Particle-induced endophthalmitis: possible mechanisms of sterile endophthalmitis after intravitreal triamcinolone.
Particle-induced endophthalmitis: possible mechanisms of sterile endophthalmitis after intravitreal triamcinolone.
复制标题
颗粒诱发的眼内炎：玻璃体内注射曲安西龙后无菌性眼内炎的可能机制。
DOI：
10.1167/iovs.12-11247
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Sakamoto T
中科院分区：
文献类型：
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作者：
Otsuka H;Kawano H;Sonoda S;Nakamura M;Sakamoto T
方法。回顾了21例体外循环手术后发生无菌性眼内炎的临床资料。进行细胞学研究，并确定房水中的细胞因子和趋化因子谱。研究了曲安奈德（TA）颗粒与培养的晶状体上皮细胞（B3）或视网膜色素上皮细胞（ARPE-19）直接接触对细胞因子产生的影响。非接触培养研究在博伊登室进行；结果：IVTA术后1 d出现炎症，严重无菌性眼内炎发生率为13.0%(6/46)，改用不含防腐剂的TA后为4.3%（2/47）。房水中发现的细胞多为粒细胞。IL-6 （447.8 ~ < 5000 pg/mL）、IL-8 （47.2 ~ < 5000 pg/mL）浓度显著升高，IL-1β、IL-10、IL-12p70、TNF-α无显著变化。在B3细胞中，当细胞与TA颗粒直接接触时，IL-8水平显著升高（是PBS的1.33倍，P< 0.05, Student’st检验），而非接触培养时，IL-8水平无显著升高。在ARPE-19细胞中发现了类似的反应模式。当细胞暴露于11-脱氧皮质醇时，也观察到这些影响。IVTA术后无菌性眼内炎的特点是粒细胞立即浸润，房水中IL-6/IL-8升高。防腐剂可能是导致这种情况的一个因素，颗粒的机械/流变应力可能是一个新的致病因素，通过增加IL-6/IL-8。
Methods.: The clinical records of 21 eyes that had sterile endophthalmitis after IVTA were reviewed. Cytologic studies were performed, and cytokine and chemokine profiles in the aqueous humor were determined. The effects of a direct contact of triamcinolone acetonide (TA) particles with cultured lens epithelial cells (B3) or retinal pigment epithelial cells (ARPE-19) on cytokine production were determined. Noncontact culture studies were performed in a Boyden chamber; 11-deoxycortisol was used for nonbioactive particles.Results.: Inflammation appeared one day after the IVTA, and the incidence of severe sterile endophthalmitis was 13.0%(6/46), which was reduced to 4.3%(2/47) after switching to preservative-free TA. Most cells found in the aqueous humor were granulocytes. The concentrations of IL-6 (447.8–< 5000 pg/mL) and IL-8 (47.2–< 5000 pg/mL) were increased significantly, but IL-1β, IL-10, IL-12p70, and TNF-α were not significantly changed. In B3 cells, the level of IL-8 increased significantly when the cells made direct contact with TA particles (1.33 times that of PBS, P< 0.05, Student's t-test), but not in noncontact cultures. Similar reaction pattern was found in ARPE-19 cells. These effects also were observed when the cells were exposed to 11-deoxycortisol.Conclusions.: Sterile endophthalmitis after IVTA is characterized by an immediate granulocytic infiltration and an increase of IL-6/IL-8 in the aqueous humor. Preservatives may be a factor causing this condition, and mechanical/rheologic stress by particles presumably might be a new causative factor by increasing IL-6/IL-8.