双氯酚酸钠在玻璃体切割术中的应用及其对视网膜结构的影响  

Application of diclofenac sodium in vitrectomy and its effects on retinal structure

作　　者：彭绍民[1] 王绍伟[1] 张中宇[1] 孙大卫[1] 

机构地区：[1]哈尔滨医科大学附属第二医院眼科,黑龙江省哈尔滨市150086

出　　处：《眼科新进展》2007年第2期84-86,共3页Recent Advances in Ophthalmology

基　　金：哈尔滨市留学归国人员基金(编号:1053HQ014)~~

摘　　要：目的研究非甾体类抗炎药双氯酚酸钠(diclofenacsodium,DFS)在兔眼玻璃体切割术灌注液中的应用及其对视网膜结构的影响,寻找此药眼内应用的安全剂量。方法30只健康成年青紫蓝兔随机分为5组,每组6只,左右眼均行玻璃体切割术,左眼为对照组,玻璃体切割术中灌注液为平衡盐溶液(BSS);右眼为实验眼,术中各组500mL灌注液BSS中分别加入25mg、50mg、75mg、100mg、150mgDFS。术前及术后1d、4d、7d、14d、21d、28d分别行双眼闪光视网膜电图(electroretinography,ERG)检查,在14d、28d分别摘除眼球行光学显微镜和透射电镜检查。结果25mg、50mg剂量组,术后1dERG明、暗适应b波波幅比率显著下降,且与术前相比具有显著意义(P<0.05),4d后进入恢复期,10d达到正常水平(P>0.05);75mg、100mg、150mg剂量组,术后1dERG明、暗适应b波波幅比率显著下降,且与术前相比具有显著意义(P<0.05),4d后进入恢复期,14d达到稳定,但仍低于正常(P<0.05)。150mg剂量组可见晶状体后囊混浊、视网膜前少许出血、视盘血管迂曲扩张等改变;75mg、100mg、150mg剂量组光学显微镜和透射电镜检查结果为视网膜组织已出现水肿、细胞核染色质浓缩集聚、细胞坏死等可逆或不可逆变化。结论DFS在玻璃体切割术灌注液中的安全剂量为100mg·L-1,150mg·L-1剂量时对视网膜各层结构产生毒性。Objective To investigate the application of diclofenac sodium （DFS）in perfusatee during vitreetomy and its effects on retinal structure of rabbit eyes, and search the safe dose of DFS used in eyes. Methods Thirty healthy adult gray rabbits were divided randomly into 5 groups, 6 rabbits in each group. Both eyes in each rabbit were performed pars plana vitrectomy. Left eye was control eye,in which the perfusate was the 500 mL balanced salt solution（BSS） ;Right eye was experimental eye,in which 25 mg,50 mg,75 mg, 100 mg, 150 mg DFS were added respectively into the perfusate of 00 mL BSS during vitreetomy. Electroretinography（ERG） was performed before surgery and on the lst,4th,7th,14th,21st and 28th day after satrgery, respeeUvely. On the 14th and 28th day after surgery,the eyeballs were enucleated, and then the light and electron microscopy was performed. Results In 25 nag and 50 nag group,compared with pre-surgery, the ratio of ERG-b wave amplitude decreased markedly on the 1st day after surgery （P 〈0.05）, recoveried on the 4th day, reached the normal level at the 10th day（P〉0.05）.In 75 mg,100 nag and 150 nag groups,the ratio of ERG-b waves amplitude decreased markedly on the 1st day after surgery （P 〈0.05）,recoveried on the 4th day,got stable level at the 14th day,but could not reach the normal level （ P 〈 0.05 ）. In 150 nag group, posterior capsule opacification,little hemorrhage and blood vessel extension was observed, but m 75 mg, 100 mg and 150 mg groups, reversible or irreversible damage of retinal had been seen. Cataract, vitreous haze and retinal damage had also been ob- served by indirect ophthalmicroscope in 75 mg,100 mg and 150 mg grouts. Conclusion The safe dose of DFS in perfusate during vitreetomy is 100 mg ·L^-1, the dose of 150 mg·L^-1 will be resulted in ocular toxicity. [Rec Adv Ophthalmol 211117;27（2） ：84-86]

关 键 词：双氯酚酸钠 毒性 玻璃体切割术 视网膜电图 

分 类 号：R774[医药卫生—眼科]