纤溶酶和透明质酸酶诱导猪玻璃体后脱离的有效性和安全性研究

Study on efficacy and safety of plasmin and hyaluronidase inducing posterior vitrous detachment of pigs

目的研究纤溶酶和透明质酸酶诱导猪玻璃体后脱离(posterior vitreous detach-ment,PVD)的有效性和安全性,比较2种酶单独应用和联合应用的效果。方法15头小型猪随机分为A、B、C3组,每组5头,随机选取1眼为实验眼,对侧眼为对照眼,A组实验眼玻璃体腔注射500×103U.L-1透明质酸酶0.1mL,B组实验眼注射5×103U.L-1纤溶酶0.1mL,C组实验眼注射10×103U.L-1纤溶酶0.05mL和1×106U.L-1透明质酸酶0.05mL,对照眼均注射平衡盐溶液0.1mL。注药后进行裂隙灯、直/间接检眼镜、Schtz眼压计临床检查、眼B超、视网膜电图等检查,7d后摘除眼球进行光镜、透射电镜、扫描电镜检查。结果B超检查显示A组有1实验眼、B组有2实验眼于注药后1d观察到部分性PVD,C组有1实验眼于注药后1h观察到部分性PVD。B超、光镜和扫描电镜检查显示注药后7dA组和B组实验眼均见部分性PVD,C组实验眼均见完全性PVD,对照眼未见PVD。7d后3组实验眼及对照眼无明显眼内炎症反应,术前术后眼压变化差异无显著性。实验及对照眼注药前、后视网膜电图a波、b波波幅均无显著性差异。实验眼光镜观察角膜、虹膜组织结构无明显异常,电镜观察晶状体、睫状体上皮细胞形态规则,结构清晰,胞膜完整,边界清楚,连接紧密,对照眼光镜及电镜观察组织结构与实验眼无差异。光镜及透射电镜检查未见视网膜损害。结论纤溶酶和透明质酸酶单独及联合应用均可快速、安全、有效地诱导猪眼玻璃体后脱离,且联合用药较单独用药诱导PVD更快速、更有效。

Objective To investigate the efflcacy and safety of intravitreal injection of plasmin or hyaluronidase or the combination of these two proteases on inducing posterior vitreous detachment （PVD） and evaluate the efficacy of these three methods. Methods Fifteen little type pigs were assigned to three groups （ Group A,B and C） ,5 pigs in each group. One eye of every pig was injected with proteases,and the follow eye was control. Group A received a vitreous injection of hyaluronidase 500 × 10^3 U · L^-1. Group B received plasmin 5 × 10^3 U · L^-1. Group C received plasmin 10 × 10^3 U · L^-1 combined with hyaluronidase 1 × 10^6 U · L^-1.The fellow eye was injected with 0.1 mL balanced salt solution. All the pigs were examined with slit-lamp biomicroscopy, direct and indirect ophthalmoscope, clinical examinations and measuring of intraocular pressure, Bscan and electroretinography. After 7 days,the animals were killed and the eyes were enucleated and examined with light microscopy,transmission electron microseopy and seanning electron microscopy. Results B-scan examination showed that 1 eye of Group A and 2 eyes of Group B had part.ial PVD at 1 day after injection,while 1 eye of Group C had partial PVD at 1 hour after injection. Light microscopy and straining electron microscopy examination demonstrated that at 7 days after operation,all the eyes of Group A and Group B were induced partial PVD,all the control eyes with no PVD. No significant intravitreal inflammatory reaction was found. There was no significant difference in the clinical examinations and in changes of intraocular pressure between the experimental group and the control group. The b-wave and a-wave amplitudes of electroretinography showed no significant difference compared with preinjection values in all groups and between the experimental eyes and controls. Light microscopy inducated no damage to the cornea, the iris and the retinal structure. Transmission electron microscopy inducated no damage to ciliary body and the lens epithelial cells and the retinal structure. Conclusion Intravitreal injection of hyaluronidase or plasmin or their combination can produce PVD effectively and fast without toxicity to the histology and fimction of the retina. The combination of the two proteases was prior to either of them alone.