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目的观察壳聚糖膜缓释给药系统在小梁切除术中应用的组织反应以及降眼压效果。方法24只48眼新西兰大白兔随机分成A、B、C3组,A组单纯行小梁切除术,作为手术对照;B组行小梁切除术联合壳聚糖膜巩膜瓣下植入;C组行小梁切除术联合曲安奈德壳聚糖膜缓释给药系统巩膜瓣下植入。术后观察眼压、炎症反应、结膜滤泡等,并分别于7d、14d、28d、56d取标本行组织学检查。结果术前各组平均眼压为(23.10±3.92)mmHg(1kPa=7·5mmHg),术后8周A组平均眼压为(21.73±2.90)mmHg,B组平均眼压为(15.64±2.74)mmHg,C组平均眼压为(15.42±2·98)mmHg,B、C组与A组之间有显著性差异(P<0.05),B、C组间无显著差异(P>0.05)。B、C组8周植入材料有断裂现象,其周围有组织间隙和滤泡存在,无明显纤维组织增生;C组炎性细胞浸润现象好于B组;A组组织结构紊乱、瘢痕形成,未见组织间隙和滤泡。结论壳聚糖膜缓释给药系统作为小梁切除术的植入材料有良好的组织相容性,有一定抑制纤维组织增生的作用,能够有效维持滤过,降眼压效果满意。
OBJECTIVE To observe the tissue reaction and the intraocular pressure lowering effect of chitosan membrane delivery system in trabeculectomy. Methods Twenty-four New Zealand white rabbits (48 eyes) were randomly divided into A, B and C3 groups. A group was treated by trabeculectomy alone. B group was treated with trabeculectomy combined with chitosan membrane sclera flap implantation. Trabeculectomy with triamcinolone acetonide sustained-release drug delivery system scleral implant. Postoperative intraocular pressure, inflammatory response, conjunctival follicles, etc., and respectively at 7d, 14d, 28d, 56d after taking samples of histological examination. Results The average intraocular pressure (IOP) in each group was (23.10 ± 3.92) mmHg (1kPa = 7.5 mmHg) preoperatively, and the mean IOP in group A was (21.73 ± 2.90) mmHg at 8 weeks after operation. The average IOP in group B was (15.64 ± 2.74) ) mmHg, the mean intraocular pressure in group C was (15.42 ± 2.98) mmHg, there was a significant difference between group B and C (P <0.05), and there was no significant difference between group B and C (P> 0.05) . B, C group 8 weeks implanted material fracture, surrounded by tissue interstitial and follicular presence, no significant proliferation of fibrous tissue; C group inflammatory cell infiltration is better than the B group; A group of organizational structure disorders, scar formation, No tissue gaps and follicles were seen. Conclusion Chitosan membrane delivery system as trabeculectomy implanted material has good histocompatibility, have a certain inhibition of the role of fibrous tissue proliferation, can effectively maintain the filtration, IOP lowering effect is satisfactory.