比较5-Fu和MMC缓释膜在青光眼滤过手术中应用的实验研究

目的 评估生物缓释膜在青光眼滤过手术中的安全性和作用,比较5-氟尿嘧啶(5-Fu)和丝裂霉素(MMC)缓释膜在青光眼滤过手术中的抗增殖的疗效.方法 以5-Fu和MMC作为模型药物,壳聚糖作为载体,溶剂挥发法成膜;通过共价交联的方式将12μg的5-Fu或MMC结合到生物缓释膜上.未植入缓释膜作为对照组,其余3组植入空白、5-Fu和MMC缓释膜.四组均行青光眼滤过手术,静脉留置针作为引流管,空白缓释膜、5-Fu缓释膜、MMC缓释膜缝于巩膜瓣下.滤过手术前和手术后1、3、5、714、21和28d,以Tonopen眼压计记录兔眼压,以裂隙灯观察滤过泡大小和眼前节的变化并照相;分别于术后28d每组处死两只兔,总共8只眼标本行病理组织学检查;用扫描电子显微镜检测每组术后28d的角膜和晶状体标本.结果 术前各组平均眼压无差异,MMC组手术前和手术后28d内比较差异有统计学意义(F值为26.866 P＜0.01),5-Fu组和单纯引流管组手术前和手术后14d内比较差异有统计学意义,(F值分别为13.467,6.567 P＜0.01),空白缓释膜组手术前和手术后7d内比较差异有统计学意义(F值分别为11.426 P＜0.01);MMC、5-Fu组滤过泡生存时间优于单纯引流管组、空白缓释膜组.5-Fu和MMC组,术后28d角膜内皮细胞和晶状体前囊无异常改变.结论 5-Fu和MMC生物缓释膜能明显提高滤过手术成功率并且是安全的,在降低眼内压和延长滤过泡减少眼前节并发症方面,MMC缓释膜比5-Fu缓释膜能更有效地提高滤过手术成功率.

To compare the effects of mitomycin C and 5-fluorouracil biological delivery film on glaucoma filtering surgery in rabbits

Objeetive To evaluate the safety and effectiveness of glaucoma filtering surgery performed with the adjunctive use biological delivery film and compare the anti-proliferation effects of mitomycin C(MMC)and 5-fluorouracil(5-Fu)biological delivery films on glaucoma filtering surgery.Methods The 5-Fu and MMC were used as a model drug,and the biological membranes with chitosan as carrier were prepared through solvent volatilization.5-Fu and MMC biological delivery films were prepared by covalent coupiing of 12μg 5-Fu or MMC respectively.The rabbits received no implant were control.The other groups received biological delivery film with no drug,5-Fu and MMC.Glaucoma filtering surgery were performed in four groups,a beveled 24-gauge intravenous cannula was as a drainage tube,the biological delivery films with no drug,5-Fu and MMC were sutured under scleral flaps.Intraocular pressure(IOP)measurements were recorded before surgery and starting from postoperative day 1,3,5,7,14,21 and 28 using a Tonopen.Bleb survival and anterior segment were examined with slit-lamp and photographed.Two animals from each group were sacrificed on days 28,yielding a total of 8 eyes for histopathological study,each specimen of comeas and lens was examined at 28 days by transmission and scanning electron microscopy.Results No differences were noted between the control group and the three experimental groups in mean preoperative IOPs.In rabbits receiving 12μ g MMC ,the differences of IOP from preoperative levels up to 28 days following surgery was statistically significant (F=26.866,P＜0.01 ).The rabbits received no implant (control) and 12μg 5-Fu,the differences of IOP from preoperative levels up to 14 days following surgery was statistically significant (F=13.467,6.567 respectively,P＜0.01 ).The rabbits received biological delivery film with no drug,the differences of IOP from preoperative levels up to 7 days following surgery was statistically significant (F=11.426,P＜0.01).The filtering blobs were only minimally different.The filtering blebs failure time was significantly longer in MMC and 5-Fu group (14 days) than other two groups (7 days).Conclusions This study provides evidence that the 5-Fu and MMC biological delivery films can significantly improve the success of filtering procedures and are safety,MMC can effectively prolongs bleb survival in rabbits,The maintenance of ocular hypotension and bleb survival along with the reduction in anterior segment complications supports the idea MMC will be more effective than use of 5-Fu in improving the success rate of filtering surgery.