新鲜与保存羊膜移植与小梁切除后的瘢痕组织增生

Proliferation of scar tissues following fresh versus preserved amniotic membrane transplantation with trabeculectomy

背景:目前新鲜羊膜在眼表疾病方面得到了广泛应用,并且取得了抗纤维组织增生、抑制新生血管形成及减轻炎症反映等方面的满意疗效,但在青光眼方面的应用还未见报道。目的:观察新鲜羊膜移植对小梁切除术后瘢痕组织的抑制作用,并与保存羊膜对比。方法:将36只新西兰大白兔按随机数字表法分为3组,新鲜羊膜组和保存羊膜组分别进行新鲜羊膜移植、保存羊膜移植联合小梁切除术,空白组行单纯小梁切除术。分别于移植后1,2,3,4周检查滤过泡的形态和功能,用链酶亲和素免疫组织化学法检测滤过泡周围组织中血小板衍生生长因子的含量。结果与结论:新鲜羊膜组和保存羊膜组移植后滤过泡轻微隆起,有较好的滤过功能;观察病理组织切片表明滤过道内成纤维细胞增生较少,瘢痕组织也比较疏松。空白组滤过道被增生的纤维组织代替,成纤维细胞比较多。免疫组化结果显示,新鲜羊膜组和保存羊膜组的血小板衍生生长因子的表达少于空白组,新鲜羊膜组的表达少于保存羊膜组。提示新鲜羊膜和保存羊膜能改善滤过泡功能,减少瘢痕形成,维持滤过道的通畅,并且新鲜羊膜的作用效果优于保存羊膜。

BACKGROUND：Fresh amniotic membrane has been extensively used in treating ocular surface disease,which can inhibit fibrous tissue proliferation,inhibit neovascularization,and relieve inflammation.However,its application in treating glaucoma is rarely reported.OBJECTIVE：To explore the antiproliferative effect of fresh amniotic membrane on postoperative scar and compared with preserved amniotic membrane.METHODS：A total of 36 New Zealand white rabbits were randomly divided into 3 groups.Fresh amniotic membrane and preserved amniotic membrane combined with trabeculectomy separately underwent fresh amniotic membrane and preserved amniotic membrane transplantation.The control group was subjected to trabeculectomy alone.After 1,2,3,and 4 weeks,the morphology and function of filtering bleb were checked,and the platelet-derived growth factor（PDGF）of surrounding tissue was determined by immunohistochemical method.RESULTS AND CONCLUSION：Fresh amniotic membrane and preserved amniotic membrane groups displayed bulged filtering bleb with good filtering function.Pathological observation showed that fibroblasts of the filtration pathway had less,but more sparse scar tissues than control group,but inflammatory infiltration was observed in all groups.The cavity of different sizes and shapes were detected in filtration pathway of control group,which was replaced by fibrous tissue hyperplasia,with a large number of fibroblasts.Immunohistochemical results showed that the expression of PDGF was significantly less in fresh amniotic membrane and preserved amniotic membrane groups compared with the control group,and the PDGF expression was less in fresh amniotic membrane group than the preserved amniotic membrane group.Fresh and preserved amniotic membrane can improve the filtering bleb function,reduce scar formation,and maintain the patency of filtering pathway.Moreover,the effects of fresh amniotic membrane is better than preserved amniotic membrane.