放射状视神经切开手术机制的初步研究

目的:观察猫眼行放射状视神经切开术 (radial opticneurotomy,RON) 后视盘结构的改变,探讨 RON 的临床机制。方法:健康成年猫共 18 只,为术后 1d 组、术后 15d 组、术后 30d 组和术后 90d 组。术后 1d 组为 6 只。单眼行放射状视神经切开术。分别于术后 1,15,30,90d 取材,组织切片特染检查。结果:RON 术后 1d 巩膜切口呈“一”型裂开,手术间隙与蛛网膜下腔相通,伴少量出血及炎细胞浸润;15～30d 切口呈“枣核”型,神经胶质细胞增殖,胶原纤维沿切口缘环形增生,增生胶原以 III型为主,筛孔呈长裂隙状;90d 瘢痕组织将筛板和巩膜切口完全填充,I 型和 III 型胶原排列不规则,边缘的筛孔形态恢复。结论:手术可将视盘周围的巩膜环及视神经眼内段软脑膜锐性切开,切口在巩膜环处呈逐渐扩宽趋势并与蛛网膜下腔相通,这可能是 RON 减轻临床症状机制之一。

Experiment study on radial optic neurotomy in cats' eyes

AIM: To explore the anatomical changes of the optic nerve head in cats after radial optic neurotomy (RON).METHODS: The normal anatomic data were obtained from 12 healthy cats. A total of 18 healthy cats were used in the experiment, which were divided into four groups: each operative group was executed at the :Lst, 15th, 30th, 90th day after undergoing RON unilaterally.(six in 1st group). The enucleated eyes of each operative group were cut section routinely and embedded in paraffin, the cross sections were stained by special staining.RESULTS: At the 1st day after operation, the incision came into being and connected with cerebral subarachnoid space of orbital optic nerve. At 15th day, incision was fusiform and hyperplastic neuroglial cells and fibroblasts aggregated at the incision. At 30th day, there was obvious proliferation of type fibril at the neurotomy. The aligned texture of collagen fibril of the lamina cribrosa near the incision was moved close to each other. At the 90th day, a discrete scar was noted at the site which reached the cribriform and sclera.CONCLUSION: RON can cut scleral ring and piamater of optic nerve sharply. The incision of RON connects with subarachnoid space of orbital optic nerve and becomes broaden gradually at the site of scleral ring. The potential role of incision of RON is relevant to the subject.