丁酰化壳聚糖膜在兔眼滤过手术抗瘢痕的研究

Experiment study of anti-scarring effect of butyrylchitosan membrane in filtering surgery for rabbit ocular hypertension model

目的研究丁酰化壳聚糖膜在兔眼高眼压模型滤过手术中的抗瘢痕作用。方法实验研究。45只青紫蓝兔随机分为3组，每组左眼为实验眼，前房均注射0．3％复方卡波姆溶液（含有0．025％地塞米松）0．3ml，诱导兔眼高眼压模型，3周后眼压为30—40mmHg（1mmHg=0．133kPa）。第1组：单纯小梁切除术；第2组：小梁切除术中使用丝裂霉素c（MMC）；第3组：将丁酰化壳聚糖膜植入小梁切除术的板层巩膜瓣下。右眼均不行手术为对照组。分别于术后1、2、4、8及12周每组随机处死3只兔，制作眼球标本。结果病理切片显示术后2周时，单纯小梁切除组巩膜瓣胶原排列紊乱，炎性细胞浸润较多，伴有新生血管形成。MMC组巩膜瓣胶原排列紊乱，胶原组织短小、断裂，伴有炎性细胞浸润。壳聚糖膜组巩膜瓣间隙可见，胶原排列整齐，炎性细胞较少。术后2周，单纯小梁切除组的眼压〉21mmHg，明显高于MMC组和壳聚糖膜组（F=392．869，P〈0．05），术后12周。壳聚糖膜组眼压低于单纯小梁切除组和MMC组（F=259．923，P〈0．05）；手术4周后，单纯小梁切除组与MMC组功能性滤过泡比率下降。结论丁酰化壳聚糖膜植入兔眼高眼压模型小梁切除术板层巩膜瓣下，有效抑制纤维细胞增生，维持滤过道通畅，术后并发症少，有助于提高手术成功率。

Objective To study the anti-scarring effect of butyrylchitosan membrane in filtering surgery for rabbit ocular hypertension model. Methods This is an experimental study. The left eyes of 45 rabbits were made into ocular hypertension animal model successfully by intracameral injection of 0.3 ml 0.3 % compound carbomer solution. The intraocular pressure achieved 30 mmHg to 40 mmHg （ 1 mmHg = 0. 133 kPa） 3 weeks after the injection. Then 45 eyes were divided into 3 groups randomly. The eyes in group 1 accepted trabeculectomy. The eyes in group 2 received trabeculectomy combined with the application of mitomycin C. The eyes in group 3 were treated by trabeculectomy combined with the implantation of bu- tyrylchitosan membrane beneath the scleral flap. Every 3 rabits were euthanized at 1 week, 2 weeks, 4 weeks, 8 weeks and 12 weeks postoperatively in each group and the eyeballs were examined. Results The pathological results of the eyeballs at 2 weeks postoperatively revealed that collagen fibers deranged with much infiltration of inflammatory cells in group 1, disorganized collagen fibers with shorter and broken colla- gen and less infiltration of inflammatory cells in group 2, collagen fibers arranged in neat rows with less infil- tration of inflammatory cells in group 3. Two weeks postoperatively, the intraocular pressure of group 1 was beyond 21 mmHg, which was higher than that of group 2 and group 3 （ F = 392. 869, P 〈 0.05 ）. At 12 weeks postoperatively, the intraocular pressure of group 3 was lower than that of group 1 and group 2 （ F = 259. 923, P 〈 0.05 ）. The percentages of functional blebs in group 1 and group 2 decreased at 4 weeks after the surgeries. Conclusion Trabecnlectomy combined with implantation of butyrylchitosan membrane beneath the scleral flap can prevent the proliferation of fibers and maintain the functional filtration, which will reduce the complications and increase the success rate of surgery.