Knorr H L, Seltsam A, Holbach L, Naumann G O
Augenklinik, Universität Erlangen--Nürnberg.
Ophthalmologe. 1996 Apr;93(2):130-8.
Previous histological studies have shown that intraocular silicone oil induces irreversible changes in ocular tissues, especially the retina. The purpose of this study was to analyze, in a larger group of enucleated eyes, changes in intraocular tissue after silicone oil injection, dependent on intraocular pressure, how long the oil was in the eye, and the viscosity of intraocular silicone oil.
We did histological examinations on 36 enucleated globes with intraocular silicone oil after vitreoretinal surgery and compared them with 68 enucleated globes treated with buckle and encircling band using immunohistochemistry (n = 5) and electron microscopy (n = 7). For statistical evaluation we used the chi(2) test and analysis of variance.
After silicone oil injection we observed a more pronounced reduction in corneal endothelial cells (58%), more frequent closed chamber angle (86%), atrophy of the ciliary body (80%) (P < 0.05), proliferative vitreoretinopathy (89%), and glaucomatous atrophy of the optic nerve (56%) (P < 0.01). The retinae showed independent of the use of silicone oil a loss of inner and outer segments of photoreceptors and of ganglion cells and thinning and rareficaton of all other retinal layers. Globes with silicone oil revealed vacuoles both free and incorporated by macrophages in all layers of the retina. Similar vacuoles were seen in the optic nerve, choroid, retinal pigment epithelium, ciliary body, iris, chamber angle and the corneal endothelium. Silicone oil vacuoles were seen in the retina and optic nerve by 1 month after surgery in two eyes with high intraocular pressure (42 mmHg). Six of eight eyes with normal intraocular pressure levels showed retinal vacuoles, 3 of them after 2 months. Vacuoles in the optic nerve were found in eight of nine eyes with intraocular instillation of 1000 mPa silicone oil. There was no clinicohistopathological correlation between the presence of vacuoles in the retina or optic nerve and the duration and viscosity of intraocular silicone oil.
This study suggests that vacuoles in eyes with silicone oil instillation can be found in the retina after 4 weeks. The period of intraocular silicone oil should be limited to 3-6 months.
以往的组织学研究表明,眼内硅油会引起眼组织不可逆的变化,尤其是视网膜。本研究的目的是在更大一组摘除眼球中,分析硅油注入后眼内组织的变化,这些变化取决于眼压、硅油在眼内的存留时间以及眼内硅油的黏度。
我们对36只玻璃体视网膜手术后眼内注入硅油的摘除眼球进行了组织学检查,并使用免疫组织化学(n = 5)和电子显微镜(n = 7),将其与68只接受巩膜扣带术和环扎带治疗的摘除眼球进行比较。我们使用卡方检验和方差分析进行统计学评估。
注入硅油后,我们观察到角膜内皮细胞减少更为明显(58%),房角关闭更为频繁(86%),睫状体萎缩(80%)(P < 0.05),增殖性玻璃体视网膜病变(89%),以及青光眼性视神经萎缩(56%)(P < 0.01)。视网膜显示,无论是否使用硅油,光感受器的内段和外段以及神经节细胞都会丢失,所有其他视网膜层都会变薄和稀疏。注入硅油的眼球在视网膜各层均可见游离的和被巨噬细胞吞噬的空泡。在视神经、脉络膜、视网膜色素上皮、睫状体、虹膜、房角和角膜内皮中也可见类似的空泡。在两只眼压高(42 mmHg)的眼中,术后1个月在视网膜和视神经中可见硅油空泡。八只眼压正常的眼中有六只出现视网膜空泡,其中三只在2个月后出现。在九只眼内滴注1000 mPa硅油的眼中,有八只在视神经中发现空泡。视网膜或视神经中空泡的存在与眼内硅油的存留时间和黏度之间没有临床组织病理学相关性。
本研究表明,滴注硅油的眼中,4周后视网膜中可发现空泡。眼内硅油的存留时间应限制在3至6个月。