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目的:应用新一代活体共焦显微镜(HRTⅢ/RCM)在细胞水平观察小梁切除术后结膜滤过泡的组织学改变,研究滤过性手术的滤过机制及术后损伤修复机制。方法:对小梁切除术后的23例患者共28只眼行裂隙灯、眼压及活体共焦显微镜检查。其中功能性滤过泡9眼,非功能性滤过泡11眼,联合应用丝裂霉素C后功能性滤过泡8眼。对滤过泡中微囊泡的大小、数量、结缔组织的密度进行统计学分析。结果:功能性滤过泡中含有大量透明的微囊泡,而非功能性滤过泡中没有或仅有少许透明度较低的微囊泡;功能性滤过泡的上皮下存在比较疏松的结缔组织,但非功能性滤过泡中的结缔组织极致密;功能性滤过泡中出现新生血管的比例远远小于非功能性滤过泡。相比之下,联合应用丝裂霉素C的功能性滤过泡中含有大量较大的微囊泡,其上皮下结缔组织较疏松,各层组织内均可见大量高反光颗粒。结论:活体共焦显微镜检查能够对结膜滤过泡进行诊断成像,是一种与来自离体组织学检查结果完全吻合的新的活体检查方法,对将来提高滤过性手术的成功率具有直接的指导作用。
OBJECTIVE: To observe the histological changes of conjunctival bleb after trabeculectomy using a new generation of live confocal microscope (HRTⅢ / RCM) to study the filtration mechanism of filtration surgery and the mechanism of postoperative injury repair. Methods: A total of 28 eyes of 23 patients undergoing trabeculectomy were examined with slit lamp, intraocular pressure and in vivo confocal microscopy. Among them, 9 were functional filtration bleb, 11 non-functional filtration bleb, and 8 functional filtration bleb after combined application of mitomycin C. The size, number and density of connective tissue in the bleb were statistically analyzed. Results: The functional filter bleb contained a large number of transparent microvesicles, but no or only a few of the non-functional filter bleb microleaves with low transparency. There was loose connective tissue under the epithelium of functional filter bleb However, the connective tissue in non-functional bleb was very dense; the proportion of functional bleb in which neovascularization was much smaller than that in non-functional bleb. In contrast, the combination of mitomycin C functional filtration bleb contains a large number of larger microvesicles, the connective tissue of the lower subcutaneous loosening, can be seen in all layers of a large number of high-reflective particles. CONCLUSIONS: In vivo confocal microscopy for the diagnostic imaging of conjunctival filtration bleb is a novel biopsy method that is completely consistent with the findings from an ex vivo histological examination and has a direct impact on future rates of success in filtering surgery Guidance.