超声生物显微镜量化观察超声乳化白内障吸除人工晶状体植入术后前房角的改变

目的:探讨超声乳化白内障吸除折叠式人工晶状体植入术后术眼前房角结构的改变。方法:对46例(50眼)老年性白内障患者行小切口超声乳化白内障吸除折叠式人工晶状体植入术,分别于术前和术后1mo使用超声生物显微镜量化测量前房深度和前房角宽度。结果:全部患者术后1mo前房深度明显增大(P<0.01);500μm处小梁虹膜夹角(TIA500)、250μm和500μm处前房角开放距离(AOD250、AOD500)与术前比较均显著增大(P<0.01),TIA500平均比值(术后TIA500/术前TIA500)为1.65(1.12～4.91),AOD250平均比值(术后AOD250/术前AOD250)为1.81(1.06～2.67),AOD500平均比值(术后AOD500/术前AOD500)为1.65(1.01～2.76),均与术前值呈显著负相关(P<0.01)。结论:超声乳化白内障吸除折叠式人工晶状体植入术可显著增大老年性白内障患者的前房角宽度;术前前房角越窄,术后前房角的变化程度越大。     

超声生物显微镜量化观察超声乳化白内障吸除人工晶状体植入术后前房角的改变

目的　探讨超声乳化白内障吸除折叠式人工晶状体植入术后术眼前房角结构的改变。方法　对 4 6例 (5 0只眼 )老年性白内障患者行小切口超声乳化白内障吸除折叠式人工晶状体植入术 ,分别于术前和术后 1个月使用超声生物显微镜量化测量前房深度和前房角宽度。结果　全部患者术后 1个月前房深度明显增大 (P <0 0 1) ;5 0 0 μm处小梁虹膜夹角 (TIA5 0 0 )、2 5 0 μm和 5 0 0 μm处前房角开放距离 (AOD2 5 0、AOD5 0 0 )与术前比较均显著增大 (均P <0 0 1) ,TIA5 0 0平均比值 (术后TIA5 0 0 /术前TIA5 0 0 )为 1 6 5 (1 12～ 4 91) ,AOD2 5 0平均比值 (术后AOD2 5 0 /术前AOD2 5 0 )为1 81(1 0 6～ 2 6 7) ,AOD5 0 0平均比值 (术后AOD5 0 0 /术前AOD5 0 0 )为 1 6 5 (1 0 1～ 2 76 ) ,均与术前值呈显著负相关 (均P <0 0 1)。结论　超声乳化白内障吸除折叠式人工晶状体植入术可显著增大老年性白内障患者的前房角宽度 ;术前前房角越窄 ,术后前房角的变化程度越大。     

白内障人工晶状体植入术前后角膜厚度和前房深度及前房角的改变

目的:探讨超声乳化白内障吸除折叠式人工晶状体植入术前后,术眼前房深度和角膜厚度及前房角结构的改变。方法:对20例20眼老年性白内障患者行超声乳化白内障吸除折叠式人工晶状体植入术,分别于术前和术后1wk使用超声生物显微镜量化测量前房深度、角膜厚度和前房角宽度。结果:全部患者术后1wk角膜厚度明显增加,前房深度明显增大;500μm处前房角开放距离(AOD500)及ACA角度均与术前值比较明显增加,且均P<0.01。结论:超声乳化白内障吸除折叠式人工晶状体植入术可以使角膜厚度显著增加;可显著增加老年性白内障患者的前房深度及房角宽度。     

使用全景超声生物显微镜观察年龄相关性白内障超声乳化手术后前房直径的改变

目的探讨使用全景超声生物显微镜（ultrasound biomicroscopy,UBM）观察白内障患者手术前后前房直径的改变。方法对109例（128眼）年龄相关性白内障患者行超声乳化白内障吸除联合折叠型人工晶状体植入术,分别于术前、术后第2个月利用全景UBM测量水平前房直径和垂直前房直径,观察其变化情况。结果年龄相关性白内障患者术前水平前房直径为（11.58±0.43）mm,术后为（11.82±0.35）mm;术前垂直前房直径为（11.59±0.44）mm,术后为（11.87±0.33）mm。术前垂直前房直径与水平前房直径相差（0.01±0.23）mm,术后相差（0.06±0.25）mm。术后水平、垂直前房直径均较术前增加,差异有统计学意义（P〈0.01）。术前与术后水平前房直径存在正相关（r=0.68,P〈0.01）,回归方程为Y=5.3945＋0.55438x。结论白内障患者垂直前房直径略大于水平前房直径;年龄相关性白内障超声乳化吸除人工晶状体植入术后水平前房直径及垂直前房直径均增加。可以用术前的前房直径预测出术后前房直径,为选择适合大小的前房型人工晶状体提供参考。     

超声乳化联合房角分离术治疗原发性闭角型青光眼

目的 观察超声乳化白内障吸除人工晶状体植入联合房角分离术治疗合并有白内障的原发性闭角型青光眼的疗效.方法 回顾性分析合并有白内障的闭角型青光眼患者35例(37眼),其中前房角关闭范围≤180°者16眼,＞180°者21眼,均行角巩膜隧道切口超声乳化白内障吸除折叠式人工晶状体植入联合房角分离术,对其手术前后的视力、眼压、视野、中央前房深度、房角状态进行对照观察.结果 随访3～24个月.术后视力除2眼有视神经萎缩外,余均有不同程度提高,末次随访平均眼压(14.31±4.13)mm Hg(1 mm Hg=0.133 kPa),较术前用药后平均眼压(26.42±3.22)mm Hg明显降低,差异有统计学意义(t=5.86,P＜0.01),中央前房深度由术前的(2.0±0.3)mm,增加到术后的(3.2±0.4)mm,房角状态与术前相比有3眼大部分开放,余房角均开放.结论 对于合并有白内障的闭角型青光眼的治疗,行超声乳化白内障吸除折叠式人工晶状体植入联合房角分离术能有效降低眼压,开放房角,加深前房,提高视力,手术并发症少.     

白内障超声乳化在闭角型青光眼中的应用

目的探讨白内障超声乳化吸除合并人工晶状体（intraocular lens，IOL）植入术对伴有白内障的闭角型青光眼的手术效果。方法对31例（33眼）闭角型青光眼伴白内障患者行白内障超声乳化吸除合并IOL植入术。观察手术前后前房角、前房深度、眼压及视力变化。术后随访1.5-3年。结果术后所有术眼眼压下降，平均（14.99±0.65）mmHg（1mmHg=0.133kPa），比术前用药后平均眼压（24.43±1.61）mmHg明显降低。手术前后眼压差异有显著性（t=5.28，P=0.000）。UBM检查中央前房深度，由术前的（1.60±0.25）mm增加到术后的（3.30±0.35）mm，两者差异有显著性（t=6.24，P=0.000）；术后前房角宽度均增加,房角开放。前房角镜检查前房角均增宽，睫状体带易于看见。术后视力明显提高（X^2=63.47，P〈0.01）。结论对由晶状体因素引起的瞳孔阻滞型闭角型青光眼合并白内障患者，白内障超声乳化吸除合并IOL植入术是可供选择的治疗方法之一。     

超声生物显微镜量化观察高度近视眼合并白内障超声乳化人工晶状体植入术后前房角的改变

目的利用UBM(ultrasound bio microscopy)对高度近视眼及其对照组正视眼白内障患者在超声乳化白内障吸除折叠式人工晶状体植入的术前、术后进行房角形态量化观察并比较分析,旨在探讨高度近视眼合并白内障手术的安全性。方法选取高度近视眼组和正视眼组做为其对照组,每组白内障的患者各30例(30只眼),采用透明角膜切口白内障超声乳化折叠式人工晶状体植入术,于术前、术后1、3个月用UBM测量前房深度(anteri-orchamber distance,ACD)、房角开放度(openangle,AA)、房角开放距离(angle opening distance,AOD)、小梁睫状体距离(trabecular-ciliary processes distance,TCPD)和虹膜睫状体距离(iris-ciliary processes distance,ICPD),同时记录眼压的变化并进行分析。结果对照组术前与术后1、3个月相比,ACD、AA、AOD500、TCPD、ICPD有显著性差异,术后1个月和术后3个月相比无显著性差异。术后眼压与术前相比有显著性差异。高度近视眼组术前与术后1、3个月相比各项测量指标有显著性差异,术后1个月和术后3个月相比无显著性差异。术后眼压与术前相比有显著性差异。高度近视眼与正视眼相比较,术前及术后除外ICPD,其它各项指标均存在显著性差异。结论高度近视眼合并白内障选择透明角膜切口超声乳化吸除折叠式人工晶状体植入术术后与术前相比前房明显加深,房角明显加宽,眼压也有一定程度的下降;与正视眼相比术前和术后的前房深度、房角宽度均大于后者,进一步证实了高度近视眼独特的前节结构,提示透明角膜切口超声乳化白内障吸除折叠式人工晶状体植入术安全有效。     

超声乳化联合人工晶状体植入术对前房深度及房角宽度的影响

目的:探讨超声乳化联合人工晶状体植入术对患者前房深度、房角宽度的影响.方法:选取2015-06/2016-05在我院行白内障超声乳化吸除联合人工晶状体植入术的患者74例89眼,于术前及术后3 mo测量患者眼压、中央前房深度(ACD)、房角开放距离(AOD500)和房角角度(ACA500).结果:术后3mo,眼压为11.34±2.38mmHg,较术前(12.60±2.5 1mmHg)有所降低,差异有统计学意义(P＜0.05);ACD为4.01 ±0.30rmm,较术前(2.30±0.42mm)明显增厚,差异有统计学意义(P＜0.05);AOD500和ACA500分别为0.915±0.223mm和41.71 °±6.55°,明显高于术前0.514±0.201mm和24.01°±8.43°,差异有统计学意义(P＜0.05);眼压值与ACD、AOD500和ACA500呈负相关(r=-0.239、-0.211、-0.252,P＜0.05).结论:超声乳化联合人工晶状体植人术可降低患者眼压,增加患者前房深度和房角宽度,从而对眼内房水循环起到积极作用.     

超声乳化白内障吸除联合小梁切除术治疗闭角型青光眼合并白内障

目的:观察超声乳化白内障吸除人工晶状体植入联合小梁切除术治疗闭角型青光眼合并白内障的临床效果。方法:对闭角型青光眼并白内障36例46眼行超声乳化白内障吸除折叠式人工晶状体植入联合小梁切除手术治疗。术前、术后分别详细记录患者视力、眼压、滤过泡、前房深度、房角及眼底情况。结果:术后随访3mo～2a,43眼(93.5%)视力较术前明显提高,44眼(95.7%)眼压保持在正常范围,术后眼压<21mmHg。35例46眼患者前房深度术前平均为2.1±0.3mm,术后平均3.8±0.4mm,术后所有患者前房深度均加深,术前关闭的前房角也有不同程度的开放。6眼(13.0%)角膜水肿,无角膜内皮失代偿。结论:合并白内障的闭角型青光眼患者行超声乳化白内障吸除联合小梁切除术安全有效,能够有效降低眼压、加深前房、开放房角,提高视力。     

白内障超声乳化联合房角分离术治疗原发性慢性闭角型青光眼

目的:探讨超声乳化白内障吸除及人工晶状体植入术联合房角分离术治疗原发性慢性闭角型青光眼的疗效。方法:采用白内障超声乳化及人工晶状体植入联合房角分离术治疗合并白内障的原发性慢性闭角型青光眼32例32眼,比较手术前后的眼压、视力、前房深度、房角形态,观察术后并发症等情况。结果:术后随访6mo～2a;所有病例术后最佳矫正视力均提高;术后眼压明显降低,术前平均眼压15.2±8.1mmHg,术后11.2±5.0mmHg,差异有显著统计学意义(t=3.126,P<0.01);术后中央前房深度显著加深,术前平均中央前房深度2.22±0.39mm,术后3.36±0.43mm,差异有显著统计学意义(t=-14.371,P<0.01);术后房角粘连范围有减少,无严重并发症出现。结论:白内障超声乳化房角分离术能有效的治疗并发白内障的原发性慢性闭角型青光眼。     

白内障患者应用Pentacam和UBM测量前房直径、前房深度的研究

目的探讨应用Pentacam三维眼前段分析诊断系统与全景超声生物显微镜（UBM）观察年龄相关性白内障患者手术前后前房直径及前房深度（ACD）的变化。比较两种方法测量结果的差异。方法前瞻性非随机对照临床研究。临床选取行晶状体超声乳化吸出联合人工晶状体（IOL）植人术后的年龄相关性白内障60例（79眼）。应用Pentaeam测量术前、术后1周、1个月、2个月的水平前房直径和ACD;应用UBM测量术前、术后2个月的水平前房直径、垂直前房直径和ACD。结果（1）Pentacain测量结果,术后水平前房直径增加（F=7．170,P=0．009）,ACD加深（F=26．439,P〈0．05）,术后1周、1个月、2个月前房直径、ACD进行两两比较,差别无统计学意义（P〉0．05）。（2）UBM测量结果,大部分患眼垂直前房直径大于水平前房直径。（3）Pentacam测量术前、术后2个月的水平前房直径与UBM测量值相比,差别无统计学意义（t=0．231,P=0．818,t=1．017,P=0．311）。Pentacam与UBM测量术前ACD,差别无统计学意义（t=0．153,P=0．995）;而测量术后ACD,差别有统计学意义（P〈0．05）。结论（1）Pentacam测量结果显示,年龄相关性白内障患者术后水平前房直径增加,ACD加深,术后1个月前房直径、ACD保持不变。（2）UBM测量结果显示,大部分患者垂直前房直径大于水平前房直径。（3）UBM与Pentacam都可以用于前房直径和ACD的测量,而且对于术前、术后前房直径以及术前ACD的测量结果相似。但测量白内障患者有晶状体眼的ACD时,两种仪器的测量结果不同。两种仪器测量角膜部位不同从而产生差别。但是每一种仪器都有各自的优缺点,使用时应根据不同的目的选用不同的仪器。     

Ultrasound biomicroscopic study of anterior segment changes after phacoemulsification and foldable intraocular lens implantation

PURPOSE: To report quantitative changes in the anterior segment configuration after clear corneal incision phacoemulsification and foldable intraocular lens (IOL) implantation by means of ultrasound biomicroscopy (UBM). DESIGN: Prospective, nonrandomized, comparative (self-controlled) trial. PARTICIPANTS: Twenty-one eyes of 19 patients with senile or presenile cataracts and no other ocular illness. METHODS: Patients were examined with UBM before and 1 and 3 months after surgery. At each UBM examination, axial images of the anterior chamber and radial sections of the angle at the superior, lateral, inferior, and medial quadrants were obtained. MAIN OUTCOME MEASURES: Central anterior chamber depth (ACD), iris-lens contact distance, iris-lens angle (ILA), angle opening distance at points 250 (AOD250) and 500 microm (AOD500) from the scleral spur, trabecular-iris angle (TIA), iris thickness 500 microm from the scleral spur (IT), trabecular-ciliary process distance (TCPD), iris-ciliary process distance (ICPD), iris-zonule distance, iris-sclera angle (ISA), and ciliary process-sclera angle (CPSA). After surgery, central anterior chamber depth was also measured from the cornea to the IOL (ACD) and from the cornea to the pupillary plane (ACD2). Each variable was measured twice in different days by the same observer. RESULTS: The variables IT, TCPD, ICPD, IZD, and CPSA did not significantly change after surgery (P > 0.01). Central anterior chamber depth increased approximately 30% after surgery (approximately 850 microm; P < 0.001), by both measurement methods used (ACD x ACD and ACD x ACD2). Anterior chamber angle significantly increased, by approximately 50% of the initial value, by the three measurement methods used: AOD250 (P 相似文献   

超声乳化吸除联合折叠IOL植入术治疗急性闭角型青光眼

目的:探讨超声乳化(Phacoemulsification,Phaco)联合折叠型人工晶状体植入术对急性闭角型青光眼的临床疗效。方法:选择>50岁患有急性闭角型青光眼伴有晶状体混浊的连续性患者20例23眼,行超声乳化联合折叠型人工晶状体植入术,比较手术前后视力和眼压的变化,超声生物显微镜(ultrasound biomicroscopy,UBM)检测手术前后前房深度(anterior chamber depth,ACD)和房角开放距离(an-gle opening distance,AOD500)的变化。结果:手术前视力和眼压是4.16±0.38和48.65±7.34mmHg,手术后视力和眼压为4.75±0.10和16.65±1.97mmHg;术前术后的前房深度为1.35±0.04mm和3.51±0.07mm,房角开放距离分别为225.09±12.43μm和511.18±12.20μm,手术前后比较差异有统计学意义(P<0.01)。结论:超声乳化联合人工晶状体植入术治疗急性闭角型青光眼安全、有效。     

Ultrasound biomicroscopy examination of intraocular lens haptic position after phacoemulsification with continuous curvilinear capsulorhexis and extracapsular cataract extraction with linear capsulotomy.

PURPOSE: Intraocular lens (IOL) haptic position in 35 eyes that had undergone cataract surgery was examined with ultrasound biomicroscopy (UBM). METHODS: In a prospective randomized study the patients were operated by phacoemulsification using continuous curvilinear capsulorhexis (CCC) (group I) or by extracapsular cataract extraction (ECCE) using linear capsulotomy (group II). Ultrasound biomicroscopy was used to localize both haptics of the implanted intraocular lenses and to measure anterior chamber depth (ACD), iris thickness and anterior chamber angle. The inflammatory reaction in the anterior chamber was assessed with laser flare photometry. Slit lamp examination was performed. RESULTS: Both IOL haptics were found in the lens capsule in all 18 eyes in group I. In group II one of the haptics was located out of the capsule in 7 of 17 eyes (41%). The difference is statistically significant (p=0.01). Postoperatively mean ACD measured with the UBM was 4.06+/-0.30 mm in group I and 3.64+/-0.24 mm in group II (p=0.00025). CONCLUSION: The UBM examinations indicate that phacoemulsification with continuous curvilinear capsulorhexis is a more reliable technique than ECCE with linear capsulotomy to achieve implantation of the intraocular lens haptics in the capsular bag.     

应用超声生物显微镜观察白内障超声乳化人工晶状体植入术后前房容积的改变

目的 应用超声生物显微镜(ultrasound biomicroscopy UBM)量化观察具有浅前房、窄房角结构和正常前房深度、宽房角结构的白内障患者在行了白内障超声乳化人工晶状体植入术后前房容积的改变,旨在探讨白内障手术对前房容积的影响,对手术时机的选择提供安全有效的临床依据.方法 选取具有浅前房、窄房角结构和正常前房深度、宽房角结构的白内障患者作为对照组,每组患者各40例(40只眼),均采用透明角膜切口白内障超声乳化后房型人工晶状体植入术,于术前和术后1个月用UBM观测前房深度(ACD)、小梁虹膜夹角(TIA)、房角开放距离(AOD250、AOD500)、小梁睫状体距离(TCPD)、虹膜睫状体距离(ICPD)、虹膜晶状体接触距离(ILCD)和前房角隐窝面积(ARA),同时记录眼压的变化和各级房角的人数构成比,对结果进行比较分析.结果 全部患者术后除ILCD值比术前明显减小以外,其余各项值ACD、TIA、AOD250、AOD500、TCPD、ICPD、ARA均较术前明显增加,差异具有统计学意义(P <0.001).术后眼压平均下降(3.77143±1.84368)mmHg,较术前差异有统计学意义(P<0.001).对宽房角组患者进行手术前后的比较,各测量值均较术前明显增加,差异有统计学意义(P<0.001),术后眼压平均下降(2.49714±1.05482)mmHg,较术前明显下降(P<0.001).对窄房角组患者进行手术前后的比较,术后各测量值比术前大大增加,差异具有显著统计学意义(P<0.001),术后眼压较术前明显降低,平均下降(5.04571±1.56287)mmHg,差异有统计学意义(P<0.001 ).分别对窄房角组和宽房角组患者进行术前结构的比较和术后结构的比较,除ICPD值外,其余各值二组间均存在显著性差异有统计学意义(P<0.001).将二组患者手术前后的变化程度进行比较,窄房角组ACD、AOD250、AOD500、TIA、ARA值的变化程度显著大于宽房角组,差异具有显著统计学意义(P<0.01).手术前后的房角构成差异有统计学意义(P <0.001),术后宽角显著增多.结论 白内障超声乳化吸除人工晶体植入术后,前房加深,房角增宽,前房容积显著增加,眼压也有一定程度的下降.具有浅前房、窄房角结构的白内障患者,手术前、后的变化程度更为显著.UBM可以明确有无晶体因素引起的瞳孔阻滞,当发现此情况时,可以将白内障手术时机提早,使具有窄房角解剖因素的白内障患者避免因晶体膨胀、瞳孔阻滞而引起的青光眼的发生,在一定程度上起到预防的作用.

Abstract：

Objective To study and analyze the changes of anterior chamber cubage of senile cataract patients before and after the surgery of phacoemulsification and foldable IOL implantation with ultrasound biomicroscopy quantitatively, to explore the influence of anterior chamber angle and anterior chamber cubage caused by senile cataract, and to provide safe and effective basis of cataract surgery options.Methods Small-incision phacoemulsification and foldable IOL implantation start from transparent cornea were performed in 80 eyes of 80 senior patients whom were divided into two groups: one group with normal anterior chamber structure, another group of shallow anterior chamber and narrow anterior chamber angle, measured numerical values of ACD (anterior chamber distance), AOD250 (angle-opening distance at 250μ m from the scleral spur)and AOD500 (angle-opening distance at 500μ m from the scleral spur), TIA500 (trabecular iris angle at 500μ m from the scleral spur), Trabecular ciliary processes distance (TCPD), iris ciliary body distance (ICPD),iris lens contact distance (ILCD) and angle recess area (ARA).At the same time, the intraocular pressures were also recorded.The number of people at all levels of composition ratio of angle and intraocular pressure by using ultrasound biomicroscopy before operation and one month later to analysis.Results In all patients, the measurements of ACD, AOD250, AOD500, TIA, TCPD, ICPD, and ARA were increased significantly after the operation except for ILCD after the operation.The intraocular pressure was also reduced to some extent after the operation.There were significant differences between two groups in ACD, AOD250, AOD500, TIA, TCPD,ICPD, and ARA except for ICPD before and after the surgery.The measurements and the intraocular pressure change more in the group of shallow anterior chamber caused by senile cataract.To compare the extent of change in two groups, the degree of change in group with narrow anterior chamber angle was significantly greater than in normal eyes group.The composition of angle had statistically significant difference pre-operation and post-operation (P<0.001), and wide-angle increased significantly after surgery.Conclusions Small incision phacoemulsification and foldable IOL implantation surgery deepens the anterior chamber, widens anterior chamber angle and increases anterior chamber cubage significantly compared with the preoperative patients,and it also reduces intraocular pressure to some extent after the operation.The added value of anterior chamber cubage is more prominent in the patients with narrow anterior chamber and shallow anterior chamber angle.Ultrasound biomicroscopy can confirm the situation of crystal-induced pupillary block.The study indicates that small incision phacoemulsification and foldable IOL implantation surgery in an early stage of senile cataract with anatomical factors of narrow angle can be effective in reducing intraocular pressure, preventing the occurrence of glaucoma caused by crystal expansion and pupillary block, which plays a role in the prevention and treatment in a certain extent.