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背景:灌注液的成分与其保护角膜内皮功能之间的联系一直是眼科界和制药业研究的热点课题。目的:观察超声乳化术中使用不同灌注液对兔眼角膜内皮细胞结构及功能的影响。设计:随机分组对照动物实验。单位:锦州医学院实验动物中心室,一所市级医院实验动物手术中心实验室。材料:实验于2004-09/2005-03在锦州医学院实验动物中心实验室和锦州市亚东眼科医院实验动物手术中心实验室进行。清洁级3.5月龄纯种日本大耳白兔16只,随机分为4组:正常对照组、生理盐水组、世可组和平衡盐液组,每组4只。灌注液世可(沈阳齐兴制药有限责任公司生产);平衡盐液(美国Alcon公司生产)。方法:用100mL/L水合氯醛(3mL/kg)腹腔麻醉,眼部用4%盐酸奥布卡因滴眼液表面麻醉。行双眼手术。使用美国Alcon超声乳化仪,常规显微手术器械,于上方巩膜缘后2mm作长约3.5mm的巩膜隧道切口,穿刺入前房,注入粘弹剂Viscoat(Alcon公司生产)0.25mL;环行撕囊,直径约5mm;超声乳化头置于中央区乳化吸出晶体核及皮质;术毕关闭切口。于术前和术后6h采用接触性角膜内皮显微镜进行角膜内皮细胞形态学定量测定:角膜内皮细胞密度、细胞面积、六边形细胞百分率和变异系数。术后6h应用锥蓝-茜素红活性染色,光镜下观察各组角膜内皮细胞微细结构的变化。主要观察指标:①角膜内皮细胞形态学定量分析(角膜内皮细胞密度、细胞平均面积、变异系数和六边形细胞百分率)。②角膜内皮细胞形态结构特征。结果:16只大耳白兔均进入结果分析。①术前各组间各项指标比较差异均无显著性。②细胞密度、细胞面积、六边形细胞百分率、变异系数:术后6h生理盐水组、世可组和平衡盐液组均低于正常对照组(P<0.05),世可组和平衡盐液组对比差异无显著性(P>0.05)。③光镜显示生理盐水组角膜内皮细胞形态改变明显,世可组和平衡盐液组角膜内皮细胞改变轻微,无细胞坏死。结论:在超声乳化术中,灌注液对角膜内皮的损伤为化学性损伤,在相同手术条件下,国产灌注液世可对角膜内皮细胞具有良好的保护作用。
BACKGROUND: The relationship between the composition of perfusate and its function of protecting the corneal endothelium has been a hot topic in ophthalmology and pharmaceutical research. Objective: To observe the effect of different perfusate on the structure and function of rabbit corneal endothelial cells during phacoemulsification. Design: Randomized controlled animal experiments. Unit: Jinzhou Medical Laboratory Animal Center Room, a municipal hospital experimental animal surgery center laboratory. MATERIALS: The experiment was performed at Laboratory of Laboratory Animal Center, Jinzhou Medical College and Laboratory of Laboratory Animal Operation Center, East Asia Eye Hospital, Jinzhou City from September 2004 to March 2005. Clean grade 3.5 purebred Japanese white rabbits, 16 were randomly divided into 4 groups: normal control group, normal saline group, Shi Ke group and balanced salt solution group, 4 rats in each group. Perfusion fluid can be (Shenyang Qi Xing Pharmaceutical Co., Ltd. production); balanced salt solution (the United States Alcon company). Methods: 100 mL / L chloral hydrate (3 mL / kg) was used for intraperitoneal anesthesia and ocular surface was anesthetized with 4% buprenorphine hydrochloride eye drops. Line eyes surgery. Using a US Alcon phacoemulsification instrument and a conventional microsurgical instrument, a scleral tunnel incision about 3.5 mm in length was made 2 mm posterior to the upper scleral margin and punctured into the anterior chamber. Viscoelastic viscoelastomer Viscoat , A diameter of about 5mm; phacoemulsification head placed in the central area of the nucleus and cortex emulsified aspiration; close the incision surgery. The morphology of corneal endothelial cells was quantitatively determined by contact angle corneal endothelial microscopy before and 6h after surgery. The corneal endothelial cell density, cell area, percentage of hexagonal cells and coefficient of variation were measured. At 6 hours after operation, cone blue-alizarin red staining was used to observe the changes of corneal endothelial cells microfine structure. MAIN OUTCOME MEASURES: ① Quantitative analysis of corneal endothelial cell morphology (corneal endothelial cell density, average cell area, coefficient of variation and percentage of hexagonal cells). ② corneal endothelial cell morphology and structure characteristics. Results: Sixteen rabbits were involved in the result analysis. ① There was no significant difference in each index between preoperative groups. ② Cell density, cell area, percentage of hexagonal cells and coefficient of variation: Saline group, Shike group and balanced salt solution group were all lower than those of normal control group 6h after operation (P <0.05) There was no significant difference between the two groups (P> 0.05). ③ The light microscope showed that corneal endothelial cells changed significantly in the saline group. The changes of corneal endothelial cells in the sclerosus group and the balanced saline group were slight and no cell necrosis. Conclusion: In phacoemulsification, corneal endothelium is chemically injured by perfusate. Under the same surgical conditions, domestic perfusion fluid can protect corneal endothelial cells.