628例原发性闭角型青光眼的小梁病理改变及其临床意义

Pathological changes of the trabeculae in 628 cases of primary angle closure glaucoma and their clinical significance

目的 :观察闭角型青光眼的小梁形态学改变 ,探讨周边虹膜和小梁粘连程度与小梁、Schlemm管病变的关系。方法 :对628例(746眼)闭角型青光眼手术切除的小梁标本用10 %福尔马林溶液固定 ,火棉胶包埋 ,苏木素 伊红染色 ,光镜下观察。结果 :所有慢性闭角型青光眼的小梁均表现出不同程度的纤维化 ,小梁网及内皮细胞中有程度不等的色素沉积 ,内皮细胞数减少或消失 ,Schlemm管压缩或闭塞。虹膜萎缩、变性 ,周边部与小梁粘连。上述病理改变尤以虹膜与小梁粘连处为甚。急性闭角型青光眼的小梁则表现为内皮细胞水肿 ,小梁网中有色素沉积 ,虹膜基质水肿 ,血管扩张 ,周边部与小梁紧密接触 ,个别切片中可见局灶性坏死。结论 :虹膜与小梁粘连可能是导致或加重小梁损害的一个重要的因素。从病理的角度出发建议 :当青光眼的病人眼压升高且伴有较明显的前房反应时 ,应局部或全身应用皮质激素。一旦发现有房角粘连应采取手术治疗。

Objective: To study the morphological changes of the trabeculae in 628 cases of primary angle closure glaucoma and the relationship of the adhesion between peripheral iris and trabeculae with the pathological changes of the trabeculae and Schlemn tube. Methods: The specimens of trabeculae were collected from 746 eyes of 628 patients with primary angle closure glaucoma. They were fixed in 10% formalin, embedded in collodion, stained with hematoxylin eosin and observed with optical microscopy. Results: Fibrosis of varying degrees of the trabeculae was found in all the cases of chronic angle closure glaucoma. There was pigment deposition of varying degrees in the trabecular meshwork and in the cytoplasm of endothelial cells which decreased in number or even totally disappeared in some areas. The Schlemn tube was compressed or obstructed. Iridoleptynsis, degeneration of the iris and adhesion of peripheral iris with trabeculae were found among which iris trabeculae adhesion was the severest. In acute angle closure glaucoma, there was edema of the endothelial cells, pigment deposition in the trabeculae, edema of the matrix of the iris, dilatation of blood vessels and a close contact of peripheral iris with the trabecular meshwork. Occasionally focal necrosis was seen. Conclusion: The adhesion of peripheral iris with trabeculae might be the main factor to induce trabecular damages. Pathologically, corticosteroid is suggested when the intraocular pressure of glaucoma patients is increased and obvious reaction of the anterior chamber exists. When adhesion of the anterior angle of the chamber is found, operation is indicated.