胰蛋白酶复合黏弹剂对后发性白内障的预防作用

Prevention of posterior capsule opacification by trypsin-VISCOAT mixture

目的探讨胰蛋白酶复合黏弹剂预防后发性白内障(PCO)的有效性及安全性。方法将25只新西兰白兔50只眼平均分为5组,每组10只眼。所有实验眼均行白内障超声乳化手术,在晶状体囊袋内分别注入普通黏弹剂、质量分数0.5%胰蛋白酶复合黏弹剂+血清复合黏弹剂、0.75%胰蛋白酶复合黏弹剂+血清复合黏弹剂、1%胰蛋白酶复合黏弹剂+血清复合黏弹剂或1%胰蛋白酶复合黏弹剂并在囊袋内保留3min。摘除实验眼并制备常规固定切片,行苏木精-伊红染色,光镜下观察各组兔晶状体上皮细胞(LECs)和角膜内皮细胞(CECs)的形态学变化。结果 LECs计数随着胰蛋白酶剂量的增加而逐渐减少,4个实验组LECs计数的差异有统计学意义(H=36.696,P=0.00)。1%胰蛋白酶复合黏弹剂+血清复合黏弹剂组的CECs计数为(34.0±2.6)个,而1%胰蛋白酶复合黏弹剂组为(27.0±4.7)个,2组差异有统计学意义(Z=-3.792,P=0.00)。组织学检查表明,光学显微镜下普通黏弹剂组LECs结构和排列正常;0.5%胰蛋白酶复合黏弹剂+血清复合黏弹剂组和0.75%胰蛋白酶复合黏弹剂+血清复合黏弹剂组可见部分LECs脱落,眼内其他组织形态无明显异常;1%胰蛋白酶复合黏弹剂+血清复合黏弹剂组LECs完全脱落,但CECs及眼内其他组织形态无明显异常;1%胰蛋白酶复合黏弹剂组LECs完全脱落,伴有CECs的小片状脱落。结论白内障术中运用1%胰蛋白酶复合黏弹剂配合血清复合黏弹剂能安全有效地去除LECs,为PCO的预防提供了一个新的治疗途径。

Background The intracapsular injection of lens of some drugs to prevent the posterior capsule opacification （PCO） is a new studying field.The lens intracapsular injection with the combination of trypsin,serum with VISCOAT during the phacoficication is concerned.Objective This study was to assess the ability of delivering trypsin-VISCOAT mixture directly into lens epithelial cells （LECs） in vitro and evaluate the effectiveness and safety of trypsin-VISCOAT mixture.Methods Fifty eyes from 25 clean New Zealand white rabbits were divided into 5 groups at average.Phacoaspiration of lens was performed in all the experimental rabbits,and regular VISCOAT,1% trypsin＋serum＋VISCOAT,0.75% trypsin＋serum＋VISCOAT,0.5% trypsin＋serum＋VISCOAT or 1% trypsin＋VISCOAT were injected into the capsular bag of lens respectively for 3 minutes and then were removed during the operation.Animal eyeballs were enucleated in 24 hours after operation and the samples of lens capsular membrane were prepared for the morphological examination under the optical microscope.Results The counts of LECs was gradually decreased with the increase of trypsin concentration （H=36.696,P=0.00）.The corneal endothelial cells counts in 1% trypsin＋serum＋VISCOAT group were 34.0±2.6 cells/field,and that in 1% trypsin＋VISCOAT group was 27.0±4.7 cells/field,showing a statistically significant difference （Z=-3.792,P=0.00）.Histological examination of capsular bag revealed the normal LECs in regular VISCOAT group.However,partical lose of LECs were seen in 0.5% trypsin＋serum＋VISCOAT group and 0.75% trypsin＋serum＋VISCOAT group,and the destruction of LECs was found in 1% trypsin＋serum＋VISCOAT group,but the corneal endothelial cells,iris and anterior chamber angle showed the normal structure under the optical microscope.In 1% trypsin＋VISCOAT group,the destruction of LECs and corneal endothelial cells could be seen.Conclusion The mixture of 1% trypsin and VISCOAT with serum and VISCOAT allows selective delivery of toxic agents directly into the capsular bag to remove the residual LECs after phacoaspiration.The intracapsular injection of mixture of 1% trypsin and VISCOAT with serum and VISCOAT is a new approach to the prevention of PCO.