【作者】 黄琴；

【导师】 周琼；

【作者基本信息】 南昌大学 ， 眼科， 2008， 硕士

【摘要】 目的:通过建立外伤性玻璃体积血模型,探讨透明质酸酶对兔眼外伤性玻璃体积血转归的影响,以及诱导完全性玻璃体后脱离的可能性,为玻璃体切除术易于清除积血玻璃体提供实验依据。方法:28只(56眼)新西兰兔,右眼为实验眼,左眼为空白对照眼(28眼),右眼均造成外伤性玻璃体积血模型,1天后随机分为实验组和阳性对照组,每组14只(14眼)。实验组玻璃体腔注射透明质酸酶20IU(0.1ml),阳性对照组玻璃体腔注射BSS(0.1ml)。给药后分别于1天,3天,7天,14天,21天,28天测量眼压,行裂隙灯检查、直接检眼镜和裂隙灯眼底照相。其后每组随机抽取2只实验兔行眼球摘除,抽取玻璃体液测定玻璃体液bFGF的含量,取眼球壁组织做病理学检查和扫描电镜检查。结果:(1)实验组和阳性对照组的玻璃体混浊分级在给药后1天、3天、7天各组之间差异无统计学意义(P>0.05),给药14天后实验组的玻璃体混浊严重程度显著低于阳性对照组,各组之间差异有统计学意义(P<0.05)。(2)眼压在给药前6小时实验组、阳性对照组和正常眼压组间比较差异无统计学意义(P>0.05)。给药后1天和给药后3天实验组兔眼眼压和正常兔眼压比较差异有统计学意义(P<0.05),和阳性对照组比较差异有统计学意义(P<0.05)。给药后7天,14天,21天和28天实验组及阳性对照组眼压与正常眼压相比及组间比较差异无统计学意义(P>0.05)。(3)实验组和阳性对照组玻璃体中bFGF的浓度随着时间推移均增高,但阳性对照组高幅度较实验组大,到给药14天时,阳性对照组bFGF的浓度浓度达到了1.24 pg/ml,而实验组bFGF的浓度浓度为0.62 pg/ml,空白组给药后1-28天bFGF的浓度为0.21～0.24 pg/ml,变化不大。(4)增生膜成纤维细胞的数量在给药后7～28天,实验组增生膜截面成纤维细胞数量小于阳性对照组,差异有统计学意义(P<0.05)。(5)组织病理学检查实验组和阳性对照组视网膜均出现了水肿和神经节细胞空泡样变、内界膜增厚等病理改变,但实验组较阳性对照组形成增殖膜少(6)扫描电镜检出1-28天兔眼实验组和对照组可见部分玻璃体后皮质和视网膜内界膜连接紧密,无完全性玻璃体后脱离(PVD)发生。结论:透明质酸酶20IU于兔眼玻璃体腔内注射对视网膜没有毒性作用,可加速外伤性玻璃体玻璃体积血的消散,进而延缓了PVR的形成和发展。可造成眼压一过性降低,但不能造成完全性PVD。更多还原

【Abstract】 Objective: Through establishing the experimemental animol model of traumatic vitreous hemorrhage,investigate the effect of Hyaluronidase on traumatic vitreous hemorrhage’s turnover ,and the possibility of induce complete posterior detachment of vitreous ,to offer experiment data of cut the hematocele vitreous body easily in vitrectomy.Methods: There is twenty eight pigmented rabbits with fifty-six eyes. All the left eyes are blank control.All the right eyes were posed the model of traumatic vitreous hemorrhage,fourteen rabbits with fouteen eyes were choosed at random received Hyaluronidase 20IU/0.1ml injected in vitreous space, and the others were injected with equivalent dose of balanced solt as control after one day. All the rabbits were monitored by clinical examination ,intraocular pressure and eyeground photograph at one day,three days,seven days,fourteen days,twenty-one days and twenty eight days.Then two rabbits in each group was sacrified ,measure the basic fibroblast growth factor by draw off vitreous humor, Light microscopy and scan electron microscopy examination were performed for the histological changes of retina .Result: (1) The grade of vitreous opacity were no obvious change in experimental group and positive control group at one day,three days,seven days, vitreous opacity of experimental group was lower than positive control group after fourteen days,there were significantly difference in two groups. (2)There were no obvious change of IOP in each groups at six hours before inject drug. There were significantly difference of IOP between experimental group and positive control group, blank control group at at one day,three days,seven days. There were no obvious change of IOP in each groups after seven days.(3) The density of bFGF were increase in experimental group and positive control group with the lapse of time,bue the positive control group riser than experimental group,at fourteen days The density of bFGFwere1.24 pg/ml in positive control group , it’s only 0.62 pg/ml in experimental group, it’s no obvious change in blank control group.(4) The amount of fibroblast on the hyperplastic membrane in experimental group not so many as positive control group,there were significantly difference in two groups after seven days.(5)There were retinal edema and balloon change of ganglion cell ,thickening of inner limiting membrane in Light microscopy between experimental group and positive control group; but the hyperplastic membrane in experimental group not fewer positive control group.(6) The part of posterior vitreous cortex and internal limiting membrance connection tight at one day to twenty eight days,no produce in complete posterior detachment of vitreous. Conclusion: No retinal toxicity of Hyaluronidase 20IU/0.1ml injected in rabbit’s vitreous space, accelerate the disappear of vitreous hemorrhage,then delay the shape and the development of proliferative vitreous retinopathy.It can make intraocular pressure temporal degrade,bue can’t result in complete posterior detachment of vitreous.更多还原