5-氟尿嘧啶多相脂质体对实验性青光眼滤过术瘢痕形成的影响

Subconjunctival 5-fluorouracil polyphase liposome interference with scar formation in experimental filtration surgery

目的为研究5-氟尿嘧啶(5-Fluorouracil,5-Fu)多相脂质体和5-Fu 预防滤过术瘢痕形成的作用。方法对20只新西兰长耳兔双眼行小梁切除术。术后将兔分为2组,每组10只,每组按随机规定一眼为用药眼,对侧眼为对照眼。第1组:用药眼术后每日结膜下注射5-Fu(水针剂)0.2ml(5mg),对照眼结膜下注射等量生理盐水。第2组:用药眼术后每隔3日结膜下注射5-Fu 多相脂质体0.2ml(5mg),对照眼结膜下注射单纯脂质体0.2ml。结果术后2周,两组用药眼眼压与其术前相比,有显著降低(P<0.05)。而对照眼术后与术前相比,无明显降低(P>0.05)。对病理切片上的瘢痕进行形态学测量分析,两组用药眼的瘢痕面积明显小于其对照组(P<0.002)。在第1组用药眼(5-Fu)中,有2只眼(20%)发生点状角膜上皮剥脱。而在5-Fu 多相脂质体治疗眼中,未发现此毒性反应。结论青光眼术后用5-Fu 脂质体代替5-Fu 水针剂抗术区瘢痕形成,不仅可提高手术的成功率,而且也较安全。

Objective A comparative study was made to determine the effect of 5-fluorouracil (5- Fu) polyphase liposome and 5-Fu solution on the prevention of scar formation in filtration surgery. Method 20 New Zealand white rabbits that underwent a standard trabeculectomy in both eyes were di- vided into two groups and each group consisted of 10 rabbits.Postoperatively,according to randomized fashion,in the first group,one eye received daily subconjunctival injection of 5 mg (0.2 ml) 5-Fu solu- tion and the fellow eye received equal subconjunctival amount of normal saline serving as the control;in the second group,one eye received once subconjunctival injection of 5 mg (0.2ml) of 5-Fu ployphase liposome with every 3 days apart and the fellow eye received the equal amount of subconjunctival injec- tion of polyphase liposome serving as the control.Results Two weeks after the surgery,the eyes treat- ed with 5-Fu solution in the first group and 5-Fu polyphase liposome in the second group showed marked reduction of intraocular pressure (IOP,P<0.05) and the control eyes of both groups did not reveal any marked reduction of IOP as compared with preoperative IOP respectively.Morphometric analysis of the areas of fibrosis in histologic section demonstrated a significant decrease (P<0.002) in episcleral fibrosis in the eyes treated with 5-Fu solution and 5-Fu polyphase liposome as compared with their control eyes respectively.Superficial punctate keratopathy occurred in two of the 5-Fu solution-treated eyes (20%) and no toxic reaction was noted in the 5-Fu polyphase liposome-treated eyes.Conclusion Postoperatively,subconjunctival 5-Fu polyphase liposome instead of 5-Fu solution inhibits the scar for- mation at filtering site,and the therapy is safe and effective,leading to a higher success rate.