不同人工晶体材料及设计方式对兔眼后囊混浊影响的实验研究

Experimental Study on the Effects of the Material and Design of Artificial Lens on the Posterior Capsular Opacity

目的对比3种不同材料及设计的人工晶体对兔眼晶状体后囊混浊的影响。方法将实验动物48只随机分成A、B、C、D4个组，超声乳化摘除术后在囊袋内分别植入不同的人工晶体。A组植入三片式聚甲基丙稀酸甲酯（PMMA）材料、光学部边缘为圆形设计的人工晶体；B组植入三片式硅胶（Silicon）材料、光学部边缘也为圆形设计的人工晶体；C组植入丙烯酸酯（Acrylic）材料、光学部边缘为直角方型侧缘设计的人工晶体，D组作为空白对照组只行超声乳化晶体摘除术，未植入人工晶体。术后1d、1周、1月、3月分别进行了术眼的裂隙灯检查及照像、术后3月行病理及电镜检查。结果术后第1天，（1）前节炎症反应：A、B、C、组瞳孔区都有膜形成，角膜轻度水肿，D组瞳孔区未见膜形成，角膜轻度水肿。术后1周时A、B、C组前房闪光阳性，三组瞳孔区渗出膜均较前吸收，D组前房闪光消失，A、B、C组后囊膜清亮，D组（空白对照组）后囊膜已有明显混浊。术后1月时，A、B组瞳孔区渗出膜仍未完全吸收，前房闪光均阳性。C组瞳孔区渗出膜完全吸收，前房闪光消失。（2）后囊膜及人工晶体在囊袋内位置情况：术后1月A、B组中央视区后囊膜轻度混浊，并发现2组中各有10只眼人工晶体在囊袋内偏位和囊膜夹持。C组后囊膜清亮，有2只眼发生了囊膜夹持，其余10只眼的人工晶体在囊袋内具有良好的居中性，D组（空白对照组）后囊膜已完全混浊。术后3月时，A、B组中央视区后囊膜混浊情况相似，均较前更加明显，C组只有2例中央视区后囊膜有轻度的混浊，其它10例术眼均保持清亮。结论C组单片式丙烯酸酯材料、光学部边缘为直角方型侧缘的人工晶体，可能对减少后囊膜混浊的发生，维持人工晶体正位有积极重要的作用。

Objective Posterior Capsule Opacification （PCO） as one of the common complications after cataract surgery is a complicated pathophysiologic process. Methed All experimental animals were separated into four groups randomly,Three-pieces PMMA and round edge optic IOL as implanted in group A; three-pieces and Silicone IOL in group B ; sigle-piece and sharp edge optic is square Acrylic IOL in group C. All surgical animals were checked with slit lamp 1 day ; lweek ; lmonth ; and 3 month. After surgery ,Fundus of surgical eyes were also checked We checked the immune globulin and cells in aqueous fluid of all surgical eyes 1 day ; 1 week ; 1 and after surgery. Histopathologic examination was done on the surgical bulbars. and the lens capsule of the surgical eyes was checked with electron micrography .Result （ 1 ） One week later on the exudative tunic pupillary area in group A, B and C were absorbed before , Proiminent Tyndall signs were seen in all three groups. One month after surgery discovered in the eyes of group A and B was opcificasion in central posterior capsular and the eyes of group C remained clear. Three months post-operation opacification in the peripheral area of all surgical eyes was more promintent than that of one month post-operation. and opicification in the central area of group A and group B was similar , but it was still clear in the central area of group C. （2） The immune globulin of the aqueous fluid in all surgical groups was extremely higner than that of the opponent group, and group C there was prominent statistic difference between group A , B. one week and one mounth after surgery. （3） All eyes had no severe complications after surgery, such as hyphema. Vitreous hemorrhage. Vitreous collapsed into anterior chamber, reinal detachment, and cystoid macular edema. （4） A great amount of fibroblast reforming from the lens epithelium cells could be seen in the peripheral area of the lens capsule in each surgical groups and also in the central area in group A and B in three months post-operaton. But nothing could be seen in the central area of group C. Conclusion All groups have no severe complication after surgery and all of the three IOL are safe. But the single-piece Acrylic IOL of group C is more effective than the other two in preventing the formation of posterior capsule opacification.