维生素A棕榈酸酯眼用凝胶对抗青光眼药物眼表损伤的防治作用

Vitamin A Palmitate Prevents the Ocular Surface Damage due to Antiglaucomatous Eyedrops

目的探讨维生素 A 棕榈酸酯眼用凝胶预防临床常用抗青光眼药物眼表损伤的作用。方法正常新西兰大白兔60只采用随机对照方式分为5组,每组12只(12眼)。A 组单纯使用维生素 A 棕榈酸酯眼用凝胶,B 组单纯使用0.5%噻吗洛尔滴眼液,C 组单纯使用0.2%溴莫尼定滴眼液,D 组联合使用维生素 A 棕榈酸酯跟用凝胶及0.5%噻吗洛尔滴眼液,E 组则联合使用维生素 A 棕榈酸酯眼用凝胶及0.2%溴莫尼定滴眼液。用药前及用药1个月后分别进行泪膜破裂时间(tear break-up time,BUT)、基础泪液分泌试验(Schirmertest)及印迹细胞学检查,并通过扫描电镜观察各组角膜上皮形态。结果用药后 B 组及 C 组 BUT 为(11.6±1.9)s 和(10.9±3.1)s,较用药前的(18.6±3.9)s 和(16.5±4.3)s 缩短,并且结膜杯状细胞密度较用药前下降,二者差异有统计学意义(P<0.05)。A,D 及 E 组的BUT及结膜杯状细胞密度用药前后无明显变化。各组用药前后基础泪液分泌的差异均无统计学意义。B 组和 C 组用药后 Nelson 分级标准评为1级;A,D 及 E 组用药后仍为0级。扫描电镜结果表明 B 组及 C 组表现为表面粗糙,细胞失去平整性,卷边、脱落明显增多,细胞间出现裂隙,同时微绒毛密度明显减少。结论长期使用抗青光眼药物可导致兔角膜及结膜结构变化。维生素A棕榈酸酯通过维持泪膜的稳定性及结膜杯状细胞密度,能够有效地减轻临床常用抗青光眼药造成的眼表损伤。(中国眼耳鼻喉科杂志,2007,7:356-358)

Purpose To determine whether vitamin A palmitate can prevent the ocular surface damage due to prolonged use of topical antiglaucomatous eyedrops. Methods Sixty eyes of 60 New Zealand white rabbits were randomized to 5 treatment groups with 12 rabbits（ 12 eyes） in each group：1% vitamin A palmitate（group A） ,0.5% timolol maleate （ group B）, 0. 2% brimonidine （ group C）, 1% vitamin A palmitate combined with O. 5 % timolol maleate （ group D）, 1% vitamin A palmitate combined with O. 2% brimonidine（group E）. Tear break-up times（BUT） and basal Schirmer tests were measured and the conjunctival changes were determined by impression cytology before and one month after the treatment. Corneal damage was evaluated using scanning electron microscopy. Results The BUT of rabbits in groups B and C after the treatment was （ 11.6 ± 1.9） s and （ 10.9 ± 3.1 ） s respectively,which was significantly shorter than （ 18.6 ± 3.9） s and （ 16. 5 ± 4.3） s before the treatment （ P 〈 0. 05 ）. There was no significant change in BUT pre-and post-treatment in groups A, D and E. The number of goblet cells in the epithelium after the treatment in groups B and C was significantly lower than before（P 〈0.05 ）. The results of basal Schirmer tests had no significant difference between rabbits before and after the treatment in every group. According to Nelson method, specimens of groups B and C were scored to grade 1 while specimens of groups A, D and E remained in grade O. The corneal damage in groups B and C assessed with scanning electron microscopy showed loss of microvilli, increased in the number of epithelial holes, cell peeling, loss of hexagonal shape and retraction of cell borders. Conclusions Prolonged treatment with antiglaucomatous medications in results corneal and conjunctival damage in rabbits ,which could be effectively attenuated by the long-term use of vitamin A palmitate by improving the stability of tear film and increasing the density of goblet cells.