| Objective To investigate the application of biological amniotic membrane soaked in pirfenidone in glaucoma filtration surgery and to evaluate the anti-scarring effects and side effects in high intraocular pressure rabbit models.Methods 36 healthy conspecific New Zealand white rabbits(72 eyes) were injected with 0.1ml 0.3% compound carbomer solution into the anterior chamber to induce high intraocular pressure rabbit models. After successful high intraocular pressure models were made, 36 rabbits( 72 eyes) were randomly divided into A,B,C,D 4 groups(18 eyes in each group).Group A underwent trabeculectomy with0.5% PFD-soaked amniotic membrane implantation; group B underwent trabeculectomy with biological amniotic membrane implantation; group C underwent trabeculectomy with 0.2mg/ml mitomycin cotton patch placed under sclera flap for 3 minutes; group D underwent trabeculectomy only. Intraocular pressure(IOP),morphologic changes of bleb, side effects and complications were evaluated with rebound tonometer SW500 and slit-lamp on the1 th,3th,7th,14 th,21th and 28 th day post-operation separately. 3 rabbits( 6 eyes)were killed with anterior auricular veins air embolization method in each group on the 7th,14 th and 28 th day post-operation respectively, remove of the eyeball as soon as the rabbit died. Histopathological changes were observed with HE, Masson staining and immunohistochemistry on five time point after surgery in the filtration area.Results No significant differences were found in IOP among each group before the compound carbomer solution were injected into the anterior chamber(P>0.05).The IOP could rise up to 26-31 mm Hg in the 10 th day after the compound carbomer solution were injected into the anterior chamber in each group. Still no significant differences were found in IOP among each group in this period(P>0.05).Differences were found in IOP on the same observation time point in each group over time after the glaucoma filtration surgery. There were statistically significant differences among each groups on the 1th,3th,7th,14 th,21th and 28 th day post-operation separately(P<0.05).The mean IOP levels were C﹤A﹤B﹤D on the 1th,3th and 7th day post-operation separately(P<0.05),while the mean IOP levels were A ﹤ C ﹤ B ﹤ D on the 14 th,21th and 28 th day post-operation separately(P<0.05).The IOP could change smoothly and sustain low levels for a long time in group A after the glaucoma filtration surgery. The diffuse and flat bleb could be found on the first day post-operation in each group. The blebs showed different changes over time after the glaucoma filtration surgery. Kaplan-Meier analysis showed a significant statistical difference in the survival distributions among the 4 groups(log rank=16.80, P<0.01).Different degrees of conjunctival congestion, corneal edema, corneal opacity and anterior chamber inflammation were found in each group within 1 week after the glaucoma filtration surgery. There were no observable signs of filtering bleb leakage, corneal ulcers, shallow anterior chamber and hypotony among all four groups in 28 days observation. Mild anterior chamber inflammation were found in group A and B, while severe anterior chamber inflammation were found in group C and D. There were statistically significant differences between group A and group C(P<0.05).Group A had an advantage over group C in long-time inhibition of inflammatory cell infiltration, fibroblast proliferation,TGF-β1-expressing and Collagen deposition, while group B showed a lower effect in above aspects. There were statistically significant differences between group A,group B and group C(P<0.05).Conclusions Biological amniotic membrane soaked in pirfenidone can inhibit inflammatory cells proliferation and impede collagen fibers hyperplasia in filtration area after the glaucoma filtration surgery. The results indicate the biological amniotic membrane soaked in pirfenidone has a long-time anti-scaring effects with fewer side effects and better safety. |
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