背景激光周边虹膜成形术(LPI)能使虹膜收缩变平，房角增宽，在临床上用于青光眼的治疗。但目前临床上对LPI的最佳作用部位尚无定论。
目的探讨选择不同部位虹膜行LPI对青光眼疗效的影响。
方法取健康成年雄性灰兔40只，用含质量分数0.3%卡波姆和质量分数0.025%地塞米松的复方卡波姆溶液0.1 ml行兔右眼前房注射建立青光眼动物模型，然后将模型眼按随机数字表法随机分为模型对照组、角巩膜缘对应部位组、距角巩膜缘1个光斑对应部位组和距角巩膜缘2个光斑对应部位组，每组各10只。按照分组描述部位应用532 nm激光对角巩膜缘对应部位组、距角巩膜缘1个光斑对应部位组和距角巩膜缘2个光斑对应部位组实验眼行LPI，光斑直径为500 μm，能量为300 mW，曝光时间为0.3 s，激光击射24个点，模型对照组未行LPI。用Schiötz眼压计记录术前及术后2、4、7、14、30 d各组兔的眼压并计算房水流畅系数(C值)，用超声生物显微镜(UBM)测定上述时间点兔眼前房深度(ACD)、房角开放度数(AA)和距巩膜突500 μm半径内的房角开放距离(AOD500)。于术后30 d摘取兔眼球，采用苏木精－伊红染色法观察各组兔眼房角的形态学改变。
结果UBM检查显示，与模型对照组比较，LPI各组兔眼房角均明显增宽，以距角巩膜缘1个光斑对应部位组最为明显，距角巩膜缘2个光斑对应部位组效果最不明显。与模型对照组比较，角巩膜缘对应部位组、距角巩膜缘1个光斑对应部位组、距角巩膜缘2个光斑对应部位组兔眼眼压均明显下降，C值均明显增加，AA和AOD500均明显增加，总体比较差异均有统计学意义(眼压： F 分组＝16.848， P<0.01；C值： F 分组＝9.629， P<0.01；AA： F 分组＝62.336， P<0.01；AOD500： F 分组＝77.779， P<0.01)。与各自LPI组内术前值比较，兔眼术后2、4、7、14、30 d眼压均明显下降，C值、AA和AOD500值均明显增加，总体比较差异均有统计学意义(眼压： F 时间＝3.041， P＝0.011；C值： F 时间＝4.311， P<0.01；AA： F 时间＝14.627， P<0.01；AOD500： F 时间＝20.378， P<0.01)。与模型对照组比较，角巩膜缘对应部位组、距角巩膜缘1个光斑对应部位组兔眼各时间点ACD值均明显增加，而距角巩膜缘2个光斑对应部位组与其相似，总体比较差异有统计学意义( F 分组＝18.017， P<0.01)，各组兔眼LPI前后不同时间点ACD的总体比较差异无统计学意义( F 时间＝0.022， P＝1.000)。苏木精－伊红染色可见各LPI组术后30 d兔眼房角处小梁网和房角粘连均被拉开，房角不同程度增宽。
结论LPI可使青光眼模型兔眼房角增宽，眼压下降。在距离角巩膜缘1个光斑处虹膜上行LPI效果最佳。
BackgroundLaser peripheral iridoplasty (LPI) is widely used in the treatment of glaucoma by flattening the iris and widening angle of anterior chamber (AA). However, no evidence suggests the optimal site of LPI in iris.
ObjectiveThis study was to compare the therapeutic effects of LPI at different sites of iris for glaucoma.
MethodsGlaucoma models were established in the right eyes of 40 healthy adult male pigment rabbits by intrachamber injection of 0.1 ml compound carbomer solution with 0.3% carbomer and 0.025% dexamethasone.The models were randomly divided into model control group, corneoscleral limbus group, one spot from corneoscleral limbus group and two spots from corneoscleral limbus group.LPI was performed at corresponding site of iris by 532 nm argon laser with the spot diameter 500 μm, energy 300 mW, exposure time 0.3 seconds and laser number 24 spots, and the rabbits in the model control group did not receive LPI.Intraocular pressure (IOP), coefficient of outflow facility (C value) were measured and calculated with Schiötz tonometer before LPI and 2, 4, 7, 14 and 30 days after LPI, and anterior chamber depth (ACD), AA, anterior chamber angle opening distance within 500 μm radius from scleral spur (AOD500) were measured with ultrasound biomicroscope (UBM). The eyeballs were extracted 30 days after LPI, and the chamber angle were observed under the optical microscope after hematoxylin and eosin staining.The use and care of the animals complied with the Guide for the Care and Use of Laboratory Animals of the National Institutes of Health.
ResultsUBM showed that compared with the model control group, the anterior chamber angle was evidently widened in all the LPI groups, with the best effectiveness in the one spot from corneoscleral limbus group and the worst one in the two spots from corneoscleral limbus group.Compared with the model control group, the IOP was evidently reduced, and C values, AA and AOD500 were significantly increased in the corneoscleral limbus group, one spot from corneoscleral limbus group and two spots from corneoscleral limbus group after LPI, showing significant differences among the four groups (IOP: F group=16.848, P<0.01; C value: F group=9.629, P<0.01; AA: F group=62.336, P<0.01; AOD500: F group=77.779, P<0.01). IOP was reduced and C value, AA and AOD500 were increased in 2, 4, 7, 14 and 30 days after LPI as compared with before LPI, with significant differences over time (IOP: F time=3.041, P=0.011; C value: F time=4.311, P<0.01; AA: F time=14.627, P<0.01; AOD500: F time=20.378, P<0.01). Compared with the model control group, the ACD was significantly increased in the corneoscleral limbus group and one spot from corneoscleral limbus group, and that in the two spots from corneoscleral limbus group was significantly reduced, and the ACD was insignificantly increased over time after LPI ( F group=18.017, P<0.01; F time=0.022, P=1.000). Hematoxylin and eosin staining showed that the trabecular meshwork and adhesion of tissure were reopened and the anterior chamber angle was widened after LPI.
ConclusionsLPI can widen anterior chamber angle and lower the IOP.The best therapeutic outcome for glaucoma is displayed when LPI is performed at the iris site corresponding to one spot from the corneoscleral limbus.
谢茂松,徐国兴,周碧婷,等. 激光周边虹膜成形术中光凝兔青光眼模型不同部位虹膜的效果比较[J]. 中华实验眼科杂志,2017,35(4)：307-313.
DOI:10.3760/cma.j.issn.2095-0160.2017.04.006版权归中华医学会所有。
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