羊膜和细胞外基质对兔眼小梁切除术后滤过泡的影响

Effects of trabeculectomy combined with amniotic membrane and extracellular matrix of conjunctiva on filtering bleb in rabbits eyes

目的探讨羊膜和结膜细胞外基质（ECM）对兔眼小梁切除术后滤过泡的影响。方法对27只新西兰白兔右眼后房注射α-糜蛋白酶，制备青光眼动物模型。将兔随机分为对照组、羊膜组、结膜ECM组，每组9只兔，行右眼手术。对照组行单纯小梁切除术，羊膜组行小梁切除联合羊膜移植术，结膜ECM组行小梁切除联合ECM移植。术后第1、7、14、21、28、35、42、56天观察小梁滤过泡形态及功能并测量术眼眼压，光学显微镜下观察小梁滤过泡下细胞的形态。结果对照组术前平均眼压（34．59±4．44）mmHg（1mmHg=0．133kPa），术后第1、7、14、28、42、56天眼压分别为（11．31±2．76）mmHg、（19．20±5．17）mmHg、（21．17±4．36）mmHg、（22．22±1．39）mmHg、（23．90±1．97）mmHg、（23．67±1．73）mmHg。羊膜组术前平均眼压（34．38±4．20）mmHg，术后第1、7、14、28、42、56天眼压分别为（10．48±2．45）mmHg、（12．80±3．41）mmHg、（13．50±2．25）mmHg、（16．17±1．73）mmHg、（17．22±1．32）mmHg、（16．71±1．52）mmHg。结膜ECM组术前平均眼压（34．66±4．49）mmHg，术后第1、7、14、28、42、56天眼压分别为（10．94±2．75）mmHg、（11．29±2．40）mmHg、（13．93±3．55）mmHg、（15．63±3．54）mmHg、（15．70±2．44）mmHg、（15．12±3．65）mmHg。术后对照组与羊膜组和结膜ECM组眼压比较，差异有统计学意义（P〈0．01）；羊膜组与结膜ECM组眼压比较，差异无统计学意义（P〉0．05）。羊膜组、结膜ECM组术后第42、56天滤过泡轻微隆起并弥散，有较好的滤过功能。对照组术后第14、21天滤过泡区瘢痕形成，滤过功能差。组织学切片观察显示羊膜组、结膜ECM组滤过泡未形成瘢痕，成纤维细胞少，但有炎性细胞浸润。结论羊膜和结膜ECM能改善小梁切除术后滤过泡功能，减少瘢痕形成。

Objective To investigate the effect of trabeculectomy combined with amniotic membrane and extraceUular matrix （ECM） of conjunctiva on filtering bleb in rabbits. Methods Glaucoma was induced by injecting α-chymotrypsin into the posterior chamber of rabbit eyes. 27 rabbits were randomly divided into the following three groups： group（ 1 ）trabeculectomy alone as control; group （2）trabeculectomy combined with amniotic membrane transplantation; group （3）trabeculectomy combined with extracellular matrix（ECM） transplantation. IOPs were measured by a Schioetz tonometer and filtering bleb observed under a microscopy and electric microscopy at day 1,7,14,21,28,35,42,56 after surgery. Results Compared with pre-operation, the IOP in the control group （group 1 ） was reduced from（34. 59 ±4. 44）mm Hg（ 1 mm Hg = 0. 133 kPa） to（11. 31 ±2.76）mm Hg, （19.20 ±5.27）mm Hg, （21.17 ±4. 36）mm Hg, （22. 22 ±1.39） mm Hg, （23.90 ± 1.97） mm Hg, （23.67 ± 1.73 ）mm Hg, respectively, after surgery. In the group 2, the IOP was decreased from （ 34.38 ± 4. 21 ） mm Hg to （ 10. 48 ± 2.45 ） mm Hg, （ 12. 80 ± 3.41 ）mm Hg, （13.50±2.25） mm Hg, （16. 17 ± 1.73）mm Hg, （17.22 ±1.32）mm Hg, （16.71 ± 1.52） mm Hg, respectively. In the group 3, the IOP was decreased from （34.66 ± 4. 49） mm Hg to （ 10. 94 ± 2.75 ） mm Hg, （11.29 ±2. 40）mm Hg,（13.93 ±3.55）mm Hg, （15.63 ±3.54）mm Hg, （15.70 ±2.44） mm Hg, （15.12 ± 3.65）ram Hg, respectively, at day 1,7,14,28,42,56, post-operatively. IOPs in the group 2 and 3 were significantly （ P 〈 0. 01 ） lower than that in the control group （ group 1 ） at post-operative day 7, 14, 28, 42,56. However, there was no IOP difference between the group 2 and 3 post-operatively at any time. Morphologically, the filtering blebs were flatted at day 28 in the group 1, while were normal in the group 2 and 3 at day 56. Less scar formation of filtering blebs was observed in group 2 and 3 compared with group 1. Conclusions Trabeculectomy combined with the application of amniotic membrane or conjunctiva ECM can improve filtering bleb function and reduce scar formation that lead to a better IOP control after surgery.