CAJ | 학술논문

目的探索飞秒激光经外路兔巩膜造瘘的可行性,评价手术的有效性和安全性.方法实验研究.对23只青紫蓝兔右眼后房注射α-糜蛋白酶,制备兔慢性高眼压模型.将兔随机分为实验组和对照组,每组10只兔.实验组右眼行飞秒激光巩膜造瘘术,对照组右眼不做手术治疗.飞秒激光脉宽50 fs,波长800nm,重复频率1 kHz,脉冲能量0.4 mJ.观察术后1个月内滤过泡形态、眼压及并发症情况.分别于术后第3、7、14、30天对滤过道组织进行光镜观察,术后14 d对滤过道组织进行扫描电镜观察.组间眼压差异比较采用重复测量方差分析.结果 10只兔眼巩膜均被飞秒激光一次性穿透性切除,激光作用时间为15～16 s,巩膜切口约2 mm×1 mm.术后第1、3、7、14、21、30天,实验组和对照组眼压比较,差异具有统计学意义(F=117.46,39.96,15.17,11.62,15.31,11.10;P<0.01).除2只眼因激光在切穿巩膜时损伤虹膜根部导致前房出血外,未见其他明显的手术并发症.术后第1天所有实验眼均有滤过泡形成,到第3天滤过泡隆起度最高.随后滤过泡逐渐缩小,泡壁增厚,第3周时滤过泡逐渐扁平消失.病理学检查显示飞秒激光巩膜造瘘的切口光滑锐利,对周围组织的附带损伤小,术后滤过道的修复反应主要表现为成纤维细胞的轻度增生和薄层疏松胶原纤维的形成.结论飞秒激光经外路兔巩膜造瘘术简便快捷,安全有效.
목적 탐색비초격광경외로토공막조루적가행성,평개수술적유효성화안전성.방법 실험연구.대23지청자람토우안후방주사α-미단백매,제비토만성고안압모형.장토수궤분위실험조화대조조,매조10지토.실험조우안행비초격광공막조루술,대조조우안불주수술치료.비초격광맥관50 fs,파장800nm,중복빈솔1 kHz,맥충능량0.4 mJ.관찰술후1개월내려과포형태、안압급병발증정황.분별우술후제3、7、14、30천대려과도조직진행광경관찰,술후14 d대려과도조직진행소묘전경관찰.조간안압차이비교채용중복측량방차분석.결과 10지토안공막균피비초격광일차성천투성절제,격광작용시간위15～16 s,공막절구약2 mm×1 mm.술후제1、3、7、14、21、30천,실험조화대조조안압비교,차이구유통계학의의(F=117.46,39.96,15.17,11.62,15.31,11.10;P<0.01).제2지안인격광재절천공막시손상홍막근부도치전방출혈외,미견기타명현적수술병발증.술후제1천소유실험안균유려과포형성,도제3천려과포륭기도최고.수후려과포축점축소,포벽증후,제3주시려과포축점편평소실.병이학검사현시비초격광공막조루적절구광활예리,대주위조직적부대손상소,술후려과도적수복반응주요표현위성섬유세포적경도증생화박층소송효원섬유적형성.결론 비초격광경외로토공막조루술간편쾌첩,안전유효.
Objective To explore the feasibility, efficacy and safety of performing ab externo sclerostomy with a femtosecond laser in rabbits with chronic ocular hypertension. Method The chronic ocular hypertension model was induced by injecting α-chymotrypsin into posterior chamber. Twenty rabbits with chronic ocular hypertension were randomly divided into experiment and control groups, each group consisting of 10 rabbits. An ab externo sclerostomy using a femtosecond laser was performed in the right eyes in the experiment group. The right eyes in control group were unoperated. The laser was a pulsed titanium-sapphire laser, operating at a repetition rate of 1000 per second, 0.4 mJ pulse energy, a central wavelength of 800 run and a pulse duration of 50 femtoseconds. The survival of filtration blebs, clinical manifestation and intraocular pressure (IOP) were observed for 1 month after surgery. Animals were killed on days 3,7, 14 and 30 post-operatively. Hematoxylin and eosin (HE) staining and scanning electron microscopy (SEM) were performed to evaluate the histopatholoGlc changes in filtering tracts. The differences in IOP between the experiment and control groups were analyzed by repeated measures analysis of variance. Results A 2 mm x 1 mm clear full-thickness scleral incision was created in each eye in the experiment group which was hit only once by the laser. The laser treated time was approximately 15-16 s. There was a significant difference (F = 117.46,39.96,15.17,11.62,15.31,11.10; P<0.01) . IOP between experiment and control groups at post-operatively day 1, 3, 7, 14, 21, 30. No serious intra- or post-operative complications happened in the treated eyes except for anterior chamber hemorrhage in 2 eyes triggered by laser injury to iris root A conjunctival bleb was successfully formed in all treated eyes at 1 day after surgery and lasted from 14 to 21 days. Histopathology showed that the perforating scleral incisions created by femtosecond laser were sharply defined, with almost no collateral damage to the surrounding tissue. The tissue repair response in the filtering tracts was characterized by mild hyperplasia of fibroblasts and the loose deposition of a small amount of new collagen fibers. Conclusion The current study demonstrates that ab externo femtosecond laser sclerostomy is a feasible, safe and effective option for the treatment of glaucoma.