视网膜色素上皮移植方法的探讨

AN INVESTIGATION OF APPROACHES OF TRANSPLANTAITION OF RETINAL PIGMENT EPITHELIUM.

目的：探讨视网膜色素上皮移植的方法。方法：以常规方法制备有色素兔眼视网膜色素上皮（ＲＰＥ）细胞作为供体，移植到１８只无色素兔眼。８只眼经外路法，即穿过巩膜和脉胳膜的方法；另１０只眼内路法，即从睫状体平部进入玻璃体，制成人为的局限性视网膜脱离，将ＲＰＥ细胞移植到受体眼视网膜下腔。术后第１０、２０、４０、９０天作光镜和电镜检查。结果：内路法组，手术后４０天光镜观察，移植区和非移植区神经视网膜层厚度无差别。透射电镜显示：移植的ＲＰＥ细胞嵌入Ｂｒｕｃｈ膜，光感受器外节在正常位置，术后９０天，移植细胞内发现吞噬外节的次级溶酶体。外路法的８只眼因脉胳膜出血或视网膜穿破而失败。结论：内路法是ＲＰＥ细胞移植切实可行的方法。

PURPOSE:To investigate the approaches for transplanting retinal pigment epithelium. METHODS:Retinal pigment epithelial cells(RPE)of pigmented rabbits′ eyes prepared by routine preparation of our institute,were transplanted in 18 unpigmented rabbits′eyes.Eight eyes were undergone outer approach, i.e., transplanting the RPE cells to the subretinal space of recipient eyes by way of perforating sclera and choroid;while 10 eyes were undergone internal approach by way of the routine procedure of vitrectomy with making artificial localized retinal detachment.Light and transmission electrone microscopy examination were done at 10th,20th,40th and 90th day after the operation.RESULTS: In internal approach group,the operated eyes revealed no difference in thickness of the neural retinal layer in transplanted and non transplanted area 40 days after operation under light microscope.Transmission electrone microscopy revealed postoperatively the transplanted RPE cells attached to the Bruch′s membrane and the outer segments of photoreceptive cells located at a normal position at the 40th day;and the secondary lysozymes with engulfed outer segment were found in the transplanted cells at the 90th day.The outer approached operations in eight eyes were failed owing to choroid hemorrhage or perforation of retina.CONCLUSION: The internal approach procedure is much effective and practical for transplantation of RPE cells.