虹膜色素颗粒对兔眼小梁切除术后滤过通道瘢痕化影响的实验研究

Experimental study on the effect of iris pigment granules on scarring process of filtration channels after trabeculectomy in rabbit

目的探讨虹膜色素上皮(iris pigment epithelium,IPE)层色素颗粒对兔眼小梁切除术后滤过通道瘢痕化过程及Tenon囊成纤维细胞增生的影响。设计实验研究。研究对象新西兰大白兔18只。方法单眼做小梁切除手术模型。实验组巩膜瓣下放置0.1 ml(100μg/ml)猪IPE层色素颗粒并保留,阳性对照组和阴性对照组分别放置0.4 mg/ml丝裂霉素C棉片和生理盐水棉片3分钟。术后观察眼压、滤过泡形态30天,并对滤过泡及其周边组织进行组织病理学检查。主要指标眼压、滤过泡形态、手术滤过区瘢痕化程度。结果实验组、阳性对照组、阴性对照组兔眼术前平均眼压分别为(24.78±1.40)、(24.11±1.18)、(24.00±1.53)mmHg(F=0.241,P=0.789)。术后30天平均眼压分别为(20.28±1.87)、(20.39±2.28)、(23.33±1.14)mmHg(F=22.500,P=0.000)。实验组与阳性对照组无显著差异(P=0.86),实验组与阳性对照组均低于阴性对照组(P均=0.000)。滤过泡平均存留时间分别为(28.17±1.72)、(27.00±2.37)、(10.67±1.97)天(F=138.592,P=0.000)。组织病理学检查示实验组和阳性对照组兔眼滤过区结构相似,胶原纤维和瘢痕组织相对较少,而阴性对照组胶原纤维和瘢痕组织明显增生。结论小样本量短期实验研究表明,IPE层色素颗粒可能阻止Tenon囊成纤维细胞增生过程,有助于延缓小梁切除术后滤过通道瘢痕化。

Objective To investigate the effect of iris pigment epithelium(IPE)pigment granules on the scarring process of filtration channels and the proliferation of Tenon's capsule fibroblasts after trabeculectomy in rabbits.Design Experimental study.Participants Eighteen healthy New Zealand rabbits.Method Rabbits underwent trabeculectomy in one eye.In the experimental group,0.1ml(100μg/ml)pigment granules extracted from hog IPE layer was placed under the scleral flap and retained permanently.In positive control group and the negative control group,0.4 mg/ml mitomycin C and saline soaked in cotton chips were placed under the scleral flap for 3 minutes,respectively.The intraocular pressure(IOP)and filtering bleb morphology was recorded on postoperative day 1,3,7 and 30.The animals were sacrificed on postoperative day 30,pathological study was carried out on the filtration area of all rabbits.Main Outcome Measures IOP,filtering bleb morphology,and scarring degree of the filtration channel.Results The average IOP of experimental group,negative control group and positive control group before surgery was(24.78±1.40),(24.11±1.18),and(24.00±1.53)mmHg,respectively(F=0.241,P=0.789).On 30 days after trabeculectomy,the IOP of the experimental group,the positive control group and the negative control group were(20.28±1.87),(20.39±2.28),and(23.33±1.14)mmHg(F=22.500,P=0.000).No statistical difference in mean IOP was discerned between the experimental group and the positive control group on postoperative day 30(P=0.86),both of which was lower than that in negative control group(all P=0.000).The average survival time of the filtering blebs among the three groups was(28.17±1.72,27.00±2.37,10.67±1.97)days(F=138.592,P=0.000).HE and Masson staining showed that the experimental group and the positive control group had similar findings in pathological study,with relatively fewer collagen fibers and scar tissues.In the negative control group,a large amount of collagen fibers and scar tissue hyperplasia were discerned.Conclusion The short-term experimental study of small sample size shows that IPE pigment granules may inhibit the proliferation of Tenon's capsule fibroblasts,thereby delay the scarring process of the filtration channel after trabeculectomy.