Suppression of avascular bleb formation by a thin biodegradable film in a rabbit filtration surgery with mitomycin C
Suppression of avascular bleb formation by a thin biodegradable film in a rabbit filtration surgery with mitomycin C
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丝裂霉素 C 兔滤过手术中可生物降解薄膜抑制无血管泡形成
DOI：
10.1007/s00417-012-2068-7
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
K. Sugiyama
中科院分区：
文献类型：
--
作者：
Tetsuhiko Okuda;T. Higashide;Yukako Fukuhira;Hiroaki Kaneko;M. Shimomura;K. Sugiyama
滤过泡无血管被认为是滤过术后应用丝裂霉素C(MMC)后最严重的并发症，是发生滤过泡感染的危险因素。没有完美的方法可以防止无血管滤过泡的形成。我们推测，使结膜远离直接接触房水滤过可能会抑制MMC滤过手术后无血管滤过泡的形成。为了验证我们的假设，我们研究了一种可生物降解的蜂窝图案薄膜(HPF)能否减少丝裂霉素C(MMC)滤过手术中的滤过泡血管。方法5只兔每只眼(对照组)1只眼接受穹窿全层滤过手术。6只兔双眼均行丝裂霉素C治疗，其中1只眼植入14μm厚的聚(ε-丙交酯-丙交酯-己内酯)聚己内酯，置于滤过处结膜下，蜂窝表面朝上。术后4周定期进行眼压测量、超声生物显微镜(UBM)评估滤过泡和体内共聚焦显微镜(IVCM)检查，并进行组织学检查。结果MMC组术后眼压下降和滤过泡存活率显著高于对照组，而单纯MMC组和MMC+HPF组无明显差异。仅有MMC的眼，滤过泡中的无血管区域持续了4周。术后IVCM显示单纯MMC组结膜上皮细胞形态改变(即大小和形状变化)和上皮缺陷，仅MMC组结缔组织密度和上皮下间隙血管密度明显低于对照组。这些IVCM的发现与UBM和组织学的结果一致。与单纯MMC组相比，MMC+HPF组的临床滤过泡外观、IVCM和组织学显示的滤过泡无血管，IVCM和组织学显示的结膜上皮损伤，以及UBM、IVCM和组织学显示的疏松上皮下结缔组织均减少。同时使用可生物降解的薄HPF可减少滤过泡中的无血管和结膜损伤，而不会影响使用MMC进行滤过手术后的兔眼滤过。
BackgroundAvascularity of the bleb is regarded as a risk of bleb infection, which is the most serious complication after filtration surgery with mitomycin C (MMC). There is no perfect way to prevent avascular bleb formation. We hypothesized that keeping the conjunctiva away from direct exposure to aqueous filtration may suppress avascular bleb formation after filtration surgery with MMC. In order to prove our hypothesis, we investigated whether a thin biodegradable, honeycomb-patterned film (HPF) can reduce bleb avascularity in a rabbit model of filtration surgery with mitomycin C (MMC).MethodsA fornix-based full-thickness filtration surgery was performed in one eye of each of five rabbits (control group). The same surgery with intraoperative MMC treatment was done in both eyes of six rabbits, with one eye receiving a 14-μm-thick HPF made from poly(L-lactide-co-ε-caprolactone), which was placed subconjunctivally over the filtration site with the honeycomb surface facing up. Intraocular pressure (IOP) measurements, bleb evaluations using ultrasound biomicroscopy (UBM), and in vivo confocal microscopy (IVCM) were performed periodically for 4 weeks postoperatively followed by histological examination.ResultsThe postoperative IOP decrease and bleb survival were significantly greater in MMC-treated eyes than in control eyes, and were similar between MMC-only and MMC + HPF eyes. The avascular area in the bleb persisted for 4 weeks in MMC-only eyes. Postoperative IVCM showed morphological changes of the conjunctival epithelial cells (i.e., enlarged and variable in size and shape) and epithelial defects in MMC-only eyes, and significantly lower density of connective tissue and vascularity in the subepithelial space in MMC-only eyes compared to the control eyes. These IVCM findings agreed with those by UBM and histology. Bleb avascularity shown by clinical bleb appearance, IVCM and histology, conjunctival epithelial damage shown by IVCM and histology, and loose subepithelial connective tissue shown by UBM, IVCM, and histology were all reduced in MMC + HPF eyes compared to MMC-only eyes.ConclusionsIVCM successfully showed the characteristic conjunctival damage in MMC-treated blebs. The concomitant use of a thin biodegradable HPF reduced avascularity and conjunctival damage in blebs, without compromising filtration in rabbits following filtration surgery with MMC.
影响因子：
--
作者：
Soltau, JB;Rothman, RF;Ritch, R
通讯作者：
Ritch, R
术中5-氟尿嘧啶或丝裂霉素C对家兔青光眼滤过手术的影响。
影响因子：
13.7
作者：
Khaw,PT;Doyle,JW;Sherwood,MB;Smith,MF;McGorray,S
通讯作者：
McGorray,S