从ECCE到Phaco的转变--核处理技术的实验研究

目的通过化学方法制成动物核性白内障模型,探讨相对能量复合指数(RECP)与角膜内皮细胞活性的关系。方法将5种化学物质注入晶状体,以透过黑白条纹的清晰程度判断晶状体混浊程度并分级。然后将实验眼球分为6组(Ⅰ组为对照组;Ⅱ-Ⅵ为实验组),行标准超声乳化白内障摘除手术。手术后立即取下角膜,作锥蓝-茜素红联合染色标本和扫描电镜标本。结果晶状体内注入甲醛、冰醋酸、无水乙醇、丙酮和苯扎溴铵均能形成晶状体混浊,其中:冰醋酸致晶状体混浊能力最弱,无水乙醇、丙酮次之,甲醛、苯扎溴铵最强。当RECP≤90时,锥蓝-茜素红双重染色和扫描电镜均表明角膜内皮细胞活性好,其形态和细胞联接均无改变。当RECP=120时,角膜内皮细胞形态尚正常,但是细胞联结和胞膜部分破坏。当RECP=150时,角膜内皮细胞严重损伤。结论用化学方法制作核性白内障模型供过渡训练使用是可行的。当RECP超过某一数值(>90)时,即与角膜内皮细胞的活性成负相关。

Transition from ECCE to phacoemulsification-research on nuclear emulsification

Aim To establish animal models of nucleus cataract and to explore the relationship between relative energy complex parameter (RECP) and activity of corneal endothelium so as to faciliate the transition from extracapsular cataract extraction (ECCE) to phacoemulsifieation. Methods Nucleus cataract was induced by injecting some chemicals into normal lens and was graded according to clarity through strips in white and black. The corneas were colored with trypanblue and alizarin red and were made into samples for scanning electron microscope (SEM) right after phacoemulsification. Results Nucleus cataract was developed with all chemicals used in this study. Formaldehyde and benzalkonii had a superior capacity of causing lens opacity followed by absolute alcohol and acetone. Glacial acetic acid had an inferior capacity. Double-dying light microscopy and SEM both revealed the best activity of corneal endothelium when RECP was no more than 90. When RECP was 120, the intercellular junction and cell membrane were partly destroyed. When RECP reached 150, endothelium was seriously destroyed. Conclusion It is feasible that animal models of nucleus cataract are established as training resources for ophthalmologists, transition from ECCE to phacoemulsification. Meanwhile it is indicated that when RECP is above certain figure (> 90), it has a negative correlation with the activity of corneal endothelium.