兔巩膜池小梁切除术后葡萄膜巩膜途径房水引流的形态学研究

发布时间：2018-06-10 07:01

  本文选题：巩膜池 + 小梁切除术　； 参考：《南昌大学》2011年硕士论文

【摘要】：目的： 通过比较兔巩膜池小梁切除术和常规小梁切除术后葡萄膜巩膜途径房水引流的形态学变化,探讨巩膜池小梁切除术可能的降压机制。 对象和方法： 1、实验对象及分组：成年新西兰白兔30只60眼,体重2.5-3.0Kg,按随机数字表法,随机挑选20只40眼为实验组,右眼行巩膜池小梁切除术为实验组Ⅰ,左眼行常规小梁切除术为实验组Ⅱ。另10只20眼为空白对照组未行任何手术。 2、手术方法：以穹窿部为基底的结膜瓣。实验组Ⅰ做以角膜缘为基底,厚为巩膜1/3的巩膜瓣,约4mm×4mm大小,剥离至透明角膜缘内1mm。在浅层巩膜瓣下的深层巩膜上,再做同样基底的1/3巩膜厚的中层巩膜瓣(大小约3mm×3mm),将其切除。沿角巩膜后缘水平剪下2mm×1mm的深层组织,10/0线间断缝合巩膜瓣,水密缝合结膜瓣。实验组Ⅱ按常规小梁切除术操作。 3、术后观察：术后1周每天裂隙灯观察角膜,前房反应,滤过泡,眼底情况等。记录滤过泡比例,监测术前、术后眼压变化,并记录数据进行统计学分析。UBM观察滤过口、流出道及睫状体的情况。挑选无并发症模型进行下一步研究。 4、荧光示踪剂实验：术后1周,取实验组Ⅰ、实验组Ⅱ各10眼,空白组5只10眼,前房穿刺注入2mg/ml FITC-Dextran示踪剂10μl,于2,4,6,8,10h,各处死实验组Ⅰ、实验组Ⅱ各2眼,空白组1只2眼,迅速摘除眼球,作冰冻切片,荧光显微镜下观察睫状体、房水池、脉络膜上腔、前、后巩膜和脉络膜的荧光强度等级。 5、HRP追踪实验：术后1周,另取实验组Ⅰ、实验组Ⅱ各10眼,空白组5只10眼,前房穿刺注入0.2mg/mlHRP10μ1,60 min后经颈动脉灌注固定液350ml,迅速摘取眼球,作冰冻切片,观察HRP随房水流动的分布情况。并行MASSION染色观察滤过道胶原纤维增生情况及睫状体有无脱离。 结果： 1、手术结果：实验组工和实验组Ⅱ术前眼压比较,差异无统计学意义(18.64±2.68mmHg,18.37±2.75mmHg,t值0.32,P=0.96),术后1周实验组Ⅰ和实验组Ⅱ眼压较术前相比均明显降低,两组眼压比较,差异无统计学意义(13.07±2.66mmHg,13.31±2.50mmHg,t值0.3,P=0.29)。 2、荧光示踪剂结果：术后1周实验组间各部位荧光强度比较均为：睫状体、巩膜池、脉络膜上腔荧光强度最强,前巩膜次之,后巩膜、脉络膜的荧光强度最低。实验组Ⅰ葡萄膜巩膜途径各部位的荧光强度均强于实验组Ⅱ、空白对照组(P0.01)。空白对照组葡萄膜巩膜途径各部位荧光强度强于实验组Ⅱ(P0.01)。 3、HRP追踪结果：术后1周,实验组Ⅰ结膜下、小梁网见散在的棕黄色HRP颗粒分布,睫状体间隙、睫状体上腔、巩膜瓣下、脉络膜、脉络膜上腔均可见密集的HRP颗粒呈强染色；实验组Ⅱ结膜下见密集的HRP颗粒呈强染色,睫状体间隙、小梁网见棕黄色HRP颗粒散在分布,巩膜瓣下、脉络膜、脉络膜上腔见少量HRP颗粒呈弱染色,睫状体上腔未见明显HRP颗粒分布。空白对照组结膜下、小梁网、睫状体间隙、虹膜睫状体突见散在的HRP颗粒分布,脉络膜、脉络膜上腔见少量HRP颗粒分布。 结论： 1.兔巩膜池小梁切除术与常规小梁切除术早期降压效果相似。 2.兔巩膜池小梁切除术后早期房水除常规小梁切除滤过口外引流外,通过巩膜池还增加了房水葡萄膜巩膜途径引流。 3.用FITC-Dextran示踪剂和HRP追踪结果提示：兔巩膜池小梁切除术后的早期葡萄膜巩膜途径房水引流较常规小梁切除术明显增加。葡萄膜巩膜途径房水引流是兔巩膜池小梁切除术后早期降眼压的主要机制之一
[Abstract]:Objective:
The possible hypotensive mechanism of the scleral pool trabeculectomy was discussed by comparing the morphological changes of the aqueous drainage of the vineal sclera after the scleral pool trabeculectomy and conventional trabeculectomy.
Objects and methods:
1, the subjects and groups: 30 adult New Zealand white rabbits with 60 eyes and weight 2.5-3.0Kg. According to the random number table method, 20 40 eyes were randomly selected as the experimental group. The right eye was treated with scleral pool trabeculectomy in the experimental group I, the left eye underwent conventional trabeculectomy for the experimental group II. The other 10 20 eyes had no operation in the blank control group.
2, the surgical method: the conjunctival flap based on the fornix. The experimental group I made the sclera flap with the corneal limbus as the base and the thick sclera 1/3, about 4mm x 4mm size, peeled off to the deep sclera under the superficial sclera flap of the transparent limbus, and then made the same basal sscleral thick sclera flap (size about 3mm x 3mm), and removed it. Along the cornea, the sclera was removed. The sclera was removed. The sclera was removed along the corneo sclera. At the posterior edge of the membrane, the deep tissue of 2mm * 1mm was cut horizontally, the scleral flap was sutured intermittently on 10/0 line, and the conjunctival flap was sutured by water tight.
3, postoperative observation: 1 weeks after the operation, the cornea, anterior chamber reaction, filter bubble, and fundus were observed every day after 1 weeks of operation. The ratio of filter bubbles was recorded, the changes of intraocular pressure before and after operation were monitored, and the data were recorded by.UBM to observe the condition of filter, outflow and ciliary body.
4, fluorescence tracer experiment: 1 weeks after the operation, the experimental group I was taken, 10 eyes in the experimental group and 5 in the blank group, 10 eyes in the blank group, the anterior chamber puncture injection of 2mg/ml FITC-Dextran tracer 10 U L, each of the experimental group I, the experimental group II each 2 eyes, the blank group 1 2 eyes, the rapid removal of eye ball, frozen section, fluorescence microscope observation of ciliary body and the chamber pool, The intensity of fluorescence intensity in the choroidal cavity, anterior, posterior sclera and choroid.
5, HRP tracking experiment: 1 weeks after operation, another group I was taken, 10 eyes in the experimental group and 5 in 10 eyes of the blank group. The anterior chamber puncture was injected into 0.2mg/mlHRP10 mu 1,60 min and 350ml was injected through the carotid artery. The eyeball was quickly extracted and frozen, and the distribution of HRP with the flow in the room was observed. Parallel MASSION staining was used to observe the proliferation of the collagen fiber in the filter channel. Whether or not the ciliary body is divorced from the condition.
Result锛，

本文编号：2002374