t-PA和5-Fu多相脂质体联合应用对兔青光眼滤过术后瘢痕形成的影响

The inhibitory effect of tissue plasminogen activator combined with 5 fluorouracil polyphase liposome on the scar formation in experimental filtration surgery

目的研究组织型纤溶酶原激活剂（ｔｉｓｓｕｅｐｌａｓｍｉｎｏｇｅｎａｃｔｉｖａｔｏｒ，ｔ－ＰＡ）联合５－氟尿嘧啶（５－Ｆｌｕｏｒｏｕｒａｃｉｌ，５－Ｆｕ）多相脂质体抑制青光眼滤过术后瘢痕形成的作用。方法将１６只健康成年新西兰长耳兔随机分成４组，每组４只，均行双眼小梁切除术。第１组：为对照组，手术结束时双眼前房内各注射生理盐水０．１ｍｌ，结膜下注射单纯脂质体０．２ｍｌ。以后每４天结膜下注射单纯脂质体０．２ｍｌ，共４次。术后不用抑制瘢痕形成的药物。第２组：手术结束时双眼前房内各注射ｔ－ＰＡ２５μｇ（０．１ｍｌ）。第３组：术后每４天双眼结膜下注射５－Ｆｕ多相脂质体５ｍｇ（０．２ｍｌ），共４次。第４组：术终时前房内注射ｔ－ＰＡ２５μｇ，术后用药同第３组。分别在术前、术后第１周及第２周各测眼压１次。２周后摘除所有兔眼，对病理切片上的滤过手术瘢痕进行形态学分析。结果术后２周时，第３、４组兔双眼压各与其术前相比，差异有显著性（Ｐ＜０．０５），而第１、２组兔双眼压与术前相比，差异无显著性（Ｐ＞０．０５）。第２、４组兔眼术后形成的滤过泡比第１、３组兔术后形成的滤过泡稍大。三种给药方法治疗的兔眼巩膜表面的瘢痕面积均小于对照组兔眼?

Objective To study the effect of tissue plasminogen activator (t PA) in combination with 5 fluorouracil (5 Fu) polyphase liposome on the prevention of scar formation in filtration surgery. Methods Bilateral trabeculectomy filtering procedures were performed on 16 New Zealand white rabbits. The rabbits were divided into 4 groups of four rabbits each. In a randomized fashion, the first group received intracameral normal saline (0.1 ml) immediately following surgery and subconjunctival injection of 0.2 ml polyphase liposome (no drug) every 4 days serving as the control. The second group received intracameral t PA 25 μg (0.1 ml) immediately following surgery. The third group received subconjunctival 5 Fu polyphase liposome 5 mg immediately after the procedures of filtration surgery and then every four days for another three injections. The fourth group received both intracameral t PA 25 μg and subconjunctival 5 Fu polyphase liposome as in the third group. All eyes of the four groups were enucleated two weeks after the operation. Results Two weeks after the surgery, the average intraocular pressure demonstrated a significant decrease in the third and fourth groups ( P <0.05), but did not show a significant decrease ( P >0.05) in the control and the second groups, as compared with the average preoperative intraocular pressure correspondingly. Morphometric analysis of the area of fibrosis from histopathological sections demonstrated a significant decrease of episcleral fibrosis in the three drug treated groups as compared with the control group. Moreover, the area of fibrosis in the fourth group was the least among the three drug treated groups. Analysis of variance of 2×2 factorial design showed that t PA and 5 Fu polyphase liposome had synergetic effect on the inhibition in all of the drug treated eyes. Conclusion Postoperatively, the inhibitory effect of intracameral t PA combined with subconjunctival 5 Fu polyphase liposome on the scar formation in filtration surgery is more prominent than that of t PA or 5 Fu used alone. They had synergetic effect on the inhibition of scar formation in filtration surgery.