially for local treatments. Despite the demonstrated advantages by the preclinical studies, further studies on improved understanding of the interactions of SLNCs with biological tissues of the target site is necessary for efficient designing functional nanoparticles for clinical applications.

Abbreviations: DG: diglycerides; FFA: free fatty acids; GMS: glyceryl monostearate; MG: monoglycerides; NLC: nanostructured lipid carriers; PL: phospholipids; SLM: solid lipid microparticles; SLN: solid lipid nanoparticles; SLNC: solid lipid nanocarriers; TG: triglycerides.     

马来酸噻吗洛尔滴眼液预防高度近视眼LASIK术后屈光回退的随机对照研究

背景 屈光回退是高度近视眼准分子激光角膜原位磨镶术（LASIK）术后较常见的并发症,影响手术的长期稳定性.目前尚无预防LASIK术后屈光回退的方法. 目的 观察马来酸噻吗洛尔滴眼液对高度近视眼LASIK术后屈光回退的预防效应.方法 采用前瞻性干预性临床随机对照研究.选取2012年2-9月在遵义医学院附属医院行LASIK的高度近视患者60例60眼,屈光度为（-7.16±0.95）D.将患者按随机数字表法分成试验组和对照组,2个组患者术后均给予常规抗炎用药,试验组患者在术后第1天开始滴加质量分数0.5％马来酸噻吗洛尔滴眼液,每日2次,1个月后改为每天晨起点眼1次.测量2个组患者术前,术后1周及1、3、6个月的裸眼视力、最佳矫正视力（BCVA）、等效球镜度（SE）、角膜前表面曲率和眼压,并测量术前及术后1、3、6个月术眼的中央角膜厚度（CCT）,术前测算残余角膜基质厚度.采用重复测量方差分析、独立样本t检验和Bonferroni检验对2个组在不同时间点间的数据进行分析. 结果 试验组及对照组间患者术前的年龄、裸眼视力、BCVA、SE、眼压、角膜前表面曲率、CCT及残余角膜基质厚度的差异均无统计学意义（P＞0.05）.2个组间手术后不同时间点的裸眼视力差异有统计学意义（F分组=3.91,P＜0.05;F时间=3.80,P＜0.05）,其中术后6个月试验组裸眼视力优于对照组（t=2.97,P＜0.05）,试验组术后6个月裸眼视力优于术后7d,差异有统计学意义（P＜0.05）.2个组术眼在术后不同时间点BCVA的差异无统计学意义（F分组=2.44,P＞0.05;F时间 =2.31,P＞0.05）.2个组间术眼术后SE的有统计学意义（F分组=11.52,P＜0.05）,术后不同时间点术眼SE的整体比较差异有统计学意义（F时间=22.06,P＜0.05）,术后6个月试验组术眼SE高于对照组（t=2.47,P＜0.05）,术后7d及术后1个月、3个月试验组术眼的校正眼压明显低于对照组（F分组=14.83,P＜0.05）,术后2个组间CCT的增幅差异无统计学意义（F分组=0.04,P＞0.05）.术后试验组角膜前表面曲率变化平稳,但对照组随着时间的延长角膜前表面曲率逐步增加（F时间=18.73,P＜0.05）.结论 高度近视眼LASIK术后早期局部使用0.5％马来酸噻吗洛尔滴眼液能减少屈光回退,提示0.5％马来酸噻吗洛尔滴眼液通过降低眼压而阻止角膜膨隆,其可能是预防术后屈光回退的主要机制.     

表面麻醉颞侧位超声乳化及人工晶状体植入术

目的:探讨并总结表面麻醉颞侧位超声乳化技术及5.5mm无缝线遂道切口人工晶状体植入术的方法和经验。方法:总计植入5.5mmPMMA人工晶状体采用无缝线隧道切口的白内障患者529例(568眼),植入折叠式人工晶状体患者51例(51眼)。前者核硬度为I和II级者248眼,III级296眼,IV级24眼。后者核硬者为I和II级者30眼,III级21眼,颞侧位超声乳化碎核,能量设定为50%~70%,有效超声时间10~88(平均46)s。结果:术后第1d视力≥0.5者分别为75%和76%,术后1mo裸眼或矫正视力≥0.5者分别为87%和84%,平均散光分别为0.25±0.38D和0.58±0.62D,两组比较,差异无显著性(P>0.05)。全部病例均无需缝线,96%的表麻颞侧位超声乳化成功,手术主要并发症是后囊破裂和虹膜色素脱失。结论:表麻颞侧位超声乳化白内障吸除术及5.5mm无缝线隧道切口的人工晶状体植入术与折叠术人工晶状体一样,具有手术时间短,无需缝线,视力恢复快等优点,而价格相对便宜,特别是对不宜在原位手术的患者是一种安全有效的手术方式,故值得推广。     

Can lubrication of the eyelid speculum reduce overall pain perception associated with cataract surgery by phacoemulsification performed under topical anesthesia?

Purpose:This study aimed to evaluate the effect of using the lubricated eyelid speculum on the overall pain perception by the subject patients who underwent cataract surgery by phacoemulsification technique under topical anesthesia.Methods:A prospective interventional randomized comparative study was conducted at the tertiary eye care center, wherein adult patients scheduled for bilateral cataract surgery with phacoemulsification techniques under topical anesthesia were randomized to undergo surgery with two different modes of eyelid speculum insertion, either with or without lubrication of the eyelid speculum. Fifty percent of the patients underwent surgery with eyelid speculum without lubrication, and 50% with lubrication of the eyelid speculum. The primary outcome was to compare the level of overall pain perception among the subject patients of the two groups by using the Visual Analogue Scale (VAS) in the immediate postoperative period.Results:The study included 130 patients who underwent bilateral cataract surgery (n = 260 eyes) under topical anesthesia, wherein n = 130 eyes underwent surgery using lubricated eyelid speculum and n = 130 eyes underwent surgery with dry eyelid speculum. Pain perception score assessed on the VAS (0–10 cm) ranged from 0.5 to 6, with a mean ± standard deviation of 2.06 ± 1.12. A significant correlation was found with two different methods of eyelid speculum insertion with reduced overall pain perception in patients with the use of lubricated eyelid speculum compared to the dry eyelid speculum (P = 0.0001).Conclusion:The overall pain perception associated with cataract surgery performed by phacoemulsification technique under topical anesthesia can be further minimized by lubricating the eyelid speculum prior to insertion for exposing the globe.     

Successful Topical Application of Botulinum Toxin After Microneedling Versus Microneedling Alone for the Treatment of Atrophic Post Acne Scars: A Prospective,Split-face,Controlled Study

BackgroundAcne scars are a source of cosmetic concern for most of the patients.ObjectiveWe sought to compare the clinical efficacy and safety of topical botulinum toxin A (BTX-A) application immediately after microneedling (Mn) versus Mn with saline in the treatment of atrophic acne scars.MethodsForty patients with atrophic acne scars (rolling, boxcar, and mixed types) were enrolled in a split-face study; microneedling was performed on both sides of the face followed by an application of topically diluted botulinum toxin on one side (Side A) and saline on the other (Side B) for two sessions both two weeks apart. Evaluation was done at baseline, two and four weeks after the session. Follow-up was performed after six months. The assessments included blinded clinical assessment and patient’s satisfaction.ResultsAfter the treatment, acne scars in (Side A) showed 70 percent overall improvement versus zero percent in Side B (P<0.0001). A statistically highly significant reduction of acne scars severity occurred in (Side A) (P=0.0008). Patient’s satisfaction was higher in (Side A) (P<0.0001). No serious side effects were reported.ConclusionMicroneedling delivery of BTX-A could be simple, safe, and innovative modality improving the appearance and decrease the depth of atrophic acne scars.     

难愈性创面的中西医研究进展

创面愈合是目前临床研究的热点及难点问题之一,随着人们对创面愈合机制认识的不断进步,促创药物的研究及开发必将成为现代医学和传统医学研究的焦点。