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目的 探讨前房内植入含环孢素A的缓释系统 (CsADDS)抑制高危角膜移植术后免疫排斥反应的有效性和可行性。方法 角膜新生血管化的近交系Wistar大鼠作为受体 ,供体取自SD大鼠 ,行穿透性角膜移植的大鼠随机分为 4组 :(1)对照组 ;(2 )CsADDS前房植入组 ;(3)CsADDS结膜下植入组 ;(4) 1%CsA橄榄油滴眼组。植片每 3天行裂隙灯显微镜检查并加以评估。分别于术后 1、2、4周行房水中CsA浓度的检测。移植后的 1、2、4周取眼球行组织病理学检查。结果 角膜植片平均存活时间分别为 :对照组 8 2± 1 4 8天 ;CsADDS结膜下植入组 11 4± 2 5 0天 ;前房植入CsADDS组 17 0± 2 0 0天。前房植入组与其它各组相比 ,有显著统计学差异 (P <0 0 5 )。相对于其它治疗组前房植入组的眼内CsA浓度明显增高 ,并且发现CsA聚合物的植入体在前房中只引起轻微而短暂的炎症反应。结论 前房植入CsA聚合物可明显延长高危角膜移植术后的植片存活时间 ,这一眼内缓释系统对于抑制高危角膜移植术后的免疫排斥反应不失为一种有效方法。
Objective To investigate the effectiveness and feasibility of anterior chamber implantation of cyclosporin A-containing delayed release system (CsADDS) in inhibiting the immune rejection after high-risk corneal transplantation. Methods Corneal neovascularization inbred Wistar rats were used as recipients. Donors were taken from SD rats and penetrating keratoplasty rats were randomly divided into 4 groups: (1) control group; (2) pre-CsADDS Room implantation group; (3) CsADDS subconjunctival implantation group; (4) 1% CsA olive oil eye group. Slittings were examined by slit-lamp microscopy every 3 days and evaluated. The levels of CsA in aqueous humor were measured at 1, 2 and 4 weeks after operation respectively. After 1, 2, 4 weeks after transplantation, the eyeballs were histopathologically examined. Results The mean survival time of corneal graft were 8 ± 14 days in control group, 114 ± 250 days in CsADDS subconjunctival implantation group and 17 ± 2000 days in anterior chamber implantation in CsADDS group. The anterior chamber implantation group compared with other groups, there was a statistically significant difference (P <0 05). Intraocular CsA concentrations were significantly increased relative to the other treatment group in the anterior chamber implantation group and it was found that CsA polymer implants caused only a slight and transient inflammatory response in the anterior chamber. Conclusion Anterior chamber implantation of CsA polymer can significantly prolong the survival time of the grafts after high-risk corneal transplantation. This intraocular slow release system is an effective method to inhibit the immune rejection after high-risk corneal transplantation.