目的探讨组织型纤溶酶原激活剂(t-PA)在兔眼青光眼滤过术毕前房小剂量(25μg)注射的有效性。方法采用前瞻性、盲法对照研究，20只健康白色家兔双眼行全厚巩膜咬切滤过手术，术毕随机选一眼为t-PA治疗眼，另一眼为等量生理盐水对照眼，术后临床观察结合光电镜检查。结果生理盐水对照组术后1日和3日滤过道及滤泡腔内有纤维蛋白凝块及红细胞栓子阻塞，而t-PA治疗组滤过道完全开放，炎性细胞及成纤维细胞的数量明显减少；术后7日和14日t-PA治疗组手术区肉芽组织和瘢痕组织的量亦明显少于对照组。与组织学检查相一致，术后1周内治疗组滤过泡比对照组明显增大。两组均未见明显毒副作用。结论 t-PA可有效溶解滤过道及滤泡腔内的纤维蛋白凝块，提高青光眼滤过手术的成功率。%Objective To investigate the effect of 25ug tissue plasminogen ctivator (t-PA) used by intracameral injection immediately after glaucoma filtration surgery in rabbits. Methods Forty eyes of 20 rabbits were randomly divided into 2 groups. A prospective, randomized, masked-observer, placebocontrolled study was performed. Light microscopic and electronic microscope examination was also studied. Results Fibrin clots and red blood cells occluded the fistulas and subconjuctival space in 1d and 3d after surgery in the control group, while patent fistulas were opened in the t-PA treated group and the amount of inflammatory cells and fibroblasts was also significantly reduced. In 7 and 14 d after surgery,light microscope showed that in treated group,the amount of granulation and scar tissue was both obviously less than that of control group. The histological examination is associated with persistence of clinically larger filter bleb in treated group during one week after surgery. There is no obvious adverse effects both in two groups. Conclusion t-PA which degrades the fibrin clots of fistula and filter bleb may promote the success of filtering urgery.
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