水囊法超声生物显微镜对儿童先天性角膜混浊影像学特点的分析

目的借助水囊法超声生物显微镜检查探讨儿童先天性角膜混浊的影像学特点。方法回顾性分析先天性角膜混浊患儿142例(181眼),观察先天性角膜混浊的眼前节发育情况,根据发育异常的表型分为A、B、C、D四型。结果 181眼中有A型43眼(23.8%),仅前部角膜混浊不伴有其他结构异常。B型11眼(6.1%)为后部或全层角膜混浊,伴角膜后部局部缺损,而虹膜晶状体正常。C型88眼(48.6%)为虹膜或房角发育异常,但晶状体未见异常,其中房角发育异常范围小于4个方位的C1型共35眼(19.3%);房角发育异常范围大于等于4个方位的C2型共53眼(29.3%)。D型39眼(21.5%)为角膜虹膜与晶状体粘连,或存在混浊、膜样、缺如等晶状体异常。双眼混浊患者两眼表现可不对称;同时伴有晶状体和虹膜异常的比例,双眼混浊(32.1%)显著多于单眼(13.6%)(χ2=8.947,P=0.003)。结论采用水囊包裹探头的超声生物显微镜是适合于儿童的眼前节检查方法,可用于分析先天性角膜混浊角膜、虹膜、房角和晶状体的影像学特点并分型,对明确其诊断和预后具有指导意义。

Characteristics of pediatric congenital corneal opacity using ultrasound biomicroscopy

Objective To investigatethe Ultrasonographic features of pediatric congenital corneal opacity by ultrasound biomicroscopy.Methods A retrospective review was made of the records from 181 eyes of 142 patients.All participants underwent ultrasound biomicroscopy(UBM) and disease-specific features were noted.According to the phenotype of abnormal development,they can be divided into four types:A,B,C,and D.Results Of the 181 eyes,43 eyes(23.8%) were type A,only with anterior corneal opacities.11 eyes(6.1%) in type B were posterior or full-thickness corneal opacities,with a defect in the posterior cornea,but with normal iris and lens.88 eyes(48.6%) with abnormal iris or angle and normal lens were type C,in which 35 eyes(19.3%) with the developmental abnormality of angle<4 positions and 53 eyes(29.3%) with the developmental abnormality of angle≥ 4 positions.Type D included 39 eyes(21.5%) with kerato-irido-lenticular adhesion or other iridolenticular anomalies.The anomaly of two eyes could be asymmetric in bilateral corneal opacities.Bilateral corneal opacities(32.1%) with iridolenticular anomaly were significantly more than monocular(13.6%)(χ2=8.947,P=0.003).Conclusions Ultrasound biomicroscopy examinationis suitable for anterior segment photography in children and it is useful in analyzing the characteristics of cornea,iris,lens,and angle.The classification is of importance for the diagnosis and prognosis of congenital corneal opacity.