CO_2激光行兔眼小梁切除术的初步探讨
摘要
青光眼是不可逆致盲的主要眼病，预计青光眼患者2010年将达到6050万，2020年将达到7960万。原发性青光眼的治疗原则是降眼压和保护视神经，降眼压主要是通过药物、激光和手术。手术目前以常规的小梁切除术是最常用的术式。近年来，激光手术因其简便、快捷、并发症少等优点，日益受到眼科学界的关注，种类也日益增多，如CO_2激光、半导体激光、准分子激光等。其中，CO_2激光属于红外激光，具有一定的止血功能。为将CO_2激光与小梁切除术的优点结合，我们用新研制的CO_2激光机进行了兔眼小梁滤过术的初步研究。
本实验选用新西兰大耳白兔40只80眼，随机分为5组，每组右眼行常规小梁切除术作为对照组，左眼作为实验组行CO_2激光小梁切除术。术后测眼压、观察前房反应、滤过泡形成情况、是否有浅前房和白内障等并发症，UBM检查术后第1天、第10天、第20天、第30天滤过区的情况。分别于术后第3天、第5天、第7天、第14天、第30天处死各组兔子，取眼球行病理及免疫组化检查。
研究结果：
1、术后早期激光组前房反应明显较对照组轻，以出血为主，术后半个月内前房反应均已吸收。
2、术后早期滤过泡以扁平弥散型为主，两组无统计学差异，术后中晚期瘢痕型滤过泡逐渐增多，激光组的瘢痕型滤过泡数量明显少于对照组，两组有统计学差异，实验中没有出现包囊型滤过泡。
3、实验期间两组均未见浅前房及白内障等并发症出现。
4、术前激光小梁切除术组与常规小梁切除术组的眼压无统计学差异，术后第1天两组眼压均明显下降，激光组较常规小梁切除术组眼压下降幅度大，两组有统计学差异(P＜0.05)。术后第2天至第6天两组眼压平稳，两组无统计学差异(P＞0.05)。第7天至30天眼压逐渐上升，激光组眼压回升较常规小梁切除术组慢，两组眼压有统计学差异。
5、UBM结果显示术后第1天两组滤过泡均隆起，滤过腔明显，激光组术后第20天以后滤过腔消失，而对照组则在术后第10天滤过腔已经不明显。术后第30天两组均无滤过腔存在。
6、病理显示激光组滤过道通畅时间明显较对照组长，对照组可见断裂的后弹力层及虹膜睫状体嵌顿滤过道内口的情况。
7、两种术式术后不同时间段滤过道内口瘢痕组织TGF-β_2均无统计学差异。
结论：
1、CO_2激光行小梁切除术是可行的；
2、CO_2激光可有效避免常规小梁切除术术后常见的并发症，如严重的前房反应、浅前房、低眼压、睫状体或脉络膜脱离等；
3、CO_2激光对房水的穿透力差，对晶状体损伤的可能性很小；
4、CO_2激光有很好的止血作用；
5、本研究为CO_2激光应用于青光眼领域奠定了基础，激光参数有待进一步实验研究完善。
Glaucoma is one of the most important eye-diseases to irreversible blindness.There will be 60.5 million patients of glaucoma in year of 2010, and 79.6 million in2020. The principle of primary glaucoma treatment is to low down intraocularpressure (IOP) by drug, laser and operation. Recently, laser surgery is noticed by mostof ophthalmologists, because of easiness, rapidity and less-complications. There aremore and more lasers used in clinical, for example, carbon dioxide (CO_2) laser,semiconductor diode laser and excimer laser. CO_2 laser can stop bleeding in operation,so we used it to do filtering surgery in normal rabbit eyes, to investigate the utility ofCO_2 laser.
We selected 40 rabbits (80 eyes), divided them into 5 groups. The right eye ofeach rabbit was treated with traditional trabeculectomy, and the left eye was donewith CO_2 laser trabeculectomy and iridectomy to study differences between them. Inthis experiment, we observed IOP, anterior reflect, filtering bleb, the complicationsand examine UBM, pathology and immune-histochemical study.
The results are:
1. Anterior chamber reaction, mostly hyphema, in laser group was milder than thatin traditional trabeculectomy group. There was no difference between them after halfmonth.
2. In the early time of post-operation, the ratio of eyes with functional filteringbleb in laser group was higher than that in the other one, but there was no statisticalsignificant difference. Fibrosis blebs became more, and there was statisticalsignificant difference after half month post-operation.
3. There were not shallow anterior chamber and cataract.
4. There was no difference in IOP between two groups pre-operation. Mean IOPdecreased significantly from pre-operation, raised from the 7th day after operation, and there was statistical significant difference between them.
5. The UBM told us that there were functional filtering bleb in two groupspost-operation. The functional filtering bleb disappeared after 10 days in traditionaltrabeculectomy group and 20 days in CO_2 laser group.
6. The filtering channel opened longer in CO_2 laser group than in trabeculectomygroup. The filtering channel were blocked up with Descemet's membrane andiris-ciliary body in several cases in traditional trabeculectomy group.
7. There were no TGF-β_2 statistical significant difference between two groups.
Conclusion:
1. It treats glaucoma patients with CO_2 laser deep trabeculectomy and iridectomyis feasible.
2. Most complications of traditional trabeculectomy can be avoided by CO_2 laserfiltering operation, for instance, serious anterior chamber reaction, shallow anteriorchamber, hypotony, ciliary body or choroid detachment.
3. The CO_2 laser cannot go through aqueous humor easily, so there is no danger todamage the lens.
4. The CO_2 laser has good hemostatic function.
5. This study provides the foundation for ophthalmic clinical work, but theparameter of CO_2 laser operation should be perfected.
本实验选用新西兰大耳白兔40只80眼，随机分为5组，每组右眼行常规小梁切除术作为对照组，左眼作为实验组行CO_2激光小梁切除术。术后测眼压、观察前房反应、滤过泡形成情况、是否有浅前房和白内障等并发症，UBM检查术后第1天、第10天、第20天、第30天滤过区的情况。分别于术后第3天、第5天、第7天、第14天、第30天处死各组兔子，取眼球行病理及免疫组化检查。
研究结果：
1、术后早期激光组前房反应明显较对照组轻，以出血为主，术后半个月内前房反应均已吸收。
2、术后早期滤过泡以扁平弥散型为主，两组无统计学差异，术后中晚期瘢痕型滤过泡逐渐增多，激光组的瘢痕型滤过泡数量明显少于对照组，两组有统计学差异，实验中没有出现包囊型滤过泡。
3、实验期间两组均未见浅前房及白内障等并发症出现。
4、术前激光小梁切除术组与常规小梁切除术组的眼压无统计学差异，术后第1天两组眼压均明显下降，激光组较常规小梁切除术组眼压下降幅度大，两组有统计学差异(P＜0.05)。术后第2天至第6天两组眼压平稳，两组无统计学差异(P＞0.05)。第7天至30天眼压逐渐上升，激光组眼压回升较常规小梁切除术组慢，两组眼压有统计学差异。
5、UBM结果显示术后第1天两组滤过泡均隆起，滤过腔明显，激光组术后第20天以后滤过腔消失，而对照组则在术后第10天滤过腔已经不明显。术后第30天两组均无滤过腔存在。
6、病理显示激光组滤过道通畅时间明显较对照组长，对照组可见断裂的后弹力层及虹膜睫状体嵌顿滤过道内口的情况。
7、两种术式术后不同时间段滤过道内口瘢痕组织TGF-β_2均无统计学差异。
结论：
1、CO_2激光行小梁切除术是可行的；
2、CO_2激光可有效避免常规小梁切除术术后常见的并发症，如严重的前房反应、浅前房、低眼压、睫状体或脉络膜脱离等；
3、CO_2激光对房水的穿透力差，对晶状体损伤的可能性很小；
4、CO_2激光有很好的止血作用；
5、本研究为CO_2激光应用于青光眼领域奠定了基础，激光参数有待进一步实验研究完善。
Glaucoma is one of the most important eye-diseases to irreversible blindness.There will be 60.5 million patients of glaucoma in year of 2010, and 79.6 million in2020. The principle of primary glaucoma treatment is to low down intraocularpressure (IOP) by drug, laser and operation. Recently, laser surgery is noticed by mostof ophthalmologists, because of easiness, rapidity and less-complications. There aremore and more lasers used in clinical, for example, carbon dioxide (CO_2) laser,semiconductor diode laser and excimer laser. CO_2 laser can stop bleeding in operation,so we used it to do filtering surgery in normal rabbit eyes, to investigate the utility ofCO_2 laser.
We selected 40 rabbits (80 eyes), divided them into 5 groups. The right eye ofeach rabbit was treated with traditional trabeculectomy, and the left eye was donewith CO_2 laser trabeculectomy and iridectomy to study differences between them. Inthis experiment, we observed IOP, anterior reflect, filtering bleb, the complicationsand examine UBM, pathology and immune-histochemical study.
The results are:
1. Anterior chamber reaction, mostly hyphema, in laser group was milder than thatin traditional trabeculectomy group. There was no difference between them after halfmonth.
2. In the early time of post-operation, the ratio of eyes with functional filteringbleb in laser group was higher than that in the other one, but there was no statisticalsignificant difference. Fibrosis blebs became more, and there was statisticalsignificant difference after half month post-operation.
3. There were not shallow anterior chamber and cataract.
4. There was no difference in IOP between two groups pre-operation. Mean IOPdecreased significantly from pre-operation, raised from the 7th day after operation, and there was statistical significant difference between them.
5. The UBM told us that there were functional filtering bleb in two groupspost-operation. The functional filtering bleb disappeared after 10 days in traditionaltrabeculectomy group and 20 days in CO_2 laser group.
6. The filtering channel opened longer in CO_2 laser group than in trabeculectomygroup. The filtering channel were blocked up with Descemet's membrane andiris-ciliary body in several cases in traditional trabeculectomy group.
7. There were no TGF-β_2 statistical significant difference between two groups.
Conclusion:
1. It treats glaucoma patients with CO_2 laser deep trabeculectomy and iridectomyis feasible.
2. Most complications of traditional trabeculectomy can be avoided by CO_2 laserfiltering operation, for instance, serious anterior chamber reaction, shallow anteriorchamber, hypotony, ciliary body or choroid detachment.
3. The CO_2 laser cannot go through aqueous humor easily, so there is no danger todamage the lens.
4. The CO_2 laser has good hemostatic function.
5. This study provides the foundation for ophthalmic clinical work, but theparameter of CO_2 laser operation should be perfected.
引文
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