Trans-scleral cyclophotocoagulation: a tale of two probes

To compare the histological effects of trans-scleral cyclophotocoagulation(TCP) performed with two different probes, the G-probe(IRIDEX Medical Instruments, Mountain View, CA, USA) and the Ciliprobe(Katalyst Surgical, Chesterfield, MO, USA). TCP was performed on two human cadaver eyes from the same corpse. The vertical meridian was marked and opposite sides were treated using either the G-probe or Ciliprobe. The first eye was treated with each probe at 2000 ms/2000 mW and the second eye at 3000 ms/1500 mW. Histological examination revealed separation and loss of the non-pigmented ciliary epithelium as well as vacuolization in all sections for both probes and settings. Changes to the non-pigmented ciliary epithelium treated at 3000 ms/1500 mW were similar between the two probes. A slightly more complete separation of the non-pigmented epithelium was noted on the Ciliprobe treated sections as compared to the G-probe treated sections in the eye treated at 2000 ms/2000 mW. Therefore, in human cadaver eyes, both the G-probe and Ciliprobe produced separation, vacuolization, and loss of the non-pigmented ciliary epithelium at two different, clinically utilized settings.

兔眼内窥镜与经巩膜睫状体光凝术的组织病理学特点比较

目的比较内窥镜睫状体光凝术(ECP)与经巩膜睫状体光凝术(TSCP)的睫状体组织病理学改变特点,了解ECP的降眼压机制。方法取健康成年青紫蓝兔30只,选择1只眼行ECP,对侧眼行TSCP,另取2只兔为正常对照组。手术后的第1、3、5、7、14、28、42、56天行裂隙灯及眼压测量。术后第7、14、28、42、56天分别随机抽取6只实验兔处死行组织病理学检查,光镜下观察2组光凝术后睫状体组织结构的改变以及邻近组织的损伤和炎症反应情况。结果与TSCP组相比,ECP组术后眼部炎症反应轻微但晶状体混浊。ECP组术后各时间点降低眼压的幅度大于TSCP组(P<0.01)。ECP组术后早期睫状突水肿、睫状体无色素上皮细胞破坏明显,42 d后光镜下可见睫状体上皮细胞排列不规则及睫状突萎缩;TSCP组睫状突水肿、出血、结构破坏,而睫状体上皮细胞层破坏不充分,42 d后可见睫状体萎缩、色素上皮和无色素上皮细胞不规则增生、巩膜变薄及睫状体基质瘢痕化。结论与TSCP相比,ECP对睫状突无色素上皮细胞的破坏更彻底,对邻近部位组织损伤轻微,但可引起晶状体混浊。

玻璃体腔注射Bevicazumab联合玻璃体切除视网膜及睫状体光凝治疗新生血管性青光眼

目的 探讨玻璃体腔注射bevacizumab（IVB）联合玻璃体切除、全视网膜光凝和睫状体光凝治疗新生血管性青光眼（neovascularglaucoma，NVG）的效果。方法21例患者21只眼因伴玻璃体积血新生血管性青光眼接受玻璃体腔注射Bevacizuma0．05mL／1．25mg，治疗后第8天进行玻璃体切除、视网膜光凝＋睫状体光凝。术后随访12个月（8～15个月），观察手术前后视力、眼压、虹膜及房角新生血管情况。结果12只眼于IVB3d后虹膜表面、房角新生血管完全消失，5只眼于7d后虹膜表面、房角新生血管完全消失，4只眼7d后新生血管部分消失。IVB治疗前平均眼压（46．8土6．35）mmHg，治疗后7d平均眼压（35．07士5．28）mmHg，两者眼压比较虽然差异有显著性（P〈0．01）。行玻璃体切除、视网膜光凝＋睫状体光凝术后1周，1、6、12月平均眼压分别（26．85±5．16；21．70±2．41；15．34±4．42；19．21±5．13）mmHg，与手术前平均眼压比较差异均有显著性（P〈0．01）。手术完全成功11只眼（52％），部分成功6只眼（29％），失败4只眼（19％）。17只眼视力保持稳定或稍有增进（HM-0．05）。结论玻璃体内注射Beva—cizumab后行玻璃体切除联合视网膜及睫状体光凝治疗，可以促进虹膜、房角、视网膜新生血管迅速消退，降低手术并发症，有效控制眼压，是治疗伴玻璃体积血的新生血管性青光眼的有效方法。