兔眼滤过性手术中植入硅凝胶膜的实验研究(英文)

目的:在兔眼行硅凝胶膜植入后,通过观察眼内压、滤过泡、病理组织检查结果评价硅凝胶膜植入的安全性和有效性。方法:共40只兔随机分为4组,每组10只。每只兔一眼行巩膜瓣下小梁咬切术,术中植入硅凝胶膜,对侧眼单纯行巩膜瓣下小梁咬切术作为对照。术后观察眼内压、滤过泡的变化,并且每只眼行组织病理学检查。结果:植入眼较对照眼低眼压和滤过泡维持时间长,光镜显示植入眼滤过道、咬切口区保持通畅。成纤维细胞增殖的活性与规律,在植入眼和对照眼是相似的。硅凝胶膜不会刺激成纤维细胞增殖的过度表达。结论:硅凝胶膜植入术作为一种新型引流术具有安全、有效、操作简单的优点。     

羊膜对兔眼滤过道成纤维细胞活性的抑制作用

目的:应用细胞增殖指标核仁组成区相关嗜银蛋白(AgNORs),研究兔眼滤过道成纤维细胞(Fb)增殖规律及羊膜的抗增殖作用,并对其临床意义进行探讨。方法:模仿人眼滤过手术方式行兔眼巩膜瓣下巩膜咬切术,切开前房前巩膜瓣下植入5mm×6mm大小的羊膜,术后1,2,3,4wk取兔眼滤过道标本,作AgNORs及HE染色,比较羊膜眼和对照眼FbAgNORs染色颗粒数量、眼压、滤过泡变化。结果:不同手术区羊膜眼FbAgNORs颗粒数显著低于对照眼,羊膜抑制率为10.8%～59.5%,羊膜眼眼压低于对照眼,术后3,4wk差异有显著性;羊膜眼滤过泡保持时间1～4wk,对照眼为1～2wk。结论:羊膜可以有效抑制滤过道Fb的增殖活性、延长眼压下降和滤过泡保留时间。     

羊膜植入联合丝裂霉素C治疗顽固性青光眼探讨

目的：探讨同种异种羊膜植入联合丝裂霉素C手术治疗顽固性青光眼的疗效。方法：对21例（22只眼－小梁切除术中巩膜瓣及结膜瓣下置丝裂霉素C浸泡棉片后,将羊膜植入巩膜床，并观察术后阻止瘢痕性滤过泡形成的效果及降眼压作用。结果：22只眼中，形成功能性滤过泡19只眼，无功能滤过泡3只眼，术后降眼压效果良好。结论：羊膜植入联合丝裂霉素C能有效防止小梁切除术后滤过道瘢痕形成，用于治疗顽固性青光眼切实用效。     

几丁糖膜在兔实验性小梁切除术后抗瘢痕作用研究

目的几丁糖制成膜状对兔实验性小梁切除术滤过泡作用。方法兔30只，双眼均行常规小梁切除术，每只兔随机选取1只眼为实验眼，植入几丁糖膜，另1只眼为对照眼，行常规小梁切除术不植入几丁糖膜。术后观察眼压，成纤维细胞计数，Kaplan—Meier分析法统计术后滤过泡情况。结果（1）眼压：实验组术后1、2、4周眼压与术前相比差异有统计学意义，第5周开始眼压与术前相比差异无统计学意义。对照组术后1周与术前相比差异有统计学意义，第2周开始眼压与术前相比差异无统计学意义。术后1～4周，6周，8周，12周实验驵与对照组眼压相比差异有统计学意义，实验组低于对照组，第5周差异无统计学意义。（2）实验组滤过泡存留时间与对照组相比差异有统计学意义。（3）成纤维细胞计数：1、2、6、12周实验组与对照组差异有统计学意义（t=-5．541，-5．713，-5．499，-3．063，P〈0．05），3周差异无统计学意义。（4）光镜下实验组1～3周均可见滤过道通畅，几丁糖膜呈均质状，6周滤过道部分阻塞，12周时闭合。对照组第3周开始滤过道消失。结论兔小梁切除术后应用几丁糖膜能抑制成纤维细胞生长，降低眼压，延长滤过泡存留时间。     

复合式小梁切除术联合巩膜瓣下羊膜植入治疗难治性青光眼

目的 观察复合式小梁切除术联合巩膜瓣F羊膜植入治疗难治性青光眼的临床疗效.方法 对32例(40眼)行复合式小梁切除术联合巩膜瓣下羊膜植入,观察术后滤过泡的形成以及眼压变化和并发症的发生.随访3～24个月.结果 滤过泡:Ⅰ、Ⅱ型滤过泡34眼,Ⅲ、Ⅳ型滤过泡6眼;眼压:术后3个月平均眼压(13.2±2.7)mmHg,术后12个月平均眼压(15.6±3.1)mmHg.,结论复合式小梁切除术联合巩膜瓣下羊膜植入治疗难治性青光眼能有效提高手术成功率.     

5—Fu抑制兔眼滤过术后成纤维细胞的AgNORs表达

应用细胞增殖指标ＡｇＮＯＲｓ,研究兔眼滤过道成道成纤维细胞增殖规律及５－Ｆｕ的抗增殖作用。方法取兔眼滤过道切片作ＡｇＮＯＲｓ及ＨＥ染色,比较５－Ｆｕ眼和对照眼,ＦｂＡｇＮＯＲｓ染色颗粒数量。结果对照眼滤过道的咬切口,巩膜瓣下,结膜瓣下均有Ｆｂ增殖,且增殖活性第７天最高,第３０天最低。     

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.     

丁酰化壳聚糖膜在兔眼滤过手术抗瘢痕的研究

目的研究丁酰化壳聚糖膜在兔眼高眼压模型滤过手术中的抗瘢痕作用。方法实验研究。45只青紫蓝兔随机分为3组,每组左眼为实验眼,前房均注射0．3％复方卡波姆溶液（含有0．025％地塞米松）0．3ml,诱导兔眼高眼压模型,3周后眼压为30—40mmHg（1mmHg=0．133kPa）。第1组：单纯小梁切除术;第2组：小梁切除术中使用丝裂霉素c（MMC）;第3组：将丁酰化壳聚糖膜植入小梁切除术的板层巩膜瓣下。右眼均不行手术为对照组。分别于术后1、2、4、8及12周每组随机处死3只兔,制作眼球标本。结果病理切片显示术后2周时,单纯小梁切除组巩膜瓣胶原排列紊乱,炎性细胞浸润较多,伴有新生血管形成。MMC组巩膜瓣胶原排列紊乱,胶原组织短小、断裂,伴有炎性细胞浸润。壳聚糖膜组巩膜瓣间隙可见,胶原排列整齐,炎性细胞较少。术后2周,单纯小梁切除组的眼压〉21mmHg,明显高于MMC组和壳聚糖膜组（F=392．869,P〈0．05）,术后12周。壳聚糖膜组眼压低于单纯小梁切除组和MMC组（F=259．923,P〈0．05）;手术4周后,单纯小梁切除组与MMC组功能性滤过泡比率下降。结论丁酰化壳聚糖膜植入兔眼高眼压模型小梁切除术板层巩膜瓣下,有效抑制纤维细胞增生,维持滤过道通畅,术后并发症少,有助于提高手术成功率。     

巩膜瓣大小对小梁切除术后功能性滤过泡形成的影响

目的 探讨青光眼小梁切除术两种不同大小巩膜瓣术后功能性滤过泡成功率.方法 比较339例(339只眼)原发性青光眼中2 mmx2 mm的小巩膜瓣149只眼,4 mmx4 mm的大巩膜瓣190只眼,小梁切除术后功能性滤过泡形成情况.结果 小巩膜瓣手术组术后1周滤过泡成功率为82.55％,3个月时为55.36％.大巩膜瓣手术组术后1周滤过泡成功率为67.89％,3个月时为77.05％.两组比较差异有统计学意义.结论 较大巩膜瓣青光眼小梁切除术后远期功能性滤过泡形成好于短小巩膜瓣且更安全,故应尽量采用较大巩膜瓣术式.     

青光眼小梁切除联合巩膜瓣下羊膜填充的疗效观察

目的探讨青光眼小梁切除联合巩膜瓣下羊膜填充治疗青光眼的疗效。方法对12例（12眼）青光眼行小梁切除手术，术中联合巩膜瓣下羊膜填充，观察术后并发症的发生和滤过泡的形成以及术后眼压变化。结果（1）眼压：术后3月内，12眼眼压均在10～21mmHg；术后6月，有1眼需用1种降眼压滴眼液使眼压控制在21mmHg以内。（2）滤过泡：滤过泡Ⅰ、Ⅱ型滤过泡10眼；Ⅱ型滤过泡2眼。（3）并发症：术后前房有渗出反应8眼，前房有少量积血1眼，均在1周内恢复。结论小梁切除联合巩膜瓣下羊膜填充，在一定程度上提高了青光眼滤过手术的成功率。     

小梁切除联合巩膜瓣下羊膜植入治疗难治性青光眼

目的观察小梁切除术联合巩膜瓣下羊膜植入治疗难治性青光眼的疗效。方法对28例（35眼）难治性青光眼患者行小梁切除联合巩膜瓣下羊膜植入,观察术后滤过泡的形成、眼压变化、手术成功率和并发症的发生率。结果术后随访12～24个月。滤过泡形成情况：I型滤过泡21眼．Ⅱ型滤过泡9眼,Ⅲ型滤过泡2眼和Ⅳ型滤过泡3眼;其中,功能型滤过泡占85．7％（30／35）,非功能型滤过泡占14．3％（5／35）。眼压情况：术后第3个月,平均眼压（13．1±2．6）mmHg;术后第12个月,平均眼压（15．4±3．1）mmHg。手术总有效率为94．3％（33／35）,主要并发症为前房渗出性反应5眼,前房有少量积血1眼（为新生血管性青光眼）,均在1周内消退。结论小梁切除联合巩膜瓣下羊膜植入术能有效提高难治性青光眼的手术成功率。     

Ex-PRESS引流器植入治疗原发性开角型青光眼的疗效

目的：观察Ex-PRESS青光眼引流器植入治疗原发性开角型青光眼的临床疗效。

方法：原发性开角型青光眼患者41例54眼分为研究组和对照组。研究组19例25眼,行Ex-PRESS青光眼引流器植入; 对照组22例29眼,行小梁切除术。比较两组患者平均手术时间、术后视力、浅前房、眼压、滤过泡及其他并发症的情况。

结果：研究组手术时间34.60±4.43min,术后1d浅前房1眼、前房出血1眼; 术后1wk高眼压2眼; 术后3mo视力下降1眼、功能性滤过泡24眼、眼压11.5±5.8mmHg。对照组手术时间44.37±3.00min,术后1d浅前房13眼、前房出血渗出12眼; 术后1wk高眼压8眼; 术后3mo视力下降6眼、功能性滤过泡25眼、眼压13.6±6.7mmHg。研究组术后并发症较少,眼压控制更低,术后视力影响、功能性滤过泡与对照组相当。

结论：Ex-PRESS青光眼引流器植入治疗原发性开角型青光眼手术时间缩短,术后浅前房、前房出血渗出并发症少,安全性高,疗效好。     

生物羊膜在青光眼小梁切除术中的应用

目的探讨生物羊膜在青光眼小梁切除术中应用的疗效。方法对21例(25眼)进行滤过性小梁切除手术,术中用生物羊膜填充在巩膜瓣下层间,进行临床观察。结果 I型、II型滤过泡22眼;Ⅲ型和Ⅳ型非功能型滤过泡3眼。25眼术后1周内眼压≤21mmHg;术后1月,1眼眼压为29mmHg。嘱患者按摩眼球后眼压恢复正常,术后1年2眼眼压≥21mmH经按摩和加用抗青光眼药物(2%盐酸卡替洛尔)均控制在正常范围内。结论生物羊膜在青光眼小梁切除术中应用,提高了滤过性小梁切除手术成功率。     

Histologic evaluation in rabbits of the biocompatibility of episcleral implant material: S-PTFEe (silicone core covered with expanded polytetrafluoroethylene)

PURPOSE: To study the tolerance of a silicone band wrapped with expanded polytetrafluoroethylene (e-PTFE) in "fauve de Bourgogne" rabbits. METHODS: A 5.7mmx3.2mm band of S-PTFE (silicone-polytetrafluoroethylene, France Chirurgie Instruments) was used. A tight seal was produced between the two materials by silicone gluing. Eight eyes were implanted episclerally and fixed with Mersilene 5-0. One silicone band was used on a control eye. RESULTS: Three eyes were removed at 4 weeks, one at 8 weeks and four at 12 weeks. No extrusion was observed except for the silicone band rejected 2 weeks after implantation. On histopathologic examination, PTFE colonisation was present in all eyes with fibroblast, inflammatory cells, and neovascularization. CONCLUSION: The S-PTFE implant was colonized and well tolerated in rabbit eyes. Advantages of silicone band (quality, stability of indentation) are combined to the tolerance of PTFE.     

非穿透性小梁切除联合羊膜植入术治疗青光眼

目的探讨非穿透性小梁切除联合羊膜植入术治疗开角型青光眼的临床疗效。方法对36例(36眼)开角型青光眼患者施行非穿透性小梁切除联合巩膜瓣下羊膜植入术。术后随访6~24月。结果所有患者术后均无严重的并发症。3例术后视力下降。最终随访的平均眼压(14.86±4.15)mmHg,明显低于术前(29.65±5.76)mmHg(1mmHg=0.133kPa)。最终随访时形成功能性滤过泡者30眼。结论非穿透性小梁切除联合羊膜植入术能有效地降低眼压,无穿透性小梁切除术所引起的术后并发症,是治疗开角型青光眼的有效术式之一。     

P50型EX-PRESS引流钉结合生物羊膜植入术治疗POAG的疗效

目的：探讨P50型EX-PRESS引流钉结合生物羊膜植入术在原发性开角型青光眼(POAG)中的治疗效果。

方法：选择2013-03/2019-01收治的POAG患者96例96眼为研究对象,以随机数字表法将患者分为观察组和对照组各48例,对照组单纯植入P50型EX-PRESS引流钉,观察组在对照组基础上结合生物羊膜植入术治疗,观察两组滤过泡情况,术前、术后7d,1、3mo的眼压、视网膜神经纤维厚度(RNFLT)变化,并发症发生情况及手术成功率。

结果：观察组术后3mo功能性滤过泡占比显著高于同期对照组(P<0.05); 两组术前眼压、RNFLT均无差异(P>0.05),观察组术后7d,1、3mo的眼压及RNFLT均明显低于同期对照组(P<0.05); 观察组与对照组并发症发生率分别为12%、25%(P>0.05); 观察组与对照组手术成功率分别为96%、75%(P<0.05)。

结论：POAG应用P50型EX-PRESS引流钉结合生物羊膜植入术治疗,疗效满意,能改善术后滤过泡情况,降低眼压及RNFLT,安全性佳,手术成功率高。     

Management of cornea-lens touch after filtering surgery for glaucoma

The success of filtering surgery for glaucoma may be compromised by a postoperative flat anterior chamber associated with cornea-lens touch, hypotony, and absence of wound leakage. The clinical course of eight patients with this complication was reviewed. Six patients had chronic angle-closure glaucoma. Only one patient responded to medical therapy which included frequent topical application of atropine sulfate 3.0% for 1 hour. Reformation of the anterior chamber with air and drainage of any suprachoroidal fluid was immediately performed in the remaining seven. At the time of follow-up (mean, 16 months), the glaucoma was controlled in all eyes except one. The mean intraocular pressure (IOP) was 14 mmHg in those eyes not requiring reoperation. Six (75%) of eight eyes had diffuse, succulent filter blebs. Five eyes (63%) required no antiglaucoma medications, one eye (12%) required one, one eye (12%) required two, and one eye (12%) underwent repeat filtering surgery. The results suggest that, once medical therapy is not immediately successful, prompt surgical reformation of the anterior chamber along with drainage of any suprachoroidal fluid may preserve the filter blebs in these eyes.     

5-fluorouracil and glaucoma filtering surgery: I. An animal model

Failure of a glaucoma filtering procedure commonly results from scarring at the surgical site. Fibroblasts play an important role in the scarring process. 5-fluorouracil is an antimetabolite capable of inhibiting fibroblast proliferation. We tested the ability of 5-fluorouracil to inhibit cicatrization at the filtering site in an experimental model. Posterior lip sclerectomies were performed in each eye of ten normal owl monkeys. Postoperatively, one eye of each animal received subconjunctival injections of fluorouracil and the fellow eye received saline injections in a randomized, masked fashion. Two animals died of undetermined causes. None of the control eyes developed blebs, but six of the eight treated eyes in surviving animals developed blebs. The difference between intraocular pressures in fluorouracil-treated and control eyes was statistically significant (P less than 0.05). Signs of ocular toxicity included persistent corneal epithelial defects and delayed healing of the conjunctival incision. These results are considerably more favorable than those previously reported with experimental filtering procedures in non-human primates. Pharmacologic modulation of wound healing may decrease the risk of failure of filtering operations.     

小梁切除联合超声乳化及人工晶状体植入术

评价无缝线的小梁切除,超声乳化白内障吸出及人工晶状体植入三联手术。方法做巩膜隧道切口及板层巩膜瓣,连续环形撕囊,原位超声乳化碎核并植入人工晶状体,最后行小梁切除。结论该手术具有眼压控制好,无需缝线,滤泡形成佳,能获得良好的视力。