全氟化碳气体玻璃体腔填充对视网膜功能和组织学的影响
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摘要
目的：评价全氟丙烷(Perfluoropropane，C3F8)和全氟已烷(Perfluoroethane，C2F6)气体在玻璃体腔中填充不同时间对视网膜功能和超微结构的影响，以及诱发视网膜细胞凋亡的可能性。
方法：20只有色兔，分成单次注气组、多次注气组和对照组。注气组左右眼分别注入C3F8和C2F6各0.4mL。多次注气组在此基础上通过不同次数加气，保持气泡体积在0.2mL以上。通过暗适应闪光视网膜电图(F—ERG)评价视网膜功能变化。注气后10d，30d，50d和80d，通过光镜、电子显微镜以及TUNEL技术进行视网膜组织学检查和凋亡细胞检测。对照组左眼注入等量BSS液，右眼仅作相应次数针刺。
结果：各组F-ERGb波波幅在术后短期内均明显下降。单次注气组和对照组波幅逐渐恢复，多次注气组未恢复。单次C3F8注气眼和多次注气组上方视网膜均出现外丛状层变薄，视杆视锥细胞突起变短，排列不整齐。多次注气组视杆视锥细胞外节明显变短乃至消失，膜盘不清，多次注气组左右眼上方视网膜无差异。注气组下方视网膜与对照组相同。TUNEL染色各组均见凋亡细胞。
结论：全氟化碳气体玻璃体腔长期滞留会引起兔眼视网膜功能不可逆性损害。组织学检查损害部位主要为视网膜外层。气体对视网膜的影响与气体种类无关，与气体在玻璃体腔中的浮力和滞留时间长短密切相关。气体诱导的视网膜细胞凋亡可能是视网膜功能损害的原因之一。
OBJECTIVE: To evaluate functional and histopathologic retinal changes and possible cell apoptosis in eyes after injection of pure perfluoropropane (C3F8),pure perfluoroethane (C2F6) into vitreous cavity.
Methods: Twenty pigmented rabbits were divided into three groups: single injection ,repeated injections and control group.C3F8 gas and C2F6 gas (0.4mL each)were injected into rabbit vitreous cavities, left and right eye respectively. The intravitreous bubble volumes of the repeated injections group were kept more than 0.4ML by repeatedly injecting gas. FERG were recorded before and after the injection to assess the functional changes of retina. At the 30d,50d and 80d ,light and electron microscopic examinations as well as TUNEL technique were conducted to investigate histopathological retinal changes. 0.4mL balanced salt solution(BSS) were injected into the control group.
Result: Mean b-wave amplitude of scotopic ERG were remarkably reduced at the 3d postoperatively. The b-wave amplitude returned gradually to normal in the single injection group. Whereas eyes in repeated injection group didn't. At all points, thinning of outer plexiform layer and variable degrees of atrophy with disappearance of out and inner segments of photoreceptors were found in eyes that received C3F8 gas or C2F6 gas repeately. In all eyes that received gas, light and electron microscopy showed that the inferior retina were the same as in control at all time points. The superior retina of the right eye were similar to the left one. The TUNEL technology showed that apoptosis cell were presented in all sections with more pronounce in the repeated injection group.
Conclusion: Retinal tamponade using perflorocarbone gas for a long-term induces irreversible functional changes of retina of the rabbit eye. Tamponade with gas is detrimental primarily to the outer layer of superior retina. The damage of gas tamponade to retina is closely related to the buoyancy force retention during the bubble, and not to the kind of gas used.
方法：20只有色兔，分成单次注气组、多次注气组和对照组。注气组左右眼分别注入C3F8和C2F6各0.4mL。多次注气组在此基础上通过不同次数加气，保持气泡体积在0.2mL以上。通过暗适应闪光视网膜电图(F—ERG)评价视网膜功能变化。注气后10d，30d，50d和80d，通过光镜、电子显微镜以及TUNEL技术进行视网膜组织学检查和凋亡细胞检测。对照组左眼注入等量BSS液，右眼仅作相应次数针刺。
结果：各组F-ERGb波波幅在术后短期内均明显下降。单次注气组和对照组波幅逐渐恢复，多次注气组未恢复。单次C3F8注气眼和多次注气组上方视网膜均出现外丛状层变薄，视杆视锥细胞突起变短，排列不整齐。多次注气组视杆视锥细胞外节明显变短乃至消失，膜盘不清，多次注气组左右眼上方视网膜无差异。注气组下方视网膜与对照组相同。TUNEL染色各组均见凋亡细胞。
结论：全氟化碳气体玻璃体腔长期滞留会引起兔眼视网膜功能不可逆性损害。组织学检查损害部位主要为视网膜外层。气体对视网膜的影响与气体种类无关，与气体在玻璃体腔中的浮力和滞留时间长短密切相关。气体诱导的视网膜细胞凋亡可能是视网膜功能损害的原因之一。
OBJECTIVE: To evaluate functional and histopathologic retinal changes and possible cell apoptosis in eyes after injection of pure perfluoropropane (C3F8),pure perfluoroethane (C2F6) into vitreous cavity.
Methods: Twenty pigmented rabbits were divided into three groups: single injection ,repeated injections and control group.C3F8 gas and C2F6 gas (0.4mL each)were injected into rabbit vitreous cavities, left and right eye respectively. The intravitreous bubble volumes of the repeated injections group were kept more than 0.4ML by repeatedly injecting gas. FERG were recorded before and after the injection to assess the functional changes of retina. At the 30d,50d and 80d ,light and electron microscopic examinations as well as TUNEL technique were conducted to investigate histopathological retinal changes. 0.4mL balanced salt solution(BSS) were injected into the control group.
Result: Mean b-wave amplitude of scotopic ERG were remarkably reduced at the 3d postoperatively. The b-wave amplitude returned gradually to normal in the single injection group. Whereas eyes in repeated injection group didn't. At all points, thinning of outer plexiform layer and variable degrees of atrophy with disappearance of out and inner segments of photoreceptors were found in eyes that received C3F8 gas or C2F6 gas repeately. In all eyes that received gas, light and electron microscopy showed that the inferior retina were the same as in control at all time points. The superior retina of the right eye were similar to the left one. The TUNEL technology showed that apoptosis cell were presented in all sections with more pronounce in the repeated injection group.
Conclusion: Retinal tamponade using perflorocarbone gas for a long-term induces irreversible functional changes of retina of the rabbit eye. Tamponade with gas is detrimental primarily to the outer layer of superior retina. The damage of gas tamponade to retina is closely related to the buoyancy force retention during the bubble, and not to the kind of gas used.
引文
1. Assi,-A-C; Charteris,et al.Pneumatic retinopexy in the treatment of primary rhegmatogenous retinal detachment. Eye. 1999 Dec; 13 (Pt 6): 725-8.
2．王方．C3F8气体与玻璃体视网膜手术．国外医学·眼科学分册 1995．12．22；19(6)：353-357．
3. Bochow-TW; Olk-RJ,et al. Pneumatic retinopexy perfluoroethane (C2F6) in the treatment of rhegmatogenous retinal detachment. Arch-Ophthalmol. 1992 Dec; 110(12): 1723-4.
4. Complications of pneumatic retinopexy. Coll-Antropol. 2001; 25 Suppl: 97-9.
5. Panessa-Warren-B; Maisel-JM,et al.Alterations in rabbit vitreal fine structure following C3F8 injection. Graefes-Arch-Clin-Exp-Ophthalmol. 1990; 228(6): 541-51 .
6. Doi,-M; Ning,-M,et al. Histopathologic abnormalities in rabbit retina after intravitreous injection of expansive gases and air. Semba,-R; Uji,-Y; Refojo,-M-F. Retina. 2000; 20(5): 506-13.
7. Lincoff-H; Coleman-J, et al. The perfluorocarbon gases in the treatment of retinal detachment. Ophthalmology. 1983 May; 90(5): 546-51.
8．赵铁英；高汝龙，等．国产过氟化碳气体在黄斑裂孔手术中的应用．
9．韩泉洪；惠延年，等．过氟丙烷对兔眼视觉电生理和超微结构的影响．西安第四军医大学西京医院眼科．眼科研究 1998．03．15；16(1)：32-34．
10. Sabates,-N-R; Tolentino,et al.The complications of perfluoropropane gas use in complex retinal detachments. Retina. 1996; 16(1): 7-12.
11. Faulborn-J; Bowald-S. The vitreous after C3F8 gas instillation: long-term histologic findings after spontaneous reabsorption of the gas in rabbit eyes. Graefes-Arch-Clin-Exp-Ophthalmol. 1987; 225(2): 99-102.
12. Juzoji,-H; Iwasaki,et al. Histological study of intraocular changes in rabbits after intravitreal gas injection. Jpn-J-Ophthalmol. 1997 Sep-Oct; 41 (5): 278-83.
13．许迅；张晰，等．C3F8注入兔眼的实验室观察．上海医学 1995．07．15；18(7)：392-394。
14. Vardanyan,-A-H; Hovakimyan,-A-V, et al. Results of surgical treatment of retinal detachments complicated with proliferative vitreoretinopathies with the use of perfluropropane (C3F8) gas. Med-Sci-Monit. 2000 Jul-Aug; 6(4): 704-7.
15．蔡文泉；李佩娟，等．补气在视网膜玻璃体手术后的应用．临床眼科杂志 1999．08．25；7(4)：224-226．
16. Vardanyan,-A-H; Hovakimyan,-A-V, et al. Results of surgical treatment of retinal detachments
complicated with proliferative vitreoretinopathies with the use of perfluropropane (C3F8) gas. Med-Sci-Monit. 2000 Jul-Aug; 6(4): 704-7.
17．李凤鸣。眼科全书．人民卫生出版社，1996年6月，780-784．
18．赵惠清；纪虹，等．玻璃体内注射C3F8气体治疗复杂性陈旧性视网膜脱离．美中国际眼科杂志 2001．06．25；1(2)：45-47．
19. Peyman-GA; Conway-MD,et al. Long-term vitreous replacement in primates with intravitreal Vitreon or Vitreon plus silicone. Ophthalmic-Surg. 1991 Nov; 22(11): 657-64.
20. Doi-M; Refojo-MF. Histopathology of rabbit eyes with intravitreous silicone-fluorosilicone copolymer oil. Exp-Eye-Res. 1994 Dec; 59(6): 737-46.
21. Hegazy,-H-M; Peyman ,-G-A,et al.Use of perfluorocarbon liquids, silicone oil, and 5-fluorouracil in the management of experimental PVR. Int-Ophthalmol. 1998-99; 22(4): 239-46.
22．罗晓刚；陈钦元．国产全氟化碳液体在眼内长期存留的临床观察．中国眼耳鼻喉科杂志2002．03．15；2(2)：84-87．
23. Krzystolik,-M-G; D'Amico,-D-J. Complications of intraocular tamponade: silicone oil versus intraocular gas.Int-Ophthalmol-Clin. 2000 Winter; 40(1): 187-200
24．姜泊主编．细胞凋亡基础与临床．人民军医出版社：1999年7月，9-11．
25．胡野，凌志强．细胞凋亡的分子医学．军事医学科学出版社．2002年8月：27-33
26. Chiou,-S-H; Liu,-J-H,et al.Apoptosis of human retina and retinal pigment cells induced by human cytomegalovirus infection. Ophthalmic-Res. 2002 Mar-Apr; 34(2): 77-82.
27. Long-term effects of light damage on the retina of albino and pigmented rats. Wasowicz,-M; Morice,-C; Ferrari,-P; Callebert,-J; Versaux-Botteri,-C Invest-Ophthalmol-Vis-Sci. 2002 Mar; 43(3): 813-20
2．王方．C3F8气体与玻璃体视网膜手术．国外医学·眼科学分册 1995．12．22；19(6)：353-357．
3. Bochow-TW; Olk-RJ,et al. Pneumatic retinopexy perfluoroethane (C2F6) in the treatment of rhegmatogenous retinal detachment. Arch-Ophthalmol. 1992 Dec; 110(12): 1723-4.
4. Complications of pneumatic retinopexy. Coll-Antropol. 2001; 25 Suppl: 97-9.
5. Panessa-Warren-B; Maisel-JM,et al.Alterations in rabbit vitreal fine structure following C3F8 injection. Graefes-Arch-Clin-Exp-Ophthalmol. 1990; 228(6): 541-51 .
6. Doi,-M; Ning,-M,et al. Histopathologic abnormalities in rabbit retina after intravitreous injection of expansive gases and air. Semba,-R; Uji,-Y; Refojo,-M-F. Retina. 2000; 20(5): 506-13.
7. Lincoff-H; Coleman-J, et al. The perfluorocarbon gases in the treatment of retinal detachment. Ophthalmology. 1983 May; 90(5): 546-51.
8．赵铁英；高汝龙，等．国产过氟化碳气体在黄斑裂孔手术中的应用．
9．韩泉洪；惠延年，等．过氟丙烷对兔眼视觉电生理和超微结构的影响．西安第四军医大学西京医院眼科．眼科研究 1998．03．15；16(1)：32-34．
10. Sabates,-N-R; Tolentino,et al.The complications of perfluoropropane gas use in complex retinal detachments. Retina. 1996; 16(1): 7-12.
11. Faulborn-J; Bowald-S. The vitreous after C3F8 gas instillation: long-term histologic findings after spontaneous reabsorption of the gas in rabbit eyes. Graefes-Arch-Clin-Exp-Ophthalmol. 1987; 225(2): 99-102.
12. Juzoji,-H; Iwasaki,et al. Histological study of intraocular changes in rabbits after intravitreal gas injection. Jpn-J-Ophthalmol. 1997 Sep-Oct; 41 (5): 278-83.
13．许迅；张晰，等．C3F8注入兔眼的实验室观察．上海医学 1995．07．15；18(7)：392-394。
14. Vardanyan,-A-H; Hovakimyan,-A-V, et al. Results of surgical treatment of retinal detachments complicated with proliferative vitreoretinopathies with the use of perfluropropane (C3F8) gas. Med-Sci-Monit. 2000 Jul-Aug; 6(4): 704-7.
15．蔡文泉；李佩娟，等．补气在视网膜玻璃体手术后的应用．临床眼科杂志 1999．08．25；7(4)：224-226．
16. Vardanyan,-A-H; Hovakimyan,-A-V, et al. Results of surgical treatment of retinal detachments
complicated with proliferative vitreoretinopathies with the use of perfluropropane (C3F8) gas. Med-Sci-Monit. 2000 Jul-Aug; 6(4): 704-7.
17．李凤鸣。眼科全书．人民卫生出版社，1996年6月，780-784．
18．赵惠清；纪虹，等．玻璃体内注射C3F8气体治疗复杂性陈旧性视网膜脱离．美中国际眼科杂志 2001．06．25；1(2)：45-47．
19. Peyman-GA; Conway-MD,et al. Long-term vitreous replacement in primates with intravitreal Vitreon or Vitreon plus silicone. Ophthalmic-Surg. 1991 Nov; 22(11): 657-64.
20. Doi-M; Refojo-MF. Histopathology of rabbit eyes with intravitreous silicone-fluorosilicone copolymer oil. Exp-Eye-Res. 1994 Dec; 59(6): 737-46.
21. Hegazy,-H-M; Peyman ,-G-A,et al.Use of perfluorocarbon liquids, silicone oil, and 5-fluorouracil in the management of experimental PVR. Int-Ophthalmol. 1998-99; 22(4): 239-46.
22．罗晓刚；陈钦元．国产全氟化碳液体在眼内长期存留的临床观察．中国眼耳鼻喉科杂志2002．03．15；2(2)：84-87．
23. Krzystolik,-M-G; D'Amico,-D-J. Complications of intraocular tamponade: silicone oil versus intraocular gas.Int-Ophthalmol-Clin. 2000 Winter; 40(1): 187-200
24．姜泊主编．细胞凋亡基础与临床．人民军医出版社：1999年7月，9-11．
25．胡野，凌志强．细胞凋亡的分子医学．军事医学科学出版社．2002年8月：27-33
26. Chiou,-S-H; Liu,-J-H,et al.Apoptosis of human retina and retinal pigment cells induced by human cytomegalovirus infection. Ophthalmic-Res. 2002 Mar-Apr; 34(2): 77-82.
27. Long-term effects of light damage on the retina of albino and pigmented rats. Wasowicz,-M; Morice,-C; Ferrari,-P; Callebert,-J; Versaux-Botteri,-C Invest-Ophthalmol-Vis-Sci. 2002 Mar; 43(3): 813-20