利多卡因表面麻醉联合前房内麻醉下兔眼角膜内皮细胞组织病理学观察

Effect of Topical plus Intraocluar Lidocaine on Corneal Endothelial cells in Rabbits

目的使用不含防腐剂的利多卡因溶液对兔眼角膜行表面麻醉联合前房内麻醉,观察其用于白内障手术麻醉的安全性。方法健康成年白兔40只,随机分成4组,对照组A组10只,实验组B、C、D组各10只。各组均使用2%利多卡因溶液表面麻醉,并行兔眼前房穿刺术,抽取房水150μl。对照组A组前房注入150μl灌注液BBSplus,实验组B、C组分别在前房注入等量不含防腐剂的1%利多卡因、2%利多卡因溶液。试验组D组则在前房内先行注入0.1ml粘弹剂Viscoat,BBsplus灌注液冲洗,再注入150μl不含防腐剂的2%利多卡因溶液。于30min,120min取角膜分别行光镜和透射电镜观察。结果联合麻醉后30、120minC组(2%利多卡因组)光镜下见角膜内皮细胞肿胀,部分脱落,透射电镜示内质网肿胀。联合麻醉后30、120min实验组B、D组光镜及透射电镜未见明显异常。结论短期内1%利多卡因溶液前房内注入对角膜内皮细胞无明显毒副作用。前房内注入2%利多卡因对兔眼角膜内皮有一定损害。联合使用粘弹剂,可能提高利多卡因麻醉的安全性。

Objective To investigate the effect of topical anesthesia and intracameral preservative--free Lidocaine on corneal endothelial cells during phacoemulsification. Methods Forty rabbits were derided into four gronps： one control group（A group A） and three experimental groups C groups B,C and D）. All the rabbits received topical anesthesia with Lidocaine 2% and underwent paracentesis of anterior chamber, from 0. 15ml aqueous humor was drawn out. Then 0.15ml BBsplus was injected into rabbit anterior chamber in the control group. Preservative-free Lidocaine 1% and Lidocaine 2% were injected into the rabbit anterior chamber prespectively in groups B and C. The rabbit anterior chamber in the other experimental group D was treated with 0. lml Viscoat and rinsed with BBsplus, and then received injection of 2 % preservative--free Lidocaine. The corneas which were taken 30 and 120 minutes after the anesthesia in all the rabbits,were examined by a light microscope and a transmisson elextron microscopy. Result The edema and shedding of corneal endothelium cells and their endoplasmic edema were observed 30 and 120 minutes in groups C after the injection of 2 % lidocaine. Along with the time extending, the impairment was gradually aggravated.. The histopathology and ultrastructure of the corneal endothelial cell in group B and D were as normalas in the cotrol group. Conclusion The intraocular injection of 1% preservative-free lidocaine after the topical anesthesiais a safe anesthesic method during phacomulsification. The intraocular injection of 2 % preservative-free Lidocaine has potential danger to corneal endothelium cells. While Viscoelastic agent was used, the safety of topical plus intraocluar lidocaine may be improved.