【摘要】 目的 探讨兔眼表碱烧伤后行角膜缘移植并术中应用丝裂霉素的远期疗效。方法 在32只兔双眼上制作眼表碱烧伤模型,1天后,双眼行异体板层角膜缘移植术;左眼在术中应用丝裂霉素(0.25 mg/ml)烧灼植床的角膜缘部(360°)5 min,术后12个月,检测术眼的角膜新生血管、混浊度、水肿度,计算免疫排斥反应指数(RI值);测量术后1、3、6及12个月的眼压。结果 32例左眼中28眼RI值均<9,治愈率达87.5%;右眼中有20例RI<9,治愈率达62.5%;两组术眼的角膜新生血管数、混浊度、水肿度及RI值差异均有统计学意义。各时间点各术眼的眼压均在正常范围,差异无统计学意义。结论 眼表碱烧伤角膜缘移植术中应用丝裂霉素治疗可减少角膜血管新生并降低排斥反应的发生,是一种安全有效的疗法。
【关键词】 角膜;碱烧伤;角膜缘移植;丝裂霉素C
Effect of mitomycin-C applied locally in the limbal graft transplantation on ocular surface alkali burns in rabbits
LIU Hai-jun,XIANG Shi-ping,YUAN Yuan,et al.Department of Ophthalmology,No.421 Hospital of PLA,Guangzhou 510318,China
[Abstract] Objective To evaluate the effect of mitomycin-C applied locally in the limbal graft on ocular surface alkali burns in rabbits.Methods Animal models of ocular surface alkali burns were established on the bilateral eyes in 32 rabbits,and one day after operation,each eye was treated with lamellar limbal graft transplantation with mitomycin-C(0.25 mg/ml) intraoperatively for 5 minutes on the left eyes.After 12 months,corneal neovascularization(CNV),turbidity and edema were observed,and worked out the RI(rejection index).The intra-ocular pressure was examined at 1,3,6 and 12 months after operation.Results Of 32 left eyes with cornea-limbus graft and MMC,the RI values of 28 cases were no more than 9(cure rate was87.5%);and 20 right eyes,RI<9(cure rate was 62.5%);the values of CNV,turbidity,edema and RI were all significantly different between two groups.The intra-ocular pressures of all cases were not significantly different.Conclusion The method of mitomycin-C applied in the limbal graft to treat the ocular surface alkali burns is an effective and safe therapy.
[Key words] cornea alkali burns;limbal graft;mitomycin-C
严重眼表碱烧伤后往往造成持续性角膜糜烂、溃疡、新生血管和假性胬肉长入,是形成角膜盲的主要原因之一,新生血管的长入,打破了角膜的免疫赦免状态,产生免疫反应,从而加重了角膜碱烧伤的病理过程;术后的免疫反应是碱烧伤角膜移植失败的主要原因。如何控制眼表碱烧伤角膜移植术后的新生血管形成,已成为许多眼科工作者研究的课题。本组在32只眼部碱烧伤的兔右眼上作异体板层角膜缘移植术的同时,在术中应用丝裂霉素,收到良好效果,现报告如下。
1 材料与方法
1.1 实验动物及分组 由第一军医大学动物所提供32只2.5~3.5 kg的新西兰大白兔,雌雄不拘,检查无眼疾及全身器质性病变。实验动物分为行单纯异体角膜缘移植组(右眼)与术中应用丝裂霉素的角膜缘移植组(左眼)。
1.2 标准 眼表碱烧伤动物模型制作、板层角膜缘植片的制备、手术方法及观测指标均参照Holland等(1991)[1]、刘海俊等(2003)[2]、(2005)[3]的标准。
1.3 观察方法 术后隔天用裂隙灯观察,记录术后角膜的新生血管分级、角膜透明度、角膜水肿度;分别测量术后1、3、6及12个月的眼压。
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