活体共焦显微镜在小梁切除术后结膜滤过泡中的应用

目的:应用新一代活体共焦显微镜(HRTⅢ/RCM)在细胞水平观察小梁切除术后结膜滤过泡的组织学改变,研究滤过性手术的滤过机制及术后损伤修复机制。方法:对小梁切除术后的23例患者共28只眼行裂隙灯、眼压及活体共焦显微镜检查。其中功能性滤过泡9眼,非功能性滤过泡11眼,联合应用丝裂霉素C后功能性滤过泡8眼。对滤过泡中微囊泡的大小、数量、结缔组织的密度进行统计学分析。结果:功能性滤过泡中含有大量透明的微囊泡,而非功能性滤过泡中没有或仅有少许透明度较低的微囊泡;功能性滤过泡的上皮下存在比较疏松的结缔组织,但非功能性滤过泡中的结缔组织极致密;功能性滤过泡中出现新生血管的比例远远小于非功能性滤过泡。相比之下,联合应用丝裂霉素C的功能性滤过泡中含有大量较大的微囊泡,其上皮下结缔组织较疏松,各层组织内均可见大量高反光颗粒。结论:活体共焦显微镜检查能够对结膜滤过泡进行诊断成像,是一种与来自离体组织学检查结果完全吻合的新的活体检查方法,对将来提高滤过性手术的成功率具有直接的指导作用。

Application of HRT Ⅲ in the Study of Filtering Blebs After Trabeculectomy

Objective: To analyze the histological changes of filtering bleb after trabeculectomy at the cellular level using a new generation in vivo confocal microscope,HRTⅢ/RCM,and to demonstrate filtering mechanisms and wound healing mechanisms after filtering surgery.Methods: A total of 28 eyes of 23 patients after trabeculectomy were enrolled in this study.Eyes were classified into three groups with functioning blebs(9 eyes),nonfunctioning blebs(11 eyes),and functioning blebs after application of mitomycin C(8 eyes).Ophthalmologic examinations included slit-lamp examination,Goldmann applanation tonometry,and in vivo confocal microscopy.Results: All functioning blebs had numerous intraepithelial optically-empty microcysts,whereas all nonfunctioning blebs had none or few.Subepithelial connective tissue was widely spaced in all functioning blebs,whereas the tissue was dense in nonfunctioning blebs.Conversely,new blood vessels were seen in 81.8% of nonfunctioning blebs,whereas new blood vessels were seen in just 22.2% of functioning blebs.Functioning blebs with mitomycin C had numerous microcysts and loosely arranged subepithelial connective tissue as compared with nonfunctioning blebs.There were massive hyper-reflective microdots in all of the filtering bleb layers.Conclusion: In vivo confocal microscopy study of blebs is an original method that agrees well with ex vivo histologic examination.The number of microcysts and the density of the subepithelial connective tissue observed with in vivo confocal microscopy are correlated to bleb function.By providing details of the structures of filtering blebs at the cellular level,in vivo confocal microscopy is valuable to enhance success rates for surgical procedures.