诱导的视网膜色素上皮细胞增生作用及其作用机制

作者：YuWen Cheng1， 王玉良2，张奕华2，彭司勋2，George C Y Chiou1 作者单位：1美国德州大学城,德州农工大学医学院,眼科药理学研究所;2210009 中国江苏省南京市，中国药科大学新药研究中心
【摘要】 目的：观察(R, R)XY10和(S, S)XY10对视网膜色素上皮细胞的增生作用，并且进一步的研究其作用机制。但(R, R)XY10和(S, S)XY10对人脐静脉内皮细胞并无增生的作用。方法：通过人视网膜色素上皮细胞(ARPE19)和人脐静脉内皮细胞(HUVECs)研究(R, R) XY10和(S, S)XY10对视网膜色素上皮细胞的增生作用，并且采用ERK、KT、PI3K、蛋白激酶C(PKC)和一氧化氮合酶(NOS)抑制剂来研究其作用机制。结果：(R, R)XY10和(S, S)XY10促进了ARPE19细胞的增生，并具有剂量依赖性，但是对HUVECs细胞没有影响。如果同时加入增生抑制剂H7 (5μmol/L)、金丝桃素(20μmol/L)、PD98059(2μmol/L)、LY294002(50μmol/L)、SH5(10μmol/L)和LNAME (100μmol/L)，则给予H7、金丝桃素、PD98059和LY294002各组的增生作用受到了抑制，而给予SH5和LNAME两组的增生作用没有影响。结论：(R, R)XY10和(S, S)XY10能够诱导ARPE19细胞增生，其作用可能是通过MAPK和PI3K的途径来发挥该作用。因此，(R, R)XY10和(S, S)XY10能通过修复损伤的RPE细胞来治疗老年性黄斑变性。

【关键词】 年龄相关性黄斑变性;(R,R)XY10; (S,S)XY10; ARPE19 cells;人脐静脉血管内皮细胞;增生

　Controlled continuous curvilinear capsulorhexis in short axial length and shallow anterior chamber eyes

　　GuangYu Yang, YouLi Huang, ZhiFeng Wu

　　Department of Ophthalmology, the Second Peoples Hospital,Wuxi 214002,Jiangsu Province,China

　　Correspondence to:GuangYu Yang.Department of Ophthalmology, the Second Peoples Hospital,Wuxi 214002,Jiangsu Province,China.wuxiygy@163.com



　AbstractAIM：To investigate the efficacy of controlled continuous curvilinear capsulorhexis(CCC) technique in short axial length and shallow anterior chamber eyes.METHODS：Sixtyeight patients(68 eyes) with short axial length and shallow anterior chamber were included.The routine CCC technique was used in 32 cases (32 eyes) and controlled CCC technique was used in 36 cases (36 eyes).The success rate and complication were compared between two groups.RESULTS：The success rate of the routine technique group and controlled technique group was 53.13% and 86.11% respectively. Incomplete CCC leading to posterior capsule tears was 9.38% and zero in two groups respectively.CONCLUSION: Controlled CCC technique can increase the success rate and reduce complications in short axial length and shallow anterior chamber eyes.

　KEYWORDS:phacoemulsification; continuous curvilinear capsulorhexis; complication

　Yang GY, Huang YL, Wu ZF. Controlled continuous curvilinear capsulorhexis in short axial length and shallow anterior chamber eyes.

　　INTRODUCTION

　　Continuous curvilinear capsulorhexis (CCC) is a standard procedure in the surgery of phacoemulsification.Successful CCC is vital for the completion of the following manipulations.It can reduce the complications of posterior capsule rupture(PCR),vitreous loss, etc. In short axial length and shallow anterior chamber eyes,especially eyes with angleclosure glaucoma(ACG), narrow operation space for capsulorhexis, and greater pressure gradient behind the crystalline lens can lead to great difficulty and low success rate of CCC[1]. By filling the anterior chamber with viscoelastic and aspirating liquid cortex,a controlled capsulorhexis can facilitate[2]. Another technique of direct puncture capsulorhexis to prevent anterior chamber shallowing and peripheral capsular tearing has also been introduced[3,4]. After filling the anterior chamber with a viscoelastic agent to decompress the lens, the capsulorhexis is completed with an endoilluminator as an oblique source of illumination. This technique allows controlled capsulorhexis in eyes with intumescent cataract[5]. In the present study, we used a new controlled CCC technique and compared the efficacy of this technique with that of the routine CCC.

　　PATIENTS AND METHODS

　　Sixtyeight patients(68 eyes) having phacoemulsification and intraocular lens(IOL) implantation or combined with trabeculectomy from January to December 2008 were included in the study.The procedures were done by one surgeon. Thirtyseven were male and thirtyone were female. The average age was 70.5±8.7 years. The axial length was 19.7±1.2mm. The anterior chamber axis depth was less than or equal to 2.5mm. The routine CCC and bimanual CCC technique were used in thirtytwo cases(32 eyes) and thirtysix cases(36 eyes), respectively.

　　The routine CCC was performed with capsulorhexis forceps alone after injecting viscoelastic agent into anterior chamber. In controlled CCC technique after injecting viscoelastic device into anterior chamber a chopper with spade tip was inserted through a corneal side port at 2∶00. The central anterior capsule was pressed with the chopper tip to form a foveation appearance. Capsulorhexis forceps was inserted into anterior chamber through the main clear corneal incision at 11∶00. Anterior capsule was directly punctured with capsulorhexis forceps at 9∶00. CCC was performed from 9∶00 to 2∶00 clockwisely and from 9∶00 to 2∶00 counterclockwisely. During CCC procedure the anterior capsule was continuously pressed to maintain the foveation form. Mannitol was preoperatively used intravenously to dehydrate the vitreous if necessary.

　　RESULTS

　　The axial length and anterior chamber axis depth of two groups were shown in Table 1. The axial length and anterior chamber axis depth were not statistically different between two groups. In the routine group the procedure of CCC were finished smoothly in 17 cases(53.13%). The capsulorhexis edge teared peripherally and needed to be cut by scissors before finishing the CCC in 15 cases (46.87%, among which the capsulorhexis edge tearing peripherally involved the posterior capsule during the surgery in 3 cases (9.38%). In the controlled group the CCC were finished successfully in 31 cases(86.11%). The capsulorhexis edge teared peripherally in 5 cases (13.89%), none of which had involved posterior capsule during the process of surgery. The complication of zonular fibers injury and lens dislocation had not occurred.Table 1The axial length and anterior chamber axis depth of two groups(mm)　Figure 1The force exerted upon the lens anterior capsule in routine CCC

　　DISCUSSION

　　Short axial length and shallow anterior chamber eyes have higher incidence of complications in the surgery of phacoemulsification[1,2]. Successful CCC is very important to maintain the integrity of capsule bag and reduce the complications.In the procedure of CCC, the capsulorhexis edge is exerted upon by the force upright, which originates from vitreous pressure transmitted by lens content and cortex swelling afer absorbing aqueous humor. The force can be separated into two component forces. One is directed vertical to the anterior capsule, the other is tangent to the anterior capsule. In routine CCC the tangent force is directed to the periphery of lens. If viscoelastic agent cant counteract the force tangent to the anterior capsule surface, the tangent force will cause the capsulorhexis edge to tear peripherally. In controlled CCC, the tangent force is directed to the center of lens because of the foveation of the anterior lens capsule and will not lead to the capsulorhexis edge tearing peripherally. (Figure 1 and Figure 2). In short axial length and shallow anterior chamber eyes, especially in those with glaucoma, vitrous pressure is higher than that in normal eye.Increased intravitreal pressure and decreased anterior chamber depth will lead to high pressure on tearing spot[6]. Filling the anterior chamber with viscoelastic agent usually cant counteract the force exerted on the anterior capsule originating from vitrous pressure and cortex swelling. The technique of controlled CCC can decrease the amount and change the direction of the force exerted upon the capsulorhexis edge. The capsulorhexis becomes more controllable and its success rate increases greatly compared with the routine CCC technique. Furthmore, the controlled CCC technique can be applied to cataract with or without liquefied cortex. Its applicable to a wider range of cases than some technique of aspirating liquid cortex before CCC to make the capsulorhexis controllable. Of course precaution should be taken that anterior lens surface be pressed properly to avoid zonular fibers injury.

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