3 PCO的治疗
3.1 经角巩膜缘切口的后囊切开术 适用于不能配合激光治疗的患儿和不能施行激光治疗的患者。
3.2 激光后囊切开术 适用于:①白内障术后发现后囊混浊;②患者视力下降与后囊混浊程度一致,排除影响视力的其他疾病;③患者有眩目感。激光后囊切开术即掺钕钇铝石榴石(Nd:YAG)激光晶体后囊膜切开术是目前治疗PCO最常用的方法。Nd:YAG激光具有光爆破击穿作用,可切割或破碎组织,Nd:YAG激光囊膜切开术可在不切开眼球的情况下,用激光切开眼内组织,是当今最安全的膜切开术,操作简便,是治疗各种原因所致后囊膜混浊行之有效的途径。但该术式易造成人工晶状体损伤,术后常出现眼压升高、视网膜脱离和黄斑囊样水肿等并发症[27]。这就要不断提高手术医生的操作技巧:准确聚焦、掌握每脉冲能量的控制、总能量的控制等。并且在PCO严重影响视力时再行切开术,以减少患者丧失视力的危险。同时术中尽量保持玻璃体前界膜的完整,以降低眼后节并发症的发生率。
4 展望 对于PCO的预防,目前还没有突破性进展。手术方面,应力求最小创伤;人工晶体植入方面,力求最有效设计、最佳生物相容性;药物治疗方面,力求探索出高效低毒的抑制LEC增殖移行的药物;在光动力学及去整合素方面更有待于我们投入精力努力钻研。在治疗方面,两种术后后囊切开术均是比较成熟的、广泛应用于临床的治疗手段。即使将来植入具有调节力的注入式人工晶体的设想成为现实,防止晶体囊袋发生混浊仍需要眼科医生不懈的努力与探索。
【参考文献】
[1] Schaumberg DA,Dana MR,Christen WG,et al.A systematic overview of the incidence of posterior capsule opacification [J].Ophthalmology,1998,105(7):1213.
[2] McDonnell PJ,Stark WJ,Green WR,et al.Posterior capsule opacification:a specular microscopic study [J].Ophthalmology,1984,91(7):853.
[3] Nishi O,Nishi K.Fibrin reaction and its cause. Prostaglandin E2-synthesis by residual lens epithelial cells [J].Dev Ophthalmol,1991,22:126-131.
[4] Apple DJ,Peng Q,Visessook N,et al.Surgical prevention of posterior capsule opacification.Part 1:progress in eliminating this complication of cataract surgery [J].J Cataract Refract Surg,2000,26(2):180-187.
[5] Spalton DJ.Posterior capsular opacification after cataract surgery [J].Eye,1999,13(Pt 36):489-492.
[6] Linnola RJ.Sandwich theory:bioactivity-based explanatation for posterior capsule opacification [J].J Cataract Refract Surg,1997,23(10):1539-1542.
[7] Ursell PG,Spalton DJ,Pande MV,et al.Relationship between intraocular lens biomaterials and posterior capsule opacification [J].J Cataract Refract Surg,1998,24(3):352-360.
[8] Nishi O,Nishi K.Inhibition of migrating lens epithelial cells at the capsular bend created by the rectangular edge of a posterior chamber intraocular lens [J].Ophthalmic Surg Lasers,1998,29(7):587.
[9] Yamamoto T,Soong HK,Linchter PR.Effect of 5-fluorouracil on cultured rabbit lens epithelial cells [J].Jpn J Ophthalmol,1990,34(4):325-327.
[10] 冉萍.后发性白内障的防治进展[J].重庆医学,2003,32(7):936-937.
[11] 马楠,马吉献.不同药物预防晶状体后囊混浊的相关机制及效果[J].国际眼科杂志,2005,5(3):504-507.
[12] 柯治生,蔡小军.术中应用紫杉醇防治兔后发性白内障[J].眼视光学杂志,2006,8(2):92.
[13] 柯治生,蔡小军.白细胞介素-1β反义寡核苷酸脂质体抑制后发性白内障的实验研究[J].武汉大学学报:医学版,2006,27(2):240.
[14] 邓小艳,蔡小军.白细胞介素-6反义寡核苷酸脂质体预防后发性白内障的初步研究[J].医学研究生学报,2005,18(12):1083.
[15] 王翔,祝磊.白内障超声乳化术中应用肝素抑制后囊混浊[J].中国实用眼科杂志,1999,17(12):747-748.
[16] 徐斌.低分子量肝素及其眼科应用的研究进展[J].中国实用眼科杂志,2001,19(10):73.
[17] 夏小平,陆道炎.肝素抑制后发性白内障的病理研究[J].上海第二医科大学学报,1998,18(4):283-285.
[18] 宋志杰,陈伟容.bEGF-SAP防治后发性白内障的研究进展[J].国外医学:眼科学分册,2001,25(1):20.
[19] Bretton RH,Swearingen A,Kash RL,et al.Use of a polylysine-saporin conjugate to prevent posterior capsule opacification [J].J Cataract Refract Surg,1999,25(7):921.
[20] Baldysiak-Figiel A,Jong-Hesse YD,Lang GK,et al.Octreotide inhibits growth factor-induced and basal proliferation of lens epithelial cells in vitro [J].J Cataract Refract Surg,2005,31(5):1059-64.
[21] 丁正华,严宏.后发性白内障的发病机制和药物防治的研究现状及前景[J].国际眼科杂志,2006,6(2):414.
[22] Nishi K,Nishio.Tissue culture of human lens epithelial cells.PartⅡ:Suppressive effect of diclofenac sodium on their proliferation and metaplasia [J].Nippon Ganka zasshi,1991,95(6):581.
[23] Melendez RF,Kumar N,Maswadi SM,et al.Photodynamic action of indocyanine green and trypan blue on human lens epithelial cells in vitro [J].Am J Ophthalmol,2005,140(1):132-134.
[24] van Tenten Y,Schuitmaker HJ,De Wolf A,et al.The effect of photodynamic therapy with bacteriochlorin A on lens epithelial cells in a capsular bag model [J].Exp Eye Res,2001,72(1):41-48.
[25] HJ Koh,SJ Lim,YK Chu,et al.The effect of photodynamic therapy with rose Bengal on posterior capsule opacification in rabbit eyes [J].Ophthalmic Res,2002,34(3):107-12.
[26] 白芳,秦莉.整合素与去整合素在后发性白内障方面的研究现状[J].国际眼科杂志,2006,6(1):150.
[27] Humphry RC,Ball SP,Brammall JE,et al.Lens epithelial cells adhere less to HEMA than to PMMA intraocular lenses [J].Eye,1991,5(Pt 1):66-69. 上一页 [1] [2] |