Blasini M, Simmons R, Shields M B
Duke University Eye Center, Durham, North Carolina 27710.
Invest Ophthalmol Vis Sci. 1990 Jun;31(6):1114-8.
Transscleral cyclophotocoagulation was performed with a neodymium: YAG laser on five patients 24-72 hr before enucleation for a blind, painful eye. The thermal mode at 20 ms and a maximum offset between aiming and therapeutic beams were kept constant. Variable parameters evaluated were energy levels between 2 and 8 J and distance from the limbus of 0.5-3.0 mm. Because of the underlying distortion in three of the eyes, meaningful interpretation by light microscopic evaluation was possible only in the other two. This suggested that the early histologic hallmark of the procedure is similar to that previously observed in human autopsy eyes with ciliary epithelial damage and elevation from underlying tissue. In addition, fibrin and scant inflammatory cells were seen in the space between ciliary epithelium and stroma. Minimal damage was observed in the ciliary muscle. These findings suggest that direct damage to the ciliary epithelium is the most likely mechanism of reduced aqueous production by this cyclodestructive procedure. The findings also support the concept that an anterior placement of approximately 1.0-1.5 mm posterior to the limbus is most likely to damage the ciliary epithelium of the pars plicata.
对于因失明且疼痛而需摘除眼球的5例患者，在眼球摘除术前24至72小时，用钕:钇铝石榴石激光进行经巩膜睫状体光凝术。保持20毫秒的热模式以及瞄准光束和治疗光束之间的最大偏移量不变。评估的可变参数为2至8焦耳的能量水平以及距角膜缘0.5至3.0毫米的距离。由于三只眼中存在潜在的变形，只有另外两只眼能够通过光学显微镜评估进行有意义的解读。这表明该手术的早期组织学特征与先前在有睫状体上皮损伤并与下方组织分离的人类尸检眼中观察到的特征相似。此外，在睫状体上皮和基质之间的间隙中可见纤维蛋白和少量炎性细胞。睫状肌损伤最小。这些发现表明，直接损伤睫状体上皮是这种睫状体破坏手术减少房水生成的最可能机制。这些发现还支持这样一种观点，即位于角膜缘后约1.0至1.5毫米的前部位置最有可能损伤睫状突的睫状体上皮。
