飞秒激光经外路巩膜造瘘治疗兔慢性高眼压的初步研究  

Preliminary study of femtosecond laser sclerostomy ab externo in a rabbit model of chronic ocular hypertension

作　　者：杨晓波[1] 戴能利[2] 龙华[2] 李宛[1] 陆培祥[2] 姜发纲[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院眼科,武汉430022 [2]华中科技大学激光技术国家重点实验室

出　　处：《中华眼科杂志》2010年第7期635-640,共6页Chinese Journal of Ophthalmology

基　　金：基金项目：国家自然科学基金资助项目（30772382）

摘　　要：目的 探索飞秒激光经外路兔巩膜造瘘的可行性,评价手术的有效性和安全性.方法 实验研究.对23只青紫蓝兔右眼后房注射α-糜蛋白酶,制备兔慢性高眼压模型.将兔随机分为实验组和对照组,每组10只兔.实验组右眼行飞秒激光巩膜造瘘术,对照组右眼不做手术治疗.飞秒激光脉宽50 fs,波长800nm,重复频率1 kHz,脉冲能量0.4 mJ.观察术后1个月内滤过泡形态、眼压及并发症情况.分别于术后第3、7、14、30天对滤过道组织进行光镜观察,术后14 d对滤过道组织进行扫描电镜观察.组间眼压差异比较采用重复测量方差分析.结果 10只兔眼巩膜均被飞秒激光一次性穿透性切除,激光作用时间为15～16 s,巩膜切口约2 mm×1 mm.术后第1、3、7、14、21、30天,实验组和对照组眼压比较,差异具有统计学意义（F=117.46,39.96,15.17,11.62,15.31,11.10;P〈0.01）.除2只眼因激光在切穿巩膜时损伤虹膜根部导致前房出血外,未见其他明显的手术并发症.术后第1天所有实验眼均有滤过泡形成,到第3天滤过泡隆起度最高.随后滤过泡逐渐缩小,泡壁增厚,第3周时滤过泡逐渐扁平消失.病理学检查显示飞秒激光巩膜造瘘的切口光滑锐利,对周围组织的附带损伤小,术后滤过道的修复反应主要表现为成纤维细胞的轻度增生和薄层疏松胶原纤维的形成.结论 飞秒激光经外路兔巩膜造瘘术简便快捷,安全有效.Objective To explore the feasibility, efficacy and safety of performing ab externo sclerostomy with a femtosecond laser in rabbits with chronic ocular hypertension. Method The chronic ocular hypertension model was induced by injecting α-chymotrypsin into posterior chamber. Twenty rabbits with chronic ocular hypertension were randomly divided into experiment and control groups, each group consisting of 10 rabbits. An ab externo sclerostomy using a femtosecond laser was performed in the right eyes in the experiment group. The right eyes in control group were unoperated. The laser was a pulsed titanium-sapphire laser, operating at a repetition rate of 1000 per second, 0.4 mJ pulse energy, a central wavelength of 800 run and a pulse duration of 50 femtoseconds. The survival of filtration blebs, clinical manifestation and intraocular pressure （IOP） were observed for 1 month after surgery. Animals were killed on days 3,7, 14 and 30 post-operatively. Hematoxylin and eosin （HE） staining and scanning electron microscopy （SEM） were performed to evaluate the histopatholoGlc changes in filtering tracts. The differences in IOP between the experiment and control groups were analyzed by repeated measures analysis of variance. Results A 2 mm x 1 mm clear full-thickness scleral incision was created in each eye in the experiment group which was hit only once by the laser. The laser treated time was approximately 15-16 s. There was a significant difference （F = 117.46,39.96,15.17,11.62,15.31,11.10; P〈0.01） . IOP between experiment and control groups at post-operatively day 1, 3, 7, 14, 21, 30. No serious intra- or post-operative complications happened in the treated eyes except for anterior chamber hemorrhage in 2 eyes triggered by laser injury to iris root A conjunctival bleb was successfully formed in all treated eyes at 1 day after surgery and lasted from 14 to 21 days. Histopathology showed that the perforating scleral incisions created by femtosecond laser were sharply defined, with almost no collateral dama

关 键 词：激光疗法 巩膜造口术 青光眼 

分 类 号：R775[医药卫生—眼科]