生物视膜抑制兔小梁切除术后结膜纤维瘢痕形成的实验研究  

Experiment study on inhibiting conjunctival fibrous scar formation after trabeculectomy with biological collagen membrane in rabbits

作　　者：张俊秀 马遥 张海娟 马科 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科研究所眼科学与视觉科学北京市重点实验室,100005

出　　处：《眼科》2018年第1期42-47,共6页Ophthalmology in China

基　　金："重大新药创制"国家科技重大专项资助项目(2011ZX09302-007-05)

摘　　要：目的观察生物视膜(一种海绵状胶原蛋白基质)对兔小梁切除术后结膜纤维瘢痕形成的抑制作用。设计实验研究。研究对象新西兰大白兔48只。方法兔随机分为空白对照组、Healaflow对照组、实验组,每组16只。每只兔一眼做小梁切除术。空白对照组:单纯做小梁切除术。生物视膜组:小梁切除术时将生物视膜缝合于巩膜瓣后方。Healaflow(一种交联透明质酸钠凝胶)组:小梁切除术时将Healaflow注入巩膜瓣及结膜瓣下。术后1、3、5、7、9、11、13、14、21、28天测量眼压,观察滤过泡情况。术后7、14、28天取眼球做局部组织切片,应用HE和免疫组化PCNA染色进行组织学观察。主要指标眼压,滤过泡情况,炎症细胞情况,胶原纤维排列情况,PCNA阳性成纤维细胞数量。结果空白对照组、生物视膜组、Healaflow组术后7天眼压分别为(4.93±1.40)、(3.56±0.50)、(3.49±0.40)mm Hg(P=0.005);术后14天分别为(5.53±1.49)、(4.00±0.58)、(4.11±0.41)mm Hg(P=0.013);术后28天分别为(5.76±0.94)、(5.93±1.34)、(5.11±0.91)mm Hg(P=0.246)。空白对照组从术后第9天开始出现非功能性滤过泡,生物视膜组和Healaflow组从术后21天开始出现少量非功能性滤过泡。HE染色:术后7天各组滤过区域炎症细胞均较少;术后14天各组炎症细胞数量最多,生物视膜开始降解,降解区域孔壁消失,由疏松排列的胶原纤维和少量成纤维细胞、炎症细胞取代;术后28天各组炎症细胞明显减少,生物视膜完全降解,由疏松的胶原纤维取代。PCNA染色:术后14天各组PCNA阳性细胞均达高峰;不同时期空白对照组PCNA阳性细胞数均较生物视膜组、Healaflow组多。结论生物视膜具有抗兔小梁切除术后结膜瘢痕形成的作用,可以维持兔小梁切除术后更持久的低眼压,尽管时间较短,但仍有一定的临床意义。Objective To observe the inhibitory effect of biological optic membrane （a sponge like collagen matrix） on the forma- tion of conjunctival fibrous scar after trabeculectomy in rabbits. Design Experimental study. Participants 48 New Zealand albinorab- bits. Methods Rabbits were randomly divided into 3 groups： blank control group, Healaflow control group and experimental group, each group of 16. Each rabbit had a trabeculectomy at one eye. Blank control group： simple trabeculectomy. Biomembrane group： suture the biological optic membrane behind the scleral flap during trabeeuleetomy. Healaflow （a crosslinked sodium hyaluronate gel） group： Healaflow was injected under the scleral flap and conjunctival flap during trabeculectomy. Intraocular pressure was measured at 1, 3, 5, 7, 9, 11, 13, 14, 21, 28 days after the operation, and the condition of filtration bleb was observed at the same time. HE and immunohis- tochemical PCNA staining were used for histological observation. Main Outcome Measures Intraocular pressure （IOP）, filtration bleb, the density and arrangement of inflammatory cells and collagen fibers, and the number of PCNA positive fibroblasts. Results The post- operative lOP of the blank control group, the biological membrane group and the Healaflow group on 7th day were （4.93± 1.40）, （3.56± 0.50）, （3.49± 0.40） mmlqg （P=-0.005）; on 14th day were （5.53±1.49）, （4.00±0.58）, （4.11± 0.41）mmHg（P=0.013）; on 28th day were （5.76±0.94）, （5.93±1.34）, （5.11 ± 0.91） mmHg （P=0.246）. In the blank control group, nonfunctional filtering blebs began to appear on the 9th day after operation. In the biological optic membrane group and Healaflow group, a small amount of nonfunctional blebs began to appear on the 21th day after operation. HE staining： On 14th day, the number of inflammatory cells reached the peak and the biological mem- brane began to degrade, the biomembrane holes were disappearring, replaced by the loose arrangement of collagen fiber

关 键 词：生物视膜 小梁切除术 结膜下瘢痕 Healafiow 

分 类 号：R779.6[医药卫生—眼科]