目的：比较正常人和青光眼患者视盘周围巩膜纵切面形态(经过视神经中轴)以及神经纤维变化，结合生物力学原理，探讨青光眼周边部视神经损伤机制。

方法：对捐献的12个正常人眼和12个青光眼绝对期患者的视神经及其周围组织标本进行固定、切片、格利染色，比较视盘周围巩膜纵切面(经过视神经中心)形态，观察毗邻的周边部视神经纤维走行特点。

结果：视盘周围巩膜孔的纵切面为一锐角(平均角度为73.3°)，青光眼绝对期患者残留的视盘周围巩膜纵切面也是锐角(平均角度为75.6°)，两者差异无显著性(t=1.44，P>0.05)。正常人视神经纤维从视网膜到筛板的走行变化急剧， 青光眼绝对期患者该段视神经纤维消失。

结论：视盘周围的巩膜前缘和内侧缘夹角为锐角。青光眼绝对期视神经纤维消失的原因可能与高眼压和视盘周围巩膜的形态、巩膜和视神经纤维的剪切模量、以及“折曲损伤”机制有关。

AIM: To compare the angles of longitudinal section of sclera around optic nerve heads and the never fiber layer changes in healthy adults and patients with glaucoma, and to investigate the mechanism of peripheral retinal axonal injury, with the combined knowledge of biomechanics.

METHODS: The optical nerves and their peripheral tissue specimen in the 12 eyes from health adult donators and 12 eyes from glaucoma patient donators were dyed by Glees' method to compare the angles of longitudinal section of sclera around optic nerve heads(through optic nerve center), and to observe the anatomical features of the peripheral retinal axons.

RESULTS: The mean angle of longitudinal section of sclera around optic nerve in healthy adults was 73.3°, while that in patients with absolute glaucoma was 75.6°. The difference showed no significance(t=1.44, P>0.05). There was a sharp bend in the course of peripheral optical fiber in healthy adults. However, the optic nerve fiber disappeared completely in patients with glaucoma end stage.

CONCLUSION: The angle between the medial edge and leading edge of sclera(around optic nerve heads)is an acute angle. The optical fiber in glaucoma end stage disappeared completely. The phenomenon may be related to high intraocular pressure, the sclera shape, the shear modulus of sclera and axons, and “axonal bending-injury” mechanism.

陕西省科技厅自然科学基金资助课题(No.2005C255)