Kim Stephen J, Toma Hassanain S
Department of Ophthalmology & Visual Sciences, Vanderbilt University, Nashville, Tennessee, USA.
Arch Ophthalmol. 2010 May;128(5):596-600. doi: 10.1001/archophthalmol.2010.69.
To determine the inhibitory effect of intravitreal nonsteroidal anti-inflammatory drugs on choroidal neovascularization (CNV) in an animal model of age-related macular degeneration.
Six laser burns of sufficient power to rupture the Bruch membrane were induced in the peripapillary area of each eye of 18 adult Brown Norway rats. Both eyes of each animal received the same 5-microL intravitreal injection of 30 mg/mL of ketorolac tromethamine, 40 mg/mL of triamcinolone acetonide, or balanced salt solution. Fluorescein angiography was performed on days 14 and 21 after injection, animals were euthanized, and retinal pigment epithelium-choroid-sclera (choroidal) flat mounts were prepared. Areas of abnormal vascular leakage on fluorescein angiography and vascular budding on choroidal mounts were measured and quantified using an image analysis program.
Intravitreal ketorolac significantly reduced CNV leakage on fluorescein angiography at 2 (P < .001) and 3 (P = .006) weeks compared with eyes injected with balanced salt solution, but intravitreal triamcinolone was a more potent inhibitor of CNV leakage than ketorolac (P < .001). Vascular budding on choroidal mounts was almost entirely suppressed with triamcinolone (P < .001) and significantly inhibited with ketorolac (P = .009).
Intravitreal ketorolac significantly reduced laser-induced CNV leakage and vascular budding as determined by fluorescein angiography and choroidal flat mounts, respectively, although this effect was less than that of triamcinolone.
Intravitreal nonsteroidal anti-inflammatory drugs may be useful in the treatment of CNV owing to age-related macular degeneration or other causes and offer distinct clinical advantages over corticosteroids because of their lack of association with cataract formation or glaucoma.
在年龄相关性黄斑变性动物模型中，确定玻璃体内注射非甾体类抗炎药对脉络膜新生血管（CNV）的抑制作用。
对18只成年棕色挪威大鼠的每只眼睛的视乳头周围区域进行6次足以破坏布鲁赫膜的激光烧灼。每只动物的双眼均接受相同的5微升玻璃体内注射，分别为30毫克/毫升的酮咯酸氨丁三醇、40毫克/毫升的曲安奈德或平衡盐溶液。在注射后第14天和第21天进行荧光素血管造影，对动物实施安乐死，并制备视网膜色素上皮-脉络膜-巩膜（脉络膜）平铺标本。使用图像分析程序测量并量化荧光素血管造影上异常血管渗漏的面积以及脉络膜平铺标本上的血管芽生情况。
与注射平衡盐溶液的眼睛相比，玻璃体内注射酮咯酸在第2周（P <.001）和第3周（P =.006）时，荧光素血管造影显示显著减少了CNV渗漏，但玻璃体内注射曲安奈德对CNV渗漏的抑制作用比酮咯酸更强（P <.001）。曲安奈德几乎完全抑制了脉络膜平铺标本上的血管芽生（P <.001），酮咯酸也显著抑制了血管芽生（P =.009）。
玻璃体内注射酮咯酸分别通过荧光素血管造影和脉络膜平铺标本测定，显著减少了激光诱导的CNV渗漏和血管芽生，尽管这种作用小于曲安奈德。
玻璃体内注射非甾体类抗炎药可能对治疗年龄相关性黄斑变性或其他原因引起的CNV有用，并且由于它们与白内障形成或青光眼无关，与皮质类固醇相比具有明显的临床优势。
