内路准分子激光小梁切开术后的前房角组织病理学改变

Histopathology of trabeculum after excimer laser trabeculotomy ab interno

目的 :研究内路准分子激光小梁切开术 (ExcimerLaserTrabeculotomyabinterno ,ELT)术后眼部表现及房角组织病理改变 ,探讨ELT的降压机理。方法 :对 5只兔共 10只眼进行了ELT ,观察其术后反应 ,分别于术后第一周到第五周取标本进行光镜和电镜检查。结果 :10只眼中有 9只眼术后反应轻微 ,术中术后无任何并发症 ;有 1只眼因术中损伤虹膜而反应较大。光镜观察显示准分子激光切削部位小梁网断裂 ,Schlemm氏管有穿通口直接与前房相通。电镜下见早期标本切片上小梁细胞内质网扩张 ,线粒体肿胀、空泡变性 ,胞浆水肿 ,但核质均匀 ,核膜、胞膜完整。后期未见异常小梁细脑。所有切片上均未发现成纤维细胞。结论 :ELT术后 ,在Schlemm氏管与前房之间可形成房水排出的直接通道 ,减轻房水外排的阻力 ,降低眼内压。

Objective: To study the clinical manifestation and histopathologic changes of trabeculum after excimer laser trabeculotomy ab interno (ELT),and investigate the mechanism of decreasing tension of ELT. Methods: ELT were performed on 10 eyes of rabbits and the postoperative responses were observed.And the limboscleral tissues were checked by light and electrical microscopy at the first to the fifth postoperative weeks. Results: 9 of 10 eyes had mild irritation without any complications after surgery.One eye had obvious inflammation because of damaging the iris during the operation.The light microscopy showed there were local fractures on the trabecular meshwork in all the specimens.And some openings were created into Schlemms canal.The electrical microscopy found that at early postoperative stage the mitochondria were turgescent and dilated like vacuoles,and the endoplasmic reticula were dilated in some trabecular cell.But at the late stage all trabecular cells were normal.And none of fibroblast could be seen. Conclusions: Permanent openings can be created through the trabecular meshwork into the inner wall of Schlemms canal by ELT.The openings reduce outflow resistance as well as intraocular pressure.