壳聚糖膜在兔眼巩膜瓣下的降解及对眼内压的影响

Degradation of chitosan film under rabbit scleral flap and its effect on intraocular pressure

目的观察壳聚糖膜在兔眼巩膜瓣下的降解,眼组织病理学变化,眼刺激反应及眼内压变化,评价壳聚糖膜的生物相容性及降眼压效果。方法新西兰大白兔16只32眼,随机分为2组,A、B组各16只眼;A组单纯行小梁切除术,作为手术对照;B组行小梁切除术联合壳聚糖膜巩膜瓣下植入。术后观察眼压、炎症反应等,并分别于7、14、28、56d取标本行组织学检查。结果观察兔眼角膜、虹膜无异常发现,结膜轻度充血水肿,眼刺激程度评价为无刺激性。病理学观察:术后7d,局部组织可见炎症反应;术后14d,壳聚糖膜部分降解,炎症反应减轻;术后56d,壳聚糖膜降解为碎片状,炎症反应基本消失;B组植入材料周围有组织间隙和滤泡存在,无明显纤维组织增生,A组组织结构紊乱,瘢痕形成,未见明显组织间隙和滤泡。术前A组眼压为(18.22±2.56)mmHg,B组眼压为(18.40±2.48)mmHg;术后8周,A组眼压为(16.87±2.45)mmHg,B组眼压为(13.78±1.89)mmHg,B组与A组之间有显著性差异(P<0.01)。结论壳聚糖膜有良好的组织相容性,有一定抑制纤维组织增生的作用,能够有效维持滤过,降眼压效果满意。

Objective To observe the degradation of chitosan film under rabbit scleral flap, eye irritation, and intraocular pressure and estimate biocompatibility of chitosan film and the effect of lessening intraocular pressure. Methods Chitosan film was extracted from shell of snow-crab. Sixteen rabbits （32 eyes） were divided randomly into 2 groups with 16 eyes in each group. Group A was treated with trabeculectomy as control and Group B treated with trabeculectomy and implantation of chitosan film under scleral flap. The intraocular pressure, inflammatory reaction, pathological change after operation were observed. Results There were no significant alterations regarding the cornea and iris. Inflammatory reaction was seen on day 7 after operation. Partial chitosan film degradation appeared and inflammatory reaction remitted on day 14 after operation. The chitosan film was degraded into fragment and the inflammatory reaction almost disappeared on day 56 after operation. There existed tissue space and follicles around the implanted materials in Group B; in Group A, however, instead of tissue space and follicles, histological structure disarrangement and cicatrisation were noticed. The intraocular tension varied significantly between the two groups at 8th week postoperatively （P 〈 0. 01 ）. Conclusion Chitosan film has good histocompatibility and inhibitory effect on fibroplasia. It can effectively decline intraocular pressure.