兔青光眼小梁切除术中应用生物羊膜与干扰素α-2b的对比研究

目的评价羊膜与干扰素α-2b在青光眼滤过术中的抗纤维增殖作用及其应用价值。方法选取日本大耳兔30只(60眼),采用随机数字表法将其分为2组,2组右眼(30眼,为羊膜组)行小梁切除术,术中巩膜瓣层间植入生物羊膜,组A左眼(15眼,为干扰素组)行小梁切除术,术后结膜下注射干扰素α-2b,组B左眼(15眼,为对照组)行单纯小梁切除术。术后3d、5d、7d、14d、30d、60d观察各组眼压、滤过泡形态、滤过泡维持时间、前房深度等指标,并于术后3d、7d、14d、30d、60d分别处死2组各3只动物,摘除眼球作病理切片,观察成纤维细胞和炎性细胞等情况。结果术后7d,羊膜组眼压为(9.95±2.15)mmHg(1kPa=7.5mmHg),对照组眼压为(12.27±1.95)mmHg,二者比较差异有显著统计学意义(P<0.01),干扰素组眼压为(10.14±2.27)mmHg,与对照组比较,差异有统计学意义(P<0.05);术后14d羊膜组与对照组、干扰素组比较,差异均有统计学意义(均为P<0.05)。术后各组滤过泡形态均以Ⅱ型为主;术后5d、7d、14d羊膜组功能性滤过泡占有率与其他2组比较,差异均有统计学意义(均为P<0.05)。羊膜组早期炎症反应重于其他2组,术后3d光镜下观察可见大量炎性细胞浸润于羊膜植入区;术后7d电镜下可见滤过通道大量成纤维细胞增殖。干扰素组术后早期光镜和电镜下仅见少量成纤维细胞增殖。结论兔眼小梁切除术中应用生物羊膜和干扰素α-2b均能降低眼压和延长滤过泡保留时间,且无明显副作用。生物羊膜作用优于干扰素α-2b,但是植入陈旧生物羊膜手术区炎症反应重,值得进一步研究。     

生物羊膜在高眼压动物模型小梁切除术中的应用

目的探讨生物羊膜在高眼压兔模型青光眼滤过术中的抗增殖作用。方法20只(40眼)健康同种系新西兰大耳白兔后房注入160Uα-糜蛋白酶诱导建立高眼压模型。随机选10只兔,一眼行标准小梁切除术(小梁切除组),另一眼行小梁切除+单层生物羊膜植入术(单层羊膜组);另10只兔一眼行小梁切除术联合在巩膜瓣下放置浸有0.4×103g.L-1丝裂霉素C(mitomycin C,MMC)的棉片3min(MMC组),另一眼行小梁切除+双层生物羊膜植入术(双层羊膜组)。分别在青光眼术后1d、3d、7d、14d、21d、28d空气栓塞法处死兔1～2只,取滤过泡周围组织应用免疫组织化学方法检测各组在眼球壁手术区组织中转化生长因子β1(transforming growth factorβ1,TGF-β1)的含量及手术区炎症细胞和成纤维细胞数。结果术后1d、3d单层及双层羊膜组炎症细胞较其余组多,7d后开始减少,各时间点单层与双层羊膜组之间差异均无统计学意义(均为P>0.05),而MMC组手术区炎性细胞数较单层、双层羊膜组及小梁切除组少(均为P<0.05)。术后1d、3d4组手术区成纤维细胞数目差异均无统计学意义,术后14d后单层及双层羊...     

兔眼滤过术联合应用苏拉明后滤过道的组织病理学观察

目的研究小梁切除术联合应用苏拉明后滤过道的组织病理学变化。方法对20只健康家兔(40眼)均行青光眼滤过手术。随机分为两组,每组各10只(20眼)。第1组:随机选择一眼做单纯小梁切除术,另一眼做小梁切除术并辅助应用苏拉明;第2组:随机选择一眼做小梁切除术联合应用丝裂霉素(mitomycine,MMC),另一眼做小梁切除术并辅助应用苏拉明。对兔眼术后3d、7d、15d、30d、60d不同时期的滤过泡组织进行病理检查,采用HE染色和天狼星-苦味酸染色、Masson三色染色法、免疫组化方法,观察成纤维细胞、新生胶原纤维、新生血管的改变化。结果成纤维细胞:应用苏拉明组和MMC组术后滤过道成纤维细胞数目与单纯小梁切除组差异均有统计学意义(P<0.05),而该两组之间差异无统计学意义;新生胶原纤维:应用苏拉明组和MMC组术后滤过道新生胶原量与单纯小梁切除组差异均有统计学意义(P<0.05),而两组之间差异无统计学意义;新生血管:应用苏拉明组和MMC组术后滤过道成纤维细胞数目与单纯小梁切除组差异均有统计学意义(P<0.05),而两组之间差异无统计学意义。结论小梁切除术联合应用苏拉明可在术后抑制成纤维细胞增殖、新生胶原纤维的合...     

兔眼滤过手术模型制作探析

目的:探讨建立长期有效的兔眼滤过手术模型.方法:对18只36眼家兔行青光眼滤过手术,其中右眼植入单层生物羊膜,左眼植入双层生物羊膜,术后观察眼压、滤过泡形态.结果:家兔术后巩膜瓣修复快,滤过通道难以长期有效维持,易导致造模失败.术中植入双层羊膜,可明显延长有效滤过通道的维持时间,部分模型有效滤过可维持14~30d.双层羊膜组眼压控制也较理想.结论:兔眼小梁切除术中植入双层羊膜,可以提高滤过模型的成功率.     

兔眼滤过术中结膜瓣下辅助应用全氟丙烷后滤过道的组织病理学变化

目的研究小梁切除术中辅助应用全氟丙烷(C3F8)气体后滤过道的组织病理学变化.方法对20只新西兰兔实施小梁切除术.随机分为两组,每组各10只兔(20只眼).第1组随机选择1只眼做单纯小梁切除术,另1只眼做小梁切除术并辅助应用C3F8气体;第2组随机选择1只眼做小梁切除术联合应用丝裂霉素C(MMC),另1只眼做小梁切除术并辅助应用C3F8气体.采用组织病理学和免疫组化技术,对兔眼术后3 d,1、2、3、4周不同时期的滤过泡组织进行病理检查,观察成纤维细胞、新生胶原纤维、新生血管、炎性细胞的改变.结果应用C3F8气体组与单纯小梁切除术组术后滤过道新生胶原纤维量、成纤维细胞量差异均有显著意义(P<0.05);应用MMC组与单纯小梁切除术组术后滤过道新生胶原纤维量、成纤维细胞量差异均有显著意义(P<0.05);应用C3F8气体组与MMC组术后滤过道新生胶原纤维量、成纤维细胞量差异无显著意义(P>0.05).3种不同术式兔眼术后滤过道的新生血管量与术后5个不同时期滤过道的炎性细胞量进行比较,差异均无显著意义(P>0.05).结论小梁切除术中辅助应用C3F8气体可以在术后早期抑制成纤维细胞增殖和新生胶原纤维的合成,抑制或减轻术后滤过道的瘢痕化,从而提高手术的成功率.     

羊膜在兔眼小梁切除术中应用的实验研究

目的:探讨羊膜在实验动物兔抗青光眼手术中的抗纤维化作用。方法:选择纯种新西兰白兔24只,随机分为3组:小梁切除加羊膜移植术组,小梁切除加丝裂霉素组,单纯小梁切除术组。分别于手术后第1、2、3、7、14、28、60d观察眼压、滤过泡、前房反应、并发症情况,术后1、2、3、4周和2个月处死相应组兔子,摘除眼球作病理切片检查,观察羊膜降解时间,进行成纤维细胞计数和炎症细胞计数。结果:眼压值在各观察点除术后第一天差异有显著性外(P=0.041,P=0.021),其余时间3组间差异无显著性(P值均>0.05);羊膜组术后并发症与另两组比较未见增多;滤过泡存留时间约1个月;羊膜降解时间约3～4周。成纤维细胞计数羊膜组[(0.0205±0.01235)个/单位面积],与小梁切除术组[(0.0673±0.03830)个/单位面积]比较差异有显著性(P=0.017<0.05),与丝裂霉素组[(0.0292±0.01085)个/单位面积]比较差异无显著性(P=0.222>0.05);而炎症细胞数羊膜组[(0.4402±0.1708)单位面积]与小梁切除术组[(0.2944±0.08876)个/单位面积]和丝裂霉素组[(0.041±0.02131)个/单位面积]比较差异均有显著性(t=5.67,P=0.002<0.05;t=4.81,P=0.004<0.05)。结论:羊膜在小梁切除术中应用其降解时间约3～4周,具有抑制成纤维细胞作用,可以提高降压效果且并发症较少。其手术区炎症反应重可能为种属间的排斥反应。     

成品生物羊膜和晶状体前囊膜在兔眼超声乳化联合小梁切除术中的应用

目的 探讨兔眼超声乳化小梁切除术中联合应用成品生物羊膜和晶状体前囊膜的疗效.方法 将24只新西兰大白兔随机分为A、B、C三组,每组各8只,随机选取每组兔的单眼行白内障超声乳化联合小梁切除术,A组术中植入成品生物羊膜,B组术中植入晶状体前囊膜,C组术中无植入物.术后1d、7d、14 d、28 d观察眼前节反应及功能性滤过泡形成情况,并测量术眼眼压,光学显微镜下观察滤过道情况.结果 A组、B组、C组术后眼压均较术前明显下降,之后逐渐升高,三组术后7d、14 d、21d眼压比较,差异有统计学意义(P＜0.05).而A、B组相比较,羊膜降眼压效果较好,两组术后7 d(7.17±0.22) mm-Hg、(7.79 ±0.16) mmHg(1 kPa=7.5 mmHg)、14 d(7.54±0.47)mmHg、(8.76±0.81) mmHg、21 d(11.81±0.74) mmHg、(14.03±0.25) mmHg眼压比较,差异均有统计学意义(均为P＜0.05).三组术后不同时间点的前房反应眼数及滤过泡类型的眼数比较:A、B组术后1d、3d、7d、14d前房反应眼数均较C组多,三组差异无统计学意义(P＞0.05)；A组、B组术后1d、7d、14 d、21 d功能性滤过泡的数量较C组多,三组比较差异无统计学意义(P＞0.05).三组术后早期滤过道均通畅.有功能滤过泡的维持和植入物有关,术后28 dA、B组滤过道均完全开放,A组成纤维细胞少,但有炎性细胞浸润,B组可见囊膜边缘变钝,未见淋巴细胞浸润,C组术区可见瘢痕组织填塞滤过道.结论 兔眼白内障超声乳化联合小梁切除术中应用成品生物羊膜、晶状体前囊膜均能安全、有效降低眼压,抑制或减轻术后滤过道的瘢痕化,而成品生物羊膜降眼压效果较好.     

羊膜与SK GEL生物胶在兔非穿透性小梁切除术中的应用

目的探讨保存人羊膜组织、sKGEL生物胶（交键透明质酸钠凝胶）在兔非穿透性小梁切除术中抗瘢痕化的安全性及有效性。方法新西兰白兔18只，随机分为A、B、c3组，每组各6只，每组兔的单眼行非穿透性小梁切除术。A组术中植入羊膜，B组术中植入SKGEL生物胶，C组术中无植入物。观察各组滤过泡的形态、内部结构及维持时间。结果A、B组滤过泡的形态及维持时间均优于c组。病理切片显示滤过空腔的保持与植入物有关，术后12周时A、B组眼空腔仍维持较好．c组眼瘢痕形成明显。结论保存人羊膜、SKGEL生物胶在兔非穿透性小梁切除术中应用均可减轻手术区滤过腔瘢痕的形成，安全有效。[眼科新进展2007；27（2）：106—109]     

丝裂霉素C缓释系统辅助兔青光眼滤过性手术的研究

目的研究丝裂霉素C缓释系统（MMC DDS）对兔眼滤过性手术后抗瘢痕形成的疗效。方法24只大白兔双眼行小梁切除术,所有兔右眼术中植入MMC DDS1粒,为实验组,左眼随机选择12只眼术中植入空白缓释系统1粒,另外12只眼术中应用0.2mg/ml MMC棉片。结果实验组维持了较长时间的低眼压水平,术后全程平均滤过泡得分及持续时间明显高于空白对照组。术后7-14d房水中的MMC保持了一个有效药物质量浓度的平台。组织病理学显示实验组滤过道部位炎性细胞及成纤维细胞明显受到抑制。免疫组织化学显示MMC DDS抑制了滤过手术后手术部位成纤维细胞PCNA（增生细胞核抗原）的表达。结论MMC DDS能有效抑制滤过性手术后的炎症反应及成纤维细胞的增生。     

青光眼小梁切除术中应用生物羊膜与丝裂霉素治疗的观察

目的观察生物羊膜与丝裂霉素C(MMC),应用于青光眼小梁切除术中治疗青光眼的临床疗效。方法随机选择39例(48只眼),分为羊膜组(22只眼)和丝裂霉素组(26只眼)。羊膜组施行小梁切除术联合巩膜瓣下生物羊膜植入术,丝裂霉素组施行小梁切除术联合巩膜瓣下放置丝裂霉素C,浓度为0.25 mg/ml,时间2分钟,术后随访3-9月,比较两种手术方式的临床疗效。结果术后与术前相比:两组眼压均明显降低。术后并发症:羊膜组副反应小,引起的并发症主要有术后浅前房;丝裂霉素组引起的并发症主要有滤过泡渗漏、低眼压等。结论小梁切除联合生物羊膜植入术可有效地减少瘢痕组织形成,且并发症较丝裂霉素少,是治疗青光眼安全、有效的手术方法。     

兔眼小梁切除术中植入改良型双层羊膜的实验研究

目的 探讨改良型双层羊膜植入对青光眼小梁切除术后手术成功率的影响.方法 随机选取日本大耳兔18只36眼,术中双眼均行小梁切除术,右眼巩膜瓣层间植入生物羊膜(单层)为单层羊膜组,左眼术中将生物羊膜折叠后双层包裹巩膜瓣(上皮面背对巩膜瓣)为双层羊膜组,观察2组术后第3天、第7天、第14天、第30天、第60天兔眼眼压、滤过泡形态、滤过泡维持时间、前房深度等指标.结果 术后第7天单层羊膜组眼压为( 8.36±1.56) mmHg(1 kPa=7.5 mmHg),双层羊膜组眼压为(6.74±1.16) mmHg,2组比较差异有显著统计学意义(P=0.001);术后第14天单层羊膜组眼压为(10.27±2.42) mmHg,双层羊膜组眼压为(7.97±1.48) mmHg,2组比较差异也有显著统计学意义(P =0.002).术后第7天、第14天双层羊膜组眼压控制较单层羊膜组更理想.术后第30天双层羊膜组功能性滤过泡形成率为61.1％,明显高于单层羊膜组的27.8％,2组比较差异有统计学意义(x2=4.050,P ＜0.05).2组术后并发症比较无明显差异.结论 改良型双层羊膜植入方法较单层植入方法在不改变手术方式、不增加手术成本的前提下,进一步提高了小梁切除术的成功率.     

Glaucoma filtration surgery using amniotic membrane transplantation.

PURPOSE. To investigate the potential use of amniotic membrane transplantation (AMT) in the construction of glaucoma filtering blebs. METHODS. Twenty-four albino rabbits underwent glaucoma filtration surgery in one eye. In alternate cases, the conjunctival flap was replaced with AMT. Postoperative examination data were grouped into three time points. Six animals with AMT and six filtration surgery-controls were euthanatized at each of two postoperative time points, and tissue was obtained for histologic examination. Conjunctival biopsies were explanted for estimation of fibroblast outgrowth. RESULTS. Bleb formation was observed in all eyes, and amniotic membranes were epithelialized after 11.2 +/- 2.48 (mean +/- SD) days. Throughout the study IOPs were significantly lower in operated than unoperated fellow eyes. Between postoperative days 11 and 16 (the middle time point), the percentage IOP reduction in AMT eyes was significantly greater than in filtration surgery controls (P = 0.014), though not at other time points. Filtration surgery survival was significantly longer in the AMT group (22.3 +/- 3.8 days; mean +/- SE) than in "No AMT" controls (14.0 +/- 1.6 days; P = 0.035). In tissue culture, significantly less fibroblast outgrowth occurred from AMT explants when compared with unoperated conjunctiva (P = 0.01) between postoperative days 3 and 9 (the early time point). Amniotic membrane transplants were intact on histologic examination after 14 days but were associated with considerable granulomatous inflammation. After 36 days, the ocular surfaces remained clinically intact, but lysis of AMT was noted histologically. CONCLUSIONS. AMT exhibits potential as an alternative tissue to conjunctiva in the construction of glaucoma filtration blebs. The healing response as demonstrated by fibroblast outgrowth is retarded when compared with conventional conjunctival closure. The improvement in bleb survival must be weighed against the potential for complications related to delayed healing. In rabbits, human amniotic membrane elicited a late xenograft reaction, leading to granulomatous inflammation and dissolution of the membrane.     

Effects of octreotide acetate and amniotic membrane on wound healing in experimental glaucoma surgery

Wound healing affects the success of glaucoma filtering surgery. Antimetabolites and antifibrotic agents are used in the modulation of surgical trauma. This study is performed to evaluate the effects of amniotic membrane and octreotide acetate on wound healing . Thirty pigmented rabbits were divided into three groups each including 10 animals. Trabeculectomy and topical postoperative prednisolone sodium phosphate four times daily for 7 days were applied to one eye of all the rabbits. After trabeculectomy, octreotide 10 g three times daily applied topically to the octreotide group for 14 days and amniotic membrane transplantation was performed by suturing amniotic membrane between scleral flap and sclera to the amniotic membrane group. The operated eyes of the rabbits were enucleated on the 14th day of the operation and histopathological specimens were obtained from the bleb sites and they were evaluated by light microscope. Fibroblast and macrophage number per cm² were counted and the average values were calculated. Compared with the control group, the fibroblasts and macrophages significantly decreased in the other two groups (p < 0.0001, p < 0.0001, respectively). The mean number of fibroblasts was lower than those of the control and amniotic membrane groups (p < 0.0001, p < 0.0001, respectively). Similarly the mean macrophage number was significantly lower in the octreotide group versus the control and amniotic membrane groups (p < 0.0001, p < 0.01, respectively). Octreotide administration and amniotic membrane transplantation might be alternative treatments in modulating the wound healing after trabeculectomy.     

非穿透性滤过手术联合羊膜移植的实验研究

探讨羊膜移植在兔眼非穿透性滤过手术中的抗瘢痕化作用及其毒副作用。方法 :选取新西兰白兔 15只 ,双眼行非穿透性滤过手术 ,术中随机选取一眼联合羊膜移植。术后观察术眼眼内反应、滤过泡形态和功能 ,并行角膜内皮活性染色、眼球组织切片及滤过区组织学检查。结果 :实验组术后第 10天时 ,全部术眼可见弥散隆起的滤过泡 ,第 14天时 ,滤过泡存留有 6眼 ;对照组术后 5～ 7天开始出现滤过区局限 ,第 10天时仅有 3眼存留滤过泡 ,第 14天仅有 1眼 ,差异有统计学意义。实验组组织学检查显示滤过区纤维组织形成少 ,但局部有炎症细胞浸润。对照组滤过区见大量纤维瘢痕组织形成。所有术眼前房反应轻微 ,角膜内皮活性染色及眼球组织切片未见异常。结论 :羊膜组织对兔眼非穿透性滤过手术有抗瘢痕形成作用 ,且对兔眼组织无毒副反应。     

引流管植入联合羊膜移植和Molteno植入物治疗角膜移植术后青光眼的研究

目的：探讨房水引流管植入联合羊膜移植对角膜移植术后难治性青光眼的治疗作用。方法：应用α－糜蛋白酶行兔眼后房注射制备青光眼动物模型,把它们随机分为照组、单纯引流管植入组、引流管植入加羊膜移植组、引流管加羊膜支架植入联合羊膜移植组,观察眼内压、管周组织学改变、引流管周组织渗透性,并且比较各治疗组对难治性青光眼的疗效。临床上４１例（４２眼）穿透性角膜移植术后青光眼进行了房水引流管植入联合羊膜移植１２眼和     

三种不同术式治疗复发性翼状胬肉的疗效观察

目的:评价羊膜移植、自体角膜缘干细胞移植、羊膜移植联合自体角膜缘干细胞移植3种不同术式治疗复发性翼状胬肉的效果。方法:将127例127眼复发性翼状胬肉患者随机分为A,B,C三组,采用不同手术方式。其中A组45例45眼行羊膜移植术;B组40例40眼行自体角膜缘干细胞移植术;C组42例42眼行羊膜移植联合自体角膜缘干细胞移植术。术后随访12～24mo,分析对比3种不同术式的手术复发率。结果:A组10眼复发,复发率为22.2%;B组9眼复发,复发率为22.5%;C组3眼复发,复发率为7.1%。A组与B组比较差异无统计学意义,C组与A,B组比较有显著性差异(P<0.05)。结论:羊膜移植联合自体角膜缘干细胞移植术治疗复发性翼状胬肉术后复发率最低,是治疗复发性翼状胬肉较为理想的手术方式,值得临床推广应用。     

羊膜对兔眼小梁切除术后滤过泡的影响

目的探讨羊膜对小梁切除术后滤过泡的影响。 方法对12只新西兰白兔双眼行小梁切除术,术中l眼于巩膜和巩膜瓣间放置6mm×4mm的羊 膜植片,另一眼作为对照。术后1周、2周、3周检查滤过泡形态和功能,光镜下观察滤过泡下巩膜 表面瘢痕形成情况。 结果实验组术后1、2、3周滤过泡轻微隆起弥散,有较好的滤过功能,对照组术后2、3周滤过泡 区瘢痕形成,滤过功能差。组织切片观察显示实验组滤过泡未形成瘢痕,成纤维细胞少,但有炎性 细胞浸润;对照组滤过泡区被增生的纤维组织所代替,成纤维细胞丰富。 结论羊膜能改善滤过泡功能,减少瘢痕形成。眼科学报2000;1673-76。     

Inhibitory effect of biopolymer materials on scar formation following trabeculectomy

AIM: To investigate the inhibitory effects of amniotic membrane, polylactic acid membrane and chitosan membrane on scar formation following trabeculectomy. METHODS: A total of 24 New Zealand white rabbits (48 eyes) were randomly divided into 4 groups: amniotic membrane group, polylactic acid membrane group, chitosan membrane group, and control group, with 6 rabbits (12 eyes) in each group. The left eyes underwent routine trabeculectomy, and the right eyes were considered as controls. Amniotic membrane, polylactic acid membrane and chitosan membrane were respectively installed under sclera flap in three groups, but any treatment was not applied in control group. Intraocular pressure, conjunctival filtering bleb, and anterior chamber inflammation responses were monitored at day 1, 3, 7, 14, 28 and 56 post-operatively. Eyeball tissue underwent histopathological examination at day 56 post-operatively. RESULTS: Fibrocytes and inflammatory cells were reduced in amniotic membrane, polylactic acid membrane and chitosan membrane groups compared to that in control group. At day 1 post-operatively, intraocular pressure was decreased in three membrane groups compared to that in control group. At day 14 post-operatively, the intraocular pressure was decreased significantly, while it of three membrane groups was significantly lower than that of preoperative (P<0.01). There were no significant differences among three membrane groups (P>0.05). Filtering bleb of four groups was clearly observed at day 7 post-operatively, but there was no significant difference in pair-wise comparison. At day 28 and 56 post-operatively, filtering bleb in control group was significantly narrowed compared to that in three membrane groups (P<0.05), but there was no significant difference in pair-wise comparison of three membrane groups. CONCLUSION: All amniotic membrane, polylactic acid membrane and chitosan membrane can effectively inhibit scar formation following trabeculectomy, the effect of amniotic membrane is the best.