后发性白内障发病机制和防治的研究进展
摘要
后发性白内障是现代白内障囊外摘除术后最常见的并发症。白内障摘除联合后房型人工晶体植入是现代白内障治疗的常用的手术方法,能给患者带来较好的视力和生活质量,然而术后的主要并发症后囊膜混浊(posterior capsular opacification, PCO)是影响术后视力的主要原因。现代白内障手术保留部分前囊膜和完整的后囊膜,术中虽然尽可能清除晶体上皮细胞,但晶体上皮细胞仍部分残留。其后囊下混浊发生的机制主要与残留晶体上皮细胞迁移、增殖和转分化有关。现在开展的治疗主要是激光后囊膜切开。现就近些年关于后发性白内障的发生机制、晶体设计、手术方式、药物及基因预防和治疗后发性白内障的研究进展作一综述。
Posterior Capsule Opacification (PCO) is the most common complication of cataract surgery.At present, the only means of treating cataract is by surgical intervention, and this initially restores high visual quality.Unfortunately, PCO develops in a significant proportion of patients to such an extent that a secondary loss of vision occurs. A modern cataract operation generates a capsular bag, which comprises a proportion of the anterior and the entire posterior capsule.However, on the remaining anterior capsule, lens epithelial cells stubbornly reside despite enduring the rigours of surgical trauma.The mechanism of posterior capsule opacification is mainly related with migration ,proliferation and transdifferentiation of remain crystal epithelial cells. At present ,the main therapy aimming to it is laser incision of posterior capsule.This article reviewed the biological mechanisms driving PCO progression and discuss the influence of IOL design, surgical techniques and putative drug therapies in regulating the rate and severity of PCO.
Posterior Capsule Opacification (PCO) is the most common complication of cataract surgery.At present, the only means of treating cataract is by surgical intervention, and this initially restores high visual quality.Unfortunately, PCO develops in a significant proportion of patients to such an extent that a secondary loss of vision occurs. A modern cataract operation generates a capsular bag, which comprises a proportion of the anterior and the entire posterior capsule.However, on the remaining anterior capsule, lens epithelial cells stubbornly reside despite enduring the rigours of surgical trauma.The mechanism of posterior capsule opacification is mainly related with migration ,proliferation and transdifferentiation of remain crystal epithelial cells. At present ,the main therapy aimming to it is laser incision of posterior capsule.This article reviewed the biological mechanisms driving PCO progression and discuss the influence of IOL design, surgical techniques and putative drug therapies in regulating the rate and severity of PCO.
引文
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2 Walker JL,Wolff IM,Zhang L,et al.Activation of SRC Kinases signals induction of posterior capusule opacification [J].Invest Ophthalmol VisSci,2007,48(5): 2214-2223
3 Er H , Gunfuz A ,Turkoz Y, et al. Effect of NG-Nitro L-arginine and corlicosteroids on aquenos humor levels og nitric oxide and cytokines after cataract surgery[J ].J Cata- ract Refract Surg , 1999 ,25:795-799
4 Elosta AA,Spalton DJ,Marshall J.In vitro modle for the study of human pco [J].J cataract Refract Surg, 2003,29(8): 1593-1600
5 Prtada J ,Ngo Tu-T, Baoct H ,et al. Detection of turmor necrosis factor alpha and interleukine-1 alpha geng expre- ssion in human lens epithelial cells[J ]. Cataract Refract Surg , 2000 ,26:114-117
6袁发焕.细胞外基质、基质金属蛋白酶及其抑制因子的研究进展.国外医学临床生物化学与检验学分册,2000,21(2) : 62
7 HassTL,Davis SJ,Madri JA. J Biol Chem, 1998, 273 (6) :3604
8 Kossakowska AE, Edwards DR,Lee SS, et al. Altered balance between matrix matallo proteineses and their inhib- itors in experimental biliary fibrosis[J]. Am J Pathal, 1998, 153 ( 6 ):1895
9 Seomun Y,Kin J,Lee EH,etal,Overexpression of matrix metalloproteinase-2 mediates phenotypic transformation of lens epithelial cells[J]. Biochem J,2001,358:41
10 Zhang XH, Ji J ,Zhang H ,et al. Detection of integrins in cataract lens epithelial cells [J]. Cataract Refract Surg,2000, 26(2):287
11 Yoshino M, Kurosaka D ,Obazawa M ,et al. Presence of alpha 5 beta 1 integrin and fibronectin in the anterior subcapsular cataract [J]. Nippon Ganka Gakkai Zasshi, 2001, 105 (2)83- 87
12 Sponer U, Pieh S, Soleiman A, et al. Upregulation of alphavbeta 6 integrin, a potent TGF- beta 1 activator ,andposterior capsule opacification [J].J Cataract Refract Surg, 2005, 31 ( 3):595 -606
13 Saika S, Miyamoto T, Ishida I, et al. TGFbeta-Smad signaling in postoperative human lens epithelial cells[J]. Br J Ophthalmol, 2002, 86: 1428-1433
14 de Iongh RU,Wederell E, Lovicu FJ, et al. Transforming growth factor-beta-induced epithelial-mesenchymal transi- tion in the lens a model for cataract formation[J]. Cells Tissues Organs,2005,179:43- 55
15 Zhu HJ, Burgess AW. Regulation of transforming growth factor-beta signaling[J]. Mol Cell Biol Res Commun,2001, 4:321 - 330
16 de Iongh RU, Gordon-Thomson C, Chamberlain CG, et al. TGFbeta receptor expression in lens Implications for differentiation and cataractogenesis[J]. Exp Eye Res,2001, 72∶649 - 659
17 Saika S,Kono SY,et al.Smad3 Signaling is required for epithelial-mesenchymal transition of lens epithelium after injury[J]. Am J Pathol, 2004,164:651
18叶盼盼,姚克,谭健,等.TGF-β2晶状体上皮细胞增生和上皮间质转分化的实验研究.眼科杂志, 2007, 25(11): 908-912
19 Deiongh Ru, Gordon YC, Chamberlai CG, et al.TGF-beta recept expression in lens:implications for differentiation and cataracto genesis[J].Exp Eye Res, 2001,72:649
20王艳青,李秋明.无血清的眼组织对晶状体上皮细胞的培养.眼科杂志, 2005, 25(1):20-21
21 Ursell PG, Spalton DJ, Pande MV. Relationship between intraocular lens biomaterials and posterior capsule opacification [J ]. J Cataract Refract Surg, 1998 , 24(3):352 -360
22 Peng Q, Apple DJ, Visessook N, et al. Surgical prevention of posteriorcapsule opacification: intraocular lens optic barrier effect as a second line of defense[J]. J Cataract Refract Surg, 2000, 26 (3): 198-213
23 Chen MJ, Chen YC, Chou CK, et al. Comparison of the effects of latanoprost and bimatoprost on intraocular pressure in chronic angle-closure glaucoma[J]. J Ocul Pharmacol Ther, 2007, 23(6): 559-566
24杨劲松. Nd :YAG激光治疗后发性白内障的临床分析[J].国际眼科杂志, 2006, 6 (1):188-190
25 Pearson PA,Jaffe GJ,M artin DF,et al. Evaluation of a delivery system providing long-term release of cyclosporine. Archthalmol,1996,114: 311-317
26刘建亭,张素华,刘杰为,等。EDTA预防后发性白内障的实验研究[J].临床眼科杂志,2008:16(1):78-80
27肖浩文,叶建锋,欧程山,等. VES抑制Raji细胞增殖中对CDK2和Bcl-2/Bax蛋白表达的影响.中国公共卫生, 2003,19:1
28 Laurell CG, Zetterstrom C. Effects of dexamethasone, diclo-fenac,orplaceboon the inflammatory response after cataract surgery. Br. J. Ophthalmol,2002,86,1380–1384
29 Yang J, Liu TJ, Lu Y. Effectsof bicistronic lentiviral vectorm ediated herpes simplex virus thymidine kinase/ganciclovir system on human lens epithelial cells. Curr Eye Res, 2007, 32(1):33-42
30王冰,翁景宁.腺病毒载体介导的单纯疱疹病毒胸苷激酶基因/丙氧鸟苷体系对晶状体上皮细胞的作用.中华眼科杂志, 2002, 38(10): 618-622
31 Lee EH,Wan XH, Song J, et al. Lens epithelial cell death and reduction of anti-apoptotic protein Bcl-2 in human anterior polar cataracts.MolVis, 2002,11 (8) : 235-240
32吴明星,李绍珍,曾骏文,等.永生化人晶状体上皮细胞细胞周期调控相关基因表达的检测.中华眼科杂志, 2002, 38(6): 367-371
2 Walker JL,Wolff IM,Zhang L,et al.Activation of SRC Kinases signals induction of posterior capusule opacification [J].Invest Ophthalmol VisSci,2007,48(5): 2214-2223
3 Er H , Gunfuz A ,Turkoz Y, et al. Effect of NG-Nitro L-arginine and corlicosteroids on aquenos humor levels og nitric oxide and cytokines after cataract surgery[J ].J Cata- ract Refract Surg , 1999 ,25:795-799
4 Elosta AA,Spalton DJ,Marshall J.In vitro modle for the study of human pco [J].J cataract Refract Surg, 2003,29(8): 1593-1600
5 Prtada J ,Ngo Tu-T, Baoct H ,et al. Detection of turmor necrosis factor alpha and interleukine-1 alpha geng expre- ssion in human lens epithelial cells[J ]. Cataract Refract Surg , 2000 ,26:114-117
6袁发焕.细胞外基质、基质金属蛋白酶及其抑制因子的研究进展.国外医学临床生物化学与检验学分册,2000,21(2) : 62
7 HassTL,Davis SJ,Madri JA. J Biol Chem, 1998, 273 (6) :3604
8 Kossakowska AE, Edwards DR,Lee SS, et al. Altered balance between matrix matallo proteineses and their inhib- itors in experimental biliary fibrosis[J]. Am J Pathal, 1998, 153 ( 6 ):1895
9 Seomun Y,Kin J,Lee EH,etal,Overexpression of matrix metalloproteinase-2 mediates phenotypic transformation of lens epithelial cells[J]. Biochem J,2001,358:41
10 Zhang XH, Ji J ,Zhang H ,et al. Detection of integrins in cataract lens epithelial cells [J]. Cataract Refract Surg,2000, 26(2):287
11 Yoshino M, Kurosaka D ,Obazawa M ,et al. Presence of alpha 5 beta 1 integrin and fibronectin in the anterior subcapsular cataract [J]. Nippon Ganka Gakkai Zasshi, 2001, 105 (2)83- 87
12 Sponer U, Pieh S, Soleiman A, et al. Upregulation of alphavbeta 6 integrin, a potent TGF- beta 1 activator ,andposterior capsule opacification [J].J Cataract Refract Surg, 2005, 31 ( 3):595 -606
13 Saika S, Miyamoto T, Ishida I, et al. TGFbeta-Smad signaling in postoperative human lens epithelial cells[J]. Br J Ophthalmol, 2002, 86: 1428-1433
14 de Iongh RU,Wederell E, Lovicu FJ, et al. Transforming growth factor-beta-induced epithelial-mesenchymal transi- tion in the lens a model for cataract formation[J]. Cells Tissues Organs,2005,179:43- 55
15 Zhu HJ, Burgess AW. Regulation of transforming growth factor-beta signaling[J]. Mol Cell Biol Res Commun,2001, 4:321 - 330
16 de Iongh RU, Gordon-Thomson C, Chamberlain CG, et al. TGFbeta receptor expression in lens Implications for differentiation and cataractogenesis[J]. Exp Eye Res,2001, 72∶649 - 659
17 Saika S,Kono SY,et al.Smad3 Signaling is required for epithelial-mesenchymal transition of lens epithelium after injury[J]. Am J Pathol, 2004,164:651
18叶盼盼,姚克,谭健,等.TGF-β2晶状体上皮细胞增生和上皮间质转分化的实验研究.眼科杂志, 2007, 25(11): 908-912
19 Deiongh Ru, Gordon YC, Chamberlai CG, et al.TGF-beta recept expression in lens:implications for differentiation and cataracto genesis[J].Exp Eye Res, 2001,72:649
20王艳青,李秋明.无血清的眼组织对晶状体上皮细胞的培养.眼科杂志, 2005, 25(1):20-21
21 Ursell PG, Spalton DJ, Pande MV. Relationship between intraocular lens biomaterials and posterior capsule opacification [J ]. J Cataract Refract Surg, 1998 , 24(3):352 -360
22 Peng Q, Apple DJ, Visessook N, et al. Surgical prevention of posteriorcapsule opacification: intraocular lens optic barrier effect as a second line of defense[J]. J Cataract Refract Surg, 2000, 26 (3): 198-213
23 Chen MJ, Chen YC, Chou CK, et al. Comparison of the effects of latanoprost and bimatoprost on intraocular pressure in chronic angle-closure glaucoma[J]. J Ocul Pharmacol Ther, 2007, 23(6): 559-566
24杨劲松. Nd :YAG激光治疗后发性白内障的临床分析[J].国际眼科杂志, 2006, 6 (1):188-190
25 Pearson PA,Jaffe GJ,M artin DF,et al. Evaluation of a delivery system providing long-term release of cyclosporine. Archthalmol,1996,114: 311-317
26刘建亭,张素华,刘杰为,等。EDTA预防后发性白内障的实验研究[J].临床眼科杂志,2008:16(1):78-80
27肖浩文,叶建锋,欧程山,等. VES抑制Raji细胞增殖中对CDK2和Bcl-2/Bax蛋白表达的影响.中国公共卫生, 2003,19:1
28 Laurell CG, Zetterstrom C. Effects of dexamethasone, diclo-fenac,orplaceboon the inflammatory response after cataract surgery. Br. J. Ophthalmol,2002,86,1380–1384
29 Yang J, Liu TJ, Lu Y. Effectsof bicistronic lentiviral vectorm ediated herpes simplex virus thymidine kinase/ganciclovir system on human lens epithelial cells. Curr Eye Res, 2007, 32(1):33-42
30王冰,翁景宁.腺病毒载体介导的单纯疱疹病毒胸苷激酶基因/丙氧鸟苷体系对晶状体上皮细胞的作用.中华眼科杂志, 2002, 38(10): 618-622
31 Lee EH,Wan XH, Song J, et al. Lens epithelial cell death and reduction of anti-apoptotic protein Bcl-2 in human anterior polar cataracts.MolVis, 2002,11 (8) : 235-240
32吴明星,李绍珍,曾骏文,等.永生化人晶状体上皮细胞细胞周期调控相关基因表达的检测.中华眼科杂志, 2002, 38(6): 367-371