| Background:Glaucoma is a common eye disease that can lead to irreversible blindness if left undiagnosed and untreated. In1996, World health organization advanced that The key point of Prevention and treatment of blindness shifted cataract to glaucoma. Laser surgery is a new therapeutic modality. However, the refractory glaucoma can not been effectively treated by current laser surgery. Therefore,a new laser surgical way that is more effective,less or no hemorrhage is needed.Purpose:(1) To develop a self-feedback glaucoma filtering surgery system, which can automatically judge and control the surgery process and meet the needs of clinic glaucoma surgery and product standard. (2)Animal trials were used to prove the safety and efficiency of this system. And a standard of surgery process is established.Materials and method:(1) A CO2 laser glaucoma surgery system was developed, which is consisted of radio frequency CO2 laser device, switching mode power supply (SMPS), surgical microscope system, optical interface and so on. The software system is explored based on Visual C++6.0 and Matlab, working under windows XP and Win CE.(2) Animal trials.40 New Zealand white rabbits were selected. CO2 laser sclerectomy with iridectomy (CLSI) surgery was performed in the left eyes of all rabbits. The traditional trabeculectomy surgery was performed in the right eyes. Anterior chamber inflammatory response, filter bleb and IOP were observed. And all the eyes were then enucleated and subjected to histopathological examination.(3)Intraocular hypertension rabbit model trials. To evaluate the efficacy and safety of the surgery system, intraocular hypertension rabbit models were established. Alpha-Chymotrypsin was used to induce intraocular hypertension rabbit models. CLSI was performed on the left eyes and traditional trabeculectomy was performed on the right eyes. Postoperative anterior chamber inflammatory reactions, filtering bleb, IOP and pathological presentations were observed. Results:(1) The design and debugging of RF CO2 laser glaucoma surgery system was finished and the surgery system could perform the LSI effectively.(2)â‘ Anterior chamber inflammatory reactions. The incidence of anterior chamber inflammatory reactions in the laser group was lower than that in the control group. Hemorrhage was the primary presentation and disappeared faster in the laser group.â‘¡Filtering blebs. There were fewer functional filtering blebs with shorter duaration in the traditional surgery group (P<0.05).â‘¢Mean IOP. As time went by, mean IOP of control group was raised faster than experimental guoup. At 14 and 21 days, there was a significant difference in mean IOP between the two groups(P<0.05).â‘£Pathological examination. Pathological examination showed that compared with the laser surgery group, the traditional surgery group had more serious hemorrhage and fiber proliferation, leading to shorter duration of filtering channel.(3) Surgical procedures. After sclera flaps were finished, the sclera was pressed in order to be close to the iris. We adjusted appropriate laser parameter, judge red reflex intensity and after the irradiation, the sclera flaps were irradiated in low-power pulse mode laser to prevent conglutination. After the above procedures, the wound was sewed up.Conclusions:(1) RF CO2 laser glaucoma surgery system is an intelligent system which can safely and effectively finish the surgery in different modes. The system can meet the needs of the Surgical safety and expectant aim. (2) Weighted algorithms of median filtering based on the HSI color Space and image segmentation based on anisotropic algorithms and Mean Value displacement enhance the robustness of the system.(3) In order to approach the real condition, intraocular hypertension rabbit models induced by Alpha-Chymotrypsin was used to evaluate the laser glaucoma surgery. (4) The CLSI can effectively Control the mean IOP with fewer complications. (5) In this study, the standards of CLSI progress were established. The exposure dose and surgery degree were definitely illuminated, laying a foundation for clinical trials and popularization. |
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