比較纖維蛋白組織膠、N-butyl與methoxypropyl氰基丙烯酸酯之角膜毒性，抗菌效果以及黏合角膜切口之能力

Abstract

實驗目的： 比較纖維蛋白組織膠（fibrin glue）與兩種商品化之氰基丙烯酸酯衍生物（cyanoacrylate; CA derivatives），其對於角膜毒性、抗菌性及黏合角膜切口之能力。 實驗方法： 使用三種組織膠，分別為fibrin glue、N-butyl cyanoacrylate（N-butyl CA）與methoxypropyl cyanoacrylate（methoxypropyl CA）。於體外培養之牛類角膜上皮、內皮與基質細胞分別點上組織膠來觀察其對於角膜細胞之毒性。抗菌能力則是使用眼科常見感染之細菌來測試，分別為：Staphylococcus aureus、Streptococcus pneumoniae、Pseudomonas aeruginosa、Escherichia coli 與 Mycobacterium chelonae。於剛劃好菌之培養基點上組織膠，觀察其對於細菌之影響，並測量抑菌圈寬度做為比較。黏合角膜切口之能力，以角膜切割刀於兔眼角膜上做一切口，並且點上組織膠，之後逐漸增加兔眼之眼內壓，觀察組織膠最大可承受之眼內壓。 實驗結果： Methoxypropyl CA對於角膜之毒性為最強，纖維蛋白組織膠則是完全沒有角膜毒性（p<0.01）。Methoxypropyl CA與N-butyl CA對於Staphylococcus aureus、Streptococcus pneumoniae與 Mycobacterium chelonae有抑菌效果，但是對於Pseudomonas aeruginosa、Escherichia coli則是沒有任何影響。Fibrin glue則亦無任何抑菌效果(p<0.01)。在黏合角膜切口能力方面，methoxypropyl CA的效果最好，其次為N-butyl CA，至於fibrin glue的效果最弱，但結果也與對照組相近。 結論：對於角膜毒性、抑菌與黏合角膜切口之能力，三種組織膠都顯現不同之特性。在角膜手術選擇組織膠時，都需要考量這些不同之性質。

Purpose: To compare the corneal cytotoxicity, bacteriostatic effect, duration of adherence and the ability to seal corneal incisions among fibrin glue and two commercially available cyanoacrylate derivatives. Methods: Fibrin glue, N-butyl cyanoacrylate and methoxypropyl cyanoacrylate were compared. Corneal cytotoxicity was tested by direct contact method using bovine corneal epithelial cells, keratocytes and corneal endothelial cells challenged with droplets of adhesives. The bacteriostatic activity was verified by measuring the inhibition zones of bacterial growth surrounding adhesive droplets on agar plates inoculated with Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, Escherichia coli and Mycobacterium chelonae. The duration of adherence was evaluated based on the morphological changes of adhesive drops when applied on cell culture system. The ability to seal corneal incisions was verified by the maximum resisted intraocular pressures before leakage of the rabbit corneal stab wounds sealed with tissue adhesives. Results: Methoxypropyl cyanoacrylate demonstrated the greatest corneal cytotoxocity followed by N-butyl cyanoacrylate. Fibrin glue showed no detectable cytotoxicity (p<0.01). Methoxypropyl cyanoacrylate and N-butyl cyanoacrylate showed bacteriostatic effects against Staphylococcus aureus, Streptococcus pneumoniae, and Mycobacterium chelonae but not Pseudomonas aeruginosa and Escherichia coli, while fibrin glue had no such effect against both Gram-positive and negative bacteria (p<0.01). Methoxypropyl cyanoacrylate and N-butyl cyanoacrylate demonstrated longer duration of adherence and greater ability to seal corneal incisions than fibrin glue (p<0.01). Conclusions: There is difference of corneal cytotoxicity, bacteriostatic effect, duration of adherence and the ability to seal corneal incisions among fibrin glue, N-butyl cyanoacrylate and methoxypropyl cyanoacrylate. These different properties should be considered when choosing tissue adhesives for corneal surgeries.