眼内灌注液中肾上腺素对视网膜管径及功能的影响

发布时间：2018-05-11 23:24

本文选题：眼内肾上腺素 + 视网膜管径　；参考：《天津医科大学》2013年博士论文

【摘要】：目的：本研究初步运用视网膜图像分析软件,探讨玻璃体切除术后视网膜管径变化及眼内灌注液中肾上腺素对视网膜管径和黄斑厚度的影响,并采用兔眼气体压迫玻璃体切除术,探讨玻璃体腔内相同浓度的肾上腺素对视网膜组织形态及视网膜功能的影响。方法：第一部分：前瞻性设计,选取屈光间质清晰拟行玻璃体手术的黄斑裂孔病例为研究对象,共32例32眼,按照玻璃体灌注液含肾上腺素1：1000和不含肾上腺素随机分为两组。16眼为实验眼,16眼为对照眼。术前拍摄基线眼底照片和OCT检查,两组病例手术方法相同,均由同一经验丰富术者进行玻璃体切除手术。手术顺利,无并发症发生。术后随诊视力,裂隙灯眼底检查,随诊第1月、第3月眼底照片和OCT检查。眼底像标准同一像素下分别以视盘和黄斑为中心拍摄两张眼底像。运用ⅣAN视网膜图像软件,测量区域位于距视盘边缘0.5～1.0视盘管径范围内,测量结果以视网膜中央动脉等效管径(CRAE)和视网膜中央静脉等效管径(CRVE)以及二者的比AVR来表示的。测量两组术后1个月视网膜黄斑厚度变化。第二部分：以10只新西兰大白兔为研究对象,随机分为2组,5只为实验组,5只为对照组。两组兔的实验眼和对照眼玻璃体腔均注入0.4m1C3F8行气体压迫玻璃体切除术,72小时后气体膨胀达到最大体积时,实验眼玻璃体腔注入0.1ml浓度1：1000的肾上腺素溶液,对照眼也采用相同的方法玻璃体腔注入0.1m1生理盐水。所有兔在术前和术后一定时间给予裂隙灯、间接检眼镜检查。分别于气体玻璃体切除手术前、玻璃体腔注射后1、2、3周行兔眼彩色眼底照相、视网膜OCT、视网膜电图(ERG)检查,记录a、b波振幅值。最后一次检查后全麻下取兔视网膜标本,光学显微镜观察视网膜组织结构变化,TUNEL染色观察视网膜细胞凋亡变化。结果：第一部分：观察实验组和对照组16眼术后1月CRAE(170.88μm±5.17vs.182.84μm±46.63),CRVE(231.26gμm±19.37vs.231.59μm±52.23),比较无统计学上意义(P0.05)；术后3月CRAE(171.60μm±23.80vs.176.03μm±9.38),CRVE (226.35μm±19.10vs.226.80μm±19.23),比较无统计学上意义(P0.05)。观察实验组和对照组16眼术后1月黄斑内环厚度(292.11μm±29.96vs.273.25μm±13.82),虽然实验组较对照组增厚,但P=0.063,无明显统计学意义。两组玻璃体切除术后视力均大幅提高(P0.001),但实验组和对照组间视力无统计学意义。第二部分：实验组及对照组玻璃体腔注射1、2、3周后眼底观察未见视网膜水肿、出血及脱离。实验组和对照组在玻璃体切除术前和玻璃体腔注射后各个时间点ERGa波、b波振幅总体差异无统计学意义(P0.05)。实验组和对照组在玻璃体切除术前和玻璃体腔注射后各个时间点的OCT测量视网膜厚度数据未有统计学意义(P0.05)。第三周HE染色显示两组视网膜结构未见明显改变；TUNEL细胞凋亡染色显示两组均未见视网膜细胞凋亡。结论：眼内灌注液中1：1000的肾上腺素浓度对视网膜管径变化和黄斑厚度没有明显影响,视网膜功能未受到进一步损害；对兔眼视网膜电生理a波、b波振幅、OCT视网膜厚度无统计学意义上的变化,视网膜组织结构未见到明显组织损伤。本研究中,1：1000眼内肾上腺素浓度没有对视网膜造成损害。
[Abstract]:Objective: To investigate the changes of retinal tube diameter and the effect of adrenaline on retinal tube diameter and macular thickness in intraocular perfusion, and to explore the same concentration of adrenaline in the vitreous cavity with the same concentration in the vitreous body. The effect of state and function of the retina.
Methods: in the first part: prospective design, a total of 32 cases of macular holes in vitreous surgery were selected as the subjects. A total of 32 cases, 32 eyes were divided into two groups of.16 eyes and 16 eyes as the control eye. The baseline photo of the baseline and the OCT examination were taken before operation. The two groups of cases had the same surgical methods, all with the same experienced surgeon for vitrectomy. The operation was smooth and no complications occurred. Postoperative visual acuity, slit lamp fundus examination, first months of follow-up, third month fundus photo and OCT examination. Two fundus images were photographed with optic disc and macula in the same pixel as standard. Using the IV AN retina image software, the measurement area was located in the 0.5 to 1 disc diameter range from the rim of the optic disc. The results were measured by the equivalent diameter of the central retinal artery (CRAE) and the equivalent diameter of the central retinal vein (CRVE) and the ratio of two to the AVR. The retinal macular thickness changes in the two groups were measured in 1 months after operation. Second part: 1 0 New Zealand white rabbits were randomly divided into 2 groups, 5 experimental groups and 5 control groups. The two groups of rabbits' experimental and control eye glass cavity were injected with 0.4m1C3F8 gas compression vitrectomy, and when the gas expansion reached the maximum volume after 72 hours, 0.1ml concentration of 1:1000 was injected into the body cavity of the experimental eye. The control eye also used the same method to inject 0.1m1 saline into the vitreous cavity. All rabbits were given slit lights and indirect ophthalmoscope at a certain time before and after the operation. Before the vitrectomy, the rabbit eye color fundus photography, the retinal membrane OCT, the electroretinogram (ERG) examination, the A, b wave vibration were recorded before the vitreous vitrectomy. After the final examination, the rabbit retina specimens were taken under general anesthesia. The changes of retinal tissue structure were observed by optical microscope, and the apoptosis of retinal cells was observed by TUNEL staining.
Results: in the first part, the 16 eyes of the experimental group and the control group were observed after 16 eyes (170.88 mu m + 5.17vs.182.84 mu m + 46.63) and CRVE (231.26g m + 19.37vs.231.59 mu m + 52.23), and there was no statistical significance (P0.05), and the March CRAE (171.60 micron m + 9.38 9.38), and 226.35 mu (226.35 micron + 19.23), were not statistically significant. The thickness of the macular inner ring was observed in the experimental group and the control group after 16 eyes (292.11 mu m + 29.96vs.273.25 mu m + 13.82), although the experimental group was thicker than the control group, but P=0.063 had no significant statistical significance. The visual acuity of the two groups after vitrectomy increased significantly (P0.001), but the visual acuity between the experimental group and the control group was not statistically significant. The two part: the experimental group and the control group were injected with the vitreous cavity after 1,2,3 weeks. There was no retinal edema, bleeding and disengagement. There was no significant difference between the experimental group and the control group before and after the vitrectomy and the ERGa wave at each time point after the vitreous cavity injection (P0.05). The experimental group and the control group were before vitrectomy. The retinal thickness data were not statistically significant (P0.05) measured by OCT after intravitreal injection at each time point. Third weeks HE staining showed no significant changes in the two groups of retina structure, and TUNEL cell apoptosis staining showed that no retinal cell apoptosis was found in two groups.
Conclusion: the epinephrine concentration of 1:1000 in the intraocular perfusion has no significant influence on the changes of retinal canal diameter and macular thickness, and the retinal function is not further damaged. There is no significant change in the a wave of the retina, the amplitude of B wave and the thickness of the retina of the retina of the rabbit eyes, and the tissue structure of the retina has not seen obvious tissue damage. In this study, the concentration of 1:1000 epinephrine did not cause damage to the retina.

【学位授予单位】：天津医科大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R774.1

【参考文献】