原发性开角型青光Schlemm管和集液管的病理形态学研究

The pathomorphology study on Schlemm’s canal and collector channel of primary open-angle glaucoma

目的研究原发性开角型青光眼(primary open-angle glaucoma,POAG)中集液管和Schlemm管的组织病理学特征,以探讨影响房水外流的阻力因素。方法选取经临床确诊的POAG病人20例(30眼)和经筛选的正常尸眼30只,采用透射电镜技术对房角组织进行超微结构形态学分析。结果实验组30眼中有27眼的集液管在Schlemm管外壁开口处存在电子致密物沉积,呈指纹状。电子致密物的数目与杯盘比(C/D)有正的直线相关关系(r=0.66,P<0.001);与年龄、术前眼压及视野缺损程度均无直线相关关系(r=0.03,P>0.50;r=-0.24,0.20<P<0.50;r=0.30,0.10<P<0.20)。在对照组30个标本的集液管在Schlemm管外壁开口处中均未观察到任何电子致密物等导致狭窄的因素。结论Schlemm管外壁尤其是集液管在Schlemm管外壁开口处的病变可能是形成POAG房水外流阻力的重要因素。

Objective To study the histopathological characteristic of Schlemm＇ s canal and collector channel in primary open angle glaucoma（POAG）,and to approach the factor which affects the outflow of aqueous humor.Methods The chamber angle tissues from 20 clinical definite POAG patients（30eyes）and 30 normal eyes were observed by transmission electron microscope.followed by hypothesis test of coefficient correlation.Results In experimental group 27 out of 30 eyes appeared fingerprintlike electro-dense materials in the debouch of Schlemm＇s canal to collector channel.The number of them had positive linear correlation with cup disc ratio（C/D）（r=0.66, P〈0.001 ）;and had no correlation with age,preoperative IOP or visual field defect （r=0.03 ,P〉0.50 ;r=-0.24.0.20〈P〈0.50 ：r=0.30. 0.10〈P〈0.20）.In the 30 eyes of CG,there was no electro-dense material or any other abnormal structure in the debouch of Schlemm＇s canal to collector channel which could affect aqueous humor outflow.Conclusion Outer wall of Schlemm＇s canal endothelium especially the debouch to collector channel may be one of the main locations of resistance to the outflow of aqueous humor.