联合抗代谢药物预防兔后发性白内障的研究

In vivo experimental study on the prevention of after cataract by using 5-fluorouracil in combination with mitomycin C in the capsular bags of lens in rabbits

目的 探讨联合抗代谢药物在预防兔后发性白内障（PCO）中的作用及其机制.方法 40只新西兰白兔随机分为两组。在兔晶状体超声乳化吸出术后，实验组右眼晶状体囊袋内注入含有02mg／ml丝裂霉素及12．5mg/ml 5-氟尿嘧啶的甲基纤维素，左眼晶状体囊袋内仪注入甲基纤维素设置空白对照组；对照组右眼晶状体囊袋内注入含有0．2mg/ml丝裂霉素的甲基纤维素，左眼晶状体囊袋内注入含有12．5mg/ml 5-氟尿嘧啶的甲基纤维素。部分动物囊袋内植入人工晶体。手术后对动物进行1～12个月临床观察，对不同阶段进行晶状体囊膜组织和人工晶体病理学检查、晶状体囊膜平片检查及人工晶体电镜扫描。结果 空白对照组在手术后2周出现后囊膜混浊，随着术后时间的延长，PCO明显加重；对照组在术后1个月发生不同程度PCO，而实验组观察12个月，未见PCO发生。结论 晶状体囊袋内联合抗肿瘤药物能有效杀伤晶状体上皮细胞（LEC）、晶状体赤道部生发区细胞，较单一抗肿瘤药物更可靠预防PCO的发生。晶状体囊袋内联合抗肿瘤药物可能为解决预防人类PCO提供一条新途径。

Objective To evaluate the efficacy and mechanism of 5 - FU in combination with MMC in preventing PCO in rabbits. Methods Forty New Zealand rabbits（80 eyes） were randomly divided into 2 groups： The fight lens capsular bags of the experimental group（twenty New Zealand rabbits）were injected with methylcellulose （MC） contained 12.5 mg/ml 5 - FU and 0.2 mg/ml MMC, and the left lens capsular bags were injected with MC only as vacuity control group; While the right lens capsular bags of the control group（twenty New Zealand rabbits）were injected with MC contained 0.2 mg/ml MMC, and the left lens capsular bags were injected with MC contained 12.5 mg/ml 5 - FU. Some rabbits were implantated with IOL in lens capsular bags. After 1 - 20 months of follow - up after operation, all eyes were examined by slit - lamp microscopy and the PCO were observed. The histology examination of the lens capsule membrane and IOL, the wholemount technique of the lens capsule membrane and the electron microscope inspection of the IOL were observed in different period. Results For clinical study, PCO appeared in the vacuity control group two weeks after operation. The longer follow - up after the operation, the stronger PCO occurred, No more PCO appeared in the experimental group 20 months after operation, Some PCO occurred in the control group. Conclusion Using 5 - FU in combination with MMC in the rabbit lens capsular bag can effectively kill LEC and equator of lens cells in different way, and also can prevent the lens capsule membrane fibrosis and capsular bag shrinkage, therefore preventing PCO. Symphysial medication may be effectively prophylactic treatment for PCO, 5 - FU in combination with MMC in the humma lens capsular bag administration may be a promising method in the prevention of PCO.