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目的:评价晶状体前囊膜作为植入物应用于兔眼青光眼白内障联合手术中阻止滤过口瘢痕形成的作用。方法:选取12只(24眼)科研用新西兰大白兔,先制作高眼压模型。采用随机对照的方法,选择右眼(12眼)为实验组,左眼(12眼)为对照组,实验组在手术显微镜下行青光眼小梁切除联合小切口白内障囊外摘除术,并将自体前囊膜放置于巩膜瓣下,对照组单纯行青光眼小梁切除联合小切口白内障囊外摘除术,观察时间为1d～6mo。术后不同时间点观察眼压、滤过泡、结膜、角膜、前房形成、房水炎症反应,眼部并发症情况及显微镜下观察巩膜滤过道内细胞病理学改变。结果:术后手术成功率、功能滤过泡的累积存活率及并发症均存在有显著性差异。实验组术后1,2,4wk眼压明显低于对照组(P<0.05),术后12,24wk眼压低于对照组,但差异无显著性(P>0.05)。实验组术后1wk手术区大量炎细胞和成纤维细胞,随后炎细胞数量和成纤维细胞减少。术后3mo晶状体前囊膜部分溶解,滤过道内仅存少量异物巨细胞,并于术后6mo接近消失,滤过道保持开放。对照组术后1wk手术区有大量炎细胞和成纤维细胞,于术后1mo左右出现部分滤过通道关闭。在整个实验观察过程中,实验组手术区成纤维细胞数量无明显变化(P>0.05),但与对照组相比较有明显统计学差异(P<0.05)。结论:晶状体前囊膜在术后6mo大部分溶解吸收。在实验动物中将将其应用于青光眼白内障联合术中可有效地降低眼压,并能抑制成纤维细胞增殖,长期有效保留功能性滤泡,保持滤过道开放,且并发症较少。
OBJECTIVE: To evaluate the role of anterior lens capsule as an implant in preventing cataract formation during cataract surgery in glaucoma of the rabbit eye. Methods: Twelve eyes (24 eyes) of New Zealand white rabbits were selected for study. The left eye (12 eyes) was selected as the control group. The experimental group underwent glaucoma trabeculectomy with small incision extracapsular cataract extraction under a surgical microscope, and the former Cysts were placed under the scleral flap, the control group was treated with glaucoma trabeculectomy combined with small incision extracapsular cataract extraction, the observation time was 1d ~ 6mo. The intraocular pressure, filtration bleb, conjunctiva, cornea, anterior chamber formation, aqueous humor inflammation and ocular complications were observed at different time points after operation and the cytopathological changes in the scleral filtration tract were observed under the microscope. Results: There was a significant difference in the success rate of postoperative operation, the cumulative survival rate of functional filtration bleb and complications. The intraocular pressure at 1, 2 and 4 weeks after operation in the experimental group was significantly lower than that in the control group (P <0.05). The intraocular pressure at 12 and 24 weeks postoperatively was lower than that in the control group (P> 0.05). In the experimental group, a large number of inflammatory cells and fibroblasts were observed in the operation area 1wk after operation, and the number of inflammatory cells and the number of fibroblasts decreased subsequently. The anterior capsule of the lens was partially dissolved 3 months after surgery, and only a few foreign bodies of giant cells were found in the filtering passage, and disappeared almost 6 months after operation. The filtration tract remained open. In the control group, there were a large number of inflammatory cells and fibroblasts in the operation area at 1wk after operation, and some filtration passages were closed at about 1mo after operation. There was no significant change in the number of fibroblasts in the experimental group (P> 0.05) during the whole experiment, but there was a significant difference compared with the control group (P <0.05). Conclusion: Most of the anterior lens capsule is dissolved and absorbed 6 months after operation. In experimental animals, it will be used in glaucoma and cataract surgery can effectively reduce intraocular pressure and inhibit fibroblast proliferation, long-term effective retention of functional follicles, to keep the filter open, and less complications.