丝裂霉素C-壳聚糖缓释微球抑制青光眼滤过术区瘢痕增殖的实验研究

摘要

目的：研究丝裂霉素C‐壳聚糖（M M C‐CS ）缓释微球对兔青光眼滤过术区瘢痕增殖的疗效。方法48只（96眼）新西兰大白兔分为4组，每组24眼，通过双眼行巩膜咬切术建立青光眼滤过术兔模型。其中24只兔的右眼术中植入M M C‐CS缓释微球（A组），其左眼术中植入CS空白缓释微球（B组）；另24只兔右眼术中应用含0．20 mg／mL MMC棉片（C组），其左眼行单纯巩膜咬切术（D组）。术后观察各组眼压、滤过泡、前房炎性反应、并发症、角膜内皮细胞计数等情况；术后第7、14、21天分批处死各组兔模型并行病理学检查。结果（1）眼压：A组能维持较长时间的低水平眼压，C组次之，B组与D组维持时间最短，组间差异有统计学意义（P＜0．01）。（2）滤过泡情况：A组滤过泡存活时间较其他各组长，差异有统计学意义（P＜0．01）。（3）并发症：各组中均未出现术后并发症。（4）角膜内皮细胞计数：A组术前与术后的计数值差异无统计学意义（P＞0．05）。（5）病理结果：A组结膜上皮完整性较好，结膜下成纤维细胞较其他各组少，滤过口周围区无明显炎症浸润，新生胶原纤维也较少。结论 MMC‐CS缓释微球能安全有效抑制兔青光眼滤过术区的成纤维细胞及新生胶原纤维的增殖，显著提高青光眼滤过术的成功率。%Objective To study the effect of mitomycin C(MMC)‐chitosan (CS)sustained release microspheres on the scar‐ring prevention of the filtering passage during glaucoma filtering surgery .Methods Filtering surgery model was established on 96 eyes of 48 healthy adult New Zealand white rabbits which were divided into 4 groups ,24 eyes in each group .The right eyes implan‐ted MMC‐CS microspheres in 24 rabbits(group A) ,whereas that of the fellow eyes implanted empty CS microspheres(group B) , and in other 24 rabbits which right eyes only used 0 .20 mg/mL MMC cotton(group C) ,on the opposite sides with no adjunctive treatment(group D) .Intraocular pressure ,filtering bleb ,anterior chamber flare ,complications and the numbers of corneal endotheli‐al cells were observed after surgery .Rabbits were killed on the 7th ,14th and 21th day postoperatively in batch and histopathological examination was carried out .Results (1)the intraocular pressure:group A can maintain the low level of intraocular pressure for a long time ,followed by group C ,group B and group D ,and difference between groups was statistically significant (P< 0 .01) .(2) The filtering blebs :the filtering bleb survival time of group A was longer than other group(P<0 .01) .(3)Complication:there was not any complication in the 4 groups .(4)The number of corneal endothelial cells :the number of corneal endothelial cells of group A preoperative and postoperative had no statistical significance differences(P>0 .05) .(5)Histopathologic findings :group A had bet‐ter conjunctival epithelial integrity ,subconjunctival fibroblast less than other groups ,filtration had no obvious inflammation infiltra‐tion around the mouth area ,but also had fewer new collagen fibers .Conclusion MMC‐CS sustained release microspheres is a safe and effective treatment to inhibit inflammatory cells activity and fibroblast activity in surgery sites ,and can significantly improve outcome of filtration surgery .