应用超声生物显微镜检查及诊断青光眼术后睫状体脱离

目的：探讨青光眼术后睫状体脱离造成浅前房的形态学改变及其临床意义。方法：应用眼科传统B超及超声生物显微镜（ultrasound biomicroscopy,UBM)对青光眼术后睫状体脱离的患眼,健眼形态进行观察并对其测量的相关数据进行统计学分析。结果：UBM对B超不能诊断的睫状体脱离和脉络膜浅脱离,能特异性地进行检查诊断,其特征性表现为：巩膜与睫状体间存在无回声区,睫状体位置前移,前旋,睫状体平坦部向眼中轴部位移动,部分患者可见睫状体平坦部呈层间分离,前房变浅的原因是睫状突向前扭转,导致虹膜根部膨隆,晶状体向前移位,所有睫状体脱离眼均为360度全周脱离,而非某一象限的脱离,不伴有脉络膜脱离的单纯睫状体脱离所致的青光眼术后浅前房,一般不致前房完全消失,保守治疗可奏效,结论：应用UBM检查可以对睫状体脱离造成的青光眼术后浅前房进行明确诊断,为临床治疗提供可靠依据。     

前段玻璃体视网膜疾病的超声生物显微镜检查

为探讨超声生物显微镜（ＵＢＭ）对前段玻璃体视网膜疾病的诊断价值。用ＵＢＭ检查３９例４０眼，并与临床检查、Ｂ型超声波检查及手术中观察结合起来，综合评价ＵＢＭ单项检查的客观性。结果：ＵＢＭ能良好地显示从角膜到赤道部的眼前段结构，发现视网膜脱离２６眼，视网膜环形收缩１７眼，视网膜前移位１４眼，玻璃体混浊或机化３７眼，睫状体或脉络膜脱离１８眼，睫状体上皮脱离３眼，巩膜穿刺孔处增殖５眼，眼内肿瘤样改变３眼，     

复杂外伤性睫状体离断的临床特征分析

 目的 探讨复杂外伤性睫状体离断的临床特征。设计 回顾性病例系列。研究对象2013年1月至2015年1月北京同仁医院就诊的复杂外伤性睫状体离断患者44例（44眼）。方法 回顾性分析患者的一般情况及临床表现特点。主要指标 性别、年龄、受伤眼别、致伤原因、视力、眼压、睫状体离断范围、眼部合并症等。结果 患者平均年龄（43±14）岁,男性39例（88.6%）,右眼占52.3%。致伤原因中钝挫伤占95.5%,以铁块崩伤、爆竹崩伤和拳击伤为主。就诊时平均视力（2.3±1.1）logMAR,平均眼压（8.0±3.4）mmHg。就诊时表现低眼压者占79.6%,浅前房占31.8%。眼压与睫状体离断范围无相关性（r=-0.09, P=0.56）。平均睫状体离断范围4.8±3.2个钟点,其中16例（37%）离断范围超过180°,3例离断范围 360°。右眼颞上象限,左眼鼻上和颞上象限易发生离断。眼部其他合并症包括晶状体损伤（84.1%）、前房积血（31.8%）、房角后退（18.2%）、虹膜根部离断（34.1%）、玻璃体积血（54.5%）、视网膜脱离（31.8%）等。结论 复杂外伤性睫状体离断常合并眼部多组织损伤尤其是晶状体损伤。对眼球钝挫伤即使无浅前房、低眼压等表现也需警惕睫状体离断的可能。（眼科, 2018, 27： 301-304）     

超声生物显微在眼球前段肿瘤检查中应用的初步报告

目的：探讨超声生物显微镜在眼前段肿瘤诊断的价值。方法：Ｅ和ＵＢＭ对１３例临床诊断或疑诊的眼球前段肿物患者进行检查。结果：３ 外伤呈手术史、临床诊断为前房 性虹膜囊肿，ＵＢＭ显示有较大的无内反射的囊性回声，８例前房较浅、房角较窄、怀凝眶膜后或睫状全肿物中，７例显示虹膜后有大小不等的囊性回声，１例睫状体部有实性肿物回声；２例临床诊断虹膜痣者，显示虹膜实性隆起或稍增厚、均匀一致的高回声影。     

应用超声生物显微镜检测原发性婴幼儿型青光眼的眼前节形态特征

目的了解原发性婴幼儿型青光眼（ｐｒｉｍａｒｙｉｎｆａｎｔｉｌｅｇｌａｕｃｏｍａ,ＰＩＧ）在活体状态下的眼前节组织结构特点。方法应用超声生物显微镜（ｕｌｔｒａｓｏｕｎｄｂｉｏｍｉｃｒｏｓｃｏｐｙ,ＵＢＭ）,以５０ｍＨｚ的超高频超声探头,对３８例（５８只眼）原发性婴幼儿型青光眼的眼前节结构进行测量和动态学检查。结果ＰＩＧ患儿无论发病早晚、病情轻重或年龄大小,其最主要的病变特征是巩膜突与房角顶点的相对位置发生变化,３／４患眼的巩膜突位于房角顶点外侧或后外方,１／４患眼的巩膜突与虹膜根部附着处平行。睫状突长度和厚度均大于同龄正常儿童。睫状突向前、向内移位,部分与虹膜相贴。结论ＰＩＧ患儿的巩膜突与房角顶点相对位置的改变,提示巩膜突发育不良或虹膜附着点靠前,这是原发性婴幼儿型青光眼发病的病理基础。     

超声生物显微镜测量正常人眼前节结构的初步研究

目的了解正常人活体状态下的眼前节组织结构。方法通过超声生物显微镜（ｕｌｔｒａ－ｓｏｕｎｄｂｉｏｍｉｃｒｏｓｃｏｐｙ，ＵＢＭ）的超高频（５０～１００ｍＨｚ）换能器，对活体眼球的眼前节结构进行测量。结果ＵＢＭ能清晰观察角膜、巩膜、虹膜、晶体、睫状体、前房、后房和眼外肌等结构。结论ＵＢＭ是一种无创伤、且在活体状态下观察眼前节结构的新方法，它弥补了既往不能在活体组织上动态观察眼前节结构的不足。因换能器频率高，探查深度仅４～５ｍｍ，只适用于观察眼部的表浅结构。     

超声生物显微镜有眼前段钝挫伤中初步应用

为探讨超声生物显微镜在眼前段钝挫伤中的应用价值。对７只眼前段钝挫伤眼进行上有科常规检查，传统眼科Ｂ超少超声生物显微镜检查。结果显示超声生物显微镜显示房角后退、虹膜根部离断、睫状体分离、晶体悬韧带断裂不全脱位和玻璃体疝，并能显示出传统Ｂ超所不能显示的睫状体和脉络膜浅脱离。表明超声生物显微镜在眼前段外伤中有极好的应用价值。尤其在屈光介质混浊（角膜混浊、前房积血），睫状体分离低眼压和隐藏在虹膜后的病变时     

两类青光眼眼前节结构在超声生物显微镜下的表现

目的：比较超声生物显微镜（ｕｌｔｒａｓｏｕｎｄ ｂｉｏｍｉｃｒｏｓｃｏｐｙ,ＵＢＭ）检查下慢性闭角型青光眼与原发性开角型青光眼前节各项指标的差异,探讨ＵＢＭ在鉴别此两种类型青光眼的作用。方法：应用ＵＢＭ测量已确诊的慢性闭角型青光眼１３例２５例,原发性开角型青光眼１１例２２眼的眼前节各参数,进行统计学分析,结果：慢性闭角型青光眼在前房深度,房角开放距离。巩膜睫状体夹角,小梁睫状体距离,小梁虹膜夹角上     

经玻璃体闭合式睫状体修复术治疗伴有睫状体离断的复杂眼外伤疗效观察

睫状体离断是指睫状体纵行肌附着在巩膜突上的肌腱断裂,睫状体与巩膜分离。对于睫状体离断伴有玻璃体积血或视网膜脱离的患者,特别是离断睫状体向眼球中轴部明显移位的患者,手术操作难度较大,睫状体难以复位。我们尝试采用经玻璃体闭合式睫状体修复手术方法对4例伴有睫状体离断的复杂眼外伤患者进行治疗,取得较为满意效果。     

睫状体缝合术治疗睫状体脱离25例

目的 探讨睫状体脱离的临床特点和治疗方法。方法 回顾性分析睫状体脱离终究事复位术治疗２５例的临床资料。结果 术后２１例（８４％）眼压提高到８￣２１ｍｍＨｇ,４例（１６％）眼压仍低于４ｍｍＨｇ。结论通过前房角及ＵＢＭ确定睫状体离的范围,在前房极浅检查房角困难时,ＵＢＭ具有无创伤、准确、直观的优点。睫状体缝合术是一 效的治疗方法。     

Pathogenesis of transient high myopia after blunt eye trauma

OBJECTIVE: To determine the pathogenesis of transient high myopia after blunt eye trauma. DESIGN: Two observational case reports and literature review. METHODS: Refraction was measured in two patients with an autorefractometer in the acute and convalescent stages after a blunt eye injury. The anterior chamber angle, the ciliary body, and the choroid were examined by ultrasound biomicroscopy (UBM) in the acute and convalescent stages. In one patient, the anterior chamber depth, lens thickness, and axial length were measured by A-scan ultrasonography in the acute and convalescent stages. MAIN OUTCOME MEASURES: Comparison of the refraction, anterior chamber depth, lens thickness, axial length, and the UBM-determined appearance of the choroid and ciliary body during the acute stage with the values during the convalescent stages. RESULTS: The first patient showed a myopic shift of -9.75 diopters (D) and an anterior chamber shallowing of 0.94 mm measured 3 days after trauma by an air bag inflation compared with the measurements at the convalescent phase. UBM showed an annular ciliochoroidal effusion with ciliary body edema, anterior rotation of the ciliary processes, and disappearance of the ciliary sulcus. Eleven days after the injury, these UBM findings normalized, and the myopia decreased to -0.75 D, 27 days after trauma. The second patient had a myopic shift of -8.9 D compared with the convalescent phase, immediately after blunt trauma by a firework. Seven days after the injury, UBM revealed a partial cyclodialysis in addition to findings similar to those in the first patient. Ten days after injury, a myopic shift (-4.75 D), anterior chamber shallowing (by 1.1 mm), and thickening of the crystalline lens (by 0.27 mm) were observed compared with the convalescent phase. Associated UBM findings confirmed the anterior shift of the lens-iris diaphragm. Seventeen days after trauma, the UBM findings, including the cyclodialysis, were normalized, and the myopia had decreased to -1.0 D. CONCLUSIONS: Transient high myopia after blunt trauma is caused by anatomic changes in the ciliary body and crystalline lens. The anterior shift of the lens-iris diaphragm caused by ciliochoroidal effusion with ciliary body edema and thickening of the crystalline lens from blunt eye trauma are involved in traumatic high myopia.     

眼挫伤后睫状体脱离的UBM观察

目的:超声生物显微镜(ultrasound biomicroscopy,UBM)观察眼挫伤后睫状体脱离的特点,并评价UBM指导下睫状体缝合手术治疗眼挫伤后睫状体脱离的临床效果。方法:应用UBM观察30例30眼因眼球挫伤导致睫状体脱离的特点,其中5例5眼行房角漏对应位置和范围的睫状体缝合复位手术,观察视力、眼压及复查UBM及B超(其余患者为门诊患者,具体治疗及预后情况不详)。结果:UBM检查示不同程度的睫状体脱离,27眼为全周睫状体脱离,26眼存在房角漏口,平均中央前房深度(1.830±0.575)mm。5眼行房角漏对应位置和范围的睫状体缝合复位手术后,所有患者房角漏口全部封闭,全周睫状体脉络膜脱离痊愈,前房加深,视力提高,眼压上升至正常。5眼中,4眼行1次手术后睫状体脉络膜脱离痊愈,1眼行4次手术后痊愈。结论:UBM是诊断眼挫伤后睫状体脱离的较好的工具,UBM指导下睫状体缝合手术治疗房角漏的临床效果好,UBM对于眼挫伤致睫状体脱离的临床诊断、治疗和随访具有指导意义。     

Four cases of hypotony maculopathy caused by traumatic cyclodialysis and treated by vitrectomy, cryotherapy, and gas tamponade

Purpose We report our results in four cases of hypotony maculopathy caused by traumatic cyclodialysis and treated by combined vitrectomy and cataract surgery.Methods The patients' visual acuities ranged from light perception to 0.2, and intraocular pressures ranged from 4.7 to 5.7 mmHg (mean 5.1 mmHg) before surgery. Ultrasound biomicroscopy (UBM) revealed cyclodialysis associated with ciliary body detachment of 180° to 360°. We performed combined vitrectomy and cataract surgery, with pars plana cryopexy for detached ciliary body and an SF₆ gas tamponade.Results Postoperative UBM showed that cyclodialysis and/or ciliary body detachment disappeared in the whole circumference of two eyes, while it partially remained at 15° in one eye and at 30° in one eye. Postoperative visual acuity ranged from 0.06 to 1.2, with IOP ranging from 9.0 to 14.7 mmHg (mean 12.2 mmHg).Conclusions Based on our results, we consider that the present combined therapy is highly reliable for closing and adhering traumatic cyclodialysis and normalizing hypotony.     

睫状体复位联合玻璃体手术治疗复杂眼外伤

目的 评价睫状体复位联合玻璃体手术在治疗伴有睫状体脱离的复杂眼外伤中的临床疗效.方法 对严重钝挫伤患者20例(20只眼),超声生物显微镜(UBM)探查所有外伤眼睫状体360°全周脱离,离断口的范围在3～5个钟点,其中6例伴有不同程度的房角后退.术前眼压4～17mmHg,12例IOP≤6mmHg.伴随症状包括外伤性扩瞳、浅前房、前房积血、虹膜根部离断、晶状体脱位或半脱位、外伤性白内障、玻璃体混浊、视网膜脱离、脉络膜脱离等.所有患眼施行玻璃体视网膜手术联合睫状体修补术.结果 术后UBM检查睫状体脱离消失,离断口封闭.术后1月眼压13≤21mmHg,平均(17±3.15)mmHg.随访所有外伤眼视网膜在位,屈光间质清晰.结论 对于复杂眼外伤,尤其是伴有低眼压的患者,术前应常规行UBM检查.对于睫状体离断口范围超过2个钟点的,在行玻璃体视网膜手术的同时要联合睫状体修补术.     

葡萄膜炎的超声生物显微镜图像特征

目的：探讨葡萄膜炎超声生物显微镜(ultrasound biomicroscopy,UBM)的图像特征及其应用价值。方法：应用UBM对20例36只眼在我中心诊断为葡萄膜炎的患者进行眼前段检查,包括前房、前房角、后房、睫状体及玻璃体基底部,并对其图像进行分析。结果：20例36只眼的UBM图像可显示不同的改变,主要有前房点状高反射回声影;虹膜前粘连或部分虹膜前粘连,房角关闭;虹膜后粘连、高度膨隆、瞳孔闭锁;后房团片状回声影;睫状体水肿、平坦部“雪堤样”片状回声影;玻璃体基底部点、线状高反射回声影。结论：UBM可显示葡萄膜炎眼前段不同的病理改变,可为葡萄膜炎的临床诊断提供客观依据。     

The Use of Anterior Segment Imaging after Trabeculectomy

Evaluation of patients after trabeculectomy can be aided by the use of anterior segment imaging. Two commonly used forms of imaging are ultrasound biomicroscopy (UBM) and optical coherence tomography (OCT). Both modalities can be used to assess bleb morphology and how it affects treatment outcome, measure anterior chamber biometry, identify the presence of supraciliochoroidal fluid, cyclodialysis clefts and malignant glaucoma, and evaluate treatment modalities after trabeculectomy such as in laser suture lysis and needling. OCT, with its finer resolution, is able to view the bleb wall anatomy in detail and because of its non-contact nature can examine the eye sooner after trabeculectomy. UBM, on the other hand, is superior for the visualization of deeper structures such as the ciliary body and posterior chamber essential to identify malignant glaucoma.     

Three cases of hypotonic maculopathy due to blunt trauma,treated by 360-degree scleral buckling

BACKGROUND: In hypotonic maculopathy with a shallow anterior chamber, it is difficult to delineate the extent of cyclodialysis. Reoperations are often reported, and a method of management for hypotonic maculopathy is not yet established. CASES: We treated three patients with hypotonic maculopathy due to blunt trauma. Case 1 did not improve after two cryoablations, two cyclopexies, and a laser photocoagulation treatment. Cases 2 and 3 did not improve after a single laser photocoagulation treatment. All cases exhibited retinal breaks, and underwent 360-degree scleral buckling. RESULTS: In all cases, intraocular pressure was normalized soon after the surgery. We found that ultrasound biomicroscopy (UBM) was helpful in clarifying cyclodialysis, and that optical coherence tomography(OCT) was useful to observe morphologic changes of the macula in detail. CONCLUSION: This procedure is considered to be useful in the treatment of hypotonic maculopathy.     

睫状体解离诊断和治疗进展

睫状体解离是指附着在巩膜突上的睫状体纵行肌断裂,睫状体与巩膜突分离,导致前房与睫状体上腔相通,为房水引流创造了异常途径,引起持续性的低眼压及其他眼部病变。持续性低眼压可引起白内障进展、屈光改变、视盘水肿及一系列视网膜并发症,需及时、准确地进行干预。目前除房角镜检查外,超声生物显微镜、眼前节光学相关断层扫描、磁共振成像及...     

Observation of physiological change in the human ciliary body using an ultrasound biomicroscope during accommodation]

PURPOSE: To evaluate changes in the ciliary body during accommodation using an ultrasound biomicroscope (UBM). SUBJECTS AND METHODS: Eleven healthy persons, aged from 24 to 33 years, served as subjects. They were asked to lie in the supine position and to fixate a target placed on the ceiling 2 m above with the left eye. A concave lens with the power of -6 to -8 diopters was then placed before the fixating left eye. The thickness of the ciliary body in the right eye was measured by UBM in the nonaccommodative and accommodative states. FINDINGS: The anterior chamber in the right eye became significantly shallow during accommodation. The thickness of the ciliary body significantly increased during accommodation at 0.5 mm and 1.0 mm posterior to the scleral spur. It significantly decreased at 2.0 mm, 2.5 mm and 3.0 mm posterior to the scleral spur. CONCLUSION: During induced accommodation in the left eye, the anterior portion of the ciliary body in the right eye increased and the posterior portion decreased in thickness. The findings imply that the circular ciliary muscles are mainly involved in accommodation and not the longitudinal muscles.     

挫伤性睫状体脱离的超声生物显微镜观察

目的探讨超声生物显微镜(UBM)在挫伤性前房积血术后睫状体脱离诊断中的应用价值。方法2001年1月~2004年10月收治的Ⅲ级前房积血25例(25眼),首诊均曾作UBM检查未发现有睫状体脱离。行手术治疗后再次应用UBM检查并对眼前段形态结构进行定量测量。检查结果采用配对t检验,进行统计分析。结果25例术后前房积血均完全消失,视力均有不同程度的提高,眼压控制在21.0 mmHg以下;术后第2天UBM检查,睫状体脱离15例,其中全脱离10例,部分脱离5例,未沟通型者13例,沟通型者2例;术后睫状体脱离患者眼压较未脱离者低;睫状体脱离眼与对侧眼比较具有前房浅、睫状体厚度增加和小梁睫状体距离缩短的形态学改变,差异有统计学意义(P<0.05);睫状体脱离于术后第14天均复位。结论挫伤性前房积血术后睫状体脱离大部分为未沟通型,2周内睫状体脱离复位;UBM对诊断睫状体脱离具有重要的应用价值。