GLAUCOMA FILTERING IMPLANTS

百分之六十接受滤过手术的青光眼患者会遇到 与伤口自然愈合有关的并发症。一种常见的短期 并发症是滤过泡在术后2至6个月内闭塞。 手术这种并发症发生时，自然伤口愈合反应 范围太广了因此，抗代谢药物应在 手术以控制早期伤口愈合反应。然而，控制 是不准确的，并且存在增加的张力减退的风险。一个共同的长期 并发症为术后2 ~ 4年滤过泡破裂 由于连续的胶原瘢痕导致的致密胶原瘢痕的闭塞， 激活伤口愈合反应。拟议的研究采用 聚合物化学和生物医学工程的工具来解决这个问题 伤口愈合反应的短期和长期控制问题 在过滤点。本材料科学研究的目标 项目是1）确定控制释放的最佳参数， 抗代谢药物，以控制伤口愈合; 2）评估是否 伤口愈合反应的长期、低水平激活是主要的 青光眼滤过泡晚期失败的原因;以及3）确定 是否有后部多孔细胞向内生长的假体植入物 表面可以减少植入物的微动，从而 最大限度地减少刺激伤口的长期异物反应 愈合，并可能导致增加胶原疤痕和纤维囊 增厚具体实验设计为：1）验证， 抗代谢药从可生物降解的塞中的受控释放可 减少滤过泡的初始伤口愈合反应， 各种类型的青光眼滤过手术; 2）评估 固定周围的中长期伤口愈合反应 与传统的管和挂线板植入物相比。方法包括 荧光光度法（水流量），组织学（纤维囊大小和 胶原纤维直径），免疫组织化学（相对量 巨噬细胞、纤连蛋白和成纤维细胞;存在的胶原类型），非 放射性原位杂交（I型和III型胶原mRNA），和 免疫化学（白细胞介素I）技术。这些研究的结果 将深入了解成功所涉及的过程， 过滤手术的失败，以及提供一个潜在的解决方案， 与复杂的外科治疗相关的问题 青光眼

Sixty percent of glaucoma patients who have filtration surgery encounter complications related to natural wound healing. A common short-term complication is occlusion of the filtering bleb within 2 to 6 months after surgery. This complication occurs when the natural wound healing response is too extensive. Antimetabolite drugs are therefore used at the time of surgery to control the early wound healing response. However the control is inexact and there is increased risk of hypotony. A common long-term complication is failure of the filtering bleb 2 to 4 years after surgery due to occlusion by dense collagen scars which result from the continued activation of the wound healing response. The proposed research employs the tools of polymer chemistry and biomedical engineering to address this problem of short-term and long-term control of the wound healing response at the filtration site. The objectives of this materials science research project are 1) to define the optimum parameters for controlled release of antimetabolite drugs to control wound healing; 2) to evaluate whether long-term, low-level activation of the wound healing response is a major cause of late failure of glaucoma filtering blebs; and 3) to determine whether prosthetic implants with posterior porous cellular ingrowth surfaces can decrease the micromovement of the implants, thereby minimizing the long-term foreign body responses that stimulate wound healing and may lead to increased collagen scars and fibrous capsule thickening. Specific experiments are designed to: 1) verify that controlled release of an antimetabolite from the biodegradable plug can decrease the initial wound healing response in the filtering blebs of various types of glaucoma filtering surgeries; and 2) evaluate the intermediate and long-term wound healing responses around immobilized versus conventional tube and seton plate implants. Methodology includes fluorophotometric (aqueous flow), histologic (fibrous capsule size and collagen fiber diameter), immunohistochemical (relative quantities of macrophages, fibronectin, and fibroblasts; type of collagen present), non- radioactive in situ hydridization (types l and Ill collagen mRNA), and immunochemical (interleukin I) techniques. The results of these studies will provide insight into the processes involved in the success and failure of filtering surgery, as well as provide a potential solution to the problems associated with the surgical treatment of complicated glaucoma.