纤溶酶联合透明质酸酶最佳组合诱导玻璃体后脱离的研究  

Best combination of plasmin and hyaluronidase in inducing posterior vitreous detachment

作　　者：李琪[1] 韩静[1] 严宏[1] 

机构地区：[1]第四军医大学唐都医院眼科,陕西省西安市710038

出　　处：《眼科新进展》2010年第11期1005-1008,共4页Recent Advances in Ophthalmology

基　　金：国家自然科学基金资助(编号:30872837)~~

摘　　要：目的探讨纤溶酶联合透明质酸酶诱导大鼠玻璃体后脱离(posterior vitreous detachment,PVD)的有效性和安全性,确定纤溶酶和透明质酸酶联合应用的最佳浓度,为下一步进行药物玻璃体溶解术后白内障动物模型的药物剂量选择提供依据。方法健康SD大鼠18只随机分为A、B、C3组,每组6只,右眼均为实验眼,左眼为对照眼。A组实验眼玻璃体内注射纤溶酶0.15U+透明质酸酶5U,B组注射纤溶酶0.25U+透明质酸酶5U,C组注射纤溶酶0.50U+透明质酸酶5U,左眼玻璃体内均注射眼用平衡盐液10μL。注药前后常规行裂隙灯、直接眼底镜检查观察眼部一般情况,7d后处死动物并摘取眼球标本做扫描电子显微镜检查和组织病理切片检查,观察玻璃体视网膜内界膜和视网膜组织结构的情况。结果各组实验眼裂隙灯检查均未发现明显眼内炎症反应。扫描电子显微镜结果显示,各组实验眼均有不同程度PVD的发生,其中A组出现部分性PVD占5/6,完全性PVD占1/6;B组出现部分性PVD占1/3,完全性PVD占2/3;C组均出现完全性PVD,发生率为100%;对照眼均未见PVD发生。A、B、C3组实验眼出现完全性PVD的总发生率为61.1%(11/18),与3组对照眼(0/18)相比,差异有显著统计学意义(P<0.001)。C组实验眼出现完全性PVD的发生率为100%(6/6)与A组实验眼16.67%(1/6)比较,差异也有统计学意义(P=0.015)。光学显微镜检查各组注射眼均未发现视网膜组织结构的异常改变。结论玻璃体内联合注射0.50U纤溶酶和5U透明质酸酶诱导玻璃体液化和完全性PVD发生的效果最好,对眼内组织无明显的毒性作用。Objective To discuss the efficacy and safety of plasmin and hyaluronidase in inducing the posterior vitreous detachment（PVD）,determine the best combined concentration of plasmin and hyaluronidase and provide the basis in choosing the drug dosage for further cataract model after vitreolysis by medicine.Methods Eighteen healthy SD rats were randomly divided into group A,B,C,6 rats in each group,their right eyes were set as experimental eyes and the left eyes as control.The intravitreal injection of 0.15 U plasmin plus 5 U hyaluronidase were performed in the right eyes in group A,0.25 U plasmin plus 5 U hyaluronidase in group B,0.50 U plasmin plus 5U hyaluronidase in group C,all the left eyes were injected with balance salt solution 10 μL.All the eyes were observed by slit-lamp biomicroscope and direct ophthalmoscope before and after intravitreal injection.The eyeballs were selected at 7 days after injection,and scanning electron microscopy and light microscopy were performed to observe the structure of inner limiting membrane and retina.Results No significant inflammatory response was detected by slit lamp biomicroscope in all right eyes of each group.Scanning electron microscopy results showed that certain degree PVD was found in all right eyes of each group,the partial PVD appeared in 5 eyes and complete PVD in 1 eye in group A,partial PVD in 2 eyes and complete PVD in 4 eyes in group B,and complete PVD in 6 eyes in group C.No PVD was appeared in all left eyes.The total rate of complete PVD in the right eyes of group A,B,C was 61.1%,there was significant difference compared with that of the left eyes（P0.001）.The rate of complete PVD in the right eyes of group C was 100%,which in group A was 16.67%,there was statistical difference between them（P=0.015）.There was no abnormal change of retinal structure in all injected eyes of each group by light microscope.Conclusion Intravitreal injection of 5 U hyaluronidase combined with 0.5 U plasmin has the most effect in producing vitreous liquefaction and comple

关 键 词：纤维蛋白溶解酶 透明质酸酶 玻璃体液化 玻璃体后脱离 大鼠 

分 类 号：R776.4[医药卫生—眼科]