晶状体前囊膜应用于兔眼超声乳化联合小梁切除术的实验研究

目的探讨兔眼超声乳化联合小梁切除术中晶状体前囊膜植入的疗效。方法 20只新西兰大白兔随机分为两组,每组各10只兔(20眼),第1组:随机选择1只眼做超声乳化+小梁切除术(A组),另1只眼做超声乳化+小梁切除术并辅助应用晶状体前囊膜(B组);第2组:随机选择1只眼做超声乳化+小梁切除术联合应用丝裂霉素C(C组);另1只眼做超声乳化+小梁切除术并辅助应用晶状体前囊膜(B组)。术后3d、7d、14d、21d、28d观察眼前房炎性反应、滤过泡形态及功能,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3d、7d、14d前房炎性反应比较,差异均无统计学意义(均为P>0.05)。术后21d,A组、B组、C组功能性滤过泡所占比例分别为14.3%(1/7)、85.7%(12/14)、85.7%(6/7),A组与B组、C组相比,差异均有统计学意义(均为P<0.05)。3组术后眼压较术前明显下降,后逐渐升高,术后14d、21dA组与B组、C组眼压比较,差异均有统计学意义(均为P<0.05)。组织病理学显示,3组早期滤过道均通畅;术后28dA组滤过道完全被瘢痕组织阻塞,C组滤过道远端闭合,近端小部分开放,B组滤过道完全开放,囊膜边缘变钝,未见淋巴细胞浸润。结论超声乳化联合小梁切除术中应用晶状体前囊膜可在术后有效降低眼压,抑制或减轻滤过道瘢痕化,提高手术成功率。

Experimental study on anterior lens capsule implantation in phacoemulsification combined with trabeculectomy in rabbit

Objective To evaluate the efficacy of anterior lens capsule implantation in phacoemulsification combined with trabeculectomy in rabbit.Methods Twenty rabbits were randomly divided into two groups,10 rabbits(20 eyes) in each group.Phacoemulsification combined with trabeculectomy was performed in one eye(group A),and phacoemulsification combined with trabeculectomy with anterior lens capsule implantation in the other eye(group B) in the first group.Meanwhile,phacoemulsification combined with trabeculectomy was performed in one eye with mitomycin C application(group C) in one eye,and phacoemulsification combined with trabeculectomy with anterior lens capsule implantation in the other eye(group B) in the second group.The anterior chamber inflammation reaction and type of filtering bleb were observed,and intraocular pressure was measured at postoperative 3 days,7 days,14 days,21 days and 28 days,the pathological changes in filtering trace were also investigated.Results There was no statistical difference in anterior chamber inflammation reaction at postoperative 3 days,7 days and 14 days among group A,B and C(all P>0.05).The proportion of functional filtering bleb in group A,B and C at postoperative 21 days were 14.3%(1/7),85.7%(12/14) and 85.7%(6/7) in these three groups,respectively,there were statistical differences between group A and B,C(both P<0.05).The postoperative intraocular pressure in three groups increased gradually,there were statistical differences between group A and B,C at postoperative 14 days and 21 days(both P<0.05).Histopathology examination showed that the passage of humor outflow kept open at early stage after surgery in all group;At postoperative 28 days,the filtering trace was completely blocked by the scar tissue in group A,the remote trace closed and proximal one opened a small part in group C,while the passage of humor outflow opened completely in group B,the edge of anterior les capsule became dull,there was still no lymphocytes.Conclusion Implantation of anterior lens capsule in phacoemulsification combined with trabeculectomy can reduce postoperative intraocular pressure,suppress or relieve the growth of fibroblasts and enhance the success rates of surgery.