【摘要】 目的寻找具有可吸收性及良好物理特性的人工合成材料作为视网膜脱离巩膜外加压术填充物。方法用灰兔做视网膜脱离模型,以可吸收性化学合成材料磷酸酯-碳酸酯共聚物弹性体作为填充物,行巩膜外加压术,术后用B超测巩膜嵴高度,相应时间取眼球做病理检查,观察视网膜复位情况及组织相容性。测量其降解率。结果视网膜平伏,巩膜嵴高度在术后3个月内变化不大。术后第3个月时共聚物吸收8.2%,组织学观察无明显炎症反应。结论磷酸酯-碳酸酯共聚物弹性体作为巩膜外填充物均使用安全、结果可靠。更多还原

【Abstract】 Objective To find new absorbable synthetic materials that can be used in retinal detachment surgery.In detachment surgery,a mechanically stable chorioretinal scar with full scleral indentation is no longer necessary.Under these considerations,absorbable scleral implants have been developed and tested in an animal model.Methods Phosphate-carbonate copolymer was synthesized by polytetrahydrofuran and bisphenol A.Rhegmatogenous retinal detachments were created in 20 rabbits,which then underwent scleral buckling procedures with phosphate-carbonate copolymer implants.The rabbits received an injection of hyaluron and a break was created with a 7G needle.A localized retinal detachment was induced by a subretinal injection of liquefied vitreous using a transvitreous approach.The crystalline lens was not removed.The follow-up period was for 1 and 2 weeks and 1,2,3,4,5 and 6 months.Pieces of absorbable material with a diameter of 7～8 mm were sutured as scleral explants in 20 rabbits.Buckle height after the operation was measured with B-scan ultrasonography and the eyes were enucleated for histopathological examination at regular intervals.The degradation of phosphate-carbonate copolymer in vivo was investigated in another 10 rabbits.Results B-scan ultrasonography showed that the initial explants had buckle heights between 2.7 mm and 3.5 mm.A clinical and ultrasonographical follow-up study showed a continuous slow decrease in buckle height.Ultrasonography measurements of the explants showed buckle heights between 2.7 mm and 3.2 mm at the end of 3 months,and between 2.0 mm and 2.7 mm at the end of 6 months.Histopathological examinations showed an incidence of a slight resorptive inflammation in the area of the buckle,which was not evident after 4 weeks.No scleral infiltration or scleral thinning was found.The retina was successfully attached in all rabbits without any local complications.The amount of postsurgical buckle height was almost unchanged during the initial 3 months.The phosphate-carbonate copolymer implant had an 8.2% absorption rate at the end of 3 months and 11.4% at the end of 4 months.Conclusion These promising results justify controlled clinical trials with the absorbable material,which would combine the advantages of silicone sponge explants(precise localization) with those of scleral buckles from inflatable balloons(reversibility).The absorbable implants were well tolerated in all eyes.Phosphate-carbonate copolymer lasted sufficiently long and produced a significant buckling effect for at least 6 months.We consider this type of explant to be the ideal material for retinal detachment healing because it has a longer reabsorption period compared to other explants,allowing for a longer indentation period.Phosphate-carbonate copolymer was effective and safe in the treatment of retinal detachment.更多还原