眼内应用丝裂霉素C抑制后囊膜混浊的组织病理学研究

目的：研究兔晶状体超声乳化术中眼内应用0．2mg／ml的丝裂霉素C(mitomycin-C，MMC)对术后后囊膜混浊的抑制作用，并比较不同给药方式对眼毒性的差异。方法：将32只新西兰白化兔随机分为A、B、C、D4组，进行晶状体超声乳化摘除术。A组为空白对照组，B组用0．2mg／ml的MMC溶液在环形撕囊后作水分离，C组在术中将混有MMC(0．2mg／ml)的粘弹剂注入空的囊袋中，D组将MMC(0．2mg／ml)溶于配好的灌注液中，在手术中应用。术后1个月对术眼进行组织病理学检查。结果：术后1个月时光镜下A组中赤道部及中央后囊膜均可见晶状体上皮细胞的明显增生、移行及大量排列紊乱的成纤维细胞和胶原纤维。B、C、D三组中可见赤道部少量残留的晶状体上皮细胞及皮质，中央后囊的表面未见品状体上皮细胞、成纤维细胞或珍珠样小体。透射电镜下，D组中虹膜上皮、睫状体上皮及视网膜各层均发生了不同程度超微结构的损伤，A、B、C三组间未见明显异常。结论：眼内应用0．2mg／ml的MMC明显抑制后囊膜混浊的发展。尽管眼内应用0．2mg／ml的MMC可以导致眼内组织的毒性，但通过改进用药方法和加强保护措施，可有效地避免或减少药物的眼毒性。在应用于临床之前，仍需进一步动物实验研究。

Inhibition of posterior capsule opacification with intraocular mitomycin-C:a histopathologic research

Objective:To investigate the inhibitior of mitomycin-C(0.2mgml)to posterior capsule opacification and its toxicity to ocular tissues.Methods:Thirty-two New Zealand albino rabbits were used and divided randomly into four groups,with eight eyes in each group.Group A:phacoemulsification without applying MMC.Group B:hydrodissection using a solution containing MMC(0.2mgml)after continuous curvilinear capsulotomy.Group C:MMC(0.2mgml) dissolved in sodium hyaluronate was injected into the empty capsular bag for 3 minutes after phacoemulsification.Group D:MMC(0.2mgml) dissolved in irrigating solution was used for irrigation.Histopathologic examination and transmission electron microscopy were performed on the eyeballs of all groups at 1 month postoperatively.Results:Histopathologic examinations showed that there were a large amount of proliferated LECs and fibroblasts in the peripheral and central areas of lens capsules in group A.In group B,C and D,only a small quantity of retained LECs and cortical material could be seen in the peripheral areas of lens capsules.There were no LECs,fibroblasts of Elschnig pearls in the center of posterior capsule.Transmission electron microscopy at 1 month postoperatively showed no significant anomalies in iris,ciliary body and retina in groups A,B and C,but various ultrastructural damage could be found in iris,ciliary body and retina in group D.Conclusion:Intraocular application of MMC(0.2mgml)in phacoemulsification can effectively reduce PCO,but it can induce drug toxicity to intraocular tissues,while some application methods of drug,as described in group B and C,can reduce the leakage of MMC from capsular bag as minimal as possible.Thus the drug toxicity to intraocular tissues can be prevented or reduced.Before it can be used clinically,further experiment studies are needed.