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目的 :观察闭角型青光眼的小梁形态学改变 ,探讨周边虹膜和小梁粘连程度与小梁、Schlemm管病变的关系。方法 :对628例(746眼)闭角型青光眼手术切除的小梁标本用10 %福尔马林溶液固定 ,火棉胶包埋 ,苏木素 伊红染色 ,光镜下观察。结果 :所有慢性闭角型青光眼的小梁均表现出不同程度的纤维化 ,小梁网及内皮细胞中有程度不等的色素沉积 ,内皮细胞数减少或消失 ,Schlemm管压缩或闭塞。虹膜萎缩、变性 ,周边部与小梁粘连。上述病理改变尤以虹膜与小梁粘连处为甚。急性闭角型青光眼的小梁则表现为内皮细胞水肿 ,小梁网中有色素沉积 ,虹膜基质水肿 ,血管扩张 ,周边部与小梁紧密接触 ,个别切片中可见局灶性坏死。结论 :虹膜与小梁粘连可能是导致或加重小梁损害的一个重要的因素。从病理的角度出发建议 :当青光眼的病人眼压升高且伴有较明显的前房反应时 ,应局部或全身应用皮质激素。一旦发现有房角粘连应采取手术治疗。
OBJECTIVE: To observe the morphological changes of trabecular meshwork in angle-closure glaucoma and to explore the relationship between the adhesion of peripheral iris and trabecular meshwork and trabecular and Schlemm’s canal. Methods: 628 cases (746 eyes) of trabeculectomy with angle-closure glaucoma were fixed with 10% formalin solution, confocted with fire cotton, stained with hematoxylin and eosin and observed under light microscope. RESULTS: All chronic angle-closure glaucoma showed varying degrees of fibrosis with varying degrees of fibrosis in trabecular meshwork and endothelial cells, reduced or absent endothelial cells, and compression or occlusion of the Schlemm’s canal. Iris atrophy, degeneration, peripheral and trabecular adhesions. The pathological changes especially in the adhesion of the iris and trabecular even. Trabecular acute angle-closure glaucoma showed endothelial cell edema, trabecular meshwork pigmentation, iris stromal edema, vasodilation, peripheral and trabecular close contact, visible in individual sections of focal necrosis. Conclusion: The adhesion of the iris to the trabeculae may be an important factor that leads to or aggravates trabecular damage. From the pathological point of view recommendations: When glaucoma patients with elevated intraocular pressure and more obvious anterior chamber reaction, should be topical or systemic corticosteroids. Once found to have room corner adhesions should be treated surgically.