脉络膜上腔置入糖皮质激素药膜对兔视网膜的保护作用  

Glucocorticosteroid membrane implanted into perichoroidal space protects retina of rabbit endophthalmitis

作　　者：李立婕[1] 金中秋[1] 

机构地区：[1]广州军区武汉总医院眼科,武汉430070

出　　处：《第三军医大学学报》2008年第13期1287-1290,共4页Journal of Third Military Medical University

摘　　要：目的探讨在眼内炎的治疗中,脉络膜上腔置入曲安奈德壳聚糖药膜与玻璃体腔注射曲安奈德对视网膜的不同影响。方法30只健康青紫蓝兔右眼玻璃体腔注射ATCC25923标准金黄色葡萄菌105CFU/ml混悬液0.1ml建立眼内炎模型。24h后随机将实验动物分为3组,每组10只眼进行不同干预,A(玻璃体腔万古霉素)组、B(玻璃体腔万古霉素+曲安奈德混悬剂)组、C[玻璃体腔万古霉素+脉络膜上腔置入壳聚糖缓释药膜(载药曲安奈德)]组。干预后每日间接眼底镜观察;注射细菌后24h及干预后14d所有实验动物行眼部玻璃体腔及视网膜B超检查;造模前及干预后14d行视网膜电图(electroretinogram,ERG)检查,干预14d后处死所有动物行光镜、电镜观察。结果C组较A、B组炎症明显减轻。A、B、C各组临床炎症评分有显著性差异(P<0.05);B超显示视网膜脱离A、B、C各组间有显著性差异(P=0.015);ERG检查A、B组实验前后ERG b波波幅平均值有显著性差异(P=0.000);C组b波波幅平均值前后无显著性差异;A与B、B与C、A与C组间b波波幅有显著性差异(P=0.015、P=0.001、P=0.000);光镜下C组视网膜结构完整,层次分明,病理评分A、B、C各组间有显著性差异(P<0.05);电镜下观察视网膜色素上皮层C组细胞器结构完整,少见细胞质空泡化,B组细胞核染色质分布不均,细胞质空化,细胞器破坏。结论脉络膜上腔置入壳聚糖药膜在眼内炎治疗中对视网膜具有明显正性保护作用。Objective To evaluate the effect of implantation of chitosan membrane with triamcinolone （TA） into perichoroidal space combined with intraocular vancomycin injection on the protection of retina in rabbit endophthalmitis. Methods The drug membrane was made of gelatin-chitosan. The right eyes of 30 normal pigment rabbits were inoculated intravitreally with 0.1 ml mixture of 105 CFU standard strain Staphylococcus aureus （ ATCC 25923 ）. Twenty-four hours later, rabbits were equally randomized to intravitreal vancomycin group （Group A）, intravitreal vancomycin and TA eye dropping （Group B ）, and intravitreal vancomycin combined with TA membrane implantation （ Group C）. Clinical observation of ocular fundus was done every day with indirect ophthalmofundoscope. B ultrasound examination was carried out in 24 h after inoculation and on the 14th day after therapy. Electroretinogram （ERG） was done before therapy and the 14th day after therapy. Histopathologic grading and electron microscopy were carried out at the 14th day. Results After implanting the drug membrane into perichoroidal space, the inflammation in group C was markedly less than the other 2 groups, and its inflammation score was significantly lowest （ P 〈 0.05 ）. Retinal detachment occurred less in the group C than in the other 2 groups. ERG demonstrated that dark adaptation b wave amplitude before the treatment was dropped more dramatically in groups A and B than those after treatment, but there was no difference in group C before and after the treatment. Significant difference was found in the wave amplitude after the treatment between groups A and B, groups B and C, and groups A and C. Electron microscopy shows that the retinal pigment epithelium （RPE） structure of group C was intact and cellular organs well-arranged. There was no statistical difference between groups A and B in histopathologic grading. Conclusion Implantation of chitosan membrane with TA into perichoroidal space combined with intraocular vancomycin injectio

关 键 词：壳聚糖膜 曲安奈德 脉络膜上腔 玻璃体腔注射 视网膜/毒性 

分 类 号：R322.91[医药卫生—人体解剖和组织胚胎学] R771.05[医药卫生—基础医学]