闭角型青光眼中虹膜睫状体囊肿的发病情况

目的:观察闭角型青光眼中虹膜睫状体囊肿的发病情况,虹膜睫状体囊肿与前房轴深、房角的关系。方法:利用超声生物显微镜(UBM)对闭角型青光眼患者740例1057眼进行眼前节检查。结果:闭角型青光眼740例1057眼中检出合并虹膜睫状体囊肿者42例60眼,占被检眼数的5.68%。60眼虹膜睫状体囊肿中虹膜睫状沟囊肿56眼(93.33%),睫状冠囊肿4眼(6.67%);其中单发囊肿33眼(55.00%),多发囊肿27眼(45.00%)。不伴有虹膜睫状体囊肿的患者前房轴深1.16～2.37(平均1.843)mm;合并有虹膜睫状体囊肿的患者前房轴深1.67～2.78(平均2.297)mm。伴有及不伴有虹膜睫状体囊肿的闭角型青光眼患者房角粘连>2个象限的比率分别为66.67%和44.59%。结论:虹膜睫状体囊肿在闭角型青光眼中的发病率较高,多为虹膜睫状沟囊肿,对前房轴深影响不大,但可以增加房角粘连范围,引起闭角型青光眼。     

原发性虹膜睫状体囊肿研究进展

原发性虹膜睫状体囊肿好发于虹膜睫状沟和睫状冠,常规眼科检查不易发现。随着超声生物显微镜（UBM）在眼科临床的应用,发现其在人群中的发病率远高于之前的报道,亦有报道认为囊肿可诱发闭角型青光眼。UBM检查在其发现和诊断中起着重要作用,且有助于判断囊肿对房角形态的影响,但该囊肿与青光眼、浅前房的关系,尚无相关的研究报道。关于该囊肿的分类、名称目前尚无统一的标准。就原发性虹膜睫状体囊肿的流行病学、组织病理学、UBM检查、并发症、诊断和治疗等做一综述,并提出关于原发性虹膜睫状体囊肿的新的分类法。     

合并虹膜睫状体囊肿的闭角型青光眼发病因素探讨

目的探讨合并虹膜睫状体囊肿的闭角型青光眼相关发病因素。方法收集有虹膜睫状体囊肿的闭角型青光眼患者35例作为青光眼组,以囊肿合并单纯白内障患者59例作为白内障组,均行UBM及A超检查。结果 94位受检者共检出囊肿202个,青光眼组检出多发性囊肿比例高(61.9%),且多见于颞下象限的虹膜睫状沟和睫状冠。青光眼组囊肿平均大小为(0.5920±0.1151)mm,中央前房深度为(2.267±0.123)mm,平均眼轴长度(23.27±0.85)mm;白内障组分别为(0.4661±0.0946)mm、(2.560±0.214)mm、(24.34±0.42)mm,两组比较差异均有统计学意义(均为P<0.05)。结论较大、多发的囊肿是公认的合并虹膜睫状体囊肿的闭角型青光眼患者发病因素,但是浅前房、小眼球等闭角型青光眼的原发因素也参与了此类闭角型青光眼患者的发病。     

超声生物显微镜观察房角四度狭窄病例

目的研究房角镜检查Scheie分级为N4患者的前房角,在超声生物显微镜(UBM)检查下的形态表现。方法青光眼患者45例(50眼),其中新生血管性青光眼5眼,急性闭角型青光眼22眼,慢性闭角型青光眼23眼。所有患者均进行房角镜和UBM检查,房角镜检查Scheie分级为N4。结果UBM检查发现房角镜下为N4的前房角存在4种不同形态类型:(1)虹膜紧密前粘连,房角完全关闭。(2)虹膜自房角隐窝向前膨隆,房角完全关闭,睫状体前旋。(3)房角入口处虹膜前粘连,房角隐窝处呈开放状态。(4)房角入口处虹膜向前膨隆,房角入口处呈裂隙状狭窄。结论UBM检查为青光眼的诊断、治疗提供一种新型的检查方法和依据,同时通过UBM检查可进一步探讨青光眼的发病机制及形态变化。     

APAC对侧眼激光周边虹膜切除术后3min暗室激发试验的临床观察

目的:观察急性原发性房角关闭(acut primary angle colsure,APAC)对侧眼激光周边虹膜切除术(laser peripheral iridotomy,LPI)后3min超声生物显微镜(ultrsounic biomicroscopy,UBM)暗室激发试验的相关生物学参数,探讨可疑原发性房角关闭(primary angle closure suspect,PACS)患者LPI术后发生接触性房角关闭的风险因素.方法:选择78例 APAC 对侧眼(无周边虹膜前粘连)为研究对象,LPI术后进行3min UBM暗室激发试验,观察中央前房深度(ACD)、房角开放距离(AOD500)、周边虹膜厚度(IT)、虹膜膨隆度(IC)、虹膜根部附着位置、小梁网睫状突距离(TCPD)等各项眼前节结构参数及房角接触性关闭方位数(NPAC) 并进行统计学分析.结果:LPI术后暗室下UBM检查至少1个方位发生接触性房角关闭的有26眼(33%),其中3min UBM暗室激发试验阳性的有19眼(24%),暗室激发试验时眼压升高值与接触性房角关闭的方位数呈正相关(r=0.84,P<0.01).接触性房角关闭(+)组与接触性房角关闭(-)组暗室时与正常光线下比较AOD500、IT、IC变化值有显著统计学意义(均P<0.01).单因数Logistic回归分析表明,AOD500(P=0.003)、IT(P=0.012)、IC(P=0.043)、TPCD(P=0.015)、虹膜根部附着位置(P=0.024)是暗室下接触性房角关闭(+)的相关因素;多因素Logistic回归分析表明IT(P=0.011)、TPCD(P=0.009)和虹膜根部附着位置(P=0.02)是暗室下接触性房角关闭(+)的独立相关因素.结论:PACS患者行LPI术后仍有部分在暗室下发生接触性房角关闭,虹膜周边肥厚、睫状体前位、虹膜根部附着点前移是重要的风险因素,在LPI术后应当进行长期随访与干预治疗.     

白内障患者原发性虹膜睫状体囊肿的超声生物显微镜检测

目的利用超声生物显微镜(UBM)检测白内障患者原发性虹膜睫状体囊肿的发生情况。方法用UBM对275例(476只眼),无外伤、手术史的白内障患者进行眼前段检查。结果275例(476只眼)中,发现原发性虹膜睫状体囊肿20例(26只眼),检出眼占被检眼数的5.46%。其中单发性囊肿13例(16只眼)占61.54%,多发性囊肿7例(10只眼)占38.46%。虹膜睫状体囊肿大小不一,最大的囊肿矢状面面积为1.59mm2,最小的囊肿为0.08mm2,平均面积为0.39mm2(以上均为最大矢状面面积)。26只眼共检出囊肿38个,其中位于颞侧17个,占44.76%;下方15个,占39.47%;鼻侧4个,占10.53%;上方2个,占5.28%。结论UBM能客观地检测出原发性虹膜睫状体囊肿,提供囊肿的大小、位置及数量信息。白内障患者原发性虹膜睫状体囊肿发生率约为5.46%。囊肿好发于颞侧及下方。     

超声生物显微镜检测虹膜睫状体囊肿临床分析

目的 利用超声生物显微镜(UBM)检测白内障患者原发性虹膜睫状体囊肿的发生情况.方法 用UBM对391例(426只眼)无外伤、内眼手术史的白内障患者进行眼前段检查.结果 391例(426只眼)中,发现原发性虹膜睫状体囊肿22例(25只眼),检出眼占被检眼数的5.87%.其中单发性囊肿15例(17只眼)占68%,多发性囊肿7例(8只眼)占32%.25只眼共检出囊肿37个,其中位于颞侧17个,占45.95%;下方14个,占37.84%;鼻侧3个,占8.11%;上方3个,占8.11%.结论 UBM能客观地检测出原发性虹膜睫状体囊肿,提供囊肿的大小、位置及数量信息.白内障患者原发性虹膜睫状体囊肿发生率约为5.87%.囊肿好发于颞侧及下方.     

房角关闭机制指导下可疑原发性房角关闭患者激光干预的疗效评价

目的 根据房角关闭的不同机制,对可疑原发性房角关闭（PACS）患者行激光周边虹膜切除（LPI）术或LPI联合激光周边虹膜成形（LPIP）术,通过超声生物显微镜（UBM）评估PACS患者激光早期干预的疗效。设计 前瞻性病例系列。 研究对象2016年1月-11月在河北省邯郸市眼科医院连续就诊的PACS患者50例（65眼）。方法 根据房角关闭的不同机制,通过UBM评估患眼,对所有入选患眼均首先行LPI治疗,术后第3天复查UBM,检查提示仍存在至少一个象限房角呈接触性关闭的患者再进一步联合LPIP治疗。术后3天复查UBM,根据测量的相关参数的前后变化评价治疗效果。主要指标 UBM图像中的中央前房深度（ACD）,巩膜突前500 μm处的房角开放距离（AOD）、小梁虹膜夹角（TIA）、房角隐窝面积（ARA）、小梁睫状体距离（TCPD）、虹膜厚度（IT）。结果 65眼中,47眼（72.3%）行LPI治疗后3天UBM检查未发现存在至少一个象限的房角接触性关闭,术后AOD、TIA、TCPD、ARA较术前均明显增加（P均<0.01）,IT较术前无明显变化（P=0.465）;18眼（27.7%）行LPI术后3天,UBM提示存在至少一个象限的房角接触性关闭,联合LPIP治疗后AOD、TIA、TCPD、ARA较术前均明显增加（P均<0.01）,IT较LPI术后减少更明显（P<0.01）。结论 LPI后UBM可用于判断房角关闭的机制,并据此考虑是否联合LPIP,可进一步改善非单纯性瞳孔阻滞机制的可疑房角关闭患者的疗效。     

达纳康对糖尿病视网膜病变眼视网膜光凝术 所致眼前段早期改变的干预效果

目的探讨达纳康对糖尿病视网膜病变（diabetic retinopathy,DR）视网膜光凝术后眼前段改变的干预效果。方法采用前瞻性随机对照方法将72例DR患者的72只视网膜光凝治疗眼(DRⅢ～Ⅳ期)分为达纳康干预组和对照组。应用超声生物显微镜（ultrasound biomicroscopy,UBM）观察和定量分析两组患者视网膜光凝术前、术后第3、7 d前房深度、前房角、睫状体和前段脉络膜的改变。结果术后第3 d,对照组视网膜光凝术眼眼压升高,与术前相比差异有显著性意义(t=－2.821,P<0.01);除鼻侧前房角外其余象限前房角较术前变窄(t= 2.033～3.150,P<0.01)。药物干预组视网膜光凝术眼眼压和各象限前房角均无显著改变。药物干预组睫状体脱离、前段脉络膜脱离的发生率分别为11.11%、5.56%,对照组分别为86.11%、88.89%。药物干预组睫状体脉络膜脱离的高度亦显著低于对照组。结论达纳康能在一定程度上减少视网膜光凝术所致的睫状 体脉络膜脱离和眼压升高、前房角变窄等眼前段并发症的发生率,减轻睫状体脉络膜脱离的程度。(中华眼底病杂志,2001,17:187-189)     

超声生物显微镜能否替代前房角镜检查

房角镜是房角检查的主要手段。近年来随着超声生物显微镜(UBM)检查技术的发展,UBM被广泛应用到房角检查中。UBM能否取代房角镜呢?本文对两种检查方法进行了比较。房角镜解剖定位能力强、分辨力高,可以进行色素分级,发现房角新生血管,通过压陷检查的方法区分对合性或粘连性关闭。UBM检查可以对房角进行定量测量,图像直观,更容易发现虹膜或睫状体囊肿及晶状体半脱位。两种检查方法各有特点,各自的优势可以弥补彼此的不足。UBM不能替代房角镜而成为房角检查的唯一方法 。     

Primary cysts in the iridociliary sulcus: ultrasound biomicroscopic features of 210 cases

BACKGROUND: Primary cysts occur spontaneously, whereas secondary cysts arise following surgical or nonsurgical injury and can lead to further complications. We performed a study to observe and characterize primary iridociliary cysts through the examination of ultrasound biomicroscopic (UBM) images from affected patients. METHODS: The UBM images from 210 patients were analysed and the characteristics of each cyst were observed and recorded. The patients had been examined and received the diagnosis of iridociliary cysts between 1990 and early 1998 at a major referral centre for the diagnosis and treatment of cancer in Toronto. RESULTS: Of the 210 cysts 169 (80%) occurred in isolation, and the remainder occurred in the presence of a tumour. The mean horizontal diameter of the isolated cysts was 1.72 mm, and the mean vertical diameter was 1.04 mm. Isolated cysts were solitary in 101 cases (60%) and showed multiple loculations in 68 (40%). Solitary cysts were slightly larger than those with multiple loculations. Isolated cysts were associated with markedly narrowed or closed angles locally in 110 cases (65%). INTERPRETATION: Primary iridociliary cysts are common and need to be differentiated from iris and ciliary body tumours. UBM is a definitive method of diagnosing these lesions. Cysts can cause localized angle closure but rarely cause clinical complications. Cysts associated with anterior segment tumours may give an erroneous impression as to tumour size.     

Ultrasound biomicroscopy evaluation of angle closure in a patient with multiple and bilateral iridociliary cysts

PURPOSE: The aim of this study was to describe the findings of ultrasound biomicroscopy (UBM) in a case with bilateral, multilobulate primary iridociliary cysts presenting as chronic angle-closure glaucoma. HISTORY AND SIGNS: An 82-year-old woman was admitted to a tertiary ophthalmological centre for a thorough exploration of the gradual deterioration of her visual fields and optic discs. Clinical evaluation of the patient revealed angle-closure glaucoma and cataract in both eyes. The use of UBM disclosed the presence of bilateral, multilobulate iridociliary cysts in all quadrants. The presence of multiple and bilateral iridociliary cysts was the cause of iris anterior displacement and the subsequent angle closure in this patient. CONCLUSIONS: Primary iridociliary cysts may rarely progress to a size that can compromise the angle. They are usually considered as benign and stationary lesions. The advent of UBM is an invaluable tool for the contemporary ophthalmologist in order to set the diagnosis and follow the evolution of those lesions.     

Narrowing of the anterior chamber angle during Valsalva maneuver: a possible mechanism for angle closure

PURPOSE: To evaluate changes at the anterior chamber angle during Valsalva maneuver in eyes suspected to have a primary adult glaucoma. METHODS: Seventy-six consecutive patients underwent recording of applanation tonometry, measurement of the anterior chamber angle recess, angle opening distance, angle recess area, scleral spur-iris root distance, iris thickness, iridociliary angle, ciliary body thickness, anterior chamber depth, and pupil size on ultrasound biomicroscopy before and during the Valsalva maneuver. The Valsalva maneuver was standardized to a pressure of 40 mmHg for 15 seconds, using a manometer. RESULTS: The mean baseline intraocular pressure changed from 19.5+/-4.1 mmHg to 29.5+/-4.8 mmHg during Valsalva (p<0.0001). The anterior chamber angle recess narrowed from 17.9+/-9.5 to 7.8+/-9.2 degrees (p=0.0001). The angle recess area diminished from 0.15+/-0.14 mm2 to 0.14+/-0.12 mm2 (p=0.03) and the scleral spur to iris distance decreased from 0.19+/-0.2 mm to 0.16+/-0.18 mm (p=0.0001). The iridociliary angle narrowed from 72.6+/-33.5 degrees to 62.5+/-32.8 degrees (p=0.04). There was a significant increase in the thickness of the ciliary body, from 0.99+/-0.19 mm to 1.12+/-0.16 mm (p=0.001) and in iris thickness from 0.47+/-0.07 mm to 0.55+/-0.09 mm (p=0.0001). There was no significant change in the angle opening distance, anterior chamber depth, or pupillary diameter. A significant narrowing of the angle to less than 5 degrees was seen in 37 eyes, with iridocorneal apposition present in 28 eyes. After multivariate regression analysis it was found that the baseline ciliary body thickness and angle recess were significant predictors of narrowing of the angle (R2=96.1%). CONCLUSIONS: Significant elevation of the intraocular pressure, narrowing of the anterior chamber angle recess, thickening of the ciliary body, and increase in the iris thickness is seen during the Valsalva maneuver. The Valsalva maneuver may lead to angle closure in eyes anatomically predisposed to primary angle closure glaucoma.     

Differential diagnosis of anterior segment cysts by ultrasound biomicroscopy

BACKGROUND: To describe the ultrasound biomicroscopic (UBM) features of anterior segment cysts. DESIGN: A retrospective case series. PARTICIPANTS: One hundred eighteen eyes with anterior segment cysts examined by UBM at The New York Eye and Ear Infirmary between August 1992 and November 1997 were included in this study. INTERVENTION: The authors reviewed demographic and diagnostic data from the medical record including ocular and medical history, age, race, gender, and intraocular pressure. Ultrasound data concerning the type, number, position, and acoustic characteristics of cysts were recorded. The authors then correlated the written, clinical, and UBM characteristics. RESULTS: One hundred eyes (92.6%) had neuroepithelial cysts. Ninety (83.3%) of these had primary neuroepithelial cysts, 10 (9.3%) had cysts associated with uveitis, 7 (6.5%) had implantation cysts, and 1 (0.9%) had a cavitated ciliary body tumor. Neuroepithelial cysts typically were round or ovoid, thin-walled, and echolucent. Of the 90 eyes with primary neuroepithelial cysts, 56 (62.2%) had 3 or fewer cysts; multiple cysts (>3 per eye) were found in 34 eyes (37.8%). The multiple cysts occupied more than 180 degrees in 12 patients (13.3%). Primary neuroepithelial cysts were located at the iridociliary junction (74.2%), pars plicata (14.0%), pars plana (6.8%), and iris (5.0%). Implantation cysts (seven eyes) tended to have thicker walls and two contained a copious, echogenic material. CONCLUSION: The UBM results provide important information regarding location and extent of anterior segment cystic lesions. Ultrasound characteristics may help differentiate between neuroepithelial, implantation, and neoplastic cysts.     

原发性虹膜睫状体囊肿在正常人群中的发生状况

目的 探讨原发性虹膜睫状体囊肿(以下简称囊肿)在正常人群中的发生及分布状况.方法 200例(400只眼)受检者采用超声生物显微镜(UBM)进行眼前段检查,记录囊肿数量、眼别、部位、象限分布,探讨囊肿在正常人群中的发生状况及年龄分布.采用t检验、χ2检验和直线相关分析进行统计分析.结果 200例(400只眼)中,发现有囊...     

Rainbow halos occur less following implantation of extended range of vision one-piece intraocular lenses vs diffractive bifocal intraocular lenses

AIM: To observe the characteristics of iridociliary cysts in myopic patients and evaluate the influences on the position and safety of implantable collamer lens (ICL) after surgery.METHODS: Totally 270 eyes of 135 patients who underwent ICL surgery for the correction of myopia were included in this study. We observed preoperative and postoperative morphology of iridociliary cysts in ultrasonic biomicroscopy (UBM) image.RESULTS: A total of 138 iridociliary cysts were found in 88 eyes of 50 patients among 270 eyes of 135 patients before surgery (37%). Twenty-five patients had cysts in one eye (50%) and 25 had cysts in both eyes (50%). The prevalence of iridociliary cysts was negatively correlated with age, but no gender difference (P>0.05). The incidence of iridociliary cysts was much less in eyes with myopia greater than -9.00 D (P<0.05). The diameter of the largest cyst was 1.96 mm and the smallest cyst was 0.24 mm, with a majority within the range of 0.5 to 1.0 mm. Most of the cysts were located in the inferior temporal quadrant. One year after ICL implantation, 51 iridociliary cysts (37%) remained unchanged, 47 cysts (34%) decreased in size, and 40 cysts (29%) disappeared. Most of cysts that changed after surgery were smaller than 1.0 mm (P<0.05) and located in the nasal and temporal sides around the haptics of implantable lens. All the implantable lens were in their original position.CONCLUSION: Iridociliary cysts are commonly seen in myopic eyes. The cysts have no impact on the safety of ICL surgery. Some cysts may decrease in size or disappear after ICL implantation.     

闭角型青光眼中睫状体囊肿的检测

目的 探讨睫状体囊肿与闭角型青光眼的关系.方法 用超声生物显微镜(UBM)对260例(260只眼)连续闭角型青光眼患者进行眼前段检查.结果 在260只连续检查的闭角型青光眼中有睫状体囊肿的20只眼(7.69%)共22个囊肿,其中单发性囊肿的有18只眼(90%),多发性囊肿的有2只眼(10%).囊肿分布颞侧9个(41%),下方9个(41%),鼻侧2个(9%),上方2个(9%).在22个囊肿中有13个囊肿其所对应处房角关闭,9个囊肿其所对应处房角未关闭,卡方检验P=0.394.结论 睫状体囊肿在闭角型青光眼中的发生率较高的.而且他们分布的位置多在颞侧和下方.     

Ultrasound biomicroscopy of haptic position after transscleral fixation of posterior chamber intraocular lenses

PURPOSE: To determine the haptic position of ab externo transsclerally fixated posterior chamber intraocular lenses (PC IOLs) by ultrasound biomicroscopy (UBM). SETTING: Mansoura Ophthalmic Center, Mansoura University, Mansoura, Egypt. METHODS: Ultrasound biomicroscopy was used to determine the haptic position in relation to the ciliary sulcus, iris, and ciliary body in 20 patients with transsclerally fixated PC IOLs. The patients ranged in age from 10 to 65 years. RESULTS: All IOL haptics were easily visualized and imaged by UBM. Of the 40 IOL haptics, 22 (55.0%) were located in the sulcus, 11 (27.5%) anterior to the sulcus, and 7 (17.5%) posterior to the sulcus region. CONCLUSIONS: Ab externo scleral fixation of PC IOLs is a blind procedure in most cases. Ultrasound biomicroscopy showed the difficulty in reliably placing the haptics in the ciliary sulcus using this technique. Thus, endoscopic visualization of the iridociliary angle during surgery is recommended.     

Inadvertent rupture of iridociliary cyst following transscleral Diode laser

Primary iridociliary cysts can induce plateau iris configuration and angle closure glaucoma. We report a patient with bilateral, primary, ring-shaped, solitary iridociliary cysts. The right eye displayed normal intraocular pressure, oppositional iridocorneal angle closure, and healthy optic nerve head. The left eye had advanced chronic angle closure glaucoma. The management strategy varied between eyes and is discussed. This, to the best of our knowledge, is the first report of transscleral Diode laser application in an eye with a large iridociliary cyst.