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目的 观察激光光凝后视网膜色素上皮 (RPE)、Bruch膜和脉络膜超微结构的改变和修复过程。方法 收集眼眶恶性肿瘤患者 7例 ,其眼球的视网膜及脉络膜结构基本正常。均经患者签署知情同意书后 ,于眶内容物剜除术前 1、3、7d ,用Ⅰ、Ⅱ、Ⅲ级光斑光凝视网膜。摘除眼球后 ,将其视网膜和脉络膜组织制成超薄切片、醋酸铀和枸橼酸铅染色 ,于透射电镜下观察其超微结构。结果激光光凝后 1d ,经Ⅰ级光斑光凝视网膜组织见部分RPE细胞肿胀、坏死、数量减少 ,微绒毛部分消失 ;Bruch膜完整 ;脉络膜毛细血管内皮肿胀 ,少数管腔闭塞。经Ⅱ级光斑光凝的视网膜组织见较多RPE细胞溶解破坏 ,Bruch膜空泡形成 ,脉络膜毛细血管广泛闭塞。经Ⅲ级光斑光凝的视网膜组织见大量RPE溶解消失 ,Bruch膜部分破坏 ,脉络膜血管受损。激光光凝后 3d ,RPE细胞和脉络膜水肿减退 ,破坏区内出现吞噬细胞 ,RPE细胞和脉络膜纤维组织开始增生。激光光凝后 7d ,增生的RPE细胞覆盖破坏区 ,脉络膜血管减少和基质纤维化。结论 激光光凝可引起RPE细胞水肿、坏死 ,Bruch膜和脉络膜血管不同程度破坏 ,随后RPE细胞和纤维组织增生修复破坏区。不同参数的激光治疗可修复病变的RPE和脉络膜组织。
Objective To observe the changes and repair process of retinal pigment epithelium (RPE), Bruch’s membrane and choroidal ultrastructure after laser photocoagulation. Methods Seven patients with orbital malignant tumor were collected. The retina and choroid of the eyeball were basically normal. After the patient signed the informed consent form, the retina was photocoagulated with Ⅰ, Ⅱ and Ⅲ spots on day 1, 3, and 7 before surgery. After removing the eyeball, the retina and choroid tissue were made into ultrathin sections, stained with uranyl acetate and lead citrate, and the ultrastructure was observed under transmission electron microscope. Results One day after laser photocoagulation, some RPE cells were swollen and necrotic, the number decreased, and the microvilli partially disappeared. The Bruch’s membrane was intact. The swollen endothelium of the choriocapillaris and few luminal occlusions. The retinal tissue photocoagulation by grade Ⅱ see more RPE cell lysis, Bruch membrane vacuolization, choroidal capillary occlusion. After grade Ⅲ photocoagulation of retinal tissue see a large number of RPE dissolved disappeared, Bruch membrane partially destroyed, choroidal vascular damage. Three days after laser photocoagulation, RPE cells and choroidal edema subsided, and phagocytic cells were found in the damaged area. RPE cells and choroidal fibrosis began to proliferate. Seven days after laser photocoagulation, hyperplastic RPE cells covered the damaged area, choroidal vascularization and fibrosis. Conclusion Laser photocoagulation can cause edema and necrosis of RPE cells and damage to Bruch’s membrane and choroidal blood vessels to varying degrees. RPE cells and fibrous tissue then repair the damaged area. Different parameters of laser treatment can repair the lesion of RPE and choroidal tissue.