羊膜在兔眼小梁切除术中应用的实验研究

目的:探讨羊膜在实验动物兔抗青光眼手术中的抗纤维化作用。方法:选择纯种新西兰白兔24只,随机分为3组:小梁切除加羊膜移植术组,小梁切除加丝裂霉素组,单纯小梁切除术组。分别于手术后第1、2、3、7、14、28、60d观察眼压、滤过泡、前房反应、并发症情况,术后1、2、3、4周和2个月处死相应组兔子,摘除眼球作病理切片检查,观察羊膜降解时间,进行成纤维细胞计数和炎症细胞计数。结果:眼压值在各观察点除术后第一天差异有显著性外(P=0.041,P=0.021),其余时间3组间差异无显著性(P值均>0.05);羊膜组术后并发症与另两组比较未见增多;滤过泡存留时间约1个月;羊膜降解时间约3～4周。成纤维细胞计数羊膜组[(0.0205±0.01235)个/单位面积],与小梁切除术组[(0.0673±0.03830)个/单位面积]比较差异有显著性(P=0.017<0.05),与丝裂霉素组[(0.0292±0.01085)个/单位面积]比较差异无显著性(P=0.222>0.05);而炎症细胞数羊膜组[(0.4402±0.1708)单位面积]与小梁切除术组[(0.2944±0.08876)个/单位面积]和丝裂霉素组[(0.041±0.02131)个/单位面积]比较差异均有显著性(t=5.67,P=0.002<0.05;t=4.81,P=0.004<0.05)。结论:羊膜在小梁切除术中应用其降解时间约3～4周,具有抑制成纤维细胞作用,可以提高降压效果且并发症较少。其手术区炎症反应重可能为种属间的排斥反应。

An Experimental Trial of Glaucoma Filtering Surgery with Amniotic Membrane

PURPOSE: To investigate the anti-fibroplastic effect of the preserved human amniotic membrane by transplanting on animals in glaucomatous surgery. METHODS: Trabeculectomy were performed on 48 eyes of 24 rabbits which were divided into 3 groups: group A was treated with the amniotic transplantation under sclerotic flap, group B was performed trabeculectomy using MMC (0.25mg/ml) under sclerotic flap and group C played the role of control which had surgery only. postoperative examinations including the intraocular pressure (IOP) , filtering bleb, reaction of the anterior chamber and complications were performed on 1, 2, 3, 7, 14, 28, 60 days after surgery respectively. A rabbit selected randomly in the three groups was killed in 1, 2, 3, 4, 8 week after operation and extirpated the eyeball to observe the time of decomposition of the amniotic membrane in pathologic tissue slice, counted the number of fibroblast and inflammatory cells with computer and compare their difference. RESULTS: There were not significant difference of IOP among the three groups except observed on the first day after operations (P > 0.05); Comparing with group B and group C, the complications of group A ( amniotic membrane) didn't increased. The duration of the existing time of the filtering blebs was about 1 month. The decomposed time of the amniotic membrane was about 3-4 weeks, after 4 weeks it was substituted by fibroblast and inflammatory cells. The number of fibroblast counted by computer showed significant difference between group A (0.0205+/-0.01235) and group C (0.0673+/-0.03830) (P=0.017 < 0.05), and no obvious difference with group B. The inflammatory cells of group A (0.4402+/-0.1708) increased greatly in comparison with group B (0.0407+/-0213) and group C (0.0294+/-08876); (t=5.67, P=0.002 < 0.05, t=4.81, P=0.004 < 0.05 respectively). CONCLUSION: The decomposed time of the amniotic membrane is about 3-4 weeks in trabeculectomy. Amniotic membrane has a restraint effect on fibroblast and it can enhance the effect of surgery to lower the IOP in trabeculectomy as well as has less complication. The inflammation reaction in the operation area of the group A is heavier than the others which may be caused by repellent reaction between different species.