不同型人工水晶體抑制兔模式水晶體後囊混濁之效果評估

水晶體後囊混濁 (posterior capsular opacification, PCO)，是現代白內障摘除手術後最常見的長期併發症，在人類，植入人工水晶體已成為預防後囊混濁的策略之一。人工水晶體抑制後囊混濁的效果，會受到其生物相容性與幾何構造的影響。目前，針對犬隻所使用之人工水晶體與後囊混濁間的相關性，尚無系統性的研究。本研究的目的，是希望能夠利用兔模式來模擬犬隻白內障手術後，水晶體後囊混濁的程度，藉以評估犬隻專用人工水晶體CLV-12 (Cara TM Life, Inc.) 抑制水晶體後囊混濁的效果。實驗中，六隻紐西蘭大白兔、共十二顆眼球被隨機分成三組：無水晶體組、IOL-C與IOL-H組。無水晶體組在接受超音波乳化術後，不再植入人工水晶體，使囊袋保持無水晶體狀態；IOL-C組植入犬隻人工水晶體 CLV-12、而IOL-H組則植入人類之人工水晶體Akreos® Adapt (Bausch& Lomb) 作為比較對照。在八週的臨床觀察期後，合併肉眼檢查、組織學與免疫化學染色等方式，進行後囊混濁的評估與分析。結果顯示，水晶體後囊混濁的臨床得分會隨時間增加，到第八週時，各組間的混濁程度並無顯著差異。肉眼觀察下，偽水晶體組 (IOL-C與IOL-H) 週邊混濁的程度較無水晶體組少；而中央區的部分，各組皆保持清澈。病理切片下顯示，人工水晶體具有減少囊袋空間、阻擋細胞增生與移行的屏障能力，而無水晶體囊袋則依靠前後囊的沾黏，來阻止細胞往視軸中央移行。另外，臨床與肉眼觀察結果僅有中度相關性。總結來說，本研究證實犬隻專用人工水晶體具有抑制兔模式週邊後囊混濁的效果，而無水晶體組中央囊袋的混濁度低，其程度與偽水晶體組類似。

關鍵字

水晶體後囊混濁；後發性白內障；人工水晶體；兔模式；犬隻

並列摘要

Posterior capsular opacification (PCO) is the most common long-term complication of modern cataract surgery both in human and dogs. Intraocular lenses (IOLs) have been introduced specifically to prevent PCO in humans. Biocompatibility and geometry are two major factors determined the inhibitory effect of IOLs. Different combinations of IOL designs and materials may result in different PCO grades. The relationship between PCO and canine IOLs is still unclear. The purpose of this study was to evaluate the inhibitory effect of currently available canine IOL- CLV12 (Cara TM Life, Inc.) in a rabbit model. Six New Zealand white rabbits were divided into 3 groups, the aphakic, IOL-C and IOL-H. In aphkic group, capsular bags were kept in aphakic after receiving phacoemulsificaiton. In IOL-C and IOL-H groups, canine IOL CLV-12 and human IOL Akreos® Adapt (Bausch& Lomb) were implanted respectively. Clinical evaluation, gross examination, and histological analysis of PCO were performed in 8-week follow up period. The results showed that clinical PCO scores increased gradually with time, but there was no statistical difference between groups. Under gross examination, pseudophakic groups (IOL-C and IOL-H) had less peripheral PCO formation than aphakic group, which indicate the inhibitory of IOLs. As for central (optic) areas of capsular bags, all groups remained clear. Histopathological evaluation confirmed the barrier effect of IOLs, and also noted that adhesion between anterior and posterior capsule were effective in preventing lens epithelium cells (LECs) migration, which results in low axial PCO grade of aphakic eyes. Clinical and gross PCO scores were moderately correlated. In conclusion, this study confirms the peripheral PCO inhibitory effects of CLV-12. Central area of aphakic eyes can remain as clear as pseudophakic ones, which achieved by capsular adhesion.

並列關鍵字

posterior capsular opacification ； after cataract ； intraocular lenses ； rabbit model ； dog

參考文獻

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不同型人工水晶體抑制兔模式水晶體後囊混濁之效果評估

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