双氯酚酸钠玻璃体内应用对视网膜结构和功能的影响  

Experimental study on the effect of intravitreal nonsteroid antiinflamatory drug on the structure and function of retina

作　　者：杨红[1] 胡正[1] 李劲[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院眼科,武汉430030

出　　处：《中华眼底病杂志》2002年第1期46-48,共3页Chinese Journal of Ocular Fundus Diseases

基　　金：国家教委留学回国人员科研启动基金资助项目 (1 997- 832 )

摘　　要：目的　了解非甾体类抗炎药物双氯酚酸钠 (diclofenac sodium,DFS)玻璃体内注射对视网膜的毒性作用 ,探索眼内应用 DFS的安全剂量范围。　方法　 2 8只健康成年大耳白兔 ,随机分为 7组 ,分别于每组右眼玻璃体内注入 4、5、6、7、8、9、10 mg/ ml的 DFS溶液 0 .1ml,左眼为对照眼。注药前及注药后 1、3、7、14、2 1、2 8d分别行双眼视网膜电图 (electroretinogram,ERG)检查。注药后 10、2 8、30 d分别摘除眼球行光学显微镜和透射电镜检查。　结果　注药剂量 0 .4、0 .5 mg组 ERG明、暗适应 b波波幅比率与注药前相比差异无显著意义 ,透射电镜及光学显微镜检查均未见组织结构有明显异常。 0 .6 mg组在注药后 1dERG明适应 b波波幅比率较注药前明显下降 (P<0 .0 5 ) ,注药后 3d开始恢复 ,至注药后 14 d已达注药前水平 (P>0 .0 5 ) ,光学显微镜及透射电镜检查显示视网膜组织已出现水肿等可逆改变 ,部分仍维持正常结构。 0 .7～ 1.0 mg组 ERG b波波幅比率与注药前相比明显下降 (P<0 .0 5 ) ,且不能恢复 ,光学显微镜及透射电镜检查显示视网膜各层结构损伤 ,在注药后 10、30 d均可见到细胞核染色质浓缩集聚、细胞坏死等不可逆改变。　结论　DFS玻璃体内注射的最大安全剂量不得超过 0 .6 mg。当注药剂量大于或等于Objective To investigate the retinal toxicity and verify the safe dose of intravitreal injection of nonsteroid anti inflamatory drug, diclofenac sodium. Methods Twenty eight healthy adult white rabbits were divided at random into 7 groups and received in every right eye the intravitreal injection of a single dose of diclofenac sodium solution ranging from 0.4～1.0 mg/0.1ml respectively,the left eyes were regarded as control ones. Before injection and on the 1st, 3rd, 7th, 14th, 21st, and 28th day after injection the electroretinography on both eyes was examined. On the 28th day after injection the retinas of two rabbits of every group were examined by using light microscopy. On the 10th and 30th day after injection the retinal tissues around the optic nerve disk of two eyes from every group at random were tested by using transmission electron microscopy. Results The ratio of amplitude of b wave of electroretinography in 0.4 mg and 0 5 mg groups had no significant difference from groups before injection,the retinal tissues showed no structural changes in light and electron microscopy examination. The ratio of amplitude of b wave of photoptic electroretinography in 0.6 mg groups in the early stage after injection was markedly reduced ( P< 0.05) and returned to that before injection with time, reversible change of the edematou retina was discovered. The ratio of amplitude of b wave of electroretinography in 0.7～1.0 mg groups was distinctly descreaded after injection ( P <0.05 or P <0.01), the cells of all the retinal layers revealed apparent and irreversible damage. Conclusion The largest dose of safety of intravitreal diclofenac sodium should be not more than 0 6 mg. The toxic effect of intravitreal diclofenac sodium on retina is concerned mostly to cones and rods.

关 键 词：双氯酚酸钠 药理学 视网膜功能 增生性玻璃体视网膜病变 动物实验 

分 类 号：R774.1[医药卫生—眼科]