本文選題：殼聚糖緩釋給藥系統(tǒng) + 脈絡(luò)膜上腔��； 參考：《南方醫(yī)科大學(xué)》2012年碩士論文

【摘要】：研究背景 前部增生性玻璃體視網(wǎng)膜病變(anterior proliferative vitreoretinopathy, aPVR)是由于玻璃體基底部后緣附著處以前的細胞增殖,引起周邊部視網(wǎng)膜環(huán)形收縮,向前移位并貼附到睫狀體、虹膜后、瞳孔緣或角膜形成的。1991年新的PVR分級標(biāo)準(zhǔn)保留1983年所定的A級和B級,取消D級。C級病變中,赤道前為CA級病變,赤道后為CP級病變,將aPVR歸入到PVR分級當(dāng)中,并且新標(biāo)準(zhǔn)將增生性膜收縮分為5種類型：1型：局限性收縮。2型：彌漫性收縮。3型：視網(wǎng)膜下增生。以上3型為后部增生性玻璃體枧網(wǎng)膜病變.4型：環(huán)形收縮,表現(xiàn)為玻璃體基底部后緣至赤道部以前環(huán)形收縮,使視網(wǎng)膜被牽拉,造成視網(wǎng)膜形成皺褶。5型：前移位,多見于玻璃體視網(wǎng)膜手術(shù)后或眼外傷病人。此外,各種級別PVR可同時累及一眼,根據(jù)受累的范圍可以用時鐘鐘點表示,分為CA1～12和CP1～12。相關(guān)研究表明外傷性aPVR膜的成分是無色素和含色素睫狀上皮細胞、視網(wǎng)膜色素上皮細胞、角膜內(nèi)皮細胞、角鞏膜或脈絡(luò)膜的纖維及基質(zhì)細胞、晶體囊膜或皮質(zhì)等成分,可伴有炎癥細胞。近期文獻報道,神經(jīng)膠質(zhì)細胞與視網(wǎng)膜是否受損傷以及外傷性PVR密切相關(guān),Muller細胞能夠有效的調(diào)節(jié)視網(wǎng)膜對外傷的應(yīng)答,此外,還能夠調(diào)節(jié)脫離的視網(wǎng)膜對機體的反應(yīng) 目前對aPVR的研究包括aPVR的分級、發(fā)病機制、診斷手段、手術(shù)方式等,尚無關(guān)于外傷性aPVR的防治的報道。激素能夠抑制組織的增殖,但是由于血眼屏障的阻礙作用使藥物不容易到達眼內(nèi),玻璃體注射雖然能夠使藥物直接作用于眼內(nèi),效果良好,但是由于藥物半衰期偏短需要反復(fù)注射,增加了眼內(nèi)感染的機會而使其應(yīng)用受到一定的限制。本實驗應(yīng)用殼聚糖作為藥物載體,載藥后置于眼內(nèi)緩慢釋放,持續(xù)發(fā)揮作用,避免了眼內(nèi)多次給藥所帶來的安全問題。由于脈絡(luò)膜上腔位于脈絡(luò)膜與鞏膜之間,殼聚糖載藥后植入脈絡(luò)膜上腔,避免了鞏膜阻礙藥物吸收,可以使藥物直接作用于周邊視網(wǎng)膜、睫狀體等眼內(nèi)病變組織,抑制炎癥反應(yīng)及細胞增殖,通過藥物緩慢釋放,持續(xù)發(fā)揮作用抑制aPVR形成,并且其藥物作用濃度大大超過通過其它途徑給藥。 目的 1、探索GICS-TA植入脈絡(luò)膜上腔防治外傷性aPVR的有效性； 2、比較殼聚糖緩釋給藥系統(tǒng)植入脈絡(luò)膜上腔與玻璃體腔注射曲安奈德防治外傷性前部增生性玻璃體視網(wǎng)膜病變的療效； 方法 實驗前選取45只健康青紫藍兔,雌雄不限,體重2.0～2.5Kg,由武漢動物實驗中心提供,按照隨機數(shù)表法依次分入A,B,C、D、E五組,A組、B組、C組、D組每組10只青紫藍兔,E組5只青紫藍兔,術(shù)前一周使用裂隙燈、眼底鏡檢查眼前、后節(jié),并測量眼壓,排除眼部疾患。手術(shù)當(dāng)天,左氧氟沙星滴眼液點眼4次,術(shù)前20min用復(fù)方托品酰胺滴眼2次,間隔5min,散大瞳孔。E組為正常對照組,不予手術(shù),其它組予以3%戊巴比妥納1ml／kg耳緣靜脈注射,A,B,C,D組青紫藍兔將其麻醉成功后,綁在手術(shù)臺上,氯霉素沖洗左眼,術(shù)眼消毒鋪中,開瞼器開左眼瞼,兔眼上方剪開球結(jié)膜和部分筋膜,暴露鞏膜后距角膜緣2.5m處于10：30～11：30作長為5mm的鞏膜穿通傷,用11號手術(shù)尖刀穿刺入約10mm,上下擺動約20°損傷睫狀體組織,制成外傷性aPVR模型。A組造模后在鞏膜穿刺口附近垂直切開鞏膜,分離鞏膜與睫狀體,形成一空腔,在此空腔塞入3mm*3mm大小空白殼聚糖膜,縫合鞏膜切口；B組用A組同樣方法,放置載藥1mg曲安奈德的殼聚糖；C組造膜后向玻璃體腔注射lmg曲安奈德后縫合鞏膜切口,D組僅造模,造模后縫合鞏膜切口。 實驗完畢后,結(jié)膜囊內(nèi)涂妥布霉素眼膏預(yù)防感染。術(shù)后2周,5周,8周使用UBM、裂隙燈分別觀察各組睫狀體增厚程度、有無增殖膜形成,并觀察各組兔眼前節(jié)炎癥反應(yīng)分級。術(shù)后8周處死動物,標(biāo)記后摘除眼球,冠狀位將眼球一分為二,將其中1／2立即放入放入AGFD眼球固定液,固定一周后,將原固定液液倒出一半,再加等量丙酮繼續(xù)固定5天。5天后取6點位眼球標(biāo)本,經(jīng)乙醇逐級脫水、二甲苯及透明石蠟包埋,然后作組織切片并行蘇木素和伊紅(HE)染色,于光鏡下觀察睫狀體組織形態(tài)。將眼球另1／2去除后節(jié)組織,取6點位睫狀體新鮮標(biāo)本,修剪得0.5cm×0.5cm大小的睫狀體標(biāo)本塊(手術(shù)器械4℃預(yù)冷),立即眼球用磷酸緩沖液(pH7.2～7.4)洗凈表面的血液,然后立即放入4%多聚甲醛—2.5%戊二醛混合固定液中固定,過夜后,1%鋨酸固定,丙酮脫水,環(huán)氧樹脂包埋,超薄切片(冠狀位),透射電鏡下觀察。 對各組兔眼睫狀體厚度的總體均數(shù)采用SPSS13.0軟件進行統(tǒng)計學(xué)分析,計量數(shù)據(jù)以均數(shù)±標(biāo)準(zhǔn)差(X±s)表示,檢驗水準(zhǔn)α=0.05。術(shù)后2周、5周和8周睫狀體厚度的數(shù)據(jù)應(yīng)首先檢查其總體均數(shù)是否滿足正態(tài)分布且方差齊同,如滿足上述條件,則采用完全隨機設(shè)計的方差分析(one-way classification ANOVA),如睫狀體厚度的總體均數(shù)有統(tǒng)計學(xué)意義,需采用Bonferroni法進一步行多重比較；如睫狀體厚度的總體均數(shù)不滿足方差分析的條件時,則采用多個獨立樣本非參數(shù)檢驗(Kruskal-Wallis檢驗),比較各組兔眼睫狀體的厚度均數(shù)是否相同,組間的多重比較采用Bonferroni法檢驗。 于手術(shù)后第1,14,28天評價各組兔眼眼前節(jié)炎癥反應(yīng),將兔眼前節(jié)炎癥反應(yīng)分級均數(shù)采用SPSS13.0軟件進行統(tǒng)計學(xué)分析。對術(shù)后各組兔眼結(jié)膜、角膜、房水和后囊膜情況分級采用多個獨立樣本非參數(shù)檢驗(Kruskal-WallisH檢驗)。 結(jié)果 蘇木精-伊紅染色病理學(xué)觀察可見,A組兔眼8周時睫狀體基質(zhì)水腫,色素上皮結(jié)構(gòu)紊亂,大量灰白色纖維組織增生,并且牽拉睫狀體,牽拉引起周邊視網(wǎng)膜局部脫離,組織結(jié)構(gòu)破壞。B組兔眼8周時睫狀體輕度水腫,虹膜部分增殖,余結(jié)構(gòu)未見明顯異常,另可見少量炎細胞浸潤。C組兔眼8周時睫狀體基質(zhì)水腫,基質(zhì)間隙增寬,細胞排列較整齊,有炎細胞浸潤。D組兔眼8周時睫狀體基質(zhì)水腫、隆起；色素上皮結(jié)構(gòu)紊亂,牽拉視網(wǎng)膜,組織結(jié)構(gòu)破壞。E組兔眼8周時可見睫狀體無水腫,組織細胞排列整齊,色素上皮完整。 透射電鏡觀察顯示,A組兔眼8周時可見線粒體腫脹,周圍可見部分空泡狀變性,線粒體周圍有少量色素顆粒；B組兔眼8周時細胞核形態(tài)大致正常,可見核仁位于核內(nèi),還可見部分內(nèi)質(zhì)網(wǎng)形態(tài)未見明顯異常,有少量色素顆粒分布于周圍。C組兔眼8周時可見細胞核染色質(zhì)深染,核周有部分色素顆粒,內(nèi)質(zhì)網(wǎng)腫脹,有分泌顆粒產(chǎn)生。D組兔眼8周時可見內(nèi)質(zhì)網(wǎng)水腫,呈空泡狀變性,另可見少許色素顆粒。E組兔眼8周時可見線粒體形態(tài)正常,內(nèi)質(zhì)網(wǎng)形態(tài)未見異常,其周可見色素顆粒。 各組兔眼8周時6點位UBM圖像顯示：A組兔眼8周時可見虹膜及睫狀體水腫增厚,厚度達2.0428mm,邊界不清,相互粘連,牽拉,其間可見低回聲區(qū)。B組兔眼8周時可見睫狀體及虹膜輕度增厚,睫狀體后隱約可見一與睫狀體平行的條狀物。C組兔眼8周可見睫狀體增殖明顯,虹膜可見增生物粘連,其后可見致密的條狀物與睫狀體粘連。D組兔眼可見虹膜及睫狀體水腫增厚,厚度為2.0356,其間可見低回聲信號,其后隱約可見條形回聲信號。E組兔眼可見虹膜向前呈弓狀隆起,睫狀突與虹膜部分相連,虹膜與睫狀突之間可見一較大間隙。使用UBM觀察術(shù)后2周、5周、8周各組兔眼睫狀體的厚度可知不同時段睫狀體厚度：D組C組B組E組,而A組與D組無統(tǒng)計學(xué)差異,說明脈絡(luò)膜上腔植入殼聚糖緩釋給藥系統(tǒng)(載藥曲安奈德)和玻璃體注射曲安奈德都能夠有效防治睫狀體組織增殖,但睫狀體的厚度相比,B組小于C組且具有統(tǒng)計學(xué)差異,說明脈絡(luò)膜上腔植入殼聚糖緩釋給藥系統(tǒng)(載藥曲安奈德)比玻璃體注射曲安奈德防治睫狀體組織增殖的效果更好,而空白殼聚糖對防治前部增生性玻璃體視網(wǎng)膜無明顯作用。 手術(shù)后28天裂隙燈觀察：A組兔眼結(jié)膜中度睫狀充血,范圍較大,色澤較紅,角膜斑片狀水腫,后彈力層明顯皺褶,厚度增加,房水中度混濁,Tyndall現(xiàn)象(++),明顯纖維素性滲出,晶體混濁明顯,眼底窺視不清；B組兔眼結(jié)膜輕度睫狀充血,范圍較局限,角膜線狀混濁水腫,較少后彈力層皺褶,房水輕度混濁,Tyndall現(xiàn)象(+),較少纖維素滲出,后囊膜中度混濁,眼底部分模糊不清；C組兔眼結(jié)膜輕度睫狀充血,范圍較局限,角膜線狀混濁水腫,后彈力層皺褶明顯,房水輕度混濁,Tyndall現(xiàn)象(+),部分纖維素滲出,后囊膜中度混濁,眼底部分模糊不清；D組兔眼結(jié)膜中度睫狀充血,范圍較大,色澤較紅,角膜斑片狀水腫,后彈力層明顯皺褶,厚度增加,房水中度混濁,Tyndall現(xiàn)象(++),可見大量纖維素性滲出,晶體混濁明顯,眼底窺視不清；E組兔眼結(jié)膜無充血,角膜清晰透明,房水清,后囊膜透明。手術(shù)后1天眼前節(jié)炎癥反應(yīng)分級實驗結(jié)果表明,H統(tǒng)計量服從x2分布,故以x2值表示檢驗統(tǒng)計量。x2=39.197,v=4,P=0.000,P0.05,五組間有顯著差異性,說明各組眼前節(jié)炎癥反應(yīng)分級有顯著差異,根據(jù)平均秩次進一步推斷,與E組相比較,B組前房炎癥反應(yīng)最輕,C組次之,A組和D組前房炎癥反應(yīng)較重。手術(shù)后1,14,28天眼前節(jié)炎癥反應(yīng)分級實驗結(jié)果表明,H統(tǒng)計量服從x2分布,故以x2值表示檢驗統(tǒng)計量。五組間有顯著差異性,說明各組眼前節(jié)炎癥反應(yīng)分級有顯著差異,根據(jù)平均秩次進一步推斷,與E組相比較,B組前房炎癥反應(yīng)最清,C組次之,A組和D組前房炎癥反應(yīng)最重。結(jié)論 aPVR是眼球穿通傷的嚴(yán)重并發(fā)癥,能夠嚴(yán)重降低眼外傷手術(shù)的成功率,因此尋找一種能減輕眼球穿通傷所致aPVR形成的方法顯得尤為重要。本實驗采用殼聚糖緩釋給藥系統(tǒng)(載藥曲安奈德)于脈絡(luò)膜上腔一次性給藥,使用后安全,高效,避免了多次給藥所帶來的不良反應(yīng)。結(jié)果顯示殼聚糖緩釋給藥系統(tǒng)(載藥曲安奈德)和玻璃體注射曲安奈德均能夠有效的預(yù)防aPVR的發(fā)生,并且殼聚糖緩釋給藥系統(tǒng)防治前部PVR的效果優(yōu)于玻璃體注射曲安奈德。其作用機理是：1脈絡(luò)膜上腔位于脈絡(luò)膜與鞏膜之間,殼聚糖緩釋給藥系統(tǒng)(載藥曲安奈德)植入脈絡(luò)膜上腔后,使藥物被迅速吸收并且可以持續(xù)的作用于玻璃體和視網(wǎng)膜,從而抑制aPVR的形成。2殼聚糖緩釋給藥系統(tǒng)具有持續(xù)均勻給藥的特點,藥物釋放穩(wěn)定,無明顯突釋效應(yīng),持續(xù)時間長,持續(xù)地作用于靶目標(biāo)。3脈絡(luò)膜與視網(wǎng)膜緊密貼在一起,藥物直接作用于脈絡(luò)膜,間接作用于視網(wǎng)膜及玻璃體可抑制aPVR形成,而對視網(wǎng)膜的毒性作用小。 在外傷性aPVR早期,組織炎癥反應(yīng)明顯,可見睫狀體組織增生,以及增值膜覆蓋于睫狀體；晚期可見大量纖維組織增生,出現(xiàn)瘢痕化,增生,增厚；睫狀體組織因受牽拉而變型。UBM是利用高頻超聲檢查眼前節(jié)組織的一種方法[14],其成像清晰,分辨率高,特別是對比較隱秘的aPVR有很好的檢出作用。通過對2周,5周,8周兔眼睫狀體的厚度測量發(fā)現(xiàn)B,C,D,E組兔眼睫狀體的厚度均數(shù)各不相同,有統(tǒng)計學(xué)意義,A組與D組厚度均數(shù)無明顯差異,說明殼聚糖緩釋給藥系統(tǒng)(載藥曲安奈德)對防治兔眼睫狀體的增殖效果最好,其次是玻璃體注射曲安奈德,而空白的殼聚糖緩釋給藥系統(tǒng)對防治aPVR發(fā)生無明顯作用。殼聚糖緩釋給藥系統(tǒng)通過植入脈絡(luò)膜上腔,使藥物迅速持久釋放避免了反復(fù)給藥帶來的副作用,在臨床上有潛在的使用價值。殼聚糖緩釋給藥系統(tǒng)(載藥曲安奈德)能夠抑制虹膜,睫狀體等的增殖,防治外傷性aPVR形成,是治療外傷性aPVR的較好方法。
[Abstract]:Research background
The anterior proliferative vitreoretinopathy (anterior proliferative vitreoretinopathy, aPVR) is due to cell proliferation before the attachment of the posterior margin of the vitreous base, causing annular contraction of the peripheral retina, shifting forward and attaching to the ciliary body. After the iris, the new PVR grading standard for the formation of the pupil or cornea in.1991 is 1983. Grade A and grade B, cancelling D grade.C lesions, CA grade lesions before equator, CP grade after equator, aPVR into PVR classification, and new standard to divide proliferative membrane contraction into 5 types: type 1: limited contraction.2: diffuse contraction of.3 type: Subretinal hyperplasia. The above 3 is a posterior proliferative vitreous soap network .4 type of membrane lesion: ring contraction, which shows the ring contraction of the posterior margin of the vitreous base to the equator, causing the retina to be pulled, causing the retina to form a wrinkle.5: the anterior displacement is often seen after the vitreoretinal surgery or the ocular trauma patient. In addition, various levels of PVR may be associated with one eye, according to the extent of the involvement of Shi Zhongzhong. CA1 - 12 and CP1 - 12. related studies showed that the components of the traumatic aPVR membrane were pigmented and pigmented ciliary epithelial cells, retinal pigment epithelial cells, corneal endothelial cells, fibrous and stromal cells of the sclera or choroid, crystalline capsule or cortex, with inflammatory cells. Recent literature, Neuroglia The cells are closely related to whether the retina is damaged and traumatic PVR. Muller cells can effectively regulate the response of the retina to the trauma. In addition, it can also regulate the response of the detachment of the retina to the body.
At present, the study of aPVR includes the classification of aPVR, pathogenesis, diagnosis and operation, and there is no report about the prevention and control of traumatic aPVR. Hormone can inhibit the proliferation of tissue, but the obstruction of the blood eye barrier makes the drug not easy to reach the eye. The vitreous injection can make the drug act directly on the eye, and the effect is good. Good, but due to the short half-life of the drug needs repeated injection, increasing the opportunity for intraocular infection to make its application limited. This experiment uses chitosan as a drug carrier, and it is released slowly in the eye after carrying the drug and keeps playing its role, avoiding the safety problems caused by the multiple administration of the eye. Between the choroid and the sclera, chitosan is implanted into the upper choroid cavity after carrying the drug, which prevents the sclera from hindering the absorption of drugs. It can make the drug directly affect the surrounding retina, ciliary body and other intraocular lesions, inhibit the inflammatory reaction and cell proliferation. The drug is released slowly and continues to play a role in inhibiting the formation of aPVR, and its drug action concentration. Much more than by other ways.
objective
1, explore the effectiveness of GICS-TA implantation in the treatment of traumatic aPVR with superior choroidal cavity.
2, the effect of chitosan sustained-release system on the prevention and treatment of traumatic anterior proliferative vitreoretinopathy by intravitoidal injection of triamcinolone into the superior choroidal cavity and vitreous cavity was compared.
Method
Before the experiment, 45 healthy blue and blue rabbits were selected, and the male and female, and male and female, 2 to 2.5Kg, were provided by the Wuhan animal experiment center. According to the random number table method, they were divided into A, B, C, D, E five groups, A group, B group, C group, D group 10 blue and purple rabbits and E group 5 blue and blue rabbits. 4 times on the day of operation, 4 times of left Ofloxacin Eye Drops eye, 2 times with compound toppinamide eye drops, interval 5min, and large pupil.E group as normal control group, no operation, the other groups were injected with 3% pentobarbital 1ml / kg ear vein, A, B, C, and D group blue and blue rabbit after the anesthesia was successfully tied to the operating table, chloramphenicol flushing. In the left eye, in the surgical eye disinfection shop, the left eyelid was opened in the eyelid device, the bulkball conjunctiva and part of the fascia were cut above the rabbit eye. The sclera was exposed to the cornea of the cornea at 10:30 to 11:30 after exposure to the sclera, and the scleral perforating injury was 5mm at 10:30 to 11:30. The ciliary body was damaged by the 11 surgical sharp knife, and the upper and lower swing about 20 degrees damaged the ciliary body, and the traumatic aPVR model group.A was made after the mold was made in the sclera. The sclera was made after the traumatic aPVR model was made in the sclera after the model of the.A group of traumatic aPVR model was made in sclera. The sclera was cut vertically near the puncture mouth to separate the sclera and ciliary body to form a cavity. The cavity was inserted into the 3mm*3mm size blank chitosan membrane and the scleral incision was sutured in the cavity. The B group used the same method of A group to put the chitosan to carry the 1mg triamcinolone acetonide; the C group injected LMG triamcinolone acetonide into the vitreous cavity and sutured the scleral incision, and the D group only made the model. The scleral incision was sutured after the model was built.
After the experiment, the conjunctival sac was coated with Tobramycin Eye Ointment to prevent infection. 2 weeks, 5 weeks and 8 weeks after the operation, UBM was used. The thickness of ciliary body was observed in each group with slit lamp. There was no proliferation membrane formation, and the inflammatory reaction classification was observed in each group. The animals were killed at 8 weeks after operation. The eyeball was removed and the eyeball was divided into two, and 1 / 2 of the eyeballs were divided. Immediately put into AGFD eyeball fixed solution, after fixed one week, half of the original liquid was poured out, and then added equal amount of acetone to continue to be fixed for 5 days.5 days after 6 point eyeball specimens, after dehydration by ethanol, dimethylbenzene and paraffin embedded, then tissue section and hematoxylin and eosin (HE) staining, under the light microscope to observe the ciliary body morphology. The other 1 / 2 of the eyeball was removed from the posterior segment, and the 6 point ciliary body was taken, and the ciliary body of 0.5cm x 0.5cm was pruned (the surgical instrument was precooled at 4 C). Immediately the eyeball was washed with phosphoric acid buffer (pH7.2 ~ 7.4) to wash the surface blood, and then immediately put into the 4% polyformaldehyde - 2.5% glutaraldehyde mixture fixed solution, and after overnight, 1% osmium acid. Fixed, acetone dehydration, epoxy resin embedding, ultrathin section (coronal), observed under transmission electron microscope.
The total average number of ciliary body thickness in each group was analyzed by SPSS13.0 software, and the measured data were expressed with mean standard deviation (X + s). The data of the ciliary body thickness at 2 weeks after alpha =0.05., and the 5 and 8 weeks' thickness of the ciliary body, should first check whether the total number of the ciliary body is satisfied with the normal distribution and the variance is homogeneous. If the above conditions are satisfied, the data should be used. The total variance analysis (one-way classification ANOVA), such as the total average of the ciliary body thickness, is statistically significant and needs to be further compared with the Bonferroni method. If the total average of the ciliary body thickness is not satisfied with the condition of the variance analysis, a number of independent sample nonparametric tests (Kruskal-Wallis test) are used. The thickness of ciliary body in each group was compared. The multiple comparisons between groups were examined by Bonferroni.
The inflammatory response in the eyes of rabbits in each group was evaluated on day 1,14,28 after operation. SPSS13.0 software was used for statistical analysis of the inflammatory response classification of the rabbit eyes. Multiple independent samples were used (Kruskal-WallisH test) for the classification of the conjunctiva, cornea, aqueous humor and posterior capsule of the rabbits.
Result
The histopathological observation of hematoxylin and eosin staining showed that the ciliary body matrix was edema in the A group of rabbits at 8 weeks, the structure of pigment epithelium was disturbed, a large number of gray white fibrous tissue proliferated, and the ciliary body was drawn, and the distraction caused local detachment of the peripheral retina. The tissue structure destroyed the 8 Zhou Shijie shape in the rabbit eyes of the.B group, and the iris was partially proliferated and the residual structure was not clear. In group.C, the ciliary body edema, the matrix gap widened and the cells arranged neatly at 8 weeks, with inflammatory cells infiltrating.D group, the ciliary body edema and eminence, the structure disorder of pigment epithelium, the distraction of the retina, and the destruction of the tissue structure in the.E group of rabbit eyes showed no edema and fine tissue. The cells arranged neatly and the pigment epithelium was complete.
The observation of transmission electron microscopy showed that the mitochondria were swollen at 8 weeks in the A group, with some vacuolated degeneration and a small amount of pigment granules around the mitochondria. The nucleus in the B group was roughly normal at 8 weeks, and the nucleolus was located in the nucleus, and the morphology of the part of the endoplasmic reticulum was not obvious, and a small amount of pigment particles were distributed in the surrounding.C groups. At 8 weeks, the nucleus chromatin chromatin was deeply stained in the rabbit eyes, and some pigment granules were found in the nucleus and the endoplasmic reticulum was swollen. The endoplasmic reticulum edema and vacuolated degeneration were seen in the.D group of rabbit eyes at 8 weeks. The morphology of mitochondria in the rabbit eyes of a little pigment granule.E group was seen at 8 weeks, and the morphology of the endoplasmic reticulum was not abnormal, and the pigments were seen in the week.
At 8 weeks, the 6 point UBM images showed that the iris and ciliary body edema was thickened at 8 weeks in the A group, the thickness was 2.0428mm, the boundary was not clear, the adhesion and traction were not clear, and during the 8 weeks of the hypoechoic rabbits, the ciliary body and the iris were slightly thickened, and the rabbit eye of.C group with the ciliary body parallel to the ciliary body of the ciliary body was 8. The proliferation of the ciliary body was obvious, and the iris and the synechia could be seen in the iris. The iris and ciliary body edema was seen in the rabbit eyes of the.D group. The thickness of the iris and ciliary body thickening was 2.0356, and the hypoechoic signal was visible. Then the rabbit eyes of the.E group showed the arsiform protruding of the iris, the ciliary process and the iris. There was a large gap between the iris and the ciliary process. The thickness of the ciliary body at 2 weeks, 5 weeks after the operation was observed with UBM. The thickness of ciliary body in each group of rabbits in each group was known at different periods of time: group C, group B, E group in group D, and there was no statistical difference between group A and D group, indicating that the upper choroid cavity was implanted with chitosan as a drug delivery system (triamcinolone acetonide carrying drug) and vitreous injection. Sach Ann Ned can effectively prevent and control the proliferation of ciliary body tissue, but the thickness of ciliary body is less than that of group B and group C, and there is a statistical difference. It shows that the effect of chitosan sustained-release drug delivery system (triamcinolone acetonide) on the prevention and control of the proliferation of ciliary body is better than that of vitreous acetonide injection, and the control of blank chitosan is effective. The anterior proliferative vitreous retina had no obvious effect.
28 day after operation slit lamp observation: in group A, the rabbit eye conjunctiva was moderately ciliary hyperemia, the range was larger, the color and lustre were red, the corneal plaques were edematous, the posterior elastic layer was obvious wrinkle, the thickness increased, the water medium turbidity, the Tyndall phenomenon (+ +), the obvious cellulose exudation, the crystal cloudy and the eye fundus peep, the B group of rabbit eye conjunctiva was mild hyperciliary congestion. Corneal linear turbid edema, less elastic layer folds, mild turbidity of aqueous humor, Tyndall phenomenon (+), less cellulosic exudation, moderate opacification of posterior capsule, and blurred part of the fundus; C group of rabbit eye conjunctiva with mild ciliary hyperemia, corneal linear turbid edema, posterior elastic layer folds, mild aqueous opacities, Tyndall phenomenon (+) ) partial cellulose exudation, posterior capsule moderate turbidity, and blurred part of the fundus; D group of rabbit eye conjunctiva is moderate ciliary hyperemia, the range is larger, the color and lustre is red, the corneal patch flaky, the posterior elastic layer folds, the thickness increase, the aqueous medium turbidity, the Tyndall phenomenon (+ +), a large number of cellulosic exudation, crystal cloudy, and the fundus peep. There was no hyperemia in the conjunctiva in the E group, the cornea clear and transparent, the hyaline water and the posterior capsule were transparent. The results of the inflammatory response classification of the anterior segment of the eye 1 days after the operation showed that the H statistics were subordinate to the X2 distribution, so there was a significant difference between the five groups with the value of the test statistics,.X2=39.197, v=4, P=0.000, P0.05, which showed that there was a significant difference in the classification of the inflammatory reaction in each group. According to the average rank order, compared with the E group, the inflammatory response of the anterior chamber of the B group was the lightest, the C group was the second, the A group and the D group were more severe in the anterior chamber inflammation. The results of the 1,14,28 sky eye inflammatory reaction grading experiment after the operation showed that the H statistic was subordinate to the X2 distribution, so the test statistics were expressed with the X2 value. There were significant differences between the five groups, indicating the eyes of each group. There was a significant difference in the grading of the inflammatory response in the anterior segment. According to the average rank, the inflammatory response in the anterior chamber of the group B was the most clear, the C group was the most, and the anterior chamber of the A group and the D group had the most severe inflammatory response compared with the E group.
APVR is a serious complication of perforating injury of the eyeball, which can seriously reduce the success rate of ocular trauma surgery. Therefore, it is very important to find a way to reduce the formation of aPVR caused by perforation of the eyeball. The experiment is to use the chitosan release system (triamcinolone acetonide) in the upper choroid cavity for one time administration, and it is safe, efficient and avoided after use. Many times

【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R779.6

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