兔高眼压模型眼行CO_2激光滤过术的实验研究
详细信息    本馆镜像全文|  推荐本文 |  |   获取CNKI官网全文
摘要
目的:研究应用CO:激光手术机对兔高眼压模型眼实施滤过性手术的安全性、有效性、可行性和优越性。
     内容:第一部分:兔高眼压模型的建立;第二部分:扫射巩膜床所用激光参数的选择;第三部分:在兔高眼压模型眼实施CO:激光滤过术的实验研究。
     方法:第一部分:用250U/0.25ml的a-糜蛋白酶在5只兔10只兔眼上制备高眼压模型,观察并记录术后眼部表现及2个月内的眼压变化;第二部分:用不同的激光参数在第一部分已制备成功的兔高眼压模型上,双眼进行巩膜瓣下巩膜床扫射,观察两眼术后第一天和第一周的病理变化情况。从而选取扫射巩膜瓣所用的最佳激光参数。第三部分:制备兔高眼压模型,选择模型制备成功的20只兔40眼,右眼应用超脉冲CO2激光进行巩膜瓣下巩膜床扫射(平均功率1W,脉宽0.1ms,频率100Hz)及巩膜切除联合虹膜切除术(平均功率4-5W,脉宽0.8ms,频率100Hz),称为激光组;左眼行传统小梁切除术与之对照,称为手术组。观察并对比两组术后不同时间段的前房反应、滤过泡情况、眼压及组织病理学变化。
     结果:第一部分:用来制备高眼压模型的10只兔眼术前平均眼压为12.1±1.05mmHg,在其后房注入α-糜蛋白酶,模型制备后兔眼眼压均明显升高,与术前相比有明显的统计学意义。除1眼发生晶状体脱位伴巩膜葡萄肿外,剩余兔眼均没有严重并发症出现,眼前节炎症反应多在术后3-7天消失。第二部分:通过显微镜下观察和病理切片的比较得出扫射巩膜床所用的最佳的激光参数为平均功率1W,脉宽0.1ms,频率100Hz。第三部分:激光组术后前房反应轻微,只有2眼出现虹膜激光孔处少量出血,手术组前房反应重,12眼发生明显的前房出血或团块状渗出。术后早期(第3天、第7天)两组功能性滤过泡均占多数,到术后第14和30天,手术组功能性滤过泡比例下降明显,分别为58.3%(7/12)和12.5%(1/8),激光组则为91.7%(11/12)和62.5%(5/8),两组之间有统计学差异。术后早期(第3天、第7天)两组眼压均较术前明显下降,两组之间没有统计学差异。随观察时间的延长,两组眼压逐渐升高,术后第14天两组的眼压出现统计学差异。且手术组出现的较激光组早,术后第30天和第60天两组眼压均升高至一定水平,手术组升高明显,激光组和手术组相比有统计学差异(P<0.05)。组织病理学检查显示,两组早期滤过道通畅,但手术组出血和炎性渗出明显。激光组增殖反应较手术组出现的晚,且程度轻,到术后第60天滤过道仍有部分间隙。
     结论第一部分:兔眼后房注入浓度为250U/0.25ml的α-糜蛋白酶可以制备出眼压稳定、持久,且并发症少的高眼压模型。第二部分:利用CO2激光的参数可调节性可以做到使巩膜床创面发生表层凝固而变的平滑又不至于造成过多损伤的效果,从而达到修复创面和减少纤维增殖的目的。第三部分:应用自制CO2激光机输出的超脉冲CO2激光在兔高眼压模型眼进行巩膜瓣下深层巩膜和虹膜组织切除,安全可行,可以有效的降低眼压,与常规小梁切除术相比术式简便快捷,术后炎症反应轻、出血少、增殖反应轻、降眼压效果稳定持久。
Purpose:To study the security,feasibility,validity and superiority of performing filtering surgery by using a CO2 laser device on rabbits intraocular hypertension model.
     Contents:Part 1:Preparation of rabbits intraocular hypertension model; Part 2:strafe laser parameters used sclerotic bed choice.Part 3:Experimental study of doing CO2 laser assisted filtering surgery on rabbits intraocular hypertension model.
     Methods:Part 1:Intraocular hypertension model was induced by posterior chamber injection of a-chymotrypsin (concentration is 250U/0.25ml) 0.15-0.20ml in 10 rabbits'eyes.After injection,the appearance of the rabbits'eyes was obseved,and the intraocular pressure was recorded in 2 months. Part 2:with different laser parameters in the first part of the rabbit already preparation successful steroid-induced ocular hypertension model, eye under the bed strafe scleral flap scleral observed, two eyes in the first week after the first day and the pathological changes of the situation. Used to select the best scleral flap strafing laser parameters. Part 3:preparation rabbit high intraocular pressure model, the preparation of successful choice model 20 rabbit right 40 eyes, super pulse CO2 laser application under the bed for sclera disc strafing (average power scleral 1W, pulse width 0.1 ms, frequency 100Hz) and sclera excision with iridectomy (average power 4-5W, pulse width 0.8 ms, frequency 100Hz, called laser group; Do traditional trabeculectomy left by contrast, called scores. Observe and comparing the two groups of different period after the anterior chamber reaction, filtering bleb, intraocular pressure and histopathological changes.
     Results:Part 1:Before injection of a-chymotrypsin,the mean IOP of the 10 eyes was 12.10±1.05mmHg.After injection,all the eyes showed a significant rising IOP, mean IOP of the 3,7,14,30 and 60 days postoperation were 15.98±2.91 mmHg,21.84±5.18mmHg,23.41±5.02mmHg,23.86±3.97 mmHg and 25.37±3.16 mmHg.They were all obviously different from the pre-operation IOP,and the IOP had no difference among the 14,30 and 60 days after injection.Lens dislocation combined staphyloma developed only in one rabbit's eye,and the other eyes had no serious complication occurred.Inflammatory reaction of anterior part had all disapeared within 3-7 days postoperation. Part 2:through a microscope and pathological comparative draw strafe the best used the sclerotic bed laser parameters for the average power 1W, pulse width 0.1 ms 100Hz, frequency. Part 3:Anterior chamber reaction of laser group was mild,only 2 eyes had slight hemorrhage around iris hole;surgery group had serious reaction,12eyes appeared obvious hemorrhage and massive exudation. Both of the two groups had most functional filtering bleb in earlier period postoperation.Until 14 days postoperation,surgery group appeared a obviously decrease of functional filtering bleb number,the proportions were 58.3% (7/12) and 12.5%(1/8),but laser group still had 91.7%(11/12) and 62.5%(5/8), there was statistical difference between them.IOP decreased significantly in early period postoperation in both the two groups,and there was no difference between them.Then IOP increased gradually,surgery group happened earlier, IOP of the two groups became differently at 14 days postoperation. Pathology examination showed both the two groups had unobstructed filtering channel in earlier period,but surgery group appeared serious hemorrhage and exudation.Fiber proliferation reacted later and milder in laser group,until 60 days postoperation there was still some interspace in filtering channel.
     Conclusion:Part 1:Posterior chamber injection of a-chymotrypsin (concentration is 250U/0.25ml) 0.15-0.20ml in rabbits'eyes could induce successful intraocular hypertension model with stable,lasting higher IOP and little complication. Part 2:use CO2 laser parameters can be accommodative can make sclera bed surface solidification and change happened wound of the smooth, without causing too much damage effect, thus reach repair wound and reduce fiber proliferation goal. Part 3: Pulse CO2 laser sclerectomy with a scleral flap and iridectomy in rabbits intraocular hypertension model was safe and feasilbe,it could lower IOP significantly,compared with conventional trabeculactomy it was easier and faster with milder inflammation,hemorrhage,proliferation and stable,lasting lower IOP.
引文
1.李凤鸣.眼科全书(第一版).北京:人民卫生出版社,1997.
    2. PTK,PS."New"surgerical treaments of glaucoma.Br J Ophthalmol,1999,83(1):1-3.
    3. Higginbotham EJ,Shahbazi MF.Laser therapy in glaucoma:an overview and update.International Ophthalmology Clinics,1990,30(3):187-197.
    4. McHam ML,Eisenberg DL,Schuaman JS,et al.Erbium:YAG laser sclerectomy with a sapphire optic fiber.Ophthalmic Surg Lasers,1997,28(1):55-58.
    5. Beckman H, Fuller TA. Carbon dioxide laser scleral dissection and filtering procedure for glaucoma.Am J Ophthalmol.,1979,88(1):73-77.
    6. L'Esperance FA Jr, Mittl RN, James WA Jr.Carbon dioxide laser trabeculostomy for the treatment of neovascular glaucoma. Ophthalmology,1983,90(7):821-829.
    7. Assia El, Rotenstreich Y, Barequet IS. Experimental studies on nonpenetrating filtration surgery using the CO2 laser.Graefes Arch Clin Exp Ophthalmol,2006, 13(10):[Epub ahead of print].
    8.李迎新,禹国强.一种新型青光眼激光滤过术——自控式脉冲CO2激光手术系统.中国激光医学杂志,2000,9(4):208-211.
    9.李文君.C02激光行小梁切除术的初步探讨.天津:天津医科大学,2007:
    10.蔡洁.改良Stegmann术治疗开角型青光眼的基础及临床研究.天津:天津医科大学,2006:
    11. Ueno A, Tawara A, Kubota T, et al. Histopathological changes in iridocorneal angle of inherited glaucoma in rabbits. Graefes Arch Clin Exp Opthalmol,1999, 237(8):654-660.
    12. L jen Drecoll E, Schenholm M, Tamm E, et al. Visualization of hyaluronic acid in the anterior segment of rabbit and monkey eyes. Exp Eye Res,1990,51(1): 55-63.
    13. Svedbergh B.Effects of artificial intraocular pressure elevation on the corneal endothelium in vervet monkey.Acta Ophthalmol,1975,53:839.
    14. Liu JHK,Bartels SP,Neufeld AH.Effective of 1-and d-timolol on cyclic AMP synthesis and intraocular pressure in water-loaded,albino and pigmented rabbits.Invest Ophthalmo Vis Sci,1983,24:1276.
    15. Sugrue MF,Gautheron P,Schmitt C,et al.On the pharmocology of L-645,151:a topically effective ocular hypotencive carboic anhydrase inhibitor.J Pharmacol ExpTher,1985,232:534.
    16. Kirsch,R.E.Use of alpha-chymotrypsin in cataract extraction followedby transient glaucoma.Arch Ophthalmol,1964,72:612.
    17. Hamasaki DI,Ellerman N.Abolition of the electroretinogram following injection of alpha-chymotrypsin into the vitreous and anterior chamber of monkey.Arch Ophthalmol,1965,73:843-850.
    18. Kalvin NH,et al.Experimental glaucoma in monkeys.Arch Opthalmol,1966,76:83.
    19. Anderson DR.Experimental alpha-chymotrypsin glaucoma studied by scanning electron microscopy.Am J Ophthalmol,1971,71:470.
    20. Chee P,Hamasaki DI.Arch Ophthalmol,1971,85:103.
    21. Lessell S,Kuwabara T.Experimental alpha-chymotrypsin glaucoma.Arch Ophthalmol,1969,81:853.
    22. Melena J,Santafe J,et al.Aqueous humor dunamics in alpha-chymotrypsin-induced ocular hypertensive rabbits.J Ocul Pharmacol Ther,1999,15:19-27.
    23. Melamed S,Solomon A,Neumann D,et al.Internal sclerostomy using laser ablation of dyed sclera in glaucoma patients:a pilot study.Br J Ophthalmol,1993,77(3):139-144.
    24. Cairns JE.Trabeculectomy.Am J Ophthalmol,1968,66:673.
    25.周文炳.临床青光眼(第二版).北京:人民卫生出版社,2000:385,503.
    26. Thomas S Dietlein,Philipp C.Erbium:YAG trabecular ablation(LTA) in the surgical treament of glaucom.Lasers Surg.Med,1998,23:104-110.
    27. Bachman JA,Conto JE.Posteriorative complications of subconjunctival THC-YAG(Holium)laser sclerostomy.J Am Optom Assoc,1994,65:311-320.
    28.李瑞峰.眼科激光治疗学概要.北京:人民卫生出版社,1998.
    29.陈跃国,张惠蓉,Nd:YAG激光及其联合氩激光虹膜切开术后虹膜病理组织
    30.学研究.中华眼科杂志,1994,30:441-444.
    1. Meyer-Schwickerath G.Erfahrungen mit der Lichtkogulation der Metzhaut und der iris.Doc Ophthalmol,1966,10:91.
    2. Khuri CH.Argon laser iridectomies.Am J Ophthalmol,1973,76:490.
    3. Beckman H,Sugar HS.Laser iridectomy therapy of glaucoma.Arch Ophthalmol.1973,90:453.
    4.邹俊,激光周边成形术,国外医学眼科学分册,1996,20:193-197.
    5. Jimmy S.M.Lai,Clement C.Y.T,Dennis S.C.Lam.Limited argon laser peripheral iridoplasty as immediate treatment for an acute attack of primary angle closure glaucoma:a preliminary study.Eye,1999,13:26-30.
    6.彭大伟,张秀兰等.激光周边虹膜成形术联合周边虹膜切除术治疗高褶虹膜型青光眼.中华眼科杂志.1997,33:165-168.
    7. Wise JB,Witter SL.Argon laser therapy for open-angle glaucoma:a pilot study.Arch Ophthalmol,1979,97:319-320.
    8. Thomas JV,Simmons RJ,et al.Argon laser trabeculoplasty in the presurgical glaucoma patient.Opthalmology,1982:187-197.
    9. Latina MA, Park C. Selective targeting of trabecular meshwork cells:in vitro studies of pulsed and CW laser interactions. Exp Eye Re,1995,60(5): 359-371.
    10.李凤鸣主编.中华眼科学(第二版).中册.北京:人民卫生出版社,2005.1895-1896.
    11.Nagar M, Ogunyomade A, O'Brart PS, et al. A randomised, prospective study comparing selective laser trabeculoplasty with latanoprost for the control of intraocular pressure in ocular hypertension and open angle glaucoma. Br J Ophthalmol,2005,89(11):1413-1417.
    12. Chen E, Golchin S, Blomdahl S. A comparison between 90 degrees and 180 degrees selecitive laser trabeculoplasty. J Glaucoma,2004,13(1):62-65.
    13. Hugh Beckman,Terry A.Fuller.Carbon dioxide laser scleral dissection and flitering procedure for glaucoma.Am J Ophthalmol,1979,88:73-77.
    14. Litwin RL. Successful argon laser sclerostomy for glaucoma. Ophthalmic Surg.1979,10(7):22-4.
    15. N.E.Saheb.Short-term results of holium laser sclerostomy in patient of uncontrolled glaucoma.Can J Ophthalmol,1993,28:317-319.
    16. Hill RA, Ozler SA, Baerveldt G, et al. Ab interno neodymium:YAG versus erbium:YAG laser sclerostomies in a rabbit model[J]. Ophthalmic Surgery, 1992,23:192-197.
    17. Rabowsky JH, Dukes AJ, Lee DA.Gonioscopic laser sclerostomy versus filtration surgery in a rabbit model.Eye,1997,11:830-837.
    18. Schuman JS, Stinson WG, et al.Holmium laser sclerectomy. Success and complications. Ophthalmology.1993; 100:1060-1065.
    19.王宁利.非穿透小梁手术进展.继续医学教育.2006,20:49-51.
    20. Klink T, Schlunck G,et al.Long-term results of Erbium YAG-laser-assisted deep sclerectomy. Eye.2006,24:Epub ahead of print.
    21. Pallikaris IG, Kozobolis VP,et al. Erbium:YAG laser deep sclerectomy:an alternative approach to glaucoma surgery. Ophthalmic Surg Lasers Imaging. 2003,34:375-380.
    22. Verges C, Llevat E,et al. Laser-assisted deep sclerectomy. J Cataract Refract Surg.2002,28:758-765.
    23.Traverso CE,Murialdo U,et al.Photoablative filtration surgery with the excimer laser for primary open-angle glaucoma,a pilot study.Int Ophthalmol,1992; 16:363-365.
    24. Argento C, Sanseau AC, Deep sclerectomy with a collagen implant using the excimer laser. J Cataract Refract Surg.2001,27:504-506.
    25.解正高,管怀进等.准分子激光非穿透性小梁手术的实验研究.眼科研究,2006,24:623-627.
    26. Assia EI, Rotenstreich Y, et al.Experimental studies on nonpenetrating filtration surgery using the CO(2) laser. Graefes Arch Clin Exp Ophthalmol. 2006,13:Epub ahead of print.
    27. Beckman H,Fuller TA.Carbon dioxide laser scleral dissections and filtering procedure for glaucoma.Am J Opthalmol.1979,88:73-77.
    28. L'Esperance FA Jr, Mittl RN. Carbon dioxide laser trabeculostomy for the treatment of neovascular glaucoma.Trans Am Ophthalmol Soc. 1982;80:262-287.
    29. Beckman H,Kinoahita A,et al.Transscleral ruby laser irradiation of the ciliary body in the treatment of intractable glaucoma.Trans Am Acad Ophthalmol Otolaryngol.1972,76:423-436.
    30. Gaasterland DE,Pollack IP.Initial experience with a new method of laser trasscleral cyclophotocoagulation for ciliary ablation in severe glaucoma.Trans Am Ophthalmol Soc.1992,90:225-246.
    31. Schlote T,Derse M,et al.Efficacy and safety of contact transscleral diode laser cyclophotocoagulation for advanced glaucoma.J Glaucoma.2001,10:294-301.
    32. Uram M.Opthalmic laser microendoscope endophotocoagulation.Ophthalmology,1992,99:182-183.
    33. Uram M.Endoscopic surgery in ophthalmology.Lippincott:Williams & Wilkins.2003,68-69.

© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号

地址:北京市海淀区学院路29号 邮编:100083

电话:办公室:(+86 10)66554848;文献借阅、咨询服务、科技查新:66554700