【作者】 郝娟；

【导师】 王文战；

【作者基本信息】 郑州大学 ， 眼科学， 2010， 硕士

【摘要】 眼科使用的硅油产品材料为聚二甲基硅氧烷(Polydimethylsiloxane,PDMS),基本分子单位是-(CH3)2-Si-O-,20℃时屈光指数1.404,与玻璃体的屈光指数1.336近似。硅油具有良好的光学透明性,疏水性,理化性能稳定,毒性低,生理惰性和有效的表面张力,填充作用持久,能防止出血和纤维收缩等理化性质,已经广泛应用于临床治疗多种复杂视网膜脱离,但同时其长期填充于眼内带来的多种并发症严重影响手术后的远期疗效,不容忽视。其中硅油乳化就是存在的比较严重的后期并发症之一。硅油乳化大多学者认为是填充玻璃体腔内的硅油大泡分离出稳定不透明的硅油小泡,呈粉尘状小滴贴附于眼内组织或扩散入眼周边组织。乳化颗粒游动于玻璃体腔、前房或黏附在视网膜、虹膜表面,引起角膜、晶状体病变或阻塞小梁网继发青光眼或进入眼周组织干扰眼生理引发一系列的并发症。硅油乳化的发生原因至今难以定论,发生率约为0.7%～40%,是近些年困扰眼科临床医师的难题之一,国内外对硅油乳化相关因素的基础研究和临床观察也是近些年的热门课题。本实验旨在体外研究分析手术过程中接触到的临床相关因素：平衡盐溶液(balanced salt solution, BSS),曲安奈德,全氟萘烷,新鲜血清,以及长期饮酒患者血液中乙醇成分对硅油乳化的影响,建立有效的体外促乳化模型,为今后硅油乳化防治的深入研究和眼内填充物性状改善提供依据。材料和方法使用特制5ml容量瓶体外仿效人眼模型,于其中加入不同的干扰因素：纯平衡盐溶液0.5ml和硅油(法国Arciolane 5500cs)4.0ml配置作为对照组,曲安奈德、新鲜血清、全氟萘烷、无水乙醇的BSS的溶液各0.5ml和硅油4.0ml配置作为实验组,在37℃置于恒温气浴摇床中,振荡速度120转/分,由一名非相关实验人员在暗视野显微镜下观察1周、2周、4周、8周每组硅油乳化情况并计数乳化颗粒数目。结果1.每个参与实验的组在不同时间相比差异均是(p<0.05),结果有统计学意义,表示随时间延长乳化颗粒均有增加趋势。2.曲安奈德组与对照BSS组每个时间乳化颗粒数目相比,使用成组定量资料t检验结果均是(p<0.05),结果有统计学意义,乳化硅油小滴数目有所减少。3.全氟萘烷(重水)组与对照BSS组每个时间乳化颗粒数目相比,使用成组定量资料t检验结果均是(p<0.05),结果有统计学意义,乳化硅油小滴数目有所增加。4.新鲜血清组与对照BSS组在1W、2W、4W时间相比,使用成组定量资料t检验结果均是(p<0.05),结果有统计学意义,乳化硅油小滴数目有所减少;8W分析结果是(t=-1.276,p>0.05),结果没有统计学意义,认为8周曲安奈德组与BSS组乳化颗粒数目没有差别。5.无水乙醇组与对照BSS组在1W、2W、4W时间相比,使用成组定量资料t检验结果均是(p<0.05),结果有统计学意义,乳化硅油小滴数目有所减少；8W时间统计(t=-14.586,p<0.05),结果有统计学意义,认为8W无水乙醇组比BSS组乳化颗粒数目多。结论1.成功建立眼模型体外实验虽不能完全模拟体内环境,但能统一众多繁杂因素,分析手术相关接触因素对硅油乳化的效能。2.在临床意义上完全避免接触干扰因素是不可能的,全氟萘烷可能增加硅油乳化,故手术中尽量减少全氟萘烷应用；手术过程中应用曲安奈德,有可能减少硅油乳化的发生；血液成分、乙醇成分渗出玻璃体腔,可能影响手术后远期硅油乳化量,术中、术后应控制出血、避免饮酒。更多还原

【Abstract】 As the vitreous cavity is filled with silicone oil material is Polydimethylsiloxane (PDMS). Its basic molecular units is-(CH3) 2-Si-O-, The refractive index is 1.404 at 20℃, similar to vitreous 1.336. Silicone oil has good hydrophobicity, optical transparency, low toxicity, stable physical and chemical properties, physical inertia and effective surface tension and lasting action. It also can prevent bleeding and fiber contraction. So it has been widely used in clinical treatment of a variety of complex retinal detachment. But we cannot ignore the fact that there are many complications if silicone oil was filled in eye for a period of long time ignored. There’s one of the more serious late complications is silicone oil emulsion.Most scholars believe that the silicone oil emulsion is a large bubble of silicone oil, which was injected into the vitreous cavity, was isolated stable opaque droplets. It presents a dust-like droplets attach to the eye tissue or spread into eyes.Emulsion particles swimming in the vitreous cavity, anterior chamber, adhesion in the retina and iris surface, causing the cornea, lens disease, or secondary glaucoma, which caused by trabecular meshwork obstruction, interference into the eye tissue physiological trigger a series of eye complications. So far the cause of silicone oil emulsion is difficult to conclude and Its incidence is about 0.7% to 40%. Silicone oil emulsion is one of the difficulties plagued ophthalmic clinicians eye in recent years. Silicone oil emulsion on experimental research and clinical observation is a hot topic at home and abroad in recent years.The experimental study is to analyze the clinical related factors on the emulsification of silicone oil in vitro. Such as balanced salt solution (balanced salt solution BSS), triamcinolone acetonide, perfluorodecalin, fresh serum and the alcohol, in the blood of patients with long-term drinking. Establish an effective in vitro model of silicone oil emulsion and provide the basis for the in-depth study of the prevention and treatment of silicone oil emulsification and improving the filling characteristics of intraocular for the future.Materials and MethodsWe use special 5ml volumetric flask as model of the human eye in vitro and add different interfering factors in it. Our model consisted of 4 ml of silicone oil and a 0.5 ml aqueous phase. The aqueous phase was prepared using pure balanced salt solution as a control group and varying quantities of triamcinolone acetonide, fresh serum, perfluorodecalin, anhydrous ethanol and BSS solution 0.5 ml as the experimental groups. For periods lasting from one week to eight weeks, the volumetric flasks were subjected to constant shear by placing them on a rotary shaker at a rate of 120 cycles per minute and incubated at 37℃. Gross and microscopic examinations of the volumetric flasks for early signs of oil-water emulsification were performed daily to quantify relative degrees of emulsification at one week, two week, four week and eight week.Results1. Comparison of results at different times for each groups was statistical significance (p<0.05). The results show that the emulsion particles are increased with time.2. Compared with BSS group, the number of emulsion particles in triamcinolone acetonide group are reduced at each time. The result shows statistically significant (p<0.05).3. The number of emulsion particles of perfluorodecalin group at each time are more than that of control group obviously. The result shows statistically significant (p <0.05).4. Compared with BSS group, the number of emulsion particles in fresh serum group are reduced at one week,two week and four week. The result shows statistically significant (p<0.05). In the eighth week, there is no difference between triamcinolone acetonide group and BSS group. The results do not shows statistically significant (t=-1.276,p> 0.05).5. Compared with BSS group, the number of emulsion particles in Anhydrous alcohol group are reduced at one week,two week and four week.The result shows statistically significant (p<0.05). In the eighth week, the number of emulsion particles in the Anhydrous ethanol group more than in the BSS group.The results shows statistically significant (t=-14.586, p<0.05).Conclusions1. We successfully established the model of the eye in vitro.Although it can not completely simulate in vivo environment of body, it can make unified of the many complicated factors. This method can be used to analyze the surgery-related exposure factors on contact with silicone oil emulsion performance.2. In the clinical sense, completely avoiding the contact with Interference factor is impossible. Perfluorodecalin may increase the silicone oil emulsion, so it should minimize the application in surgery; Intravitreal injection of triamcinolone acetonide, may reduce the incidence of silicone oil emulsion; Vitreous cavity effusion of blood components and alcohol components may affect the long-term silicone oil emulsion volume after surgery. Therefore, intraoperative or postoperative bleeding should be controlled and avoid alcohol.更多还原