羊膜在兔眼非穿透小梁切除手术后的抗增殖研究

目的 探讨羊膜在非穿透小梁切除手术(NPTS)后抗增殖的作用效果.方法 新西兰大白兔随机分为羊膜组和丝裂霉素组(MMC组),另一眼作为对照组,行非穿透小梁切除手术,分别在术中应用羊膜或MMC,对照组巩膜瓣直接缝合复位.术后观察滤过泡(高度、范围、持续时间)、角膜上皮、结膜充血情况、前房反应及有关并发症.分别于术后3d,7d,14d,30d对滤过区结膜组织行光学显微镜观察,术后1个月的病理切片测量术区瘢痕厚度、成纤维细胞面积,并行成纤维细胞计数.取术后14d的滤过区结膜下组织行透射电镜观察.结果 羊膜组和MMC组兔眼NPTS后可以形成功能性滤过泡,持续时间长,与对照组比较差异有显著性(P＜0.05).病理切片及电镜结果显示,羊膜组与MMC组滤过泡结膜下组织细胞数量减少,胶原形成减少,瘢痕组织较为疏松,可见大小不等、形态各异的空腔存在.但在MMC组可见大量的胶原纤维断裂溶解,细胞固缩坏死.羊膜组与MMC组成纤维细胞面积和密度明显低于对照组,且瘢痕厚度亦明显低于对照组,但实验组之间差异无显著性.结论 在非穿透小梁切除手术中应用羊膜可以抑制瘢痕形成,维持滤过道的畅通,其作用效果与MMC类似.MMC对结膜上皮及结膜下组织具有毒性作用,容易导致并发症,而羊膜未发现明显不良反应,具有临床推广应用价值.

Experimental Study of Amniotic Membrane Antiproliferative Effects in NPTS

Objective To study the antiproliferative effects of amniotic membrane in non-penetrating trabecular surgery(NPTS) with a rabbit model.Methods The eyes of all 48 rabbits were undergone NPTS,amongy them,24 eyes were combined with amniotic membrane transplantation under the scleral flap,while the other 24 eyes with MMC.The following parameters were assessed:conjunctival bleb appearance,condition of cornea and conjunctiva,reaction of anterior chamber and the related complication.Histopathological changes of the filtering tract was observed on 3d,7d,14d and 30d postoperatively.Scar thickness of the filtering tract,the density and areas of fibroblast was recored on 30th postoperative day.Transmition electron microscopic examination was taken on 14th postoperative day.Results In amniotic membrane transplatation and MMC group,longevity of functional filtering blebs was longer than in control group.Under light and electron microscope,detached conjunctival epithelial and focally disrupted collagen in various spaces was found in amniotic membrane transplatation and MMC eyes,and their scar thickness of the filtering tract,density and areas of fibroblast were lower than in control grounp significantly.Conclusion Similar to MMC,amniotic membrane is shown to possess anti-fibrotic properties and facilitate aqueous outflow through the filtering tract.Amniotic membrane transplatation with few complications is worth applying widely in NPTS.