玻璃体腔注射阿霉素和万古霉素治疗眼球穿孔伤并发症的实验研究

Treament of complications of penetrating ocular injury with intravitreal adriamycin and vancomycinin-jection in a rabbit model

目的观察玻璃体腔注射阿霉素和万古霉素对感染性眼内炎及外伤性增生性玻璃体视网膜病变（PVR）的抑制效果。方法40只新西兰白兔随机分为4组，每组10只。右眼建立外伤性出血性眼球穿孔伤模型，左眼为空白对照眼。4个组中生理盐水组，玻璃体腔注射生理盐水0．1mL；阿霉素组，注射阿霉素2．5μg（0．1mL）；万古霉素组，注射万古霉素1．0mg（0．1mL）；联合用药，注射阿霉素2．5μg（0．1mL）及万古霉素1．0mg（0．1mL）。以裂隙灯显微镜观察眼前段炎症情况，炎症持续超过2周者行玻璃体微生物学培养；直接检眼镜观察外伤性PVR情况。结果联合用药组PVR程度低于生理盐水组（P=0．023）及万古霉素组（P=0．034）；生理盐水组、阿霉素组各发生细菌性眼内炎2例（20．0％）；万古霉素组、联合用药组未见细菌性眼内炎发生。结论在外伤性出血性眼球穿孔伤动物模型中，玻璃体腔注射阿霉素可能降低外伤性PVR程度；而玻璃体腔注射万古霉素可能降低感染性眼内炎症发生率。

Objective To investigate the inhibiting effect of intravitreal adriamycin and vancomycin injection on traumatic proliferative vitreoretinopathy （PVR） and infectious endophthalmitis. Methods All of the right eyes of 40 New Zealand albino rabbits were taken as experiental rabbit model eyes of hemorrhagic penetrating ocular injury and all the left eyes were intact as control. The rabbits were divided into four groups randomly and 10 rabbits in each group. In phosphate buffered saline group, 0.1 ml phosphate buffered saline was injected in vitreous;adriamyein group which were injected with 2.5 μg（0.1 ml） adriamyein in vitreous; vancomycin group which were injected with 1.0 rag（0.1 ml） vancomyein in vitreous;adriamycin combination with vaneomyein group which were injected with 2.5 μg（0.1 ml） adriamycin and 1.0 mg（0.1 ml） vaneomycin in vitreous respectively. The inflammation in anterior segment of eye was estimated by slit-lamp microscope examination. Microbiology culture of vitreous cavity puncture material must be taken upon those eyes that the inflammation had lasted over two weeks in anterior segment. Degree of PVR in vitreous was estimated by direct fundseopy examination. Results The degree of PVR in adriamyein combination with vaneomycin group was lower than both phosphate buffered saline group （P = 0. 023 ） and vancomycin group （P = 0. 034） ;There were 2 eyes （20%） suffered endophthalmitis in phosphate buffered saline group and adriamyein group respectively;There was no eye suffered endophthalmitis in vaneomyein group or adriamycin combined with vaneomyein group. Conclusions The therapeutics of intravitreal adriamycin can decrease the degree of PVR While vaneomyein might reduce the occurrence of bacterial endophthalmitis in rabbit model of hemorrhagic pentrating eye injury