兔眼抗青光眼滤过术中应用C3F8观察滤过道的组织病理学变化

目的:研究小梁切除术中辅助应用C3F8气体后滤过道的病理组织学变化,探讨C3F8改善滤过泡的性状和功能、提高手术成功率的作用机理。方法:将新西兰兔进行小梁切除术随机分为单纯小梁切除术组、小梁切除术组联合C3F8气体组、小梁切除术组联合MMC组;并应用病理组织学和免疫组化技术,对兔眼术后3d,1,2,4wk5个不同时期的滤过泡组织进行病理检查,观察成纤维细胞、新生胶原纤维、新生血管、炎症细胞的改变。结果:C3F8气体组和单纯小梁切除术组术后滤过道新生胶原纤维量、成纤维细胞差异均有统计学意义;MMC组和单纯小梁切除术组术后滤过道新生胶原纤维量、成纤维细胞差异均有统计学意义;C3F8气体和MMC组术后差异无统计学意义。三种不同手术方式术后滤过道的新生血管生长情况和术后5个不同时期的滤过道的炎症细胞进行比较差异都无统计学意义。结论:小梁切除术中应用C3F8气体可在术后早期抑制成纤维细胞增殖和新生胶原纤维的合成,抑制或减轻术后滤过道的疤痕化,提高手术成功率。     

针拨联合球结膜下注射丝裂霉素C治疗功能不良滤过泡

目的 探讨针拨联合丝裂霉素C(mitomycin C,MMC)球结膜下注射治疗青光眼患者小梁切除术后早期功能不良滤过泡的疗效.方法 对47例(50眼)小梁切除术后2～8周滤过泡功能不良青光眼患者行针拨联合MMC 0.2 mL(0.04 mg)结膜下注射,术后所有患者随访3～6个月,观察患者眼压、滤过泡形态和并发症.结果 小梁切除术后2～8周,低平、限局、肥厚、充血型滤过泡32眼、包囊型囊样滤过泡18眼.针拨联合MMC结膜下注射治疗后3～6个月,46眼的滤过泡转为功能性的,轻度膨隆弥散型31眼,多腔或薄壁型15眼,限局肥厚型或无滤过泡4眼.治疗前患眼的平均眼压为(28.5±6.5)mmHg(1 kPa=7.5 mmHg),随访3～6个月平均眼压为(16.3±2.9)mmHg,与注射前比较二者差异有统计学意义(P<0.05).46眼没有用抗青光眼药物或用一种抗青光眼药物眼压控制在21 mmHg以下,成功率占92%.治疗后视物模糊10眼,结膜下出血6眼,角膜上皮点状脱落2眼,无低眼压、伤口渗漏和前房变浅等并发症.结论 针拨联合MMC结膜下注射治疗小梁切除术后早期功能不良滤过泡是安全、有效、简单的方法.     

兔眼滤过术中结膜瓣下辅助应用全氟丙烷后滤过道的组织病理学变化

目的研究小梁切除术中辅助应用全氟丙烷(C3F8)气体后滤过道的组织病理学变化.方法对20只新西兰兔实施小梁切除术.随机分为两组,每组各10只兔(20只眼).第1组随机选择1只眼做单纯小梁切除术,另1只眼做小梁切除术并辅助应用C3F8气体;第2组随机选择1只眼做小梁切除术联合应用丝裂霉素C(MMC),另1只眼做小梁切除术并辅助应用C3F8气体.采用组织病理学和免疫组化技术,对兔眼术后3 d,1、2、3、4周不同时期的滤过泡组织进行病理检查,观察成纤维细胞、新生胶原纤维、新生血管、炎性细胞的改变.结果应用C3F8气体组与单纯小梁切除术组术后滤过道新生胶原纤维量、成纤维细胞量差异均有显著意义(P<0.05);应用MMC组与单纯小梁切除术组术后滤过道新生胶原纤维量、成纤维细胞量差异均有显著意义(P<0.05);应用C3F8气体组与MMC组术后滤过道新生胶原纤维量、成纤维细胞量差异无显著意义(P>0.05).3种不同术式兔眼术后滤过道的新生血管量与术后5个不同时期滤过道的炎性细胞量进行比较,差异均无显著意义(P>0.05).结论小梁切除术中辅助应用C3F8气体可以在术后早期抑制成纤维细胞增殖和新生胶原纤维的合成,抑制或减轻术后滤过道的瘢痕化,从而提高手术的成功率.     

丝裂霉素C结膜下注射联合针拨治疗功能不良滤过泡

目的：探讨丝裂霉素C（ mitomycin C,MMC）结膜下注射联合针拨治疗青光眼小梁切除术后功能不良滤过泡的疗效。方法：对36例39眼因青光眼行小梁切除术后2～12 wk滤过泡功能不良者进行MMC 0．1mL（0．2mg／mL）结膜下注射联合针拨治疗,平均治疗1．31±0．58次,观察眼压、滤过泡和并发症．并随访3 mo。
　　结果：治疗后3mo时平均眼压为15．8±6．6mmHg,显著低于治疗前平均眼压27．4±5．7 mmHg;成功滤过泡32眼,成功率为82．1％。结膜下出血7眼,浅前房低眼压1眼,无伤口渗漏和脉络膜渗漏等并发症。
　　结论：MMC结膜下注射联合针拨治疗小梁切除术后功能不良滤过泡是安全、简单、有效的方法。     

丁酰化壳聚糖膜在兔眼滤过手术抗瘢痕的研究

目的研究丁酰化壳聚糖膜在兔眼高眼压模型滤过手术中的抗瘢痕作用。方法实验研究。45只青紫蓝兔随机分为3组,每组左眼为实验眼,前房均注射0．3％复方卡波姆溶液（含有0．025％地塞米松）0．3ml,诱导兔眼高眼压模型,3周后眼压为30—40mmHg（1mmHg=0．133kPa）。第1组：单纯小梁切除术;第2组：小梁切除术中使用丝裂霉素c（MMC）;第3组：将丁酰化壳聚糖膜植入小梁切除术的板层巩膜瓣下。右眼均不行手术为对照组。分别于术后1、2、4、8及12周每组随机处死3只兔,制作眼球标本。结果病理切片显示术后2周时,单纯小梁切除组巩膜瓣胶原排列紊乱,炎性细胞浸润较多,伴有新生血管形成。MMC组巩膜瓣胶原排列紊乱,胶原组织短小、断裂,伴有炎性细胞浸润。壳聚糖膜组巩膜瓣间隙可见,胶原排列整齐,炎性细胞较少。术后2周,单纯小梁切除组的眼压〉21mmHg,明显高于MMC组和壳聚糖膜组（F=392．869,P〈0．05）,术后12周。壳聚糖膜组眼压低于单纯小梁切除组和MMC组（F=259．923,P〈0．05）;手术4周后,单纯小梁切除组与MMC组功能性滤过泡比率下降。结论丁酰化壳聚糖膜植入兔眼高眼压模型小梁切除术板层巩膜瓣下,有效抑制纤维细胞增生,维持滤过道通畅,术后并发症少,有助于提高手术成功率。     

不同巩膜瓣缝线方法在青光眼小梁切除术中的应用

目的探讨可拆除缝线小梁切除术联合丝裂霉素C在闭角型青光眼小梁切除术中的临床疗效和并发症。方法采用随机对照临床研究方法，将原发性闭角型青光眼55例随机分为2组。A组：小梁切除术＋丝裂霉素C（MMC），29例（29眼）；B组：可拆除缝线小梁切除术＋MMC，26例（29眼）。观察并比较两组术后前房、眼压、早期并发症及滤过泡情况。结果术后3月、6月、1年2组间眼压差异及手术成功率差异均无统计学意义。术后浅前房的发生率两组间差异有统计学意义。B组浅前房发生率低于A组。结论小梁切除术＋MMC与可拆除缝线小梁切除术＋MMC两种术式相比疗效相当。可拆除缝线技术的应用有利于减少术后早期并发症。     

羊膜在小梁切除术中抗瘢痕作用的随机对照研究

背景 小梁切除术后滤过泡的瘢痕化是手术失败的主要原因,术中丝裂霉素C(MMC)的应用可抑制胶原纤维的增生,改善滤过泡的功能,但术后并发症较多,影响手术效果.羊膜在抗青光眼滤过手术中的作用已有较多研究,与MMC临床效果的比较研究却较少. 目的 评价羊膜在小梁切除术中应用后的临床效果.方法 本研究为临床随机对照试验.经北京大学第三医院临床试验伦理委员会批准,患者及家属均于术前签署知情同意书.共纳入2009年10月至2011年10月在北京大学第三医院眼科行小梁切除术的原发性青光眼患者47例52眼,按照单盲和随机对照的原则,采用随机数字表法将患者分为羊膜组26眼及MMC组26眼,前者行小梁切除术联合结膜及巩膜瓣下羊膜植入术,后者在小梁切除术中于结膜及巩膜瓣下给予质量分数0.02％ MMC作用3 min.患者随访期为3个月,分别于术后1周、2周、1个月、3个月时测量2个组术眼的眼压和前房深度,检查滤过泡形态的功能,评估并发症的发生率,并对术眼的前房深度、滤过泡情况进行分级.术后疗效的判断指标主要是眼压的变化. 结果 2个组患者的术前人口基线特征均衡(均P＞0.05).MMC组和羊膜组分别有17眼和22眼完成最终3个月的随访.羊膜组术后3个月眼压为(16.60±5.04)mmHg(1 mmHg=0.133 kPa),与术前(23.52±6.52) mmHg相比明显降低;MMC组术后3个月眼压值为(17.04±3.69) mmHg,比术前(24.09±12.79) mmHg明显下降(均P＜0.05).术后3个月MMC组及羊膜组眼压下降值各为6.94 mmHg及6.98 mmHg.术后1周、2周、1个月和3个月羊膜组与MMC组比较眼压值的差异均无统计学意义(t=0.972,P=0.336;t=-0.512,P=0.611;t=-0.372,P=0.712;t=0.427,P=0.672).两组间术后3个月滤过泡高度为1～3级的眼数、滤过泡血管化为1～3级的眼数、各范围分级眼数的差异均无统计学意义(x2 =0.991,P=0.320; x2 =0.474,P=0.491;x2=2.008,P=0.156).羊膜组总成功率为90.49％,MMC组总成功率为100％,差异有统计学意义(x2=26.180,P=0.000).术后1周、2周及1个月MMC组不同级别的滤过泡渗漏发生率与羊膜组比较差异均无统计学意义(x2=3.556,P=0.059;x2=1.129,P=0.800;x2 =0.434,P=0.510),术后3个月两组滤光泡渗漏情况相同. 结论 小梁手术中联合羊膜植入术后的短期疗效与小梁手术中联合MMC的降眼压效果和滤过泡形态学表现接近,但羊膜植入术浅前房和滤过泡渗漏发生率不高于MMC组.     

定量滤过性小梁切除术

目的：探讨定量滤过性小梁切除术的方法及疗效。方法：将145例（180只眼）原发性青光眼随机分为A、B、C组，每组均为60只眼，A组行小梁切除联合调整缝线；B组行小梁切除联合MMC；C组行小梁切除联合MMC及调整缝线，观察术后眼压，视力，滤过泡，眼底等。结果：随访1年，手术成功率A组为81．7％，B组为93．3％，C组为96．7％，B、C两组与A组对比有显著差异。低眼压，浅前房，脉络膜脱离，黄斑水肿，视力下降等并发症，A、C两组较B组显著减少，结论：C组方法既能抑制瘢痕化又可避免术后早期超滤过引起的并发症，可定量改善滤过。     

γ-干扰素对实验性青光眼滤过术瘢痕形成的影响

目的探讨γ-干扰素（γ-interferon，γ-IF）在实验性青光眼滤过术中抗结膜下瘢痕形成的效果。方法16只家兔随机分为对照组和用药组，每组8只16眼。均行小梁切除术，用药组于术毕即刻、术后第3天、第7天、第14天结膜下注射γ-IF500×10^3 IU，对照组注射生理盐水。分别作眼压（intraocular pressure，IOP）、滤过泡及透射电镜和光镜观察。结果IOP：2组术后IOP均较术前下降，但2组间术后IOP无差异。功能性滤过泡：用药组14眼，对照组6眼。电镜观察：术后21d，用药组纤维排列整齐；对照组纤维排列紊乱。光镜观察：术后21d，用药组结膜下组织疏松，可见纤维间隙，成纤维细胞较少；对照组结膜下被纤维组织填充，成纤维细胞较多。结论γ-IF可有效防止滤过泡瘢痕化及巩膜瘘道阻塞，提高滤过术成功率，有临床应用价值。【眼科新进展2007；27（2）：99-101]     

复合式与单纯小梁切除术治疗青光眼的临床对比观察

目的比较复合式小梁切除术和单纯小梁切除术治疗青光眼的临床疗效。方法将70例(84眼)青光眼患者随机分为2组:复合式小梁切除术组35例(41眼),单纯小梁切除术35例(43眼)。复合式小梁切除术组术中联合应用丝裂霉素C和可调节缝线,其他手术操作步骤与单纯小梁切除术组基本相同。比较分析2组术后前房形成、眼压、滤过泡等情况。结果复合式小梁切除术组2眼(4.88%)在拆除可调节缝线后出现浅前房,单纯小梁切除术组有12眼(27.91%)发生浅前房,2组浅前房发生率差异有统计学意义(P<0.05)。2组患者出院时眼压均控制在21mmHg(1kPa=7.5mmHg)以下;术后6个月时,复合式小梁切除术组眼压<21mmHg共38眼(92.68%),单纯小梁切除术组共29眼(67.44%),2组眼压控制率差异有统计学意义(P<0.05)。2组患者出院时均形成功能性滤过泡;术后6个月时,复合式小梁切除术组37眼(90.24%)形成功能性滤过泡,单纯小梁切除术组30眼(69·77%),2组功能性滤过泡形成率差异有统计学意义(P<0.05)。结论复合式小梁切除术可有效减少术后浅前房的发生,在控制远期眼压和功能性滤过泡形成方面疗效显著,提高了手术成功率。     

Wound modulation after trabeculectomy by different formulations of antimetabolites in rabbits.

A prospective, randomized study was performed to examine the effects of subconjunctival retention of 5-fluorouracil (5-FU) microparticles or 5-FU microparticles combined with mitomycin-C (MMC) on the success of trabeculectomy procedure in 32 New Zealand white rabbits. Drug-loaded microparticles were prepared using a biodegradable polymer, 50:50 ploy (D,L-lactide-co-glycolide) (50:50, PLG, MW 9000), by an oil-in-oil emulsification/solvent extraction technique. Each rabbit underwent trabeculectomy on both eyes, then one of the 5-FU and/or MMC preparations was placed at the site of the filtering surgery intraoperatively in the right eye, while the left eye was used as a control. The rabbits were randomly allocated to one of four treatment groups: group 1 rabbits received 5% 5-FU microparticles 10 mg; group 2 rabbits received 10% 5-FU microparticles 10 mg; group 3 rabbits received 10% 5-FU microparticles 5 mg and MMC 0.01 mg (5-FU/MMC); and group 4 rabbits received MMC 0.02 mg. Postoperatively, intraocularpressure (IOP), bleb survival, complications and IOP dynamics were compared during a follow-up period of 42 days. The results showed that IOPs were significantly lower in the eyes that received groups 3 and 4 treatments, while the eyes that received low concentrations of 5-FU microparticles resulted in no difference in IOPs as compared with those of controls. At 42 days, blebs were present in 100% of the eyes treated with 5-FU/MMC and MMC, but 0% of the eyes treated with 5-FU microparticles. The blebs in the eyes treated with MMC 0.02 mg were thinner, and significant complications (endophthalmitis, transient corneal opacification and neovascularization) occurred. In addition, the IOP dynamics study revealed that the eyes treated with 5-FU/MMC and MMC resulted in less IOP spikings after intravenous infusion of 0.9% NaCl solution. Our study suggested that the use of 5-FU microparticles in promoting the success of trabeculectomy in rabbits is dose-dependent, and its effect is less potent than a single intraoperative application of MMC.     

Determinants of bleb morphology in minimally invasive, clear-cornea micropenetrating glaucoma surgery with mitomycin C

PURPOSE: Antimetabolites, especially mitomycin C (MMC), increase the incidence of late bleb-related endophthalmitis in trabeculectomy. This is related to a higher incidence of avascular, thin, cystic, translucent blebs, which may be caused by a toxic effect on conjunctival tissue. An MMC dose-response study was carried out focusing on bleb morphology and function. PATIENTS AND METHODS: In a retrospective, comparative case series study, 2 successive groups of patients with complicated glaucoma were compared 2 years after a special, minimally invasive, filtering procedure (intrastromal holmium laser keratostomy). Preoperative local subconjunctival injections of a fixed MMC dose (4 microg) were used in group A, and lower MMC doses, calculated individually (1 or 2 microg), were used in group B. Bleb vascularity and morphology were evaluated by masked grading of photomicrographs. Bleb function was evaluated by intraocular pressure (IOP). RESULTS: Total bleb avascularity occurred in 63% of the blebs in group A and 0% in group B (P < 0.01). In eyes with IOP < or = 20 mmHg without medical treatment, the mean IOP was significantly lower in group 1 (8 vs 15 mm Hg, P < 0.002). A translucent cystic bleb without conjunctival stroma was observed in only 1 eye in group A. An optimal spongy stromal bleb was observed in all other eyes (96%) despite the different MMC doses. The numbers of complications in the 2 groups were nearly equal. CONCLUSIONS: Bleb avascularity after 4 microg MMC could be avoided by the use of 1 or 2 microg MMC on the basis of preoperative prognosticators for failure, but at the expense of some of the IOP-lowering effect. This indicates that the therapeutic index (clinical safety margin) of MMC seems to be narrow. An MMC dose-response relation was not observed for the thin, cystic, and translucent bleb. The low incidence of this bleb (4%) indicates that the operative technique, apart from the vascularity, may be the most essential determinant of bleb morphology.     

Correlation between the early morphological appearance of filtering blebs and outcome of trabeculectomy with mitomycin C

PURPOSE: To correlate the morphologic appearance of filtering blebs in the early postoperative period with the outcome of trabeculectomy with mitomycin C (MMC) during the first postoperative year. PATIENTS AND METHODS: In a prospective study, the morphologic appearance of filtering blebs after primary trabeculectomy with adjunctive MMC (0.1 mg/ml for 5 minutes intra-operatively) was classified; 49 eyes of 49 patients were examined preoperatively, 1 and 3 days, 1 and 2 weeks, 1, 3, 6, and 12 months postoperatively. Status of filtering bleb, intraocular pressure (IOP), and number of medications were recorded. RESULTS: One year after surgery all patients had IOP < or = 21; 6 patients received antiglaucoma medication. One eye required needling of the filtering bleb because of encapsulation. During the first postoperative year, eyes with conjunctival subepithelial micro cysts, observed in the first and the second postoperative week, had significantly lower mean IOP, than eyes without (11.1 mm Hg vs. 13.9 mm Hg; p:0.0043, ANOVA). Eyes with corkscrew vessels, observed in the first and the second postoperative week, had significantly higher mean IOP, than eyes without during the first postoperative year (13.4 mm Hg vs. 11.7 mm Hg; p:0.0141, ANOVA). CONCLUSION: Classification of filtering blebs after trabeculectomy with MMC may help to disclose patients with an increased failure risk.     

难治性青光眼早期功能不良滤过泡处理的临床观察

目的：观察难治性青光眼小梁切除术后早期功能不良滤过泡的处理方法、治疗效果,探讨有效、安全的早期功能不良滤过泡处理方法。

方法：收集我院2006-01/2012-01诊断为难治性青光眼且行小梁切除术后出现早期功能不良滤过泡(或倾向)者20例20眼于小梁切除术后3～8d进行治疗,治疗方法包括：眼球按摩、断(或拆除)巩膜缝线后再行眼球按摩、钝针头针拨分离滤过泡或联合结膜下注射5-氟尿嘧啶(5-FU)。所有患者术中曾用过抗代谢药丝裂霉素C(MMC, 0.3g/L)。随访6mo。

结果：经眼球按摩后有9眼获得功能滤过泡,联合钝针头针拨分离滤过泡治疗后有5眼为功能滤过泡,4眼经联合5-FU结膜下注射后为功能滤过泡,其综合成功率达90%。治疗前平均眼压24.61±5.4mmHg(1mmHg=0.133kPa),随访6mo结束时平均眼压为15.20±4.8mmHg,治疗前后眼压差异有显著统计学意义(P<0.01)。操作中和操作后未见任何并发症。

结论：难治性青光眼病情复杂,小梁切除术后极易出现早期功能不良滤过泡(或倾向),我们提倡尽早处理,综合眼球按摩、断(或拆除)巩膜缝线、钝针头针拨分离滤过泡或联合结膜下注射5-FU更安全有效,可很大程度上挽救早期濒临失败的滤过泡,提高手术成功率。     

Avastin抑制兔眼小梁切除术后滤过泡瘢痕化的作用

目的:探讨Avastin抑制兔眼小梁切除术后滤过泡纤维瘢痕形成的作用。方法:兔20只40眼随机分为3个不同剂量Avastin实验组、丝裂霉素C(MMC)对照组及空白对照组。对兔眼行常规小梁切除术,Avastin实验组于术毕及术后3,7d术区结膜下分别注射0.5,1及2mg Avastin;MMC对照组术中筋膜囊、巩膜瓣下放置0.2g/LMMC棉片。术后裂隙灯下观察滤过泡形态及角膜、前房等情况;术后7,14d摘除眼球,常规HE染色观察组织形态,在高倍视野中,通过滤过泡腔面在结膜中形成的面积百分比及滤过泡形成区在结膜中面积百分比,评价不同剂量Avastin结膜下注射对滤过泡形成及纤维化的影响。结果:术后7d各组结膜纤维结缔组织中均可见明显的滤过泡形成。术后14d仅注射2mg Avastin实验组及MMC对照组的结膜组织中可见明显滤过泡;1mg Avastin实验组见少量面积微小的滤过泡;0.5mg Avastin实验组及空白对照组滤过泡均消失,纤维组织增生明显。术后7d各组高倍视野下滤过泡腔面在结膜中形成的面积百分比及滤过泡形成区在结膜中面积百分比无明显差异。术后14d,2mg及1mg Avastin实验组滤过泡腔面积在结膜中形成的面积百分比分别为1.0%,0.8%,MMC组为0.9%。2mg及1mgAvastin实验组滤过泡形成区在结膜中面积百分比分别为26.1%,2.9%,MMC组为25.8%。2mg及1mgAvastin实验组的滤过泡腔面及形成区面积与结膜面积的百分比均明显高于空白对照组,单项方差分析结果分别为F=270.10,P=0.00;F=49.99,P=0.00;2mg Avastin实验组的上述滤过泡面积百分比与MMC组无差异。结论:结膜下注射Avastin可有效帮助滤过术后滤过泡的形成与维持,缓解滤过泡的纤维增生。     

Control of filtering bleb structure through tissue bioengineering: An animal model

PURPOSE: To devise a means of providing controlled resistance between the anterior chamber and the subconjunctival space after trabeculectomy by implantation of a biodegradable, porous collagen matrix. METHODS: Matrices were implanted in the right eyes of 17 rabbits after trabeculectomy, while left eyes served as surgical controls. The scleral flap was sutured loosely, and the implant provided pressure on the scleral flap to reduce overfiltration. Trabeculectomy in the control eyes was performed with tight sutures using standard methodology. Intraocular pressure (IOP) was measured before surgery and on days 3, 7, 14, 21, and 28 after surgery. Masson trichrome and alpha-smooth muscle actin stains were used for histologic study of the filtering blebs. RESULTS: The initial postoperative IOP reduction was approximately equal, at 14% to 16%, for both groups. In the implanted group, the IOP continued to decrease to 55% below baseline at day 28 as the implant gradually degraded. In the control group, IOP had returned to the preoperative level by day 21. Histologic examination with Masson trichrome and alpha-smooth muscle actin stains showed a prominent bleb in the implanted group compared with scar formation and limited bleb formation in the control group. CONCLUSIONS: Implantation of a biodegradable, porous collagen matrix in the subconjunctival space offers the potential for a new means of avoiding early scar formation and maintaining long-term IOP control by creating a loosely structured filtering bleb.     

比较5-Fu和MMC缓释膜在青光眼滤过手术中应用的实验研究

目的 评估生物缓释膜在青光眼滤过手术中的安全性和作用,比较5-氟尿嘧啶(5-Fu)和丝裂霉素(MMC)缓释膜在青光眼滤过手术中的抗增殖的疗效.方法 以5-Fu和MMC作为模型药物,壳聚糖作为载体,溶剂挥发法成膜;通过共价交联的方式将12μg的5-Fu或MMC结合到生物缓释膜上.未植入缓释膜作为对照组,其余3组植入空白、5-Fu和MMC缓释膜.四组均行青光眼滤过手术,静脉留置针作为引流管,空白缓释膜、5-Fu缓释膜、MMC缓释膜缝于巩膜瓣下.滤过手术前和手术后1、3、5、714、21和28d,以Tonopen眼压计记录兔眼压,以裂隙灯观察滤过泡大小和眼前节的变化并照相;分别于术后28d每组处死两只兔,总共8只眼标本行病理组织学检查;用扫描电子显微镜检测每组术后28d的角膜和晶状体标本.结果 术前各组平均眼压无差异,MMC组手术前和手术后28d内比较差异有统计学意义(F值为26.866 P＜0.01),5-Fu组和单纯引流管组手术前和手术后14d内比较差异有统计学意义,(F值分别为13.467,6.567 P＜0.01),空白缓释膜组手术前和手术后7d内比较差异有统计学意义(F值分别为11.426 P＜0.01);MMC、5-Fu组滤过泡生存时间优于单纯引流管组、空白缓释膜组.5-Fu和MMC组,术后28d角膜内皮细胞和晶状体前囊无异常改变.结论 5-Fu和MMC生物缓释膜能明显提高滤过手术成功率并且是安全的,在降低眼内压和延长滤过泡减少眼前节并发症方面,MMC缓释膜比5-Fu缓释膜能更有效地提高滤过手术成功率.