黏弹剂选择对百康复视伦有晶状体眼人工晶状体的影响

The influence of elastic materials to the posterior chamber phakic refractive lens

目的观察黏弹剂对百康复视伦有晶状体眼后房屈光晶状体(PC-PRL)植入手术的影响,分析可能的影响因素。设计实验研究。研究对象36只新西兰标准实验兔(36眼)。方法将36只实验动物随机分为6组,每组6只,右眼为手术眼。将两种相同材料的人工晶状体A和B(LA,LB)及三种黏弹剂A,B,C(EA,EB,EC)进行不同组合(LA+EA,LA+EB,LA+EC,LB+EA,LB+EB,LB+EC)植入动物眼内,其中LA+EA为临床中发生术后人工晶状体后表面混浊的PC-PRL+HealonGV。手术后1天观察人工晶状体表面混浊情况。术后2天～1周,将裂隙灯观察到发生混浊膜的实验兔处死,手术剥取人工晶状体表面纤维膜,电镜下观察。对于术后发生增生膜的组合,使用人眼房水作为培养基,进行人工晶状体与相应黏弹剂的体外培养,并观察晶状体表面的蛋白沉淀情况。主要指标前房闪光,人工晶状体表面增生膜。结果在动物体内实验中观察到仅在PC-PRL与HealonGV配合使用的动物组,5眼(83.33%)术后发生人工晶状体后表面混浊,与其他组比较差异有统计学意义(χ2=16.31,P=0.006)。电镜下显示混浊为纤维增生。体外培养各组均未发生该现象。结论 PC-PRL与HealonGV在术中共同使用是术后人工晶状体后表面混浊的原因,其机制尚需进一步研究。

Objective To observe the effect of viscoelastic materials to the posterior chamber phakic refractive lens （PC-PRL） implantation. Design Experimental study. Participant Thirty six New Zealand standard experiment rabbits （36 eyes）. Methods Rabbits were randomly divided into 6 groups, and the right eye was operated. Two kinds of intraocular lens made up of the same material （ Lens A, Lens B） and three kinds of viscoelastic materials （ Elastic A, B, C） were matched separately in each group （LA＋EA,LA＋EB,LA＋ EC,LB＋EA, LB＋EB,LB＋EC）. Opacification on intraocular lens surface was observed 1 day post-opration. Rabbit which opacification was found were sacriticed and got the opacification membrane stripped for electron microscopy. Membrane was cultured in human aqueous humour to observe the protein deposition on surface. Main Outcome Measures Glare in anterior chamber, membranes on surface of intraocular lens. Results In vivo test, only 5 cases （5 eyes, 83.33%） in PC-PRL combined with Healon GV group occurred opacification on posterior surface of the intraocular lens, which was significantly higher than any other groups（χ^2= 16.31, P=0.006）. The membrane was found to be fibroplasis with electron microscopy. No positive result was observed in vitro test. Conclusion PC-PRL matched Healon GV during PC-PRL implantation is the reason for opacification on intraocular lens surface, and its mechanism needs further research. （Ophthalmol CHN, 2010, 19： 93-96）