Biocompatibility of an x-shaped zirconium implant in deep sclerectomy in rabbits

Background The aim of this study was to evaluate the mid-term biocompatibility of a new x-shaped implant made of zirconium in an animal model of glaucoma surgery. Methods Preoperatively, ultrasound biomicroscopy (UBM), intraocular pressure (IOP) and outflow facility (OF) data were acquired. Upon surgery, one eye was chosen randomly to receive an implant, while the other received none. Ten rabbits went through a 1-, 2-, 3-, 4- and 6-month follow-up. IOP was measured regularly, UBM performed at 1, 3 and 6 months after surgery. At the end of the follow-up, OF was again measured. Histology sections were analyzed. Results For both groups IOP control was satisfactory, while OF initially increased at month 1 to resume preoperative values thereafter. Eyes with implants had larger filtration blebs which decreased faster than in eyes without the implant. Drainage vessel density, inflammatory cell number and fibrosis were higher in tissues near the implant. Conclusions The zirconium implant initially promoted the positive effects of the surgery (IOP control, OF increase). Nevertheless, after several months, foreign body reactions and fibrosis had occurred on some implants that restrained the early benefit of such a procedure. Modifications of the zirconium implant geometry could enhance the overall success rate. With the financial support of the Swiss National Science Foundation N° 32–64103.00     

国产房水引流置入物治疗顽固性青光眼近期疗效观察

目的 观察国产引流置人物治疗顽固性青光眼的疗效.方法 对10例顽固性青光眼施行颞上象限或颞下象限到赤道部区域的国产HAD房水引流物置人术.结果 术后半年以上由术前眼压46.6±4.5 mmHg,下降至19.75±5.78 mmHg,总成功率为70%.并发症有短暂性前房出血,术后早期低眼压引流管过长或过短.结论 国产HAD房水引流物置入术较为经济,是治疗难治性青光眼的一种有效方法之一.     

原发性开角型青光眼房水外流通路改变的研究进展

原发性开角型青光眼(POAG)是一种以视神经轴索及相关视网膜神经节细胞丢失为特征的视神经病变.眼压升高是POAG最重要的危险因素.大多数POAG患者眼压升高主要是房水外流阻力异常增高所致.小梁网是产生房水排出阻力的主要部位.目前多数研究者认为POAG患者小梁网功能不良与致炎因子表达、细胞老化、氧化应激损伤及细胞质成分减少等因素有关.小梁网细胞本身及细胞外基质的变化均可以引起房水外流阻力的改变,进而导致眼内压的升高.为了进一步开展对POAG发病机制的研究,有必要就目前有关POAG患者房水外流通路改变的研究进展予以综述,旨在为POAG的深入研究提供参考依据.     

单纯性非穿透小梁切除手术与穿透小梁切除手术的比较

目的 对单纯性非穿透小梁切除手术(即不联合植入物)与穿透性小梁切除手术(即传统的小梁切除术)术后早期的降眼压效果及并发症进行比较。方法 共选取33例青光眼患者(47只眼)，包括开角型青光眼28例(39只眼)，慢性闭角型青光眼5例(8只眼)。其中16例(24只眼)接受穿透性小梁手术，17例(23只眼)接受单纯性非穿透小梁手术。比较两组的年龄、术前眼压、术前视力及术前术后眼压、视力的变化幅度，两组术中及术后的并发症发生情况。结果 两组间年龄、术前眼压及术前视力经统计学检验均无显著性差异，两组的术前术后眼压自身比较均有极显著性差异，术前术后眼压下降的幅度两组间无显著性差异；至于术中及术后早期的并发症，单纯性非穿透小梁手术组明显减少。结论 单纯性非穿透小梁手术术后早期的降眼压效果与穿透性小梁手术相当，但安全性明显提高。     

Biomechanics of Schlemm's canal endothelium and intraocular pressure reduction

Ocular hypertension in glaucoma develops due to age-related cellular dysfunction in the conventional outflow tract, resulting in increased resistance to aqueous humor outflow. Two cell types, trabecular meshwork (TM) and Schlemm's canal (SC) endothelia, interact in the juxtacanalicular tissue (JCT) region of the conventional outflow tract to regulate outflow resistance. Unlike endothelial cells lining the systemic vasculature, endothelial cells lining the inner wall of SC support a transcellular pressure gradient in the basal to apical direction, thus acting to push the cells off their basal lamina. The resulting biomechanical strain in SC cells is quite large and is likely to be an important determinant of endothelial barrier function, outflow resistance and intraocular pressure. This review summarizes recent work demonstrating how biomechanical properties of SC cells impact glaucoma. SC cells are highly contractile, and such contraction greatly increases cell stiffness. Elevated cell stiffness in glaucoma may reduce the strain experienced by SC cells, decrease the propensity of SC cells to form pores, and thus impair the egress of aqueous humor from the eye. Furthermore, SC cells are sensitive to the stiffness of their local mechanical microenvironment, altering their own cell stiffness and modulating gene expression in response. Significantly, glaucomatous SC cells appear to be hyper-responsive to substrate stiffness. Thus, evidence suggests that targeting the material properties of SC cells will have therapeutic benefits for lowering intraocular pressure in glaucoma.     

人眼小梁细胞体外培养及传代实验

目的探索体外培养人眼小梁细胞的方法,为进一步研究原发性开角型青光眼的发病机理提供实验的依据。方法用器官培养及组织块培养两种方法,进行人眼小梁细胞的原代培养和传代实验,并同时对照培养人眼巩膜成纤维细胞,对二者从形态学上进行比较。结果（１）器官培养较单纯组织块培养更易获得原代小梁细胞;（２）传３～５代人眼小梁细胞处于最稳定阶段,可利用此阶段细胞进行多种体外实验。结论体外培养人眼小梁细胞可获得生长形态及特征稳定的小梁细胞。     

Measurement of episcleral venous pressure

Episcleral venous pressure (EVP) is an important determinant of intraocular pressure (IOP) and can be measured by using various techniques. It has been measured non-invasively by estimating the pressure required to compress an episcleral vein to a predetermined endpoint. However, the lack of objective endpoints makes EVP measurement in humans uncertain, and a wide range of mean EVP has been reported in the literature. We review the evidence for physiologic regulation of EVP and its role in glaucoma therapy, techniques that have been used to measure EVP and the need for objective measurements, and reported values for EVP. We also review recent progress toward developing an objective technique for EVP measurement.     

非穿透性小梁手术联合透明质酸生物胶植入术的疗效

目的 研究非穿透性小梁手术联合透明质酸生物胶植入术治疗开角型青光眼的手术效果及有效的降压机制。方法 将临床接治的19例(28只眼)开角型青光眼行非穿透性小梁手术联合透明质酸生物胶植入术,术后观察眼压、结膜滤枕及前房反应等情况,随访6～24个月。结果 28只眼术前平均眼压(23.92±1.26)mmHg,下降幅度36.33％,差异有显著性(P＜0.01),24只眼结膜形成功能性滤过泡,4只眼功能性滤过泡消失。28只眼均无前房出血,术后前房反应轻。结论 非穿透性小梁手术联合透明质酸生物胶植入术能有效地降低开角型青光眼的眼压,术后并发症少,可做为此类青光眼病人手术的选择。     

Effects of Trabecular Meshwork Width and Schlemm’s Canal Area on Intraocular Pressure Reduction in Glaucoma Patients

PurposeTo evaluate the effects of baseline trabecular meshwork (TM) and Schlemm’s canal (SC) microstructures on intraocular pressure (IOP) reduction amount in treatment-naïve patients with primary open-angle glaucoma (POAG).MethodsA total 69 eyes of POAG patients who had not been treated with IOP-lowering agent were enrolled in this retrospective study. The patients had been prescribed topical IOP-lowering agent and used it for 1 year. The morphologic features of the TM and SC were collected using anterior segment module of spectral-domain optical coherence tomography with enhanced depth imaging at baseline. Images of the nasal and temporal corneoscleral limbus were obtained with serial horizontal enhanced depth imaging B-scans and TM width and SC area were measured in each scan. We investigated the effects of baseline TM and SC microstructures on IOP reduction amount.ResultsThe baseline IOP of 69 glaucomatous eyes was 17.9 ± 3.8 mmHg, and the mean amount of IOP reduction was 3.5 ± 2.1 mmHg after 1 year. Mean TM widths of nasal and temporal sector were 470.33 ± 80.05 and 479.74 ± 79.59 μm, respectively. SC area was measured as 4,818.50 ± 1,464.28, 4,604.23 ± 1,567.73 μm² at nasal sector and temporal sector, respectively. The correlation analysis revealed a positive correlation between SC area and average amount of IOP reduction, indicating that the larger baseline SC area, the greater the IOP drop with topical IOP-lowering agents. However, no correlation was found between TM width and IOP lowering amount in patients with POAG.ConclusionsThe baseline SC area showed positive correlation with the IOP reduction amount in patients with POAG. This finding suggests that the SC area can be a clinical parameter to predict the IOP reduction amount before using IOP-lowering agents in POAG patient.     

Excimer laser trabeculotomy: a new, minimally invasive procedure for patients with glaucoma

Background Excimer laser trabeculotomy (ELT) ab interno is a new surgical technique to reduce intraocular pressure (IOP) in patients with glaucoma or ocular hypertension. Our purpose was to examine IOP reduction and the use of antiglaucoma drugs (AGD) in patients treated with ELT and to evaluate the safety of this laser treatment.Methods To increase the outflow of aqueous humor, ten microperforations of the trabecular meshwork were performed by an endoscope-guided photoablative laser probe (Excimer laser, AIDA, TUI-Laser, Munich; pulse energy: 1.2 mJ at fiber tip, pulse duration: 60 ns, repetition rate: 20 Hz). Average operation time usually was about 2 min. In our pilot study, one group of patients without cataract underwent ELT, the other group with cataract underwent phacoemulsification (PHACO) plus ELT. IOP, visual acuity, and AGD were determined preoperatively (T0) and 2–4 months (T1), 5–7 months (T2), 11–13 months (T3), and 22–26 (T4) months after surgery. Treatment was defined to be successful if (1) postoperative IOP was ≤21 mmHg, and (2) IOP reduction was at least 20%.Results ELT reduced the IOP from 24.1±0.7 (n=69) mmHg preoperatively to 18.8±0.4 (T1, n=66), 20.0±0.5 (T2, n=51), 18.8±0.8 (T3, n= 37), and 16.8±1.0 (T4, n=15) mmHg, respectively. However, 28% of the eyes needed repeat surgery due to insufficient IOP reduction. According to Kaplan-Meier statistics, the success rate was 60% (T1), 49% (T2), and 46% (T3), respectively. The number of AGD was 1.9±0.1 (T0), 1.2±0.2 (T1), 1.3±0.2 (T2), 1.8±0.2 (T3), and 1.5±0.3 (T4). Combined phacoemulsification plus ELT reduced the IOP from 22.4 mmHg±0.6 (T0, n=57) to 16.5±0.4 (T1, n=52), 16.1±0.5 (T2, n= 40), 16.4±0.4 (T3, n= 35), and 12.8±1.5 (T4, n=4) mmHg, respectively; 7% of the eyes treated with the combined procedure needed repeat surgery due to insufficient IOP reduction. According to Kaplan-Meier statistics, the success rate was 85% (T1), 74% (T2), and 66% (T3), respectively. The number of AGD was 1.1±0.2 (T0), 0.9±0.2 (T1), 1.1±0.2 (T2), 1.2±0.2 (T3), and 1.8±0.9 (T4).Conclusions ELT, especially in combination with phacoemulsification, is a new, promising, minimally invasive laser treatment to reduce IOP for at least 1–2 years. ELT alone is less effective in IOP reduction.The authors have no proprietary interest in the techniques used. This study was presented at the 102nd. meeting of the Deutsche Ophthalmologische Gesellschaft (DOG), Berlin, 2004.     

米非司酮对培养的牛眼小梁细胞糖胺多糖代谢的影响

为了从发病学角度研究和发掘治疗青光眼的药物，在体外培养新生牛小梁细胞至第３代，掺入米非司酮（１１β－Ｉ４－（Ｎ，Ｎ－二甲胺基）苯基Ｊ－４，９－雌甾二烯－１７ａ－（１－丙炔）－１７β－羟基－３－酮，以下按国际贯例简称ＲＵ４８６）５０、１００、２００、４００ｕｇ／ｍｌ培养液和３Ｈ－葡萄糖胺，分离提纯后用乙酸纤维薄膜电泳、酶分解及液体闪烁等于手段测定生成的糖胺多糖（ｇｌｙｃｏｓａｍｉｎｏｇｌｙｃａｎｓ，     

原发性开角型青光眼非穿透小梁手术患者深层巩膜瓣及小梁膜的病理学观察

目的 研究原发性开角型青光眼患者(POAG)非穿透小梁手术的解剖学基础,探讨POAG患者房水外流的阻力部位及其病理改变。方法 选择行非穿透小梁手术的POAG患者12例(18只眼),取术中切除的深层巩膜瓣及撕除的外层小梁膜进行光镜、扫描电镜及透射电镜观察。结果 光镜观察标本见：深层巩膜瓣前端为少许深层角膜基质,并可见Schlemm管外壁单层内皮细胞。扫描电镜观察见：深层巩膜瓣内侧可见被打开的Schlemm管管腔和狭长的积液管开口;撕除膜小粱面可见角巩膜小粱的网状结构,排列致密,网眼较小,近管腔侧呈致密的板状结构。透射电镜观察见：Schlemm管外壁周围散在高电子密度物质;撕除膜包括Schlemm管内壁,邻管组织(内皮网)和部分角巩膜小梁,邻管组织细胞减少,细胞外基质增多,可见大量致密斑块沉积;角巩膜小粱网胶原板层结构增厚,弹力纤维增多,细胞体积增大,尤以细胞核增大明显。晚期患者的角巩膜小梁网内有致密斑块沉积,阻塞了小梁间隙。结论 非穿透小梁手术的深层巩膜瓣包括Schlemm管外壁,撕除膜包括邻管组织和部分角巩膜小梁。邻管组织和部分角巩膜小梁是POAG患者房水外流的主要阻力部位,同时Schlemm管外壁也是其重要构成部分。     

葡萄糖对POAG患者小梁网细胞凋亡的影响

目的探讨不同浓度葡萄糖对POAG患者小梁网细胞凋亡的影响,研究葡萄糖与POAG以及糖尿病与POAG之间的关系,进一步探讨POAG的发病机制。方法实验研究。采用组织块培养法原代培养POAG患者小梁网细胞,取传代的小梁网细胞分别加入含葡萄糖终浓度为0.0（对照组）、5.5、45.0 mmol/L的无血清培养基,分别培养48 h后,采用CCK-8和流式细胞仪法检测不同浓度葡萄糖对小梁网细胞的影响。数据采用单因素方差进行分析。结果通过CCK-8检测发现,随着浓度的增加,葡萄糖对小梁网细胞的增殖抑制作用增强,可促进细胞凋亡,且各实验组与对照组之间相比差异有统计学意义（F=13.87,P＜0.01）;通过流式细胞仪法检测葡萄糖浓度为5.5、45.0 mmol/L实验组小梁网细胞凋亡率分别为10.65%±0.03%、25.74%±0.02%,均高于对照组（4.02%±0.03%）,且差异有统计学意义（F=25.34,P＜0.01）。结论高糖可以使小梁网细胞的增殖能力下降,凋亡率增加,从而可能导致小梁网细胞网状结构改变,房水流出途径的阻力增加。     

正常人和原发性开角型青光眼患者小梁网M3受体的表达

目的 研究正常人和晚期原发性开角型青光眼（primary open angle glaucoma,POAG）患者小梁网M3受体的表达,探讨POAG患者小梁网的病理生理改变。方法 取5例正常人及10例晚期POAG患者小梁网组织标本,应用免疫组化方法检测小梁细胞M3受体,并利用计算机图像分析系统对检测结果进行分析。结果 5例正常人的小梁网组织标本的M3受体表达,阳性细胞主要分布在葡萄膜小梁网处,前至Schwalbe线,后达巩膜突。晚期POAG患者小梁网组织标本中,小梁细胞数量明显减少,M3受体阳性细胞亦相应减少且散在分布,部分标本甚至无阳性M3受体表达。结论 正常人小梁网细胞M3受体表达阳性,晚期POAG患者小梁网M3受体阳性细胞数量明显减少且分布不规则。     

兔外周血淋巴细胞和小梁组织中糖皮质激素受体与激素性青光眼关系的研究

目的检测兔外周血淋巴细胞和小梁组织中糖皮质激素受体(GR)含量并探讨其与激素性青光眼的关系。方法隔日给兔眼球结膜下注射地塞米松1个月,制作糖皮质激素性高眼压模型。实验前后采用3H地塞米松放射配体法,测定兔外周血淋巴细胞与小梁细胞GR数目,探讨其两者间的关系,比较初始GR含量和GR表达的变化与高眼压的关系。结果兔外周血淋巴细胞和小梁细胞均表达GR,淋巴细胞GR表达水平为(3642±947)位点/细胞,小梁细胞GR含量为(2437.85±733.93)dmp/mg,两者表达水平呈正相关(r=0.862,P<0.01)。3H地塞米松处理组,兔外周血淋巴细胞中GR受体数量下降,眼压升高。实验前与实验后兔外周血淋巴细胞中GR数量变化与眼压升高的程度呈正相关(r=0.78,0.79;P<0.01)。结论外周血淋巴细胞中GR数量可间接反映小梁细胞的GR水平,与糖皮质激素性青光眼的发病密切相关。     

生物膜在小梁切除术中防止滤过泡粘连的实验研究

目的 研究生物膜在实验性小梁切除术中防止滤过道粘连的作用。方法 将生物膜植入家兔小梁切除术的巩膜瓣及结膜瓣下，同一只家兔的另一只眼术中未植入生物膜作为对照眼，进行滤过泡，眼压及组织学观察。结果 （１）创伤后的修复过程于术后２～３周达到高峰，而生物膜要术后６周以后开始吸收，生物膜与瘢痕组织间不发生紧密粘连，从而保持滤过道通畅，（２）术后２～７周实验组功能性滤过存留比率明显高于对照组（Ｐ〈０．０５），     

原发性开角型青光眼小梁细胞的体外培养及其生物学特性

背景原发性开角型青光眼（POAG）是一种常见致盲性眼病,其特点是房水外流阻力增加导致眼压增高。位于房水外流通道的小梁网调节房水的外流,因此研究小梁网细胞的生物学特性有着重要的意义。目的探讨POAG小梁细胞体外培养的方法及其生物学特性。方法经小梁切除术收集8例开角型青光眼患者患眼的带小梁网的深层巩膜组织块进行体外原代和传代培养,用鼠抗人层黏连蛋白（LM）单克隆抗体、兔抗人纤维连结蛋白（FN）单克隆抗体、鼠抗人神经元特异性烯醇化酶（NSE）单克隆抗体进行免疫组织化学检测以对传代细胞进行鉴定,在透射电子显微镜下对传代细胞的超微结构进行观察,并将传代小梁细胞的生物学特性与本研究组前期培养的正常小梁细胞进行比较。结果组织块培养10d左右,可见细胞从其边缘向外生长。传代细胞在4d内处于对数生长期,其后进入平台期,第7天细胞基本融合。第3代POAG小梁细胞及正常人眼小梁细胞中可见FN、LM和NSE均呈阳性表达,证实传代细胞为小梁细胞,而空白对照组细胞未见FN、LM和NSE表达。第3代POAG小梁细胞和正常小梁细胞中FN的A450值分别为0．354±0．06和0．26±0．01,LM的A450值分别为0．34±0．03和0．25±0．02,差异均有统计学意义（FN：t=14．446,P=0．001;LM：t=9．346,P=0．001）。与正常小梁细胞比较,第3代POAG小梁细胞表面的微绒毛、细胞质的溶酶体及吞噬小泡含量减少。结论采用组织块培养法可成功在体外培养POAG小梁细胞,该研究结果为研究青光眼的发病机制提供了细胞学基础。     

非穿透性小梁切除术联合人羊膜植入临床观察

目的：观察非穿透性小梁切除术联合人羊膜植入的临床效果。方法：对18例（30眼）中、晚期开角型青光眼进行非穿透性小梁切除术联合人羊膜植入，术后观察视力、视野、眼压及滤过泡形成情况。结果：术后随访3－9月，视力、视野稳定，眼压≤20mmHg(1mmHg=0.133kPa)，滤过泡形成良好，并发症少。结论：非穿透性小梁切除术 联合人羊膜植入治疗开角型青光眼，能有效降低眼压，形成功能性滤过泡和并发症少等优点，是治疗开角型青光眼较理想的方法。