玻璃体腔注射组织型纤维蛋白酶原激活剂诱导玻璃体后脱离的实验研究

Posterior vitreous detachment induced by intravitreal injection of tissue type plasminogen activator(t PA) in the rabbit eye

目的 :观察对兔眼玻璃腔注射组织型纤维蛋白酶原激活剂 (tissue typeplasminogenactivator,t PA)联合周边视网膜冷凝诱导玻璃体后脱离 (posteriorvitreousdetachment,PVD)的效果。方法 :30只兔随机分为三组 (A、B、C) ,每组 10只兔 ,右眼为实验组 ,左眼为对照组。实验组A组平坦部注入t PA(5 0 μg/ 0 .1ml) ;B组周边视网膜冷凝 +平坦部注入t PA(5 0 μg/ 0 .1ml) ;C组行周边视网膜冷凝术 ,2 4h后平坦部注入t PA(5 0 μg/ 0 .1ml) ;对照组方法同实验组 ,眼内注入BSS0 .1ml。术前、术后用裂隙灯、间接检眼镜、VOLK +90D、B超收稿日期 :2 0 0 4-0 3 -2 2 ;修回日期 :2 0 0 4-10 -0 8基金项目 :陕西省自然科学研究基金资助项目 (2 0 0 2C2 80 )。作者简介 :王丽丽 (195 7-) ,女 ,陕西清涧人 ,主任医师 ,研究方向 :玻璃体视网膜疾病。E -mail:wanglili72 2 @sohu .com及视觉电生理 (electroretinograghy ,ERG)进行随访观察 ,最后取眼球标本进行扫描、透射电镜观察。结果 :实验组A组 :玻璃体后脱离 10 % (1/ 10 ) ,与对照组相比无统计学意义 (P >0 .0 5 )。B、C组玻璃体部脱离 6 0 % (6 / 10 )和 90 % (9/ 10 ) ,与A组相比差异有显著性 (P <0 .0 5 )。对照组均未见玻璃体后脱离。透射电镜观察t PA 5 0

Objective:To investigate the occurrence of posterior vitreous detachment(PVD) induced by intravitreal injection of tissue type plasminogen activator(t PA) combined with or without cryosurgury in the peripheral retina.Methods:Thirty right eyes of rabbits were randomly divided into 3 groups(10 in A,10 in B,10 in C). Group A was injected with t PA(50 μg/0.1 ml) into the vitreous cavity through the pars plana. Group B underwent cryosurgury in the peripheral retina and was injected simultaneously with t PA(50 μg/0.1 ml). Group C received an intravitreal injection of t PA in the peripheral retina 24 h after cryosurgury. Thirty left eyes were injected with 0.1 ml BSS into the vitreous cavity for controls. Biomicroscopy,ophthalmoscopy,VOLK+90D,B scan ultrasonography,and electroretinography(ERG) were performed before and after surgery. Enucleated eyes were examined by scanning and transmission electron microscopy.Results:In group A,one eye showed PVD(10%,P>0.05). Six eyes(60%,P<0.05) in group B and 9 eyes(90%,P<0.05) in group C presented with PVD. PVD was not observed in any control eyes. Moreover,50 μg t PA did not harm the structure or the function of the retina.Conclusion:Cryosurgury in the peripheral retina combined with an intravitreal injection of t PA can induce PVD without intraocular toxicity. The effectiveness of PVD depends on when it is administered. [