成品生物羊膜和晶状体前囊膜在兔眼超声乳化联合小梁切除术中的应用

Application of finished-product amniotic membrane and anterior lens capsule in phacoemulsification combined with trabeculectomy in rabbits

目的探讨兔眼超声乳化小梁切除术中联合应用成品生物羊膜和晶状体前囊膜的疗效。方法将24只新西兰大白兔随机分为A、B、C三组,每组各8只,随机选取每组兔的单眼行白内障超声乳化联合小梁切除术,A组术中植入成品生物羊膜,B组术中植入晶状体前囊膜,C组术中无植入物。术后1d、7d、14d、28d观察眼前节反应及功能性滤过泡形成情况,并测量术眼眼压,光学显微镜下观察滤过道情况。结果 A组、B组、C组术后眼压均较术前明显下降,之后逐渐升高,三组术后7d、14d、21d眼压比较,差异有统计学意义(P<0.05)。而A、B组相比较,羊膜降眼压效果较好,两组术后7d(7.17±0.22)mmHg、(7.79±0.16)mmHg(1kPa=7.5mmHg)、14d(7.54±0.47)mmHg、(8.76±0.81)mmHg、21d(11.81±0.74)mmHg、(14.03±0.25)mmHg眼压比较,差异均有统计学意义(均为P<0.05)。三组术后不同时间点的前房反应眼数及滤过泡类型的眼数比较:A、B组术后1d、3d、7d、14d前房反应眼数均较C组多,三组差异无统计学意义(P>0.05);A组、B组术后1d、7d、14d、21d功能性滤过泡的数量较C组多,三组比较差异无统计学意义(P>0.05)。三组术后早期滤过道均通畅。有功能滤过泡的维持和植入物有关,术后28dA、B组滤过道均完全开放,A组成纤维细胞少,但有炎性细胞浸润,B组可见囊膜边缘变钝,未见淋巴细胞浸润,C组术区可见瘢痕组织填塞滤过道。结论兔眼白内障超声乳化联合小梁切除术中应用成品生物羊膜、晶状体前囊膜均能安全、有效降低眼压,抑制或减轻术后滤过道的瘢痕化,而成品生物羊膜降眼压效果较好。

Objective To evaluate the efficacy of finished-product amniotic membrane and anterior lens capsule implantation in phacoemulsification combined with trabeculectomy in rabbits.Methods Twenty-four New Zealand white rabbits were randomly divided into group A,B and C,8 cases in each group.The finished-product amniotic membrane and anterior lens capsule were respectively implanted under the scleral flap in phacoemulsification combined with trabeculectomy in group A and group B,while only phacoemulsification combined with trabeculectomy in group C.The anterior chamber inflammation reaction and type of filtering bleb were observed under the slit lamp,intraocular pressure （ IOP） was measured at postoperative 1 day,7 days,14 days,28 days,and pathological changes in filter corridor were also observed under the photon microscope.Results The postoperative IOP in group A,B and C decreased obviously,there were statistical differences among the three groups at postoperative 7 days,14 days,21 days（ P 0.05） .Whilecompared group A with group B,finished-product amniotic membrane could effectively depress IOP,which at postoperative 7 days,14 days,21 days in group A were （ 7.17±0.22） mmHg （ 1 kPa = 7.5 mmHg） ,（ 7.54±0.47） mmHg and （ 11.81±0.74） mmHg,in group B were （ 7.79±0.16） mmHg,（ 8.76±0.81） mmHg and （ 14.03±0.25） mmHg,there were statistical differences between two groups（ all P 0.05） .While anterior chamber inflammation reaction and filtering bleb type at postoperative 1 day,7 days,14 days,21 days among group A,B and C,group A and B had more functional filtering bleb and serious anterior chamber inflammation reaction,but the difference was not statistically significant （ P 0.05 ） .Histopathology examination showed that the passage of humor outflow kept open at early stage after surgery in all groups.The maintenance of functional filtering bleb associated with implants.At postoperative 28 days,the passage of humor outflow opened completely in group A and B,and there were less fibroblasts in group A,but few inflammatory cells infiltrated,the edge of anterior lens capsule became dull,there were still no lymphocytes in group B,the filtering trace was completely blocked by the scar tissue in group C.Conclusion Application of finished-product amniotic membrane and anterior lens capsule in phacoemulsification combined with trabeculectomy may safely and effectively depress IOP,inhibit or relieve the growth of fibroblasts,and improve the success rate of surgery.