改良PHEMA-PMMA一体化人工角膜治疗兔角膜碱烧伤的实验研究  

Implantation of modified PHEMA-PMMA Keratoprostheses in alkali-burned rabbit corneas

作　　者：郭萍[1] 陈家祺[1] 王智崇[1] 覃百花[2] 刘祖国[1] 顾建军[1] 袁进[1] 黄海[2] 

机构地区：[1]中山大学眼科中心眼科学教育部重点实验室 [2]暨南大学生物医学工程系,广州510632

出　　处：《眼科研究》2006年第6期593-597,共5页Chinese Ophthalmic Research

基　　金：国家"十五"攻关项目(2004BA720A15);卫生部临床学科重点项目(卫规财发[2004]468);深圳市科技计划项目医疗卫生类项目(200602099)资助。

摘　　要：目的评价改良聚羟乙基丙烯酸甲酯（PHEMA）-聚甲基丙烯酸甲酯（PMMA）一体化人工角膜时兔角膜碱烧伤的治疗效果。方法通过两阶段化学聚合结合车床机械切削合成改良的一体化人工角膜。将PHEMA海绵边裙材料植入10只正常兔角膜板层间，另10只碱烧伤兔眼角膜囊袋内1期植入一体化PHEMA—PMMA人工角膜，术后用组织病理、免疫组织化学和电镜检查观察海绵边裙与角膜组织的生物学愈合情况。术后2个月行II期手术．术后随访观察3～6个月。结果接受板层间植入术的10只兔角膜未见任何并发症。术后2周成纤维细胞长入PHEMA海绵，术后2～3个月多量细胞长入伴有新生血管；海绵孔隙中生长细胞和角膜基质细胞波形蛋白（Vim）免疫反应阳性；电镜下，细胞在海绵材料间隙中生长状态良好，并分泌胶原和细胞外基质。接受人工角膜移植术的10只碱烧伤兔眼中，1眼1期术中角膜穿孔而被排除，另9眼Ⅱ期术后，3眼2周内人工角膜镜柱偏位，6眼观察期间人工角膜在位。结论PHEMA海绵能够与角膜组织达到良好的生物学愈合；人工角膜的片型和整体强度有待进一步改良。Objective To evaluate the therapeutic： effects of modified porous poly（2-hydroxyethyl methacrylate, PHEMA） Keratoprostheses（KPro） on alkali-burned rabbit corneas. Methods The KPro were made using two-stage polymerization combined with mechanical cutting. Ten normal New Zealand white rabbits received lamellar implantation of PHEMA sponges as controls. The sponges were collected 2 weeks, 1,2,3 and 4 months after operation. The cell proliferation and neovascularization in the sponges were observed using light and transmission electron microscopy （TEM） and immunohistochemistry. The models of corneal alkali-burn were produced in 10 rabbits using a filter paper soaked in 1 mol/L NaOH solution. The porous PHEMA KPros were inserted into the lamellar pockets of 10 model rabbits （stage 1 operation）. The healing process was investigated by slit-lamp microscopy. The anterior lamellar cornea tissues were removed 2 months after surgery and exposed the transparent core （ stage 11 operation）. The rabbit models were followed up for 3 -6 months. Results No complication was observed in the control group. Under the light microscope,fibroblasts started to grow into the cornea 2 weeks after operation, and several cells and new blood vessels invaded into the cornea 2 - 3 months after surgery. Under the electron microscope,the invading cells looked healthy and were surrounded by extracellular matrix and collagen. Invading cells in sponges and keratocytes were positive for vimentin. One eye of the experimental group was excluded because of the cornea perforation during the stage 1 operation. After the stage 11 operation ,the central core was extruded in 3 eyes within 2 weeks, and the other six KPros remained in situ during observation. Conclusion The porous KPros can obtain a close fusion with the host cornea.

关 键 词：聚羟乙基丙烯酸甲酯(PHEMA) 人工角膜 兔 生物相容性 

分 类 号：R779.1[医药卫生—眼科]