壳聚糖缓释给药系统植入脉络膜上腔防治外伤性aPVR

发布时间：2018-05-03 14:52

本文选题：壳聚糖缓释给药系统 + 脉络膜上腔　；参考：《南方医科大学》2012年硕士论文

【摘要】：研究背景前部增生性玻璃体视网膜病变(anterior proliferative vitreoretinopathy, aPVR)是由于玻璃体基底部后缘附着处以前的细胞增殖,引起周边部视网膜环形收缩,向前移位并贴附到睫状体、虹膜后、瞳孔缘或角膜形成的。1991年新的PVR分级标准保留1983年所定的A级和B级,取消D级。C级病变中,赤道前为CA级病变,赤道后为CP级病变,将aPVR归入到PVR分级当中,并且新标准将增生性膜收缩分为5种类型：1型：局限性收缩。2型：弥漫性收缩。3型：视网膜下增生。以上3型为后部增生性玻璃体枧网膜病变.4型：环形收缩,表现为玻璃体基底部后缘至赤道部以前环形收缩,使视网膜被牵拉,造成视网膜形成皱褶。5型：前移位,多见于玻璃体视网膜手术后或眼外伤病人。此外,各种级别PVR可同时累及一眼,根据受累的范围可以用时钟钟点表示,分为CA1～12和CP1～12。相关研究表明外伤性aPVR膜的成分是无色素和含色素睫状上皮细胞、视网膜色素上皮细胞、角膜内皮细胞、角巩膜或脉络膜的纤维及基质细胞、晶体囊膜或皮质等成分,可伴有炎症细胞。近期文献报道,神经胶质细胞与视网膜是否受损伤以及外伤性PVR密切相关,Muller细胞能够有效的调节视网膜对外伤的应答,此外,还能够调节脱离的视网膜对机体的反应目前对aPVR的研究包括aPVR的分级、发病机制、诊断手段、手术方式等,尚无关于外伤性aPVR的防治的报道。激素能够抑制组织的增殖,但是由于血眼屏障的阻碍作用使药物不容易到达眼内,玻璃体注射虽然能够使药物直接作用于眼内,效果良好,但是由于药物半衰期偏短需要反复注射,增加了眼内感染的机会而使其应用受到一定的限制。本实验应用壳聚糖作为药物载体,载药后置于眼内缓慢释放,持续发挥作用,避免了眼内多次给药所带来的安全问题。由于脉络膜上腔位于脉络膜与巩膜之间,壳聚糖载药后植入脉络膜上腔,避免了巩膜阻碍药物吸收,可以使药物直接作用于周边视网膜、睫状体等眼内病变组织,抑制炎症反应及细胞增殖,通过药物缓慢释放,持续发挥作用抑制aPVR形成,并且其药物作用浓度大大超过通过其它途径给药。目的 1、探索GICS-TA植入脉络膜上腔防治外伤性aPVR的有效性； 2、比较壳聚糖缓释给药系统植入脉络膜上腔与玻璃体腔注射曲安奈德防治外伤性前部增生性玻璃体视网膜病变的疗效；方法实验前选取45只健康青紫蓝兔,雌雄不限,体重2.0～2.5Kg,由武汉动物实验中心提供,按照随机数表法依次分入A,B,C、D、E五组,A组、B组、C组、D组每组10只青紫蓝兔,E组5只青紫蓝兔,术前一周使用裂隙灯、眼底镜检查眼前、后节,并测量眼压,排除眼部疾患。手术当天,左氧氟沙星滴眼液点眼4次,术前20min用复方托品酰胺滴眼2次,间隔5min,散大瞳孔。E组为正常对照组,不予手术,其它组予以3%戊巴比妥纳1ml／kg耳缘静脉注射,A,B,C,D组青紫蓝兔将其麻醉成功后,绑在手术台上,氯霉素冲洗左眼,术眼消毒铺中,开睑器开左眼睑,兔眼上方剪开球结膜和部分筋膜,暴露巩膜后距角膜缘2.5m处于10：30～11：30作长为5mm的巩膜穿通伤,用11号手术尖刀穿刺入约10mm,上下摆动约20°损伤睫状体组织,制成外伤性aPVR模型。A组造模后在巩膜穿刺口附近垂直切开巩膜,分离巩膜与睫状体,形成一空腔,在此空腔塞入3mm*3mm大小空白壳聚糖膜,缝合巩膜切口；B组用A组同样方法,放置载药1mg曲安奈德的壳聚糖；C组造膜后向玻璃体腔注射lmg曲安奈德后缝合巩膜切口,D组仅造模,造模后缝合巩膜切口。实验完毕后,结膜囊内涂妥布霉素眼膏预防感染。术后2周,5周,8周使用UBM、裂隙灯分别观察各组睫状体增厚程度、有无增殖膜形成,并观察各组兔眼前节炎症反应分级。术后8周处死动物,标记后摘除眼球,冠状位将眼球一分为二,将其中1／2立即放入放入AGFD眼球固定液,固定一周后,将原固定液液倒出一半,再加等量丙酮继续固定5天。5天后取6点位眼球标本,经乙醇逐级脱水、二甲苯及透明石蜡包埋,然后作组织切片并行苏木素和伊红(HE)染色,于光镜下观察睫状体组织形态。将眼球另1／2去除后节组织,取6点位睫状体新鲜标本,修剪得0.5cm×0.5cm大小的睫状体标本块(手术器械4℃预冷),立即眼球用磷酸缓冲液(pH7.2～7.4)洗净表面的血液,然后立即放入4%多聚甲醛—2.5%戊二醛混合固定液中固定,过夜后,1%锇酸固定,丙酮脱水,环氧树脂包埋,超薄切片(冠状位),透射电镜下观察。对各组兔眼睫状体厚度的总体均数采用SPSS13.0软件进行统计学分析,计量数据以均数±标准差(X±s)表示,检验水准α=0.05。术后2周、5周和8周睫状体厚度的数据应首先检查其总体均数是否满足正态分布且方差齐同,如满足上述条件,则采用完全随机设计的方差分析(one-way classification ANOVA),如睫状体厚度的总体均数有统计学意义,需采用Bonferroni法进一步行多重比较；如睫状体厚度的总体均数不满足方差分析的条件时,则采用多个独立样本非参数检验(Kruskal-Wallis检验),比较各组兔眼睫状体的厚度均数是否相同,组间的多重比较采用Bonferroni法检验。于手术后第1,14,28天评价各组兔眼眼前节炎症反应,将兔眼前节炎症反应分级均数采用SPSS13.0软件进行统计学分析。对术后各组兔眼结膜、角膜、房水和后囊膜情况分级采用多个独立样本非参数检验(Kruskal-WallisH检验)。结果苏木精-伊红染色病理学观察可见,A组兔眼8周时睫状体基质水肿,色素上皮结构紊乱,大量灰白色纤维组织增生,并且牵拉睫状体,牵拉引起周边视网膜局部脱离,组织结构破坏。B组兔眼8周时睫状体轻度水肿,虹膜部分增殖,余结构未见明显异常,另可见少量炎细胞浸润。C组兔眼8周时睫状体基质水肿,基质间隙增宽,细胞排列较整齐,有炎细胞浸润。D组兔眼8周时睫状体基质水肿、隆起；色素上皮结构紊乱,牵拉视网膜,组织结构破坏。E组兔眼8周时可见睫状体无水肿,组织细胞排列整齐,色素上皮完整。透射电镜观察显示,A组兔眼8周时可见线粒体肿胀,周围可见部分空泡状变性,线粒体周围有少量色素颗粒；B组兔眼8周时细胞核形态大致正常,可见核仁位于核内,还可见部分内质网形态未见明显异常,有少量色素颗粒分布于周围。C组兔眼8周时可见细胞核染色质深染,核周有部分色素颗粒,内质网肿胀,有分泌颗粒产生。D组兔眼8周时可见内质网水肿,呈空泡状变性,另可见少许色素颗粒。E组兔眼8周时可见线粒体形态正常,内质网形态未见异常,其周可见色素颗粒。各组兔眼8周时6点位UBM图像显示：A组兔眼8周时可见虹膜及睫状体水肿增厚,厚度达2.0428mm,边界不清,相互粘连,牵拉,其间可见低回声区。B组兔眼8周时可见睫状体及虹膜轻度增厚,睫状体后隐约可见一与睫状体平行的条状物。C组兔眼8周可见睫状体增殖明显,虹膜可见增生物粘连,其后可见致密的条状物与睫状体粘连。D组兔眼可见虹膜及睫状体水肿增厚,厚度为2.0356,其间可见低回声信号,其后隐约可见条形回声信号。E组兔眼可见虹膜向前呈弓状隆起,睫状突与虹膜部分相连,虹膜与睫状突之间可见一较大间隙。使用UBM观察术后2周、5周、8周各组兔眼睫状体的厚度可知不同时段睫状体厚度：D组C组B组E组,而A组与D组无统计学差异,说明脉络膜上腔植入壳聚糖缓释给药系统(载药曲安奈德)和玻璃体注射曲安奈德都能够有效防治睫状体组织增殖,但睫状体的厚度相比,B组小于C组且具有统计学差异,说明脉络膜上腔植入壳聚糖缓释给药系统(载药曲安奈德)比玻璃体注射曲安奈德防治睫状体组织增殖的效果更好,而空白壳聚糖对防治前部增生性玻璃体视网膜无明显作用。手术后28天裂隙灯观察：A组兔眼结膜中度睫状充血,范围较大,色泽较红,角膜斑片状水肿,后弹力层明显皱褶,厚度增加,房水中度混浊,Tyndall现象(++),明显纤维素性渗出,晶体混浊明显,眼底窥视不清；B组兔眼结膜轻度睫状充血,范围较局限,角膜线状混浊水肿,较少后弹力层皱褶,房水轻度混浊,Tyndall现象(+),较少纤维素渗出,后囊膜中度混浊,眼底部分模糊不清；C组兔眼结膜轻度睫状充血,范围较局限,角膜线状混浊水肿,后弹力层皱褶明显,房水轻度混浊,Tyndall现象(+),部分纤维素渗出,后囊膜中度混浊,眼底部分模糊不清；D组兔眼结膜中度睫状充血,范围较大,色泽较红,角膜斑片状水肿,后弹力层明显皱褶,厚度增加,房水中度混浊,Tyndall现象(++),可见大量纤维素性渗出,晶体混浊明显,眼底窥视不清；E组兔眼结膜无充血,角膜清晰透明,房水清,后囊膜透明。手术后1天眼前节炎症反应分级实验结果表明,H统计量服从x2分布,故以x2值表示检验统计量。x2=39.197,v=4,P=0.000,P0.05,五组间有显著差异性,说明各组眼前节炎症反应分级有显著差异,根据平均秩次进一步推断,与E组相比较,B组前房炎症反应最轻,C组次之,A组和D组前房炎症反应较重。手术后1,14,28天眼前节炎症反应分级实验结果表明,H统计量服从x2分布,故以x2值表示检验统计量。五组间有显著差异性,说明各组眼前节炎症反应分级有显著差异,根据平均秩次进一步推断,与E组相比较,B组前房炎症反应最清,C组次之,A组和D组前房炎症反应最重。结论 aPVR是眼球穿通伤的严重并发症,能够严重降低眼外伤手术的成功率,因此寻找一种能减轻眼球穿通伤所致aPVR形成的方法显得尤为重要。本实验采用壳聚糖缓释给药系统(载药曲安奈德)于脉络膜上腔一次性给药,使用后安全,高效,避免了多次给药所带来的不良反应。结果显示壳聚糖缓释给药系统(载药曲安奈德)和玻璃体注射曲安奈德均能够有效的预防aPVR的发生,并且壳聚糖缓释给药系统防治前部PVR的效果优于玻璃体注射曲安奈德。其作用机理是：1脉络膜上腔位于脉络膜与巩膜之间,壳聚糖缓释给药系统(载药曲安奈德)植入脉络膜上腔后,使药物被迅速吸收并且可以持续的作用于玻璃体和视网膜,从而抑制aPVR的形成。2壳聚糖缓释给药系统具有持续均匀给药的特点,药物释放稳定,无明显突释效应,持续时间长,持续地作用于靶目标。3脉络膜与视网膜紧密贴在一起,药物直接作用于脉络膜,间接作用于视网膜及玻璃体可抑制aPVR形成,而对视网膜的毒性作用小。在外伤性aPVR早期,组织炎症反应明显,可见睫状体组织增生,以及增值膜覆盖于睫状体；晚期可见大量纤维组织增生,出现瘢痕化,增生,增厚；睫状体组织因受牵拉而变型。UBM是利用高频超声检查眼前节组织的一种方法[14],其成像清晰,分辨率高,特别是对比较隐秘的aPVR有很好的检出作用。通过对2周,5周,8周兔眼睫状体的厚度测量发现B,C,D,E组兔眼睫状体的厚度均数各不相同,有统计学意义,A组与D组厚度均数无明显差异,说明壳聚糖缓释给药系统(载药曲安奈德)对防治兔眼睫状体的增殖效果最好,其次是玻璃体注射曲安奈德,而空白的壳聚糖缓释给药系统对防治aPVR发生无明显作用。壳聚糖缓释给药系统通过植入脉络膜上腔,使药物迅速持久释放避免了反复给药带来的副作用,在临床上有潜在的使用价值。壳聚糖缓释给药系统(载药曲安奈德)能够抑制虹膜,睫状体等的增殖,防治外伤性aPVR形成,是治疗外伤性aPVR的较好方法。
[Abstract]:Research background
The anterior proliferative vitreoretinopathy (anterior proliferative vitreoretinopathy, aPVR) is due to cell proliferation before the attachment of the posterior margin of the vitreous base, causing annular contraction of the peripheral retina, shifting forward and attaching to the ciliary body. After the iris, the new PVR grading standard for the formation of the pupil or cornea in.1991 is 1983. Grade A and grade B, cancelling D grade.C lesions, CA grade lesions before equator, CP grade after equator, aPVR into PVR classification, and new standard to divide proliferative membrane contraction into 5 types: type 1: limited contraction.2: diffuse contraction of.3 type: Subretinal hyperplasia. The above 3 is a posterior proliferative vitreous soap network .4 type of membrane lesion: ring contraction, which shows the ring contraction of the posterior margin of the vitreous base to the equator, causing the retina to be pulled, causing the retina to form a wrinkle.5: the anterior displacement is often seen after the vitreoretinal surgery or the ocular trauma patient. In addition, various levels of PVR may be associated with one eye, according to the extent of the involvement of Shi Zhongzhong. CA1 - 12 and CP1 - 12. related studies showed that the components of the traumatic aPVR membrane were pigmented and pigmented ciliary epithelial cells, retinal pigment epithelial cells, corneal endothelial cells, fibrous and stromal cells of the sclera or choroid, crystalline capsule or cortex, with inflammatory cells. Recent literature, Neuroglia The cells are closely related to whether the retina is damaged and traumatic PVR. Muller cells can effectively regulate the response of the retina to the trauma. In addition, it can also regulate the response of the detachment of the retina to the body.
At present, the study of aPVR includes the classification of aPVR, pathogenesis, diagnosis and operation, and there is no report about the prevention and control of traumatic aPVR. Hormone can inhibit the proliferation of tissue, but the obstruction of the blood eye barrier makes the drug not easy to reach the eye. The vitreous injection can make the drug act directly on the eye, and the effect is good. Good, but due to the short half-life of the drug needs repeated injection, increasing the opportunity for intraocular infection to make its application limited. This experiment uses chitosan as a drug carrier, and it is released slowly in the eye after carrying the drug and keeps playing its role, avoiding the safety problems caused by the multiple administration of the eye. Between the choroid and the sclera, chitosan is implanted into the upper choroid cavity after carrying the drug, which prevents the sclera from hindering the absorption of drugs. It can make the drug directly affect the surrounding retina, ciliary body and other intraocular lesions, inhibit the inflammatory reaction and cell proliferation. The drug is released slowly and continues to play a role in inhibiting the formation of aPVR, and its drug action concentration. Much more than by other ways.
objective
1, explore the effectiveness of GICS-TA implantation in the treatment of traumatic aPVR with superior choroidal cavity.
2, the effect of chitosan sustained-release system on the prevention and treatment of traumatic anterior proliferative vitreoretinopathy by intravitoidal injection of triamcinolone into the superior choroidal cavity and vitreous cavity was compared.
Method
Before the experiment, 45 healthy blue and blue rabbits were selected, and the male and female, and male and female, 2 to 2.5Kg, were provided by the Wuhan animal experiment center. According to the random number table method, they were divided into A, B, C, D, E five groups, A group, B group, C group, D group 10 blue and purple rabbits and E group 5 blue and blue rabbits. 4 times on the day of operation, 4 times of left Ofloxacin Eye Drops eye, 2 times with compound toppinamide eye drops, interval 5min, and large pupil.E group as normal control group, no operation, the other groups were injected with 3% pentobarbital 1ml / kg ear vein, A, B, C, and D group blue and blue rabbit after the anesthesia was successfully tied to the operating table, chloramphenicol flushing. In the left eye, in the surgical eye disinfection shop, the left eyelid was opened in the eyelid device, the bulkball conjunctiva and part of the fascia were cut above the rabbit eye. The sclera was exposed to the cornea of the cornea at 10:30 to 11:30 after exposure to the sclera, and the scleral perforating injury was 5mm at 10:30 to 11:30. The ciliary body was damaged by the 11 surgical sharp knife, and the upper and lower swing about 20 degrees damaged the ciliary body, and the traumatic aPVR model group.A was made after the mold was made in the sclera. The sclera was made after the traumatic aPVR model was made in the sclera after the model of the.A group of traumatic aPVR model was made in sclera. The sclera was cut vertically near the puncture mouth to separate the sclera and ciliary body to form a cavity. The cavity was inserted into the 3mm*3mm size blank chitosan membrane and the scleral incision was sutured in the cavity. The B group used the same method of A group to put the chitosan to carry the 1mg triamcinolone acetonide; the C group injected LMG triamcinolone acetonide into the vitreous cavity and sutured the scleral incision, and the D group only made the model. The scleral incision was sutured after the model was built.
After the experiment, the conjunctival sac was coated with Tobramycin Eye Ointment to prevent infection. 2 weeks, 5 weeks and 8 weeks after the operation, UBM was used. The thickness of ciliary body was observed in each group with slit lamp. There was no proliferation membrane formation, and the inflammatory reaction classification was observed in each group. The animals were killed at 8 weeks after operation. The eyeball was removed and the eyeball was divided into two, and 1 / 2 of the eyeballs were divided. Immediately put into AGFD eyeball fixed solution, after fixed one week, half of the original liquid was poured out, and then added equal amount of acetone to continue to be fixed for 5 days.5 days after 6 point eyeball specimens, after dehydration by ethanol, dimethylbenzene and paraffin embedded, then tissue section and hematoxylin and eosin (HE) staining, under the light microscope to observe the ciliary body morphology. The other 1 / 2 of the eyeball was removed from the posterior segment, and the 6 point ciliary body was taken, and the ciliary body of 0.5cm x 0.5cm was pruned (the surgical instrument was precooled at 4 C). Immediately the eyeball was washed with phosphoric acid buffer (pH7.2 ~ 7.4) to wash the surface blood, and then immediately put into the 4% polyformaldehyde - 2.5% glutaraldehyde mixture fixed solution, and after overnight, 1% osmium acid. Fixed, acetone dehydration, epoxy resin embedding, ultrathin section (coronal), observed under transmission electron microscope.
The total average number of ciliary body thickness in each group was analyzed by SPSS13.0 software, and the measured data were expressed with mean standard deviation (X + s). The data of the ciliary body thickness at 2 weeks after alpha =0.05., and the 5 and 8 weeks' thickness of the ciliary body, should first check whether the total number of the ciliary body is satisfied with the normal distribution and the variance is homogeneous. If the above conditions are satisfied, the data should be used. The total variance analysis (one-way classification ANOVA), such as the total average of the ciliary body thickness, is statistically significant and needs to be further compared with the Bonferroni method. If the total average of the ciliary body thickness is not satisfied with the condition of the variance analysis, a number of independent sample nonparametric tests (Kruskal-Wallis test) are used. The thickness of ciliary body in each group was compared. The multiple comparisons between groups were examined by Bonferroni.
The inflammatory response in the eyes of rabbits in each group was evaluated on day 1,14,28 after operation. SPSS13.0 software was used for statistical analysis of the inflammatory response classification of the rabbit eyes. Multiple independent samples were used (Kruskal-WallisH test) for the classification of the conjunctiva, cornea, aqueous humor and posterior capsule of the rabbits.
Result
The histopathological observation of hematoxylin and eosin staining showed that the ciliary body matrix was edema in the A group of rabbits at 8 weeks, the structure of pigment epithelium was disturbed, a large number of gray white fibrous tissue proliferated, and the ciliary body was drawn, and the distraction caused local detachment of the peripheral retina. The tissue structure destroyed the 8 Zhou Shijie shape in the rabbit eyes of the.B group, and the iris was partially proliferated and the residual structure was not clear. In group.C, the ciliary body edema, the matrix gap widened and the cells arranged neatly at 8 weeks, with inflammatory cells infiltrating.D group, the ciliary body edema and eminence, the structure disorder of pigment epithelium, the distraction of the retina, and the destruction of the tissue structure in the.E group of rabbit eyes showed no edema and fine tissue. The cells arranged neatly and the pigment epithelium was complete.
The observation of transmission electron microscopy showed that the mitochondria were swollen at 8 weeks in the A group, with some vacuolated degeneration and a small amount of pigment granules around the mitochondria. The nucleus in the B group was roughly normal at 8 weeks, and the nucleolus was located in the nucleus, and the morphology of the part of the endoplasmic reticulum was not obvious, and a small amount of pigment particles were distributed in the surrounding.C groups. At 8 weeks, the nucleus chromatin chromatin was deeply stained in the rabbit eyes, and some pigment granules were found in the nucleus and the endoplasmic reticulum was swollen. The endoplasmic reticulum edema and vacuolated degeneration were seen in the.D group of rabbit eyes at 8 weeks. The morphology of mitochondria in the rabbit eyes of a little pigment granule.E group was seen at 8 weeks, and the morphology of the endoplasmic reticulum was not abnormal, and the pigments were seen in the week.
At 8 weeks, the 6 point UBM images showed that the iris and ciliary body edema was thickened at 8 weeks in the A group, the thickness was 2.0428mm, the boundary was not clear, the adhesion and traction were not clear, and during the 8 weeks of the hypoechoic rabbits, the ciliary body and the iris were slightly thickened, and the rabbit eye of.C group with the ciliary body parallel to the ciliary body of the ciliary body was 8. The proliferation of the ciliary body was obvious, and the iris and the synechia could be seen in the iris. The iris and ciliary body edema was seen in the rabbit eyes of the.D group. The thickness of the iris and ciliary body thickening was 2.0356, and the hypoechoic signal was visible. Then the rabbit eyes of the.E group showed the arsiform protruding of the iris, the ciliary process and the iris. There was a large gap between the iris and the ciliary process. The thickness of the ciliary body at 2 weeks, 5 weeks after the operation was observed with UBM. The thickness of ciliary body in each group of rabbits in each group was known at different periods of time: group C, group B, E group in group D, and there was no statistical difference between group A and D group, indicating that the upper choroid cavity was implanted with chitosan as a drug delivery system (triamcinolone acetonide carrying drug) and vitreous injection. Sach Ann Ned can effectively prevent and control the proliferation of ciliary body tissue, but the thickness of ciliary body is less than that of group B and group C, and there is a statistical difference. It shows that the effect of chitosan sustained-release drug delivery system (triamcinolone acetonide) on the prevention and control of the proliferation of ciliary body is better than that of vitreous acetonide injection, and the control of blank chitosan is effective. The anterior proliferative vitreous retina had no obvious effect.
28 day after operation slit lamp observation: in group A, the rabbit eye conjunctiva was moderately ciliary hyperemia, the range was larger, the color and lustre were red, the corneal plaques were edematous, the posterior elastic layer was obvious wrinkle, the thickness increased, the water medium turbidity, the Tyndall phenomenon (+ +), the obvious cellulose exudation, the crystal cloudy and the eye fundus peep, the B group of rabbit eye conjunctiva was mild hyperciliary congestion. Corneal linear turbid edema, less elastic layer folds, mild turbidity of aqueous humor, Tyndall phenomenon (+), less cellulosic exudation, moderate opacification of posterior capsule, and blurred part of the fundus; C group of rabbit eye conjunctiva with mild ciliary hyperemia, corneal linear turbid edema, posterior elastic layer folds, mild aqueous opacities, Tyndall phenomenon (+) ) partial cellulose exudation, posterior capsule moderate turbidity, and blurred part of the fundus; D group of rabbit eye conjunctiva is moderate ciliary hyperemia, the range is larger, the color and lustre is red, the corneal patch flaky, the posterior elastic layer folds, the thickness increase, the aqueous medium turbidity, the Tyndall phenomenon (+ +), a large number of cellulosic exudation, crystal cloudy, and the fundus peep. There was no hyperemia in the conjunctiva in the E group, the cornea clear and transparent, the hyaline water and the posterior capsule were transparent. The results of the inflammatory response classification of the anterior segment of the eye 1 days after the operation showed that the H statistics were subordinate to the X2 distribution, so there was a significant difference between the five groups with the value of the test statistics,.X2=39.197, v=4, P=0.000, P0.05, which showed that there was a significant difference in the classification of the inflammatory reaction in each group. According to the average rank order, compared with the E group, the inflammatory response of the anterior chamber of the B group was the lightest, the C group was the second, the A group and the D group were more severe in the anterior chamber inflammation. The results of the 1,14,28 sky eye inflammatory reaction grading experiment after the operation showed that the H statistic was subordinate to the X2 distribution, so the test statistics were expressed with the X2 value. There were significant differences between the five groups, indicating the eyes of each group. There was a significant difference in the grading of the inflammatory response in the anterior segment. According to the average rank, the inflammatory response in the anterior chamber of the group B was the most clear, the C group was the most, and the anterior chamber of the A group and the D group had the most severe inflammatory response compared with the E group.
APVR is a serious complication of perforating injury of the eyeball, which can seriously reduce the success rate of ocular trauma surgery. Therefore, it is very important to find a way to reduce the formation of aPVR caused by perforation of the eyeball. The experiment is to use the chitosan release system (triamcinolone acetonide) in the upper choroid cavity for one time administration, and it is safe, efficient and avoided after use. Many times

【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.6

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