Background Posterior capsule opacification (PCO) is a main cause for visual acuity decline after modern extracapsular cataract surgery.Objective The aim of this study was to investigate the effect of rapamycin on PCO formation following phacoemulsification combined with intraocular lens (IOL) implantation in rabbit eyes.Methods Thirty New Zealand albino rabbits were randomized into three groups according to the difference in the implanted IOLs:conventional IOL without modification,IOL coated by a polymer material and IOL with sustained released rapamycin.Phacoemulsification combined with intraocular lens implantation surgery was performed in the left eye.The anterior ocular segment and PCO formation in the rabbit eyes were examined by slit lamp biomicroscope 1-7 days after operation,and the flare and inflammatory response of the anterior chamber as well as the degree of PCO severity were graded based on the criteria of Yang.The differences in examination outcomes were compared by the Kruskal-Wallis H test.The animals were sacrificed 12 days after surgery and eye specimens were prepared for histopathological examination to evaluate the biological behavior of lens epithelial cells (LECs) on the posterior capsule.Results The coated area of the implanted lens was semi-transparent with a smooth surface.The number of eyes with aqueous flare at grades 3 and 4 insignificantly increased but those with an inflammatory response at grades 3 and 4 significantly increased in the conventional IOL group and the polymer modified IOL group,compared with the rapamycin modified IOL group on the first day after operation (H =4.038,P =0.133 ; H =8.604,P =0.014).On the seventh day,the number of eyes with aqueous flare at grades 3 and 4 and inflammatory response at grades 3 and 4 significantly increased in the conventional IOL group and the polymer modified IOL group,compared with the rapamycin modified IOL group (H =8.891,P =0.012 ; H =7.664,P =0.0220).The histopathological examination showed that marked proliferation of LECs appeared between the anterior and posterior capsule in the conventional IOL group and the polymer modified IOL group;however,less LECs and regenerative cortex were seen in the rapamycin modified IOL group.Conclusions IOL loaded with rapamycin can inhibit the inflammatory response and alleviate the severity of PCO after phacoemulsification combined with IOL implantation.The implantation of IOL loaded with rapamycin may be a new approach to the prevention and treatment of PCO.%背景 晶状体后囊膜混浊(PCO)是白内障囊外摘出术后视力下降的主要原因. 目的 研究兔眼透明晶状体超声乳化囊外摘出联合人工晶状体(IOL)植入术后雷帕霉素对晶状体PCO的影响.方法 将30只新西兰大白兔以随机数字表法分为3个组,分别采用不同的IOL植入方式.对侧眼为正常对照组,普通IOL组兔眼植入普通IOL,高分子涂层IOL组兔眼植入用高分子涂层但无雷帕霉素的IOL,雷帕霉素涂层IOL组兔眼植入用雷帕霉素表面处理的高分子涂层IOL,手术眼均为左眼.术后1～7d裂隙灯显微镜下检查各组兔眼眼前节及PCO情况,并对前房闪辉和房水炎性细胞情况进行分级,术后12d对各组兔眼PCO严重程度进行分级,并用Kruskal-WallisH检验法进行比较.于术后12周处死实验动物并获取动物眼球,对晶状体后囊膜组织进行苏木精-伊红染色,检查并比较各组兔眼晶状体后囊膜晶状体上皮细胞(LECs)的生物学行为.结果 涂层后的IOL涂层区半透明,表面光滑,光学显微镜下涂层在IOL表面分布均匀,颗粒细腻.术后第1天普通IOL组和高分子涂层IOL组3级、4级房水闪辉的眼数明显多于雷帕霉素涂层IOL组,但3个组间差异无统计学意义(H=4.038,P=0.133);普通IOL组和高分子涂层IOL组3级、4级房水炎性细胞的眼数明显多于雷帕霉素涂层IOL组,3个组间差异有统计学意义(H=8.604,P=0.014).术后第7天,普通IOL组和高分子涂层IOL组2级、3级房水闪辉的眼数及房水炎性细胞为2级、3级的眼数均明显多于雷帕霉素涂层IOL组,差异均有统计学意义(H=8.891,P=0.012;H=7.664,P=0.022).组织病理学检查结果显示,普通IOL组和高分子涂层IOL组晶状体后囊膜可见大量增生的LECs,聚集于前囊膜和后囊膜之间,而雷帕霉素涂层IOL组未观察到LECs的增生及再生的晶状体皮质. 结论 携带雷帕霉素的载药IOL能抑制兔眼透明晶状体摘出联合IOL植入术后前房的炎症反应,减轻PCO的严重程度,有望成为防治PCO发生的新的治疗途径.
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