血管内皮生长因子及贝伐单抗在小梁切除术后伤口愈合过程中的作用

摘要

Proper wound healing and scaring are the key factor to the success of trabeculectomy in glaucoma patients.The inadequate wound healing will lead to bleb leakage and ocular hypotension after surgery;however,excessive wound healing and scaring will cause the failure of the surgery and eventually increase the intraocular pressure.The applying of antimetabolic drugs such as mitomycin C (MMC) and 5-fluorouracil (5-FU) are able to relieve the excessive wound healing in some degree;however,the side effects like ocular hypotension,dysesthesia endophthalmitis can never be ignored.What is worse,some patients are not sensitive to such drugs.Subconjunctival injection of CAT-152 (monoclonal antibody against transforming growth factor-β) was able to control wound healing in animal trabeculectomy model,while failed in multi-center clinical trial.Recent studies have focused on the role of vascular endothelial growth factor (VEGF) and VEGF inhibitors on the wound healing after trabeculectomy.This paper aims to review the mechanism of wound healing after trabeculectomy,as well as the role of anti-VEGF on this kind of wound healing and scaring.%青光眼患者小梁切除术成功的关键在于术后伤口的愈合以及瘢痕化.伤口愈合延迟,甚至不愈合将导致术后滤过泡的过度渗漏和术后低眼压,伤口过度愈合以及瘢痕化则会导致术后高眼压.临床上应用抗代谢药物,如丝裂霉素C(MMC)和5-氟尿嘧啶(5-FU)等可降低术后过度的伤口愈合以及瘢痕化,但是伴有低眼压、眼内炎以及感觉迟钝等不良反应,个别患者对抗代谢药物不敏感.研究表明,在小梁切除模型中结膜下注射转化生长因子-B的单克隆抗体CAT-152能有效降低术后的瘢痕化,为青光眼术后抗瘢痕治疗带来了曙光,然而在临床试验中,其与对照组相比较并没有显著差异.近些年,越来越多的证据显示血管内皮生长因子(VEGF)抗体在小梁切除术后伤口愈合过程中有着重要的影响.本文中对小梁切除术后伤口愈合的机制和VEGF及其抗体贝伐单抗在伤口愈合中的作用进行综述.