三例Peters异常UBM表现

病例1,女,35岁。因出生后即发现左眼角膜发白来诊。眼部检查：右眼视力0.5,左眼光感。右眼结膜未见充血,角膜透明,前房未见异常,晶状体轻度混浊,眼底正常;左眼结膜未见充血,角膜中央白斑,前房浅,晶状体及眼底无法窥入（见图1）。UBM影像：右眼部分象限虹膜角膜粘连,瞳孔缘虹膜晶状体粘连,晶状体皱缩变形,回声增强,左眼角膜中央部增厚,回声增强,虹膜角膜粘连（见图2）。临床诊断：右眼白内障,左眼Peters异常I型。 病例2,女,21岁。因出生后即发现左眼角膜发白,左眼胀痛4个月余来诊。眼部检查：右眼视力0.4,左眼视力为手动/眼前30 cm。右眼眼压19 mmHg（1 mmHg=0.133 kPa）,左眼眼压27 mmHg。右眼结膜未见充血,角膜透明,前房未见异常,晶状体透明,眼底正常;左眼结膜轻度充血,角膜中央及颞下方可见白斑并遮盖瞳孔,角膜缘可见新生血管,前房浅,晶状体前囊混浊,眼底无法窥入（见图3）。UBM影像：右眼未见异常,左眼角膜中央局部增厚,回声增强,下方瞳孔区虹膜与角膜及晶状体前囊膜粘连,360度虹膜根部与角膜内皮面粘连,鼻下方可见虹膜睫状体囊肿（见图4）。临床诊断：右眼屈光不正,左眼Peters异常II型伴青光眼。 病例3,女,3岁。因出生后即发现双眼角膜发白,身材矮小,智力低下来诊。眼部检查：视力检查不配合。双眼眼压15 mmHg。右眼结膜轻度充血,角膜中央白斑并遮盖瞳孔,前房、晶状体及眼底均无法窥入（见图5）;左眼结膜未见充血,角膜中央云翳,周边角膜透明,前房未见异常,晶状体透明,眼底正常。UBM影像：右眼角膜中央部增厚,回声增强,虹膜萎缩变薄,未见虹膜前后粘连（见图6）,左眼虹膜萎缩变薄。临床诊断：Peters 综合征。 讨论：1906年Peter发现并报道一例以前房变浅、角膜虹膜粘连、角膜中央白斑和Descemet膜缺损等为特征的疾病,之后此类先天性眼前节病变被统称为Peters异常（Peters anomaly）[1]。研究发现,Peters异常属于眼前段发育不全（anterior segment dysgenesis,ASD）,是一种多基因遗传病,由发育过程中异常神经嵴细胞迁移至角膜后所致,这一非正常迁移已被证实与PAX6、PITX2、FOXE3和CYP1B1等基因突变有关[2-5]。Peters异常患者的严重程度不一,单双眼均可发病,可表现为角膜白斑或伴有角膜虹膜粘连,即Peters异常I型（病例1）;角膜白斑伴有白内障或角膜晶状体粘连,即Peters异常II型（病例2）;双眼发病者较多伴有全身其他系统疾病,如身材矮小、精神迟滞等,即Peters综合征（病例3）。针对不同分型的治疗原则有所不同,Peters异常I型的患者治疗可根据角膜病变的深度采取穿透性角膜移植或板层角膜移植;Peters异常II型患者的治疗则根据房角和晶状体受累情况采取角膜移植、白内障摘除联合手术,必要时辅助抗青光眼治疗;Peters综合征患者的治疗除眼部治疗外,还应关注全身其他系统的发育异常[2,6-7]。 影像学检查手段如UBM为Peters异常的诊断、分型、治疗和随访提供了有益的参考依据,其在Peters异常患者分型和眼前节状态评估中的作用逐渐受到重视。UBM是20世纪90年代初发展起来的新型眼科影像学检测工具,利用高频超声（50～100 MHz）作为探测能源,结合计算机图像处理技术,可获得眼前节任意子午线二维切面图像,并且可对任意距离和角度进行定量检测,具有实时、无创、高分辨率等特点[8-9]。除此之外,采用UBM对活体组织进行检查,其平卧体位适合全麻患儿,影像获得不受角膜混浊的影响,可以通过混浊的屈光介质,显示隐藏在其后的病理变化,更重要的是,UBM对眼后房结构,这一常规裂隙灯检查盲区的探查有效地增加了眼前节的可观测范围。以上观察的3例患者中,UBM清晰地显示了Peters异常患者角膜和虹膜、晶状体的结构关系,其图像表现为特征性的中央角膜回声增强伴有虹膜角膜粘连或角膜晶状体粘连,充分弥补了其他常规检查无法在角膜混浊的条件下显示其后病理变化的不足。因此,UBM可以提高Peters异常诊断的全面性和可靠性,对于以角膜中央混浊为特点,病变累及虹膜、房角和晶状体的Peters异常等眼前段发育不全性疾病的诊断和治疗具有不可替代的价值。然而,UBM同样有其弱点,如检查的实施对睑裂大小存在要求,目前尚无法进行精确的解剖学定位以及其非彩色图像缺乏对新生血管、出血等色泽变化的辨别等缺陷,随着技术的更新,相信未来的UBM在Peters异常等眼前段发育不全性疾病的应用中将展现更广阔的前景。     

先天性无虹膜症一家系

无虹膜症是一种较为少见的眼先天发育畸形 ,而在同一系中多人发病则更为罕见。现遇见此症一家系 ,特报道如下。先证者 :女 ,36岁。自幼双眼视力不佳 ,全身检查无明显异常。视力右眼指数 ,左眼光感。双眼球水平震颤 ,左角膜变形混浊 ,无虹膜 ,晶状体全混 ,右眼角膜清 ,无虹膜 ,晶状体前后极斑点状混浊 ,房角镜下仅见部分虹膜残段 ,眼底结构不清。先证者长女 ,12岁。双眼自幼视力不佳。全身检查正常。视力均为眼前指数。眼球水平震颤 ,角膜清 ,无虹膜 ,晶状体呈弥漫性点状混浊且向上移位 ,下方晶状体悬韧带呈细长纤维玻璃丝状。先证者次女 ,9…     

Peters异常的临床特点及治疗

背景 Peters异常是临床上罕见的眼病,且容易与一些先天性眼科异常疾病相混淆.了解Peters异常的临床特征和治疗方法有助于对其进行及时的诊治,改善患者的预后. 目的 总结Peters异常患儿的临床体征和治疗方法,为其诊断和个性化治疗提供依据.方法 采用描述性研究方法,对2014年1月1日至2016年3月30日在北京儿童医院眼科诊治的Peters异常患儿4例8眼的临床资料进行回顾性分析.纳入的患儿均行手持裂隙灯显微镜下眼前段检查、角膜曲率和角膜厚度测定及眼轴长度和眼压测量,对患儿全身和眼部的临床特征及针对患儿的不同情况所采取的不同治疗方式进行总结和分析. 结果 根据患儿的眼部和全身表现及文献报道的标准可将Peters异常分为Ⅰ型、Ⅱ型和Peters plus综合征.从纳入患儿的临床特征来看,纳入的4例8眼均有角膜白斑、周边房角与角膜的粘连、前房较浅或消失,2例2眼仅有上述表现,属于Ⅰ型Peters异常;6例6眼除上述症状外,出现晶状体前囊中央混浊,并且前囊与角膜内皮粘连,属于Ⅱ型Peters异常.测量的4眼角膜厚度均较厚,平均为(680±127) μm;测量的4眼角膜曲率均平坦,平均为(37.40±1.79)D;测量的4眼眼轴均较短,长度为(21.06±0.19) mm;8眼角膜直径均较小,平均为(9.4±0.5) mm;4眼有虹膜缺损,4眼无虹膜;1例内斜,3例眼球震颤.3例患儿除Ⅱ型Peters异常眼部表现外,还存在全身神经源性发育异常,诊断为Peters plus综合征.根据患眼的具体情况制定治疗方案:术前眼压高于30 mmHg(1 mrnHg=0.133 kPa)的2眼行小梁切除术和前部玻璃体切割术,术后眼压降至21 mmHg以下;角膜中央明显混浊的1眼行穿透角膜移植术,术后1个月角膜植片发生排斥反应,术后3个月植片完全混浊;4眼合并晶状体混浊者行晶状体摘出术,2眼植入人工晶状体,2眼行光学虹膜切除术,术后视力均有所改善. 结论 Peters异常的主要临床特征是角膜白斑、浅前房和虹膜周边与角膜粘连,伴有晶状体混浊者一般是晶状体前囊膜混浊并与角膜内皮粘连.需要手术的患眼需要根据具体情况个性化设计手术方案.     

先天性无虹膜合并白内障1家系

1 临床资料 例1 先证者,女,36岁,自幼双眼视力差,畏先,进行性视力下降2a,于2001年10月22日入院。非近亲婚配史,体格检查无异常。眼部检查:视力:右眼:手动/20cm,左眼:数指/眼前。双眼快速型水平震颤,近角膜缘有多处角膜云翳,并见新生血管长入,前房浅,虹膜完全缺如,仅见周边部有少许残余虹膜,双眼晶状体呈灰白色混浊,囊膜上有钙化斑,眼后节     

先天性晶状体及虹膜缺损并发白内障一例

患者,男,47岁,维吾尔族,因右眼视力下降1年,加重1个月就诊.患者无眼部手术及外伤史,无其他疾病史,父母非近亲婚配,家族中无类似疾病史.患者发育正常,全身检查未见异常.眼部检查:视力:右眼0.02,左眼0.2,均不能矫正;眼压:右眼12.5 mmHg(1 mmHg=0.133 kPa),左眼13.5 mmHg.双眼外眼未见异常,结膜无充血,角膜透明,前房正常,瞳孔呈倒梨形.右眼6:00处虹膜缺损,左眼6:30处虹膜缺损.双眼晶状体混浊.散瞳后见右眼虹膜缺损处晶状体下方边缘呈切迹状缺损,该部位无悬韧带,其附近皮质较其他区域明显混浊;左眼虹膜缺损处晶状体皮质较其他区域明显混浊.右眼玻璃体及眼底均窥不清.左眼玻璃体轻度混浊,眼底未见明显异常.诊断:双眼并发性白内障;右眼先天性晶状体缺损;双眼先天性虹膜缺损.患者因个人原因,放弃进一步检查和治疗.     

眼前节钝挫伤的后果

作者对眼挫伤后1—14年的212眼205例眼前节病变进行评价。前房角后退在190眼中有153眼(80.5%),为最常见的并发症。但是只有1例发展成高眼压。受伤眼中37.3%虹膜异常,最常见异常为瞳孔缘撕裂和瞳孔缺损。由外伤所致的白内障和晶体脱位占24.5%,但多数晶体混浊局限,静止,不合并明显的视力减退。发生晶体混浊的眼中,有15.4%在受伤18个月内作了白内障摘出。对角膜功能的影响少见,偶见角膜混浊掩盖了穿透性损伤。大多数眼挫伤中,眼前节首当其冲地承受直     

原发性闭角型青光眼的超声生物测量研究

目的 应用A型眼科超声和超声生物显微镜(ultrasound biomicroscope,UBM)研究原发性闭角型青光眼(primary angle-closure glaucoma,PACG)不同瞳孔直径下眼前节和后房结构的解剖特征.方法 正常对照组24例(48眼)及PACG组24例(48眼)按照检查时瞳孔直径(d)分为以下3组:d ＜2.5 mm组,2.5 mm≤d≤4.0 mm组,d＞4.0 mm组,进行眼轴测量和UBM检查.眼轴长度采用STORZ-A型眼科超声诊断仪测量,眼前节各项参数采用Zeiss-Humphrey-840型UBM检查.结果 PACG眼较正常眼前房浅,眼轴短,小梁网虹膜夹角变小,房角开放距离缩短,睫状突高度减小,巩膜外侧面与虹膜长轴的夹角、与睫状突夹角减小.PACG眼的角膜厚度较正常眼增厚,分别为(584.208±78.210) μm、(577.583±39.681)μm,但差异无统计学意义(P＞0.05).反映瞳孔阻滞的参数虹膜晶状体接触距离差异无统计学意义(P＞0.05).PACG眼与具有正常瞳孔直径的眼相比,瞳孔直径越大,小梁网虹膜夹角越小,根部虹膜越厚,虹膜晶状体接触距离越小,而正常眼的根部虹膜厚度、小梁网虹膜夹角、虹膜晶状体接触距离与瞳孔直径无相关性.结论 PACG眼与正常眼解剖结构在任何瞳孔直径下均不同.PACG眼随瞳孔直径增大,眼前节更为拥挤,睫状体旋前增加房角关闭可能.     

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。     

虹膜型人工晶状体植入术后取出二例

例 1　男 ,6岁。因体检时发现双眼视力差 ,于 1999年4月 19日来我院就诊。全身体检无异常。眼部检查 :双眼视力 0 2 ,无法矫正 ;双眼晶状体核混浊 ,左眼 5～ 6点钟方位虹膜呈扇形缺损 ,瞳孔向下延伸达角膜缘 ,散大瞳孔检查眼底 ,仅可见周边部视网膜。诊断 :双眼先天性核性白内障 ;左眼先天性单纯性虹膜缺损。于全麻下行双眼囊外白内障摘除人工晶状体植入术 ,右眼植入普通后房型人工晶状体 ,左眼植入虹膜型人工晶状体 ,屈光度数均为 +2 1 0 0Ｄ。术后静脉滴注青霉素 4 80万Ｕ及地塞米松 5ｍｇ ,1次 /ｄ ;双眼眼球旁注射庆大霉素 2万Ｕ及地塞…     

眼前节异常眼的玻璃体手术特点和疗效

目的　探讨眼前节异常眼的玻璃体手术特点并评价临床疗效。方法　回顾性分析 96例 96眼伴有角膜或 /和晶状体异常的复杂性玻璃体视网膜病变患者 ,其中按术前主要诊断分为视网膜脱离 60眼 ,玻璃体积血 2 2眼 ,糖尿病视网膜病变Ⅵ期 2眼 ,球内异物 6眼 ,人工晶体脱位 2眼 ,化脓性眼内炎 4眼 ,均在角膜触镜下行玻璃体手术。眼前节异常包括 :角膜混浊 63眼 ,晶状体异常 47眼 ;其中 14眼并存角膜和晶状体的异常。随访期 2～ 3 9个月 ,平均 5 2 9± 6 99月。结果　视网膜脱离 60眼中 ,术后 41眼网膜全复位 (68 3 3 % )。非视网膜脱离 3 6眼中 ,术后 9眼继发视网膜脱离 ,最终网膜平伏率 2 8眼 (77 78% )。术后视力提高≥ 1行者为网脱组 5 6 14 %和非网脱组 65 63 %。结论　玻璃体手术对治疗大多数伴有眼前节异常的严重玻璃体视网膜疾病是有效的 ,但其术前疗效预测性较差 ,术中选择重新处理角膜创口 ,配合不同角度接触镜的运用和巩膜外顶压 ,可以克服术中观察的困难性     

Ultrasound biomicroscopy diagnosis of congenital glaucoma

BACKGROUND: In children with congenital glaucoma the assessment of the anterior chamber and the chamber angle might be difficult since scarring and opacities of the cornea are often seen. The purpose of our study was to reveal in vivo--morphology of the anterior segment in patients with congenital glaucoma and opaque cornea. PATIENTS AND METHODS: In 46 eyes of 23 children with different degrees of corneal opacities we performed ultrasoundbiomicroscopy (UBM) of the anterior chamber after having performed a complete ophthalmological examination in general anesthesia. RESULTS: Massive abnormalities of the anterior segment morphology were detected in 5 eyes with completely cloudy cornea. In eyes with partial opacity of the cornea, UBM gave additional information concerning the anterior chamber angle topography, as iris remnants in aniridia, or anterior synechia. CONCLUSION: Especially in cases with extensive corneal opacities the UBM allows us to get morphological and topographic information about the anterior segment and helps to establish an individual strategy for surgical management.     

OCT3 exploration of anterior segment

PURPOSE: Posterior pole imaging with OCT3 provides macular scans with a very high resolution. Use of OCT1 has already been described for anterior segment imaging. This work presents the advantages of OCT3 in anterior segment imaging compared to UBM (50 MHz) and 20-MHz ultrasound imaging with long focal distance (patent pending PCT/FR98/02788). MATERIAL: and methods: We used an OCT3 unit dedicated to the posterior pole. By defocusing the laser beam we obtained high-resolution scans of the cornea, angle, lens and IOLs. Fifty-seven eyes (35 patients) were imaged by OCT3 and high-resolution ultrasound in cases of corneal dystrophy, corneal transplant, LASIK, narrow angle, iris bowing, etc. RESULTS: In all cases OCT3 provided high-resolution information with a limit of penetration at the posterior part of the iris. This limitation was not observed with ultrasound imaging. Nevertheless, OCT3 is a useful tool for corneal imaging in cases of opacities limiting biomicroscope imaging. OCT3 corneal scans at high resolution make it possible to identify the corneal interface in lamellar transplants or LASIK. With a narrow angle, a dynamic test of angle closure can be done. With iris bowing, OCT3 can differentiate iris cysts and iris tumors. Anterior chamber IOLs can be imaged with their relationships to anterior segment structures. CONCLUSION: OCT3 provides non-contact anterior segment imaging with high resolution but with a limit of penetration given by posterior part of the iris.     

Ausgeprägte intrakorneale Keloidbildung bei Peters-Plus-Syndrom und bei einer Maximalvariante der Peters-Anomalie

We present two cases of Peters anomaly (Peters plus syndrome and a maximum manifestation variant) with abnormally thickened cornea and corneal staphyloma. Both patients presented to our hospital shortly after birth and were treated with perforating keratoplasty and lensectomy. Histological analysis showed marked thickening of the corneal stroma due to abnormal stromal connective tissue deposition. Additionally, both eyes showed the characteristic changes of Peters anomaly with corneal opacity, adherence of the iris stroma and anterior lens surface to the posterior corneal surface, absence of the corneal endothelium, Descemet and Bowmans layers. Peters anomaly with abnormally thick intracorneal fibrosis with or without congenital corneal staphyloma is a very rare manifestation.     

闭合性Ⅱ区眼外伤的超声生物显微镜观察

目的探讨超声生物显微镜（UBM）在闭合性Ⅱ区眼外伤诊断中的临床意义。方法对73例（75眼）闭合性眼外伤进行UBM检查,了解相应部位虹膜、睫状体及晶状体的情况,结果进行分析和总结。结果本组75眼均有不同程度的眼前段损伤,前房积血34眼、前房角后退28眼、虹膜根部断离17眼、睫状体脱离29眼（睫状体浅脱离3眼）、晶状体脱位9眼、晶状体混浊3眼。结论 UBM可清晰显示闭合性眼外伤Ⅱ区前房积血、房角后退、虹膜根部断离、睫状体脱离、晶状体不全脱位及晶状体混浊,还可显示传统B超不能显示的睫状体浅脱离;不受屈光间质影响,对闭合性Ⅱ区眼外伤有较高的诊断价值。     

Cataract Surgery for Tilted Lens in Peters’ Anomaly Type 2

Background

Cases of cataract surgery without penetrating keratoplasty in patients with Peters’ anomaly are very rare. We report a case of Peters’ anomaly type 2 with tilted lens due to synechia between the lens and iris that was treated with cataract surgery without penetrating keratoplasty.

Case Presentation

A 16-year-old girl had Peters’ anomaly in both eyes. Corneal opacity was severe in the left eye due to high-grade dysgenesis of the anterior segment. In the right eye, corneal opacity had spread from the center of the cornea to the inferotemporal side, and there was synechia between the iris and corneal endothelium from the inferonasal side to the inferotemporal side. Opacity was observed in the anterior pole of the lens, and there was synechia between the anterior iris and the lens. Ultrasound biomicroscopy (UBM) revealed that the lens was tilted because of synechia. The tilted lens induced astigmatism, which reduced visual acuity to 20/250, in conjunction with a cataract. Cataract surgery was performed; the synechia between the lens capsule and the iris was severed, an intraocular lens was inserted, and the tilt was repaired. UBM was used postoperatively to confirm that the lens capsule synechia had been corrected and that the intraocular lens was not tilted. As a result, visual acuity improved to 20/100; glaucoma and expansion of corneal opacity were not observed.

Conclusions

Severing of the synechia between the cataract and iris, during cataract surgery, in a patient with Peters’ anomaly type 2 resulted in favorable postoperative visual acuity.Key words: Peters’ anomaly type 2, Synechia, Phacoemulsification, Tilted lens     

Ultrasound biomicroscopy of the iris-claw phakic intraocular lens for high myopia

PURPOSE: To study the in situ relative intraocular position of the Ophtec Artisan iris-claw phakic intraocular lens (PIOL) for high myopia using ultrasound biomicroscopy. METHODS: Three PIOLs (13.00, 17.00 and 18.00 D lens powers) were implanted in phakic myopic eyes. Using ultrasound biomicroscopy, echograms were taken in the anterior chamber to measure the preoperative anterior chamber depth, postoperative distance between the PIOL and the corneal endothelium (endothelial-optic distance), and the postoperative distance between the PIOL and the crystalline lens. RESULTS: Preoperative anterior chamber depth ranged from 3.10 to 3.40 mm and the postoperative endothelial-optic distance measured 2.11 to 2.44 mm. The distance between the crystalline lens and the posterior surface of the IOL ranged from 0.78 to 0.93 mm. Several echograms revealed the position of the PIOL on the iris. The pigment layer of the iris did not seem to be disturbed by the presence of the PIOL. CONCLUSION: The original anterior chamber depths were reduced by 28% to 34% after implantation. The PIOL-crystalline lens distance ranged from 0.78 to 0.93 mm. This study of 3 eyes revealed that echograms taken by ultrasound biomicroscopy are useful in verifying the intraocular position of the PIOL within the anterior chamber.     

Ultrasound biomicroscopy of the Artisan phakic intraocular lens in hyperopic eyes

PURPOSE: To study in situ the intraocular position of the Artisan iris-claw intraocular lens (IOL) (model 203) (Ophtec) in phakic hyperopic eyes using ultrasound biomicroscopy (UBM). METHODS: Echograms of the anterior chamber were taken preoperatively and 24 to 317 days postoperatively in 4 eyes implanted with the Artisan IOL (power +4.0 to +6.0 diopters). The preoperative anterior chamber depth (ACD) and the postoperative distance between the IOL and the corneal endothelium (endothelium-optic distance) and between the IOL and the lens were measured. The echograms were assessed for the effect of the IOL on iris tissue. RESULTS: The preoperative ACD ranged from 3.10 to 3.56 mm and the postoperative endothelium-optic distance, from 2.03 to 2.54 mm. The distance between the lens and the posterior surface of the IOL ranged from 0.35 to 0.79 mm. Several UBM echograms showed indentation of iris tissue by the IOL haptics and optic edge, although no pigmentary dispersion was noted. CONCLUSIONS: Adequate space was maintained between the Artisan hyperopic IOL and the corneal endothelium, angle, and crystalline lens. Haptic indentation of the iris, which could lead to pigment erosion, was observed. Preoperative gonioscopy and maintenance of normal intraocular pressure postoperatively suggest the indentation was secondary to inadequate lens vaulting relative to the high natural arch of the iris in hyperopic eyes. Shortening the haptics or increasing the lens vault might resolve this problem.     

超声生物显微镜观察弹性开放襻前房型人工晶状体对眼前段结构的影响

目的 评价弹性开放襻一体型前房型人工晶状体（anter chamber intraocular lens,AC-IOL)植入式的疗效及其安全性。方法 应用超声生物显微镜观察20例（20只眼）弹性开放襻一体型AC-IOL植入术后患者IOL襻的位置,以及其与虹膜及房角结构的关系,从而评价IOL对眼前段结构的影响。随访时间6～20个月。结果 40个IOL襻中,26个襻固定于房角隐窝;14个襻（8只眼）穿过虹膜侵入至睫状体实质内,并伴有反复发作的葡萄膜炎。术后8只眼虹膜前粘连与IOL襻有关。结论 超声生物显微镜检查是动态了解IOL对眼前段结构影响的有效方法。AC-IOL襻的设计有待进一步改进。     

Imaging implanted keratoprostheses with anterior-segment optical coherence tomography and ultrasound biomicroscopy

PURPOSE: To describe the anterior ocular segment findings of eyes with implanted Boston type 1 keratoprostheses (KPro) in vivo by using anterior-segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM). METHODS: A retrospective, comparative study was made of patients with implanted KPros who were examined with AS-OCT (AC Cornea OCT) and UBM (OTI Scan 35-50 MHz Ultrasound). RESULTS: One pseudophakic and 1 aphakic eye were included in the study. Cross-sectional AS-OCT adequately imaged the components of the KPro (front plate with stem, back plate, and titanium ring), the corneal graft, and host cornea. The angles could be seen as open, filled with debris, or closed. Coronal AS-OCT showed en face views of each KPro part. Retrokeratoprosthetic membranes were depicted to be thick opacities covering the rear optical surface of the stem. UBM, on the other hand, imaged the KPro front plate as a muffin-shaped space at the apical center, with the corneal graft appearing wispy and the host cornea grainy. The back plate, titanium ring, and angles could not be resolved. Glaucoma tubes and posterior-chamber intraocular lens (PCIOL) haptics were imaged below the iris plane. CONCLUSIONS: Cross-sectional AS-OCT adequately imaged the components of the assembled KPro in vivo, as well as its interaction with surrounding anterior-segment structures. It allowed visualization of the anterior chamber, iris, and angle, essential in the postoperative care of these patients. Coronal AS-OCT showed graphic en face images of the KPro device and suspected retrokeratoprosthetic membranes. UBM, on the other hand, adequately imaged glaucoma tube shunts and PCIOL haptics beneath the iris plane.