Department of Ophthalmology, University of Washington, Seattle, WA, USA.
Department of Ophthalmology, McGill University, Montreal, QC, Canada.
Exp Eye Res. 2014 Feb;119:70-6. doi: 10.1016/j.exer.2013.12.011. Epub 2013 Dec 24.
This study evaluates the morphologic effect of the implantation of two different sizes of the Hydrus microstent on the outer wall of Schlemm's canal (SC) and collector channel (CC) ostia. Twelve human eyes were dissected at the equator removing the iris, lens, ciliary body and vitreous. The cornea was excised with a corneal trephine exposing a direct view of the angle while leaving the trabecular meshwork (TM) intact. The Hydrus delivery system was used to deliver microstents of 8 mm and 15 mm in length into SC. Following delivery, the tissues were immediately immersed in fixative. After tissue fixation, the microstents were gently lifted out of SC through the TM leaving a small slit opening in the TM. The slit opening was widened by gently dissecting the entire TM. Control eyes underwent dissection before fixation by gently removing the TM exposing the outer wall of SC. The tissues were prepared for scanning electron microscopy (SEM). The external wall of SC was imaged using SEM and were reviewed with particular attention focused on the distribution of irregular particulate matter (IPM), the shape of the CC ostia and the health of the SC endothelium. Three eyes received the 8 mm microstent, two the 15 mm microstent and 6 eyes served as controls. Five of the controls had reported histories of glaucoma while all other eyes were normal. All eyes showed evidence of removal of the trabecular meshwork revealing the external wall of SC. CCs were regularly visible in all eyes and were not obstructed, compressed or their margins disrupted. Nuclear profiles were oriented circumferentially in SC except at regions of CC ostia where they assumed a radial configuration oriented toward the lumen of the CC. The area of microstent contact with SC external wall was examined with SEM and a comparison made between the 8 and 15 mm microstent showing a smaller area of indentation with the 8 mm microstent. The indentations were generally free of particulate debris, were smooth and were devoid of nuclear profiles. In bridged areas adjacent to areas of microstent contact, CCs were identified, appearing patent and intact like those of the control eyes. The eyes receiving 8 mm and 15 mm Hydrus microstents both maintained CC ostia patency but a smaller area of external wall contact was evident from insertion of the 8 mm microstent.
本研究评估了植入两种不同尺寸的 Hydrus 微支架对施莱姆氏管（SC）和收集管（CC）口外壁的形态学影响。12 个人眼在赤道处被解剖，去除虹膜、晶状体、睫状体和玻璃体。角膜用角膜环钻切除，直接暴露前房角，同时保持小梁网（TM）完整。使用 Hydrus 输送系统将 8mm 和 15mm 长的微支架输送到 SC 中。输送后，组织立即浸泡在固定剂中。组织固定后，微支架通过 TM 轻轻提起，在 TM 上留下一个小的狭缝开口。通过轻轻解剖整个 TM 来扩大狭缝开口。对照眼在固定前通过轻轻去除 TM 暴露 SC 的外壁进行解剖。准备好组织进行扫描电子显微镜（SEM）检查。使用 SEM 对 SC 的外壁进行成像，并特别注意不规则颗粒物质（IPM）的分布、CC 口的形状和 SC 内皮的健康状况。三只眼接受了 8mm 微支架，两只眼接受了 15mm 微支架，六只眼作为对照。五名对照者有青光眼病史，而所有其他眼睛均正常。所有眼睛均显示出去除小梁网的证据，揭示了 SC 的外壁。在所有眼睛中均可见 CC，并且没有阻塞、压缩或其边缘破裂。核轮廓在 SC 中呈环形排列，除了在 CC 口区域，它们呈径向排列，朝向 CC 的管腔。使用 SEM 检查微支架与 SC 外壁接触的区域，并比较 8mm 和 15mm 微支架，结果显示 8mm 微支架的压痕面积较小。压痕通常没有颗粒状碎片，表面光滑，没有核轮廓。在与微支架接触区域相邻的桥接区域，识别出 CC，它们与对照眼的 CC 一样，保持通畅且完整。植入 8mm 和 15mm Hydrus 微支架的眼睛都保持 CC 口通畅，但从插入 8mm 微支架来看，与外壁接触的面积较小。
