2.6非甾体类抗炎药 Nishi 等[25]认为白内障术后血—房水屏障破坏，房水中细胞因子和PGE2 含量增高，刺激晶状体上皮细胞增殖和移行，而晶状体上皮细胞增殖的过程中可进一步释放和产生PGE2 加重晶状体后囊混浊。双氯灭痛可抑制PGE2 合成，且对眼内组织无毒性，对防治晶状体后囊混浊有一定作用。Araie将1g/L双氯灭痛用于白内障囊外摘除术后，用荧光光度计测定证实血—房水屏障崩解被抑制。
2.7生长抑素 有研究表明生长抑素显著抑制体外培养的小牛晶状体上皮细胞的增殖和胶原合成。有研究生长抑素可抑制白内障术后的晶状体上皮细胞增殖,从而减少PCO 的发生。有研究表明生长抑素8 肽显著抑制PCO 的发生，其作用机制除了抑制晶状体上皮细胞的增殖和细胞外间质的合成外,还可能也抑制了其他细胞如成纤维细胞、色素上皮细胞的增殖，另外也可能与减少血流量和减弱炎症反应有关。
2.8其他抑制LEC增殖途径 p21 蛋白为最早发现并克隆的细胞周期蛋白依赖性抑制因子（CKI），可与多种细胞周期蛋白激酶(CDK)竞争结合cyclin，从而抑制细胞的增殖；且可与增殖细胞核抗原结合，阻断增殖细胞核抗原依赖的DNA 复制，抑制CDK活性，从而使细胞生长受阻于G1 期[26-28]。外源性p21基因可在人晶状体上皮细胞系HLE-B3中过度表达，并对细胞周期调控产生抑制作用，基因转染抑制晶状体上皮细胞增殖可能成为防治后发性白内障的新途径。肾上腺素及地塞米松对白内障患者LEC有明显的抑制作用，可用于防治后囊膜混浊的发生。生长因子抑制剂苏拉明能将牛晶状体上皮细胞阻抑于细胞增殖周期的G2 /M 期。且其抑制程度随作用时间的延长和试剂浓度的升高而逐渐增强，苏拉明囊袋内灌注的安全性和有效性，该药可能成为防治后囊膜混浊的新方向。
3展望
白内障摘出联合IOL植入术后，残留晶状体上皮细胞发生创伤愈合发应，并有巨噬细胞浸润且释放多种细胞因子。这些细胞因子在体内与其特异性受体结合，既可单独发挥作用，又可互相影响形成细胞因子网络，调节基因的转录以及细胞的生物学行为，从而引起后囊膜混浊。
Nd：YAG激光囊膜切开可治疗后囊混浊的大多数病例[29-32]。但是即使手术后很长时间后囊中央保持透明，前部囊膜切开口边缘或后囊周边部的混浊阻碍眼底检查和光疗视网膜病变，所以希望能有安全、有效的药物治疗后发障。可能的治疗药物包括细胞毒药物、凋亡诱导剂或阻止细胞粘附的药物，但是它们同时对眼部的其他组织如视网膜、角膜内皮、小梁结构有伤害。为了减少眼内这些化学药物的扩散，最近有研究在人工晶状体表面包裹这些药物的缓释系统，如水凝胶。阻止上皮间质转化和细胞外基质的表达是防治后发障新的方向， TGFβ在这过程中起重要作用。CAT-152人单克隆抗TGFβ抗体是候选药物[33]。通过Smad3缺陷的大鼠的实验表明，表现为snail和α平滑肌肌动蛋白都不表达，所以切除Smad3信号完全阻止损伤诱导的晶状体上皮间质转化。腺病毒瞬时表达Smad7成功阻止组织纤维化反应[34,35]，在晶状体损伤大鼠，腺病毒短期转移Smad7基因阻止上皮间质转化和抑制Smads2/3信号。
【参考文献】
1 Ibaraki N. A brighter future for cataract surgery. Nat Med ,1997;3(9):958-960
2 Sundelin K, Sjostrand J. Posterior capsule opacification 5 years after extracapsular cataract extraction. J Cataract Refract Surg ,1999;25(2):246-250
3 Marcantonio JM, Vrensen GF. Cell biology of posterior capsular opacification. Eye ,1999;13(Pt3b):484-488
4 Mulhall KJ, Curtin WA, Given HF. Comparison of different anti-in.ammatory agents in suppressing the monocyte response to orthopedic particles. Orthopedics , 2003;26:1219-1223
5 Hay ED.An overview of epithelio-mesenchymal transformation.Acta Anat (Basel) ,1995;154(1):8-20
6 Serini G, Bochaton-Piallat ML, Ropraz P, Geinoz A, Borsi L, Zardi L, Gabbiani G. The .bronectin domain ED-A is crucial for myo.broblastic phenotype induction by transforming growth factor-b1. J Cell Biol ,1998;142:873-881
7 Scaffidi AK, Moodley YP, Weichselbaum M, Thompson PJ, Knight DA. Regulation of human lung .broblast phenotype and function by vitronectin and vitronectin integrins. J Cell Sci ,2001;114:3507-3516
8 Saika S, Miyamoto T, Tanaka S, Tanaka T, Ishida I, Ohnishi Y, Ooshima A, Ishiwata T, Asano G, Chikama T, Shiraishi A, Liu CY, Kao CW, Kao WW. Response of lens epithelial cells to injury: role of lumican in epithelial杕esenchymal transition. Invest Ophthalmol Vis Sci ,2003;44:2094-2102
9 Verrecchia F, Mauviel A. Transforming growth factor-bsignaling through the Smad pathway: role in extracellular matrix gene expression and regulation. J Invest Dermatol ,2002;118:211-215
10 Evans RA, Tian YC, Steadman R, Phillips AO. TGF-β1-mediated. fibroblast–myofibroblast terminal differentiation—the role of Smad proteins. Exp Cell Res ,2003;282:90-100
11 Saika S, Kono-Saika S, Ohnishi Y, Sato M, Muragaki Y, Ooshima A, Flanders KC, Yoo J, Anzano M, Liu CY, Kao WWY, Roberts AB, Smad3 signaling is required for epithelial杕esenchymal transition of lens epithelium postinjury. Am J Pathol ,2004;164:651-663
12 Majima K. Effect of epidermal growth factor upon morphological changes of human lens epithelial cells. Ophthalmologica ,1998;212(4):250-256
13 Nishi O, Nishi K, Fujiwara T, Shirasawa E, Ohmoto Y. Effects of the cytokines on the proliferation of and collagen synthesis by human cataract lens epithelial cells. Br J Ophthalmol ,1996,80(1):63-68
14 Wormstone IM, Del Rio-Tsonis K, McMahon G, Tamiya S, Davies PD, Marcantonio JM, Duncan G. FGF: an autocrine regulator of human lens cell growth independent of added stimuli. Invest Ophthalmol Vis Sci ,2001;42(6):1305-1311
15 Nishi O, Nishi K, Ohmoto Y. Synthesis of interleukin-1, interleukin-6, and basic fibroblast growth factor by human cataract lens epithelial cells. J Cataract Refract Surg ,1996;22(Suppl 1):852-858
16 Ibaraki N, Lin LR, Reddy VN. Effects of growth factors on proliferation and differentiation in human lens epithelial cells in early subculture. Invest Ophthalmol Vis Sci ,1995;36(11):2304-2312
17 Reneker LW, Overbeek PA. Lens-specific expression of PDGF-A alters lens growth and development. Dev Biol ,1996;180(2):554-565
18 Bates RC, Mercurio AM.Tumor necrosis factor-alpha stimulates the epithelial-to-mesenchymal transition of human colonic organoids. Mol Biol Cell , 2003;14(5):1790-1800.
19 Prada J, Ngo-Tu T, Baatz H, Hartmann C, Pleyer U. Detection of tumor necrosis factor alpha and interleukin 1 alpha gene expression in human lens epithelial cells. J Cataract Refract Surg ,2000;26(1):114-117
20 Zhang XH, Sun HM, Yuan JQ. Extracellular matrix production of lens epithelial cells. J Cataract Refract Surg ,2001;27(8):1303-1309
21 Schulz MW, Chamberlain CG, de Iongh RU, McAvoy JW. Acidic and basic FGF in ocular media and lens: implications for lens polarity and growth patterns. Development ,1993;118(1):117-126
22 Hansen TJ, Tyndall R, Soll DB. Methotrexate-anticollagen conjugate inhibits in vitro lens cell outgrouth. Invest Ophthalmol Vis Sci ,1987;28:1206
23 Hak SC, Seung JL, Hong BK. Effect of mitomycin C on posterior capsule opaci.cation in rabbit eyes. J Cataract Refract Surg ,2000;26:1537-1542
24 Yoshitomi F, Utsumi E, Hayashi M, Futenma M, Yamada R, Yamada S. Postoperative fluctua tions of tissue plasminogen activator (t - PA) in aqueous humor of pseudophakes. J Cataract Rcfract Surg ,1991;5 :543-546
25 Nishi O, Nishi K, Fujiwara T, Shirasawa E.Types of collagen synthesised by the lens epithelial cells of human cataracts.Br J Ophthalmol ,1995;79(10):939-943
26 Xiong Y, Hannon GJ, Zhang H, Casso D, Kobayashi R, Beach D. P21 is a universal inhibitor of cyclin kinase. Nature ,1993;366:701-704
27 Reed SI. Control of the G1/ S transition. Cancer Surv ,1997;29:7-23
28 Koff A, Giordano A, Desai D, Yamashita K, Harper JW, Elledge S, Nishimoto T, Morgan DO, Franza BR, Roberts JM. Formation and activation of a cyclin E-cdk2 complex during the G1 phase of the human cell cycle. Science ,1992;257:1689-1694
29 Song YP, Ding Q, Liu Q, Zhao X. Nd:YAG laser resection to children with after-cataract in 50 cases. Int J Ophthalmol(Guoji Yanke Zazhi) ,2005;5(3):564-565
30 Zhou Y, Tang LS. Nd:YAG laser for treating the after cataract. Int J Ophthalmol(Guoji Yanke Zazhi) ,2004;4(4):699-701
31 Li YZ, Cai JP. Causes for posterior capsule opacification. Int J Ophthalmol(Guoji Yanke Zazhi) ,2004;4(4):695-698
32 Wang L, Li P. Clinical observation in posterior capsule opacification treatment by Nd:YAG laser. Int J Ophthalmol(Guoji Yanke Zazhi) ,2005;5(4):768-770
33 Wormstone IM, Tamiya S, Anderson I, Duncan G. TGFb2-induced matrix modi.cation and cell transdifferentiation in the human lens capsular bag. Invest Ophthalmol Vis Sci ,2002;43:2301-2308
34 Lan HY, Mu W, Tomita N, Huang XR, Li JH, Zhu HJ, Morishita R, Johnson RJ. Inhibition of renal. brosis by gene transfer of inducible Smad7 using ultrasound-microbubble system in rat UUO model. J Am Soc Nephrol ,2003;14:1535-1548
35 Dooley S, Hamzavi J, Breitkopf K, Wiercinska E, Said HM, Lorenzen J, ten Dijke P, Gressner AM. Smad7 prevents activation of hepatic stellate cells and liver. brosis in rats. Gastroenterology ,2003;125:178-191
鼻内镜鼻部手术护理的体会
治疗性准分子激光原位角膜磨镶术手术疗效分析