囊袋内联合注入丝裂霉素及汉防己甲素水凝胶防治晶状体摘除术后后囊浑浊的研究

发布时间：2018-08-20 09:02

【摘要】：研究目的: 探讨囊袋内联合注入丝裂霉素水凝胶与汉防己甲素水凝胶对晶状体摘除术后后囊混浊的影响,研究其防治后囊混浊的作用机制。研究方法: 将48只健康无眼病的清洁级新西兰大白兔随机分为六组,每组8只。A为对照组,B、C、D、E、F组为用药组。手术显微镜下行透明晶体囊外摘除术,术毕A组囊袋内注入平衡盐溶液0.1ml,B、C、D组囊袋内分别注入0.1mg/ml、0.2mg/ml、0.4mg/ml的丝裂霉素水凝胶0.1ml,E组囊袋内注入0.2mg/ml的丝裂霉素水凝胶和0.1%的汉防己甲素水凝胶对半共0.1ml,F组囊袋内注入0.1%的汉防己甲素水凝胶0.1ml。术后观察眼前节情况(结膜充血程度,角膜是否水肿和前房炎症反应轻重等情况),后囊膜混浊情况(裂隙灯照相系统拍照记录);进行房水免疫球蛋白的定量检查,以分析丝裂霉素水凝胶对血-房水屏障的影响;进行组织病理学检查和组织透射电镜检查以检测丝裂霉素水凝胶对眼内组织的影响。采用SPSS16统计软件包进行统计学处理。研究结果: 1、术后眼前节情况术后1周内,所有术眼均有不同程度的结膜充血、角膜水肿,7天左右充血消退,2周角膜恢复透明;术后前房均出现不同程度的房水闪辉,术后2周消失,术后3天,汉防己甲素用药组(E组和F组)与其他用药组有显著性差异(P0.05)。 2、术后后囊混浊情况术后8周,A、B、C、D、E、F组分别有7、5、3、2、1、6眼出现后囊混浊,阳性率分别为100%、62.5%、37.5%、25%、12.5%、75%,囊袋内注入丝裂霉素水凝胶各用药组(A组、B组、C组和D组)与其他组差异有显著性(P0.05)。 3、组织病理学观察术后1月,HE染色后角膜基本恢复正常,内皮细胞排列紧密,房角结构基本正常。术后透射电镜示,空白对照组晶状体上皮细胞结构完整,细胞器丰富。用药组晶状体上皮细胞不同程度体积变小,细胞表面微绒毛消失。研究结论: (1)丝裂霉素C水凝胶可抑制晶体上皮细胞的增殖和纤维化,预防后发性白内障的发生,抑制作用随浓度(0.1mg/ml、0.2mg/ml、0.4mg/ml)的增高而增强。 (2)汉防己甲素水凝胶可以有效减轻术后炎症反应,在一定程度上预防后发性白内障的发生。 (3)丝裂霉素C和汉防己甲素水凝胶联合应用,可以更好抑制后发障的发生,减轻术后炎症反应。
[Abstract]:Objective: to investigate the effects of mitomycin hydrogel and Tetrandrine hydrogel on the posterior capsular opacification after lens extraction and the mechanism of prevention and treatment of posterior capsular opacification. Methods: Forty-eight clean grade New Zealand rabbits without eye disease were randomly divided into six groups. Extracapsular excision of transparent lens was performed under the operation microscope. At the end of the operation, group A was injected with a balanced salt solution (0.1ml / ml) and group D (group D) were injected with 0.1 mg / ml 0.2mg / ml of mitomycin hydrogel (0.1mg / ml) respectively. Group E (group E) was injected with 0.2mg/ml 's mitomycin hydrogel (0.2mg/ml) and 0.1% Tetrandrine hydrogel (0.1%) in the bag of group F (half total 0.1 ml / ml). Group E was injected with 0.1% of mitomycin hydrogel and 0.1% of hydrogel of Tetrandrine was injected into the bag of group F with 0.1 mg / ml of mitomycin. Tetrandrine hydrogel 0.1 ml. Postoperative observation of anterior segment (degree of conjunctival congestion, corneal edema and severity of inflammation in the anterior chamber), posterior capsule opacity (slit lamp camera recording), quantitative examination of aqueous humor immunoglobulin, The effects of mitomycin hydrogel on blood-aqueous barrier were analyzed, and the effects of mitomycin hydrogel on intraocular tissue were examined by histopathology and transmission electron microscopy. SPSS16 statistical software package was used for statistical processing. Results: 1. Within 1 week after operation, all eyes had different degrees of conjunctival congestion, corneal edema disappeared within 7 days and corneal transparency was restored in 2 weeks. There were different degrees of aqueous flare in anterior chamber after operation, disappeared 2 weeks after operation, and 3 days after operation. There was significant difference between Tetrandrine group (group E and group F) and other groups (P0.05). The positive rates of mitomycin hydrogel in the capsule bag were significantly higher than those in the other groups (P 0.05). The histopathological observation showed that there was a significant difference between the two groups (P 0.05). The histopathological observation showed that there was a significant difference between the two groups (P 0.05). The histopathological observation showed that there was a significant difference between the two groups (group A, group B, group C and group D) and the other groups (P < 0.05). The histopathology was observed one month after operation. The membrane basically returned to normal. The endothelial cells were arranged closely and the angle structure was normal. Transmission electron microscopy showed that lens epithelial cells in the blank control group had complete structure and abundant organelles. In the drug group, the volume of lens epithelial cells became smaller and the microvilli disappeared. Conclusion: (1) mitomycin C hydrogel can inhibit the proliferation and fibrosis of lens epithelial cells and prevent the occurrence of post-cataract. The inhibitory effect was increased with the increase of 0.1 mg / ml 0.2mg / ml 0.4mg / ml. (2) Tetrandrine hydrogel could effectively reduce the postoperative inflammatory response. (3) the combination of mitomycin C and Tetrandrine hydrogel can better inhibit the occurrence of post-traumatic cataract and alleviate the postoperative inflammatory reaction.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.66

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