兔青光眼小梁切除术中应用生物羊膜与干扰素α-2b的对比研究

Comparative study of amniotic membrane with interferon α-2b applied in trabeculectomy in rabbits with glaucoma

目的评价羊膜与干扰素α-2b在青光眼滤过术中的抗纤维增殖作用及其应用价值。方法选取日本大耳兔30只(60眼),采用随机数字表法将其分为2组,2组右眼(30眼,为羊膜组)行小梁切除术,术中巩膜瓣层间植入生物羊膜,组A左眼(15眼,为干扰素组)行小梁切除术,术后结膜下注射干扰素α-2b,组B左眼(15眼,为对照组)行单纯小梁切除术。术后3d、5d、7d、14d、30d、60d观察各组眼压、滤过泡形态、滤过泡维持时间、前房深度等指标,并于术后3d、7d、14d、30d、60d分别处死2组各3只动物,摘除眼球作病理切片,观察成纤维细胞和炎性细胞等情况。结果术后7d,羊膜组眼压为(9.95±2.15)mmHg(1kPa=7.5mmHg),对照组眼压为(12.27±1.95)mmHg,二者比较差异有显著统计学意义(P<0.01),干扰素组眼压为(10.14±2.27)mmHg,与对照组比较,差异有统计学意义(P<0.05);术后14d羊膜组与对照组、干扰素组比较,差异均有统计学意义(均为P<0.05)。术后各组滤过泡形态均以Ⅱ型为主;术后5d、7d、14d羊膜组功能性滤过泡占有率与其他2组比较,差异均有统计学意义(均为P<0.05)。羊膜组早期炎症反应重于其他2组,术后3d光镜下观察可见大量炎性细胞浸润于羊膜植入区;术后7d电镜下可见滤过通道大量成纤维细胞增殖。干扰素组术后早期光镜和电镜下仅见少量成纤维细胞增殖。结论兔眼小梁切除术中应用生物羊膜和干扰素α-2b均能降低眼压和延长滤过泡保留时间,且无明显副作用。生物羊膜作用优于干扰素α-2b,但是植入陈旧生物羊膜手术区炎症反应重,值得进一步研究。

Objective To compare the anti-fibre proliferation effect and application of amniotic membrane with interferon α-2b treatment for glaucoma filtering operation in rabbits.MethodsAbout 30 Japanese rabbits（60 eyes）were selected and randomly divided into 2 groups with random number table.Right eyes of rabbits（30 eyes;amniotic membrane group）in both two groups were taken trabeculectomy.Biological amnion was implanted into scleral flap layers during surgery.Left eyes of rabbits in group A（15 eyes;Interferon group）were taken trabeculectomy,and subconjunctival injection of interferon α-2b was taken during surgery.Left eyes of rabbits in group B（15 eyes;Control group）were just taken trabeculectomy.Intraocular pressure,morphology and maintain time of filtering bleb and anterior chamber depth were observed at 3 days,5 days,7 days,14 days,30 days and 60 days after surgery.Three rabbits were executed in each group at 3 days,7 days,14 days,30 days and 60 days after surgery,eyeballs were taken out for pathological section,conditions of fibroblasts and inflammatory cells were observed.ResultsAt 7 days after surgery,intraocular pressure were（9.95±2.15）mmHg（1 kPa=7.5 mmHg）in amniotic membrane group and（12.27±1.95）mmHg in control group,there was statistical difference between the two groups（P0.01）;The intraocular pressure was（10.14±2.27）mmHg in interferon group,which had statistical difference comparing with the control group（P0.05）.There were significant difference in intraocular pressure for control group and interferon group comparing with amniotic membrane group at 14 days after surgery（both P0.05）.Morphologies of filtering blebs were mainly with type Ⅱ in each group after surgery.Rate of functional filtering blebs in amniotic membrane had statistical differences with the other two groups at 5 days,7 days and 14 days after surgery（all P0.05）.Inflammatory reaction at early stage in amniotic membrane group was serious to the other two groups.Lots of inflammatory cells were found in implantation place of amniotic membrane under light microscopy at 3 days after surgery.Proliferation of lots of fibroblasts was found in filtering tunnels under light microscopy at 7 days after surgery.Proliferation of few fibroblasts was found in interferon group at early stage under light microscopy and electron microscopy at 3 days after surgery.ConclusionsAmniotic membrane and interferon α-2b can decrease intraocular pressure and prolong the maintain time of filtering bleb during trabeculectomy in rabbits,and have no obvious side effect.Amniotic membrane has better effect than interferon α-2b,but the inflammation reaction in operation area is heavier for implantation of dated amniotic membrane.More studies are needed.