晶状体前囊膜在青光眼白内障联合手术中抗滤过泡瘢痕形成的实验研究(英文)  

An experiment study on the prevention of scar formation of the filtering bleb by the application of anterior lens capsule in trabeculectomy with cataract surgery in rabbit eyes

作　　者：邵毅[1] 裴重刚[1] 周琼[1] 周辉[2] 刘永琰[1] 高贵平[1] 

机构地区：[1]南昌大学第一附属医院眼科,中国江西省南昌市330006 [2]南昌大学第二附属医院眼科,中国江西省南昌市330006

出　　处：《国际眼科杂志》2006年第6期1237-1240,共4页International Eye Science

基　　金：中国江西省卫生厅科技计划立项项目(No.041059)~~

摘　　要：目的:评价晶状体前囊膜作为植入物应用于兔眼青光眼白内障联合手术中阻止滤过口瘢痕形成的作用。方法:选取12只(24眼)科研用新西兰大白兔,先制作高眼压模型。采用随机对照的方法,选择右眼(12眼)为实验组,左眼(12眼)为对照组,实验组在手术显微镜下行青光眼小梁切除联合小切口白内障囊外摘除术,并将自体前囊膜放置于巩膜瓣下,对照组单纯行青光眼小梁切除联合小切口白内障囊外摘除术,观察时间为1d～6mo。术后不同时间点观察眼压、滤过泡、结膜、角膜、前房形成、房水炎症反应,眼部并发症情况及显微镜下观察巩膜滤过道内细胞病理学改变。结果:术后手术成功率、功能滤过泡的累积存活率及并发症均存在有显著性差异。实验组术后1,2,4wk眼压明显低于对照组(P<0.05),术后12,24wk眼压低于对照组,但差异无显著性(P>0.05)。实验组术后1wk手术区大量炎细胞和成纤维细胞,随后炎细胞数量和成纤维细胞减少。术后3mo晶状体前囊膜部分溶解,滤过道内仅存少量异物巨细胞,并于术后6mo接近消失,滤过道保持开放。对照组术后1wk手术区有大量炎细胞和成纤维细胞,于术后1mo左右出现部分滤过通道关闭。在整个实验观察过程中,实验组手术区成纤维细胞数量无明显变化(P>0.05),但与对照组相比较有明显统计学差异(P<0.05)。结论:晶状体前囊膜在术后6mo大部分溶解吸收。在实验动物中将将其应用于青光眼白内障联合术中可有效地降低眼压,并能抑制成纤维细胞增殖,长期有效保留功能性滤泡,保持滤过道开放,且并发症较少。AIM： This study was designed to evaluate the effectiveness of anterior lens capsule inclusion in combined trabeculectomy and cataract surgery in preventing scar formation of the filtering bleb in rabbit model. METHODS： Twerty-Four eyes （12 rabbits） with glaucoma model were studied, anterior lens capsule inclusion in tra- beculectomy with the small-incision cataract surgery were performed on all right eyes （experimental group） and no implants were applicator in trabeculectomy with the small-incision cataract surgery on all left eyes （control group）. These operated eyes were followed up from day 1 to 6 months postoperatively. Intraocular pressure （IOP） was measured and filtering blebs were observed after surgery. Other main outcome measures： cornea,conjunctiva,formation of the anterior chamber, anterior chamber depth,inflammatory reaction, achievement ratio of operation and complications were analyzed. On week 1, 2, 4, 12 and 24 after surgery the animal were killed in batch. Tissue was harvested from the bleb area and was made pathological section. HE staining,light microscope and micro photo analysis technique were applied to observe the cytological and histopathologic characteristics of the filtering tunnels. RESULTS： There were significant differences between the two groups on IOP （1, 2, 4 weeks）,filtration bleb, achievement ratio of operation and complications. In experimental group, at the first month postoperatively, anterior lens cap- sule absorption started with inflammatory characteristics. The peak of inflammatory reaction occurred 1 week after operation and all the cells in the filtrating tunnel disappeared 6 month after surgery. The fibroblast proliferation in control group occurred at I week and the filtrating tunnel dosed with angiogenesis at 1 month after surgery. Fibroblast proliferation started lweek after surgery with no statistical difference during the time course （P 〉0.05）. Significant statistical differences were observed by comparing the fibro blasts numbers

关 键 词：晶状体前囊膜 青光眼 白内障联合手术 移植 病理学 

分 类 号：R779.6[医药卫生—眼科]