睫状体平坦部外滤过术对高眼压兔眼切口相关组织形态学的影响

目的探讨睫状体平坦部(后路切口)外滤过术对高眼压兔眼相关组织形态学的影响。方法以高眼压兔眼为对照,采用前路小梁切除术、后路睫状体平坦部外滤过术(后路Ⅰ组)、睫状体平坦部外滤过术联合硅胶引流管植入(后路Ⅱ组),观察术后兔眼局部表现,利用眼B超及UBM探查活体眼球切口部位、滤过通道及眼内形态,并在光镜下进行组织病理学观察。结果 1.光镜观察:术后1周前路组与后路I、II组术区炎症细胞、成纤维细胞的数量与分布无明显差别。术后4周前路组巩膜切口周围成纤维细胞增殖移行,滤过道趋于瘢痕化;后路Ⅰ组巩膜切口周围成纤维细胞增殖移行,滤过道欠通畅;后路Ⅱ组巩膜切口周围成纤维细胞沿引流管眼内段增殖移行,滤过道较通畅。术后8周前路组切口周围结膜下致密结缔组织,滤过口完全闭合;后路Ⅰ组切口周围球结膜发生瘢痕包裹,滤过口不完全闭合;后路Ⅱ组切口周围球结膜组织包裹硅胶引流管,滤过口未闭合。2.UBM检查:后路I、II组术后滤过道维持时间长于前路组,后路Ⅰ组发现切口处少量玻璃体嵌顿。3.前路及后路各组均未发现浅前房、脉络膜及视网膜脱离。结论睫状体平坦部外滤过术的较大切口能有效延缓滤过道的纤维增生,硅胶引流管的植入有助于减轻滤过道纤维膜性阻塞,防止切口处发生玻璃体嵌顿;该术式对于高眼压兔眼组织是安全的。

Experimental study of effect of pars plana filtration technique on incision-related morphology of glaucoma rabbits

OBJECTIVE To investigate the effect of pars plana filtration technique on intraocular tissue and incision-related morphology in glaucoma rabbits.METHODS One group of eyes with high IOP as control group received no treatment,and other three groups of eyes as treatment groups received trabeculectomy,pars plana filtration surgery or pars plana filtration surgery combined silica gel pipe implantation respectively.Investigated the appearance of anterior segment,observed the intraocular tissue with ultrasonography,and then studied the ocular region histopathology under light microscope.RESULTS 1.Light microscope result： At postoperative1st week,there was nearly no significant difference on the number of inflammatory cells and proliferated fibroblasts infiltration around incision among the three treatment groups.At 4th week,the fibroblasts proliferated around incision and inflammatory reaction improved,filtered aisles blocked with scar formation in the 1st treatment group that received trabeculectomy.Filtered aisles turned narrow in the 2nd treatment group that received pars plana filtration surgery,but were still smooth in the 3rd treatment group that received pars plana filtration surgery combined silica gel pipe implantation.At 8th week,there was limited conglutination in scleral flap gap and incision scared over in the 1st treatment group.In the 2nd treatment group,conglutination limited in scleral flap gap and incision,then the scar formation made filtered aisles blocked incompletely.There was little scar formation round incision in the 3rd treatment group,but filtered aisles opened.2.UBM：Filtered aisles of eyes in the 2nd and 3rd treatment group kept longer time than in the 1st one.But in the 2nd treatment group,there was little vitreous in incision.3.Eyes in the three treatment groups found no abnormity such as flat chamber,retinal detachment or choroidal detachment.CONCLUSIONS Compared with trabeculectomy,pars plana filtration technique could make larger incision in order to inhibit the scar formation.The implantation of silica gel pipe could reduce the obstruction of fibrous proliferation membrane and the happening of vitreous wedge in pars plana incision.The security could be identified that the ocular tissues in glaucoma rabbits had no serious injury with this technique.