【作者】 王越；

【导师】 徐延山； 李迎新； 季建；

【作者基本信息】 天津医科大学 ， 眼科学， 2008， 硕士

【摘要】 目的:研究应用自制CO₂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:在兔高眼压模型眼实施CO₂激光滤过术的实验研究。方法:第一部分:在8只正常兔眼后房注入320U/0.25ml的α-糜蛋白酶0.15-0.20ml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:制备兔高眼压模型,选择模型制备成功的24只兔48眼,右眼应用CO₂激光机输出的超脉冲CO₂激光（平均功率4-5W,脉宽0.8ms,频率100Hz）进行巩膜瓣下巩膜切除联合虹膜切除术,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2个月内的前房反应、滤过泡情况,眼压、组织病理学变化。结果:第一部分:用来制备高眼压模型的8只兔眼术前平均眼压为10.1±1.05mmHg,在后房注入α-糜蛋白酶后眼压均明显升高,术后第3、7、14、30、60天的平均眼压分别为15.98±2.91 mmHg、21.84±5.18mmHg、23.41±5.02mmHg、23.86±3.97 mmHg、25.37±3.1 6 mmHg,与术前眼压相比均有明显的统计学差异,且术后14、30、60天之间的眼压没有统计学差异。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3-10天消失。第二部分: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,16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21天,手术组功能性滤过泡比例下降明显,分别为62.5%（10/16）和33.3%（4/12）,激光组则为93.8%（15/16）和75%（9/12）,两组之间有统计学差异。术后早期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,手术组出现的较激光组早,术后第14天和第21天两组眼压出现统计学差异。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320U/0.25ml的α-糜蛋白酶0.15-0.20ml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:应用自制CO₂激光机出的超脉冲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: 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 ofα-chymotrypsin（concentration is 320U/0.25ml）0.15-0.20ml in 8 rabbits’ eyes.After injection,the appearance of the rabbits’ eyes was obseved,and the intraocular pressure was recorded in 2 months.Part 2:Induce rabbits intraocular hypertension model,then chose 24 rabbits 48 eyes which were successful induced. On the right eye of each rabbit we performed sclerectomy with a scleral flap and iridectomy by pulse CO₂ laser（power 4-5W,pulse duration 0.8ms,frequency 100Hz）which was outputed by the CO₂ laser device,and we called it as laser group,the left eye was treated with conventional trabeculectomy as a comparison,called surgery group.Postoperative anterior chamber reaction,filtering bleb,intraocular pressure and pathology examination were observed and contrasted in 2 months between the two groups.Results:Part 1:Before injection ofα-chymotrypsin,the mean IOP of the 8 eyes was 10.1±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 3-10 days postoperation.Part 2:Anterior chamber reaction of laser group was mild,only 2 eyes had slight hemorrhage around iris hole;surgery group had serious reaction,16 eyes appeared obvious hemorrhage and massive exudation.Both of the two groups had most functional filtering bleb in earlier period postoperation.Until 14 and 21 days postoperation,surgery group appeared a obviously decrease of functional filtering bleb number,the proportions were 62.5%（10/16）and 33.3%（4/12）,but laser group still had 93.8%（15/16）and 75%（9/12）,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 and 21 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 ofα-chymotrypsin（concentration is 320U/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: 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