阿霉素药物缓释系统抑制人工晶状体植入术后后囊膜混浊的实验研究

Experimental study on adriamycin drug delivery system inhibiting posterior capsule opacification following implantation of intraocular lens

目的 探讨阿霉素药物缓释系统(ADM-DDS)对兔眼人工晶状体植入术后后囊膜混浊(PCO)的抑制作用及其毒副作用,为临床应用提供实验依据。方法 自制聚乳酸(PLA)为载体的眼内植入型ADM-DDS,内含ADM 22μg。采用兔眼晶状体囊外摘出联合人工晶状体植入术的动物模型,术中将ADM-DDS植入15只兔眼晶状体囊袋内。术后临床常规检查,第4周行病理组织学及电镜检查。结果 实验组与对照组比较,晶状体后囊膜混浊减轻(t=2,P<0.01),Soemmering环面积减小(t=20.51,P<0.01),兔眼晶状体上皮细胞(RLECs)细胞核固缩坏死,胞浆凝集、空泡变性。两组之间的眼压、角膜内皮细胞形态及密度以及光镜下角膜、虹膜、睫状体、视网膜组织均无差异。结论 兔眼内植入ADM-DDS通过ADM缓释作用抑制了人工晶状体植入术后RLECs的增殖。ADM-DDS对兔眼角膜、虹膜、睫状体及视网膜无明显毒性。以PLA为载体的DDS将有可能成为临床上药物预防PCO的一种有效而安全的给药途径。

Objective To investigate the inhibition of adriamycin drug delivery system ( ADM-DDS) on posterior capsular opacification (PCO) after intraocular lens(IOL) implantation in rabbits and assess the safety of ADM-DDS to normal cells of eyes. Methods A polylactic acid ( PLA) disk containing 22μg ADM was implanted between the posterior capsule and intraocular lens during the ECCE and IOL surgery in 15 rabbit eyes. Slitlamp,ophthalmoscopy,tonometry and corneal endothelial cell counts were monitored for 4 weeks following operation and operative eyes were observed with histopathologic method and transmmision electronic microscopy in the 4th week. Results At the 4th week after operation, the posterior capsule was much clearer and the area of Soemmering ring was significantly smaller in test group in comparison with control group (t = 2 P < 0. 01 ,( = 20. 51 P < 0. 01 ) . Transmmision electronic microscopy demonstrated diminished nucleus and cytoplasmic coagulation and vacuolization in test group. There was no obvious difference in density of corneal endothelial cell, intraocular pressure and histopathology of cornea, iris, ciliary body and retina between both groups. Conclusions ADM-DDS can prevent PCO in rabbits following IOL operation by inhibiting proliferation of RLEC without obvious toxicity to normal cells. As carrier of drug using PLA,DDS can offer an effective and a safe approach.