两种不同波长激光小梁成形术后急性期组织学形态比较

Acute histopathological changes after two types of trabeculoplasty with different wavelength laser: A Comparative Study

目的 探讨选择性激光小梁成形术 (SLT)的优越性及可能的作用机制。方法 选取因恶性肿瘤而摘除的人眼球 5只 ,经检查房角结构正常 ,摘除后立即行SLT和氪绿激光小梁成形术 ,每只眼球的颞侧做 180°范围的SLT ,Q 开关Nd∶YAG激光波长 5 32nm ,光斑直径 4 0 0 μm ,每脉冲持续 3ns,能量为 1 5～ 2 1mJ,总能量 5 2 4 6mJ,共 5 0个非重叠光斑。每只眼的鼻侧 180°范围做氪绿激光 (5 2 1nm)小梁成形术 ,光斑直径 5 0 μm ,脉冲时间 0 1s ,总能量6 0 0～ 80 0mJ,共 5 0个光斑。术后取小梁组织制成切片 ,于光镜和电镜下进行观察比较。结果 两种激光均能有效地进行小梁成形术 ,但SLT对小梁损伤小 ,且仅对色素性小梁内皮细胞起作用 ,对非色素细胞无损伤作用。氪绿激光小梁成形术则破坏小梁网细胞。结论 SLT治疗开角型青光眼安全有效 ,损伤小 ,其房水流出量的增加可能与激光刺激小梁干细胞 ,使其参与小梁结构重建 ,恢复小梁正常功能 ,增强滤过有关。

Objective To study the superiority and probable mechanism of the selective laser trabeculoplasty (SLT) and promote its clinical use. Methods The laser trabeculoplasty was performed in 5 human eyes which were removed because of choroidal melanoma or other reasons while its anterior chamber angle are normal. Half of the eye was done with frequency doubled Nd∶YAG laser immediately after the operation and another half with the krypton laser. The histopathological changes were observed and compared. Results Trabeculoplasty with the two types of wavelength lasers was both effective. The histopathologic change in SLT group was lighter than that in the krypton laser group. Conclusion SLT is a safe and effective treatment for primary open angle glaucoma and its damage is little. The increase in the flow of the aqueous humor is probable relative to the stimulation of trabecula stem cell by laser, which reconstructs trabecula and enbances the filtration of aqueous humor.