【作者】 于朋朋；

【导师】 徐延山；

【作者基本信息】 天津医科大学 ， 眼科学， 2011， 硕士

【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。更多还原

【Abstract】 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.更多还原