晶状体囊袋内联合应用丝裂霉素C和5-氟尿嘧啶预防后发性白内障

Lens capsular bag combined use of 5-fluorouracil and mitomycin C for prevention of after-cataract

目的：探讨晶状体囊袋内联合应用抗代谢药物预防后发性白内障的作用及其机制.方法：2007年10月至2009年10月本科室收治老年性白内障患者618例（651眼）,术中在白内障超声乳化吸除后晶状体囊袋内分别注入含有或不含有不同抗代谢药物的甲基纤维素溶液0.5 mL.所有患者完全随机法分为4组：实验组155例（157眼）注入含有0.2 mg/mL丝裂霉素C（MMC）、12.5 mg/mL 5-氟尿嘧啶（5-FU）的甲基纤维素溶液;空白对照组173例（194眼）仅注入甲基纤维素溶液;MMC对照组145例（151眼）注入含有0.2mg/mL MMC的甲基纤维素溶液;5-FU对照组145例（149眼）注入含有12.5 mg/mL 5-Fu的甲基纤维素溶液.5 min后用灌注液置换晶状体囊袋内的药物并在囊袋内植入人工晶体.术后随访1年,观察患者术眼术后角膜内皮细胞生长情况,眼内压变化及晶状体前、后囊膜混浊情况,并与术前进行比较.结果：各组患者术后角膜内皮细胞损伤情况无明显差异,术前后眼内压及角膜内皮细胞计数差异无统计学意义（均P〉0.05）.术后随访6个月及以上的患者中,实验组、空白对照组、MMC对照组、5-FU对照组患者晶状体前囊混浊发生率分别为11.83%（11/93）、57.65%（49/85）、50.60%（42/83）、52.63%（40/76）,晶状体后囊混浊发生率分别为3.23%（3/93）、20.00%（17/85）、10.84%（9/83）、14.47%（11/76）,与其他各组比较.实验组晶状体前、后囊混浊发生率均明显下降（均P〈0.05）.结论：晶状体囊袋内联合应用抗代谢药物能有效抑制晶状体上皮细胞增殖,从而预防后发性白内障.

Objective：To evaluate the efficacy and mechanism of lens capsular bags combined use of 5-fluorouracil（ 5-FU ） and mitomycin-C （MMC） for prevention of after-cataract. Methods： Between October 2007 and October 2009,618 senile cataract patients （651 eyes） received phacoemulsification at our department. At surgery, the patients were randomly assigned to receive intracapsular injection of 0.5 ml methylcellulose （MC） with or without addition of antimetabolic agents, and were thereby allocated to 4 groups ： the experimental group [0.5 mL MC with O. 2 mg/mL MMC plus 12.5mg/mL 5-FU,155 patients and 157 eyes] ,blank control group （0.5 mL MC alone,173 patients and 194 eyes）,MMC control group （0.5 mL MC with 0. 2 mg/mL MMC, 145 patients and 151 eyes） and 5-FU control group （0.5 mL MC with 12.5 mg/mL 5-FU, 145 patients and 149 eyes）. Five minutes later, the lens capsular bags of all subjects were rinsed with irrigating solution and implanted with artificial mtraocular lens （IOL）. All patients were followed up for 12 months to study the growth of corneal endothelium, intraocular pressure, as well as anterior and posterior capsule opacification, as compared with before surgery. Results：There was no inter-group difference in growth of corneal endothelium, or changes in intraocular pressure and corneal endothelial cell counts from pre-operation in every group （ all P 〉 0.05 ）. Among patients followed up for more than 6 months, the rates of anterior and posterior capsule opacification were, respectively, 11.83% （ 11/93 ） and 3.23% （ 3/93 ） in the experimental group ,57.65% （49/85） and 20.00% （ 17/85 ） in the blank control group,50.60% （42/83） and 10.84% （9/83） in the MMC control group, and 52.63 % （40/76） and 14.47% （11/76） in the 5-FU control group. Compared with other 3 groups, there was a significant reduction in opacifieation of either anterior or posterior capsule among patients in the experimental group （ both P 〈 0.05 ）. Conclusion：Lens capsular bag combined use of 5-FU and MMC appears effective in suppression of lens endothelial proliferation, and is therefore protective against after-cataract.