玻璃体腔注射万古霉素和蛇毒降纤酶治疗兔眼球穿通伤并发症的效果

Treatment of complications of penetrating ocular injury with intravitreal defibrase and vancomycin injection in rabbit model

目的：观察玻璃体腔注射蛇毒降纤酶和万古霉素对外伤性增生性玻璃体视网膜病变（proliferative vitreoretinopathy,PVR）的抑制效果.方法：新西兰白兔40只右眼建立外伤性出血性眼球穿通伤动物模型.左眼为空白对照眼.随机分为4组,生理盐水组10眼,玻璃体腔注射生理盐水0.1mL;蛇毒降纤酶组10眼,玻璃体腔注射蛇毒降纤酶0.1U（0.1mL）;万古霉素组10眼,玻璃体腔注射万古霉素1mg（0.1mL）;联合用药10眼,玻璃体腔分别注射蛇毒降纤酶0.1 U及万古霉素1mg.通过裂隙灯显微镜观察眼前节炎症情况,眼前节炎症持续超过2wk以上者行玻璃体腔微生物学培养;直接眼底镜观察玻璃体出血指数、外伤性PVR情况.结果：联合用药组玻璃体出血指数低于生理盐水组（P〈0.01）、外伤性PVR程度低于生理盐水组（P〈0.01）;联合用药组玻璃体出血指数低于万古霉素组（P〈0.05）、外伤性PVR程度低于万古霉素组（P〈0.01）;生理盐水组、蛇毒降纤酶组各发生细菌性眼内炎3例（30%）;万古霉素组、联合用药组未见细菌性眼内炎的发生.结论：在外伤性出血性眼球穿通伤动物模型中,玻璃体腔注射蛇毒降纤酶和万古霉素可能可以促进玻璃体腔出血的吸收、降低外伤性PVR程度和减低感染性眼内炎症发生率.

AIM： To investigate the inhibiting effect of intravitreal defibrase and vancomycin injection on proliferative vitreoretinopathy （PVR）, infectious endophthalmitis in rabbit model eyes of hemorrhagic penetrating ocular injury. METHODS= Totally 40 New Zealand albino rabbits （right eyes） were taken as experimental rabbit model eyes of hemorrhagic penetrating ocular injury and all their left eyes were intact. The rabbits were divided into four groups randomly; phosphate buffered saline group （10 eyes）which were injected with 0. lmL phosphate buffered saline in vitreous; defibrase group（10 eyes）which were injected with 0.1U（0. lmL） defibrase in vitreous; vancomycin group（lO eyes）which were injected with lmg （0. lmL） vancomycin in vitreous; defibrase combined with vancomycin group （10 eyes）which were injected with 0.1 U （0.1 mL） defibrase and 1 mg （0.1 mL） vancomycin in vitreous respectively. The inflammation in anterior segment of eye was estimated by slit-lamp microscope examination. Microbiology examination in vitreous must be taken upon these eyes that the inflammation have last over two weeks in anterior segment. Both degree of PVR and the bleeding indexes in vitreous were estimated by direct funduscopy examination. RESULTS： Both the bleeding indexes and degree of PVR in vitreous in defibrase combined with vancomycin group were lower than both phosphate buffered saline group （P〈0.01;P〈0.01） and vancomycin group（P〈0.05;P〈0.01 ） ;There were 3 eyes （30%） suffered endophthalmitis in both phosphate buffered saline group and defibrase group respectively; There was no eye suffered endophthalmitis in both vancomycin group and defibrase combined with vancomycin group. CONCLUSION ： The therapeutics of intravitreal defibrase combined with vancomycin injection can promotes the absorption of vitreous hemorrhage and decrease both the occurrence of bacterial endophthalmitis and the degree of PVR.