Shi Yao, Yang Xiao-Bo, Dai Neng-Li, Long Hua, Lu Pei-Xiang, Jin Ling, Jiang Fa-Gang
Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China.
Int J Ophthalmol. 2012;5(3):258-65. doi: 10.3980/j.issn.2222-3959.2012.03.02. Epub 2012 Jun 18.
To experimentally compare the external sclerostomy produced using a femtosecond laser with that made by a surgical knife and to evaluate the healing patterns, efficacy and technical advantages of femtosecond laser sclerostomy.
In a prospective randomized, controlled, masked-observer study, 10 pigmented rabbits underwent external sclerostomy with a femtosecond laser in the right eye; 10 additional rabbits underwent sclerostomy with a surgical superblade in the right eye. Clinical characteristics, which included bleb morphology and intraocular pressure, were recorded for 1 month after surgery. Six additional rabbits underwent external femtosecond laser sclerostomy in the right eye and mechanical sclerostomy in the left eye and were killed at day 14 after surgery. Histologic staining, immunohistochemistry and scanning electron microscopy were subsequently performed to assess the morphology of the filtering fistula. The titanium-sapphire femtosecond laboratory laser was operating at a repetition rate of 1 kHz, 0.4 mJ pulse energy, a central wavelength of 800nm and a pulse duration of 50 femtoseconds. Mann-Whitney and Kaplan-Meier tests were used for statistical analysis.
Successful complete sclerostomy was achieved in each laser-treated eye which was hit only once by the laser. The laser treated time was approximately 15s-16s. In the laser-treated group (n=16), 2 eyes (12%) developed mild hyphema at the site of entry and 8 eyes (50%) showed transient edema in the corneal periphery adjacent to the laser impact zone. The differences between the groups in duration of function blebs and pressure reduction were statistically significant (P=0.025 and 0.016, respectively). The success rate of the laser-treated group was significantly higher than the knife group (P=0.005). Histologically, the subconjunctival connective tissue was loosely arranged with partially patent sclerostomy in the laser-treated eyes at postoperative day 14. This contrasted with the completely scarred sclerostomy tract in the knife group. The mean numbers of fibroblasts and new vessels as well as the amount of new collagen deposition at bleb site were significantly decreased in the laser group (P=0.045, 0.013 and 0.036, respectively).
The current study demonstrates that external femtosecond laser sclerostomy may offer a safe and effective alternative for the minimally invasive surgical management of glaucoma.
通过实验比较飞秒激光制作的外路巩膜造口术与手术刀制作的外路巩膜造口术，并评估飞秒激光巩膜造口术的愈合模式、疗效及技术优势。
在一项前瞻性随机对照、设盲观察研究中，10只色素沉着兔右眼接受飞秒激光外路巩膜造口术；另外10只兔右眼接受手术超刃手术刀巩膜造口术。术后1个月记录临床特征，包括滤过泡形态和眼压。另外6只兔右眼接受飞秒激光外路巩膜造口术，左眼接受机械巩膜造口术，术后第14天处死。随后进行组织学染色、免疫组化和扫描电子显微镜检查以评估滤过瘘的形态。钛宝石飞秒实验室激光以1kHz的重复频率、0.4mJ的脉冲能量、800nm的中心波长和50飞秒的脉冲持续时间运行。采用Mann-Whitney和Kaplan-Meier检验进行统计分析。
每只仅被激光照射一次的激光治疗眼均成功完成巩膜造口术。激光治疗时间约为15秒至16秒。在激光治疗组（n = 16）中，2只眼（12%）在进入部位出现轻度前房积血，8只眼（50%）在与激光冲击区相邻的角膜周边出现短暂水肿。两组在功能性滤过泡持续时间和眼压降低方面的差异具有统计学意义（分别为P = 0.025和0.016）。激光治疗组的成功率显著高于手术刀组（P = 0.005）。组织学上，术后第14天激光治疗眼的结膜下结缔组织排列疏松，巩膜造口部分通畅。这与手术刀组完全瘢痕化的巩膜造口通道形成对比。激光组滤过泡部位的成纤维细胞和新生血管平均数以及新胶原沉积量均显著减少（分别为P = 0.045、0.013和0.036）。
本研究表明，外路飞秒激光巩膜造口术可能为青光眼的微创外科治疗提供一种安全有效的替代方法。
