人眼睫状体在调节中形态与位置的动态变化

目的了解健康活体人眼在自发视远视近调节中,睫状体形态和位置动态变化的特点。方法利用超声生物显微镜(UBM)的50MHz高频换能器,对68例正常人眼注视远、近不同视标时睫状体形态、位置的变化进行动态观测和统计学分析。结果(1)视近调节时,睫状体前部厚度、睫状突长度、睫状体总面积和环形肌面积增大,睫状突宽度及内尖成角、睫状突与小梁、虹膜、巩膜突的距离,以及其和虹膜、巩膜的夹角减小,前房角开放程度变小。而睫状体后部厚度、纵行肌面积、巩膜虹膜夹角以及小梁虹膜夹角的差异无显著意义。(2)形态各参数间的变化相辅相成、高度一致,位置各参数亦然,但形态与位置之间关系无显著意义。结论人眼视近调节时,睫状体各部肌纤维协调收缩,尤其是环形肌收缩,使睫状突变得尖而细长,睫状体向前向内移动,松弛悬韧带,支持Helmholtz的调节松弛学说。UBM可实时观测人眼调节时睫状体各部分形态和位置等的变化情况。     

睫状体形态和位置对眼前段空间结构的影响

目的:探讨正常人眼睫状体形态和位置对眼前段空间结构的影响。方法:应用超声生物显微镜(UBM)、A超、Pentacam三维眼前段图像分析仪测量186例186眼正常人睫状体厚度(CBT)、睫状突长度(CPL)、巩膜睫状突夹角(θ)、前房体积(ACV)、前房深度(ACD)、晶状体厚度(LT)、相对晶状体位置(RLP)、房角开放距离(AOD500)。采用直线相关与回归分析方法分析CBT,CPL,θ与ACV,ACD,LT,RLP,AOD500的相关关系。结果:正常人CBT,CPL,θ与ACV,ACD,LT,RLP,AOD500分别为0.740±0.099mm,1.228±0.166mm,45.81°±5.11°,171.15±44.23mm3,2.822±0.314mm,4.29±0.48mm,0.231±0.013,0.373±0.069mm。CBT与ACV,ACD,RLP正相关,与LT负相关,与AOD500无相关性;CPL与ACV,ACD,RLP,AOD500负相关,与LT正相关。θ与ACV,ACD,RLP,AOD500正相关、与LT无相关性。结论:睫状体形态与位置是眼前段空间结构差异的影响因素。     

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.     

超声生物显微镜在人工晶状体缝线固定术中的应用

目的 通过对超声生物显微镜(UBM)指导下设计人工晶状体缝线固定术的临床观察,为判定手术效果提供有效的临床依据.方法 选取行人工晶状体缝线固定术者63例(63眼),术前行UBM检查并依此设计手术方式的35例为A组;术前未行UBM检查按常规术式植入人工晶状体的28例为B组.常规悬吊植入人工晶状体.记录术中进、出针位置及人工晶状体位置相关数据进行统计学比较.结果 A组的进针位置位于角膜缘后平均(0.70±0.11)mm;B纽进针位置位于角膜缘后1.0mm.两者的出针位置分别为(0.5588±0.3465)mm和(1.4404±1.0077)mm .A组中能确切植入睫状沟的襻数为46个(65.71%),而B组中仅6个襻(10.71%)能确切植入睫状沟.A组人工晶状体平均偏心(0.5588±0.3465)mm,平均偏位(0.4080±0.3559)mm;B组人工晶状体平均偏心(0.8095±0.1818)mm,平均偏位(1.1132±0.6609)mm,结论 人工晶状体缝线同定术者术前常规行UBM检查,能提高人工晶状体襻睫状沟固定的准确性,减少术后人工晶状体偏心和偏位的发生.     

原发性急性闭角型青光眼小梁切除术前后眼前节超声生物显微镜测量比较

目的通过超声生物显微镜（UBM）眼前节测量了解急性闭角型青光眼行小梁切除术后眼前节组织空间结构变化。方法对20例（21只眼）急性闭角型青光眼患者,术前及术后3个月行UBM测量中央前房深度、房角开放距离、小梁网睫状突距离、虹膜厚度、虹膜晶状体接触距离。结果术前与术后比较,中央前房深度、小梁网睫状突距离、虹膜厚度无统计学差异（P〉0．05）,房角开放距离、虹膜晶状体接触距离差异有统计学意义（P〈0．05）。结论急性闭角型青光眼患者行小梁切除术后,房角开放距离增加,瞳孔阻滞缓解,但睫状突前位没有改变。UBM是一种客观的、有效的随访工具。     

超声生物显微镜对慢性闭角型青光眼合并白内障手术疗效的评价研究

目的探讨超声生物显微镜(ultrasound biomicroscopy,UBM)对慢性闭角型青光眼合并白内障手术疗效的评价。方法选择2010年5月至2011年11月在我院治疗的慢性闭角型青光眼合并白内障患者63例(88眼)作为研究对象,所有患者均接受白内障超声乳化及人工晶状体植入术,分别在术前1个月及术后1个月对患眼进行UBM检查,并观察患眼随访末期的矫正视力。结果 UBM检查结果显示,术前房角开放距离、小梁网睫状突距离、前房深度、小梁虹膜夹角、巩膜睫状突夹角分别为(0.23±0.11)mm、(0.69±0.22)mm、(2.20±0.39)mm、(22.49±10.98)°、(44.16±13.46)°,术后分别为(0.53±0.12)mm、(0.84±0.23)mm、(3.12±0.33)mm、(35.58±11.23)°、(49.01±13.27)°,术后均明显大于术前,差异均有统计学意义(均为P<0.05);术后虹膜厚度、虹膜晶状体夹角、虹膜悬韧带距离与术前比较,差异均无统计学意义(均为P>0.05)。术后患者矫正视力均明显提高,与术前比较,差异有统计学意义(P<0.05)。结论 UBM能够对慢性闭角型青光眼合并白内障患者的手术治疗效果进行有效评价。     

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。     

超声生物显微镜诊断小范围晶状体不全脱位

目的探讨超声生物显微镜诊断小范围晶状体不全脱位的临床应用。方法回顾性分析晶状体不全脱位范围≤3个钟点位者62例（62只眼）。同时以正常人80例（80只眼）作为对照组。应用超声生物显微镜测量晶状体赤道部与睫状突的最远距离及最近距离,观察脱位晶状体、睫状体形态特点。结果晶状体不全脱位1个钟点位者10例,最远距离平均为（0．86±0．10）mm,最近距离为（0．41±0．05）mm,两者差值0．46±0．11;脱位2个钟点位者21例,最远距离为（0．88±0．15）mm,最近距离为（0．36±0．10）mm,两者差值0．52±0．14;脱位3个钟点位者31例,最远距离为（1．11±0．21）mm,最近距离为（0．42±0．14）mm,两者差值0．61±0．15。脱位患者与正常人品状体赤道部与睫状突的最远距离、最近距离及差值的差异有统计学意义,正常人与不同范围脱位者晶状体赤道部与睫状突间最远距离、最近距离及差值的差异有统计学意义。所有脱位者均出现不同程度的晶状体赤道部变圆或睫状体变平的表现。结论超声生物显微镜可以诊断小范围晶状体不全脱位。     

马凡综合征晶状体半脱位超声生物显微镜检查特点

目的：应用超声生物显微镜（ UBM）观察马凡综合征的眼前节改变特点。方法对已确诊为马凡综合征者进行UBM检查,观察眼前节的结构改变。结果4例（8只眼）晶状体全部半脱位,2只眼偏向鼻侧,6只眼偏向鼻上方。虹膜根部附着偏前;睫状体变薄,睫状突不明显。结论马凡综合征具有明显的眼前节改变,UBM是一种有价值的辅助检查,能较好地显示晶状体半脱位情况及睫状体形态改变。     

应用超声生物显微镜对挫伤性近视发病机制的研究

目的应用超声生物显微镜（UBM）并结合普通超声波，初步探讨挫伤性近视的发病机制。方法对51例（66只眼）眼球钝挫伤患者，在急性期和恢复期分别用自动验光仪测量屈光度；A超测量晶状体厚度；UBM测量角膜厚度、前房轴深、小梁睫状突距离（TCPD）、A角、睫状突的高度（T值）；66例正常眼为对照进行分析。结果眼球受钝挫伤后均表现为近视；且急性期晶状体变厚、前房变浅、TCPD缩短、A角变小、T值增大（P〈0．05）；而角膜厚度变化不明显（P〉0．05）。对照组各参数比较无明显差异（P〉0．05）。结论挫伤性近视的发病有诸多因素。除睫状肌痉挛外，前房变浅、晶状体变凸是共同机制；而睫状体肿胀及位置的改变是原发因素；UBM具有重要的临床应用价值。     

应用超声生物显微镜探讨原发性闭角型青光眼的发病机制

目的探讨原发性闭角型青光眼的发病机制,研究睫状体改变在青光眼发病中的作用。方法应用超声生物显微镜（ｕｌｔｒａｓｏｕｎｄｂｉｏｍｉｃｒｏｓｃｏｐｙ,ＵＢＭ）结合Ａ超检测９９只原发性闭角型青光眼及５８只正常眼的活体眼前节结构,并对两组测量参数进行对比研究。其中急性闭角型青光眼（急闭）５０只眼,慢性闭角型青光眼（慢闭）４９只眼。结果原发性闭角型青光眼与正常眼相比,角膜小、前房浅、眼轴短、晶体厚、相对晶体位置偏前、睫状突肿胀、睫状体前置,以上差异均有显著性（Ｐ＜００５）。急闭与慢闭相比,前者前房更浅,相对晶体位置更偏前,差异有显著性（Ｐ＜００１）。急闭与正常眼相比,前者的睫状体与晶体距离较短,差异有显著性（Ｐ＜００５）;而慢闭与正常眼相比,前者的睫状体与晶体距离亦较短,但差异无显著性（Ｐ＞００５）。结论原发性闭角型青光眼的发病与其自身的解剖特点有关。其中晶体位置前移导致的瞳孔阻滞及继发的房角变窄是闭角型青光眼发病的共同机制;而睫状突肿胀、睫状体位置的改变及与年龄相关的晶体厚度增大是导致晶体位置前移的可能原发因素。对于急闭而言,瞳孔阻滞是其发病的更重要因素。     

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。     

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.     

眼球挫伤的超声生物显微镜检查

目的 探讨超声生物显微镜(UBM)在眼球挫伤诊断中的临床意义.方法 对67例(67眼)眼球挫伤UBM检查结果进行分析和总结.结果 超声生物显微镜可清晰显示前房角后退、虹膜根部断离、睫状体分离及晶状体不全脱位,还可显示出传统B超所不能显示的睫状体和脉络膜浅脱离.本组67眼均有不同程度的眼前段损伤,前房角后退18眼、虹膜根部断离15眼、睫状体脱离14眼、睫状体分离8眼、以及晶状体脱位和不全脱位12眼.结论 UBM能清晰显示虹膜、睫状体、前房角和晶状体损伤的形态、位置和范围；不受屈光间质影响,对眼前段损伤的诊断有重要意义并对治疗提供确切的指导.     

Accommodative ciliary body and lens function in rhesus monkeys, I: normal lens, zonule and ciliary process configuration in the iridectomized eye

PURPOSE: The underlying causes of presbyopia, and the functional relationship between the ciliary muscle and lens during aging are unclear. In the current study, these relationships were studied in rhesus monkeys, whose accommodative apparatus and age-related loss of accommodation are similar to those in humans. METHODS: Centripetal ciliary body and lens equator movements were measured during accommodation in 28 eyes of 21 rhesus monkeys (ages, 5.7-26 years) by goniovideography. Ultrasound biomicroscopy was performed in 21 eyes of 17 monkeys. Narrowing of the angle between the anterior aspect of the ciliary body and the inner aspect of the cornea was used as a surrogate indicator of forward ciliary body movement during accommodation. RESULTS: Average centripetal ciliary body movement in older eyes (age > or =17 years, n = 16) was approximately 20% (0.09 mm) less than in young eyes (age, 6-10 years, n = 6), but not enough to explain the 60% (0.21 mm) loss in centripetal lens movement nor the 76% (10.2 D) loss in accommodative amplitude. Average forward ciliary body movement was 67% (49 degrees ) less in older (n = 11) versus young (n = 6) eyes. Maximum accommodative amplitude correlated significantly with the amplitude of centripetal lens movement (0.02 +/- 0.003 mm/D; n = 28; P < 0.001) and with forward ciliary body movement (3.34 +/- 0.54 deg/D; n = 21; P = 0.01). CONCLUSIONS: Decreased lens movement with age could be in part secondary to extralenticular age-related changes, such as loss of ciliary body forward movement. Ciliary body centripetal movement may not be the limiting component in accommodation in the older eye.     

Anterior segment changes during accommodation in eyes with a monofocal intraocular lens: high-frequency ultrasound study

PURPOSE: To analyze anterior segment structure changes during accommodative stimuli after monofocal intraocular lens (IOL) implantation using 2 ultrasound biomicroscopy (UBM) systems. SETTING: Department of Ophthalmology, University of Verona, Verona, Italy. METHODS: Twenty-six eyes (23 patients) with 1 of 4 monofocal IOL types were studied. Five to 9 months postoperatively, the patients were examined by high-frequency UBM using the HiScan system (Optikon 2000 SpA) and UBM 840 system (Carl Zeiss Meditec). Anterior chamber depth (ACD), iris-zonule distance, anterior chamber angle (ACA), scleral-ciliary process angle, and iris-ciliary process angle were measured using both systems. The iris-ciliary process distance and scleral spur perpendicular-sulcus distance were measured with the UBM 840 system and the sulcus-sulcus distance and capsular bag-IOL position with respect to ciliary process apex, with the HiScan system. Two experienced examiners performed all measurements. RESULTS: All parameters except the horizontal iris-ciliary process distance and vertical ACA measured by the UBM 840 system and horizontal ACA by the HiScan system showed significant variation during accommodation. An anterior shift of the IOL-capsular bag ciliary processes--sulcus-zonular iris complex was observed. A simultaneous centripetal shift of ciliary bodies and processes, shown by a reduction in sulcus and capsular bag diameter, was also observed. CONCLUSION: Anterior segment structures demonstrated accommodative movement on UBM after implantation of standard monofocal IOLs.     

Feasibility and development of a high-power real accommodating intraocular lens

PURPOSE: To develop an accommodating intraocular lens (IOL) that changes power with ciliary body action and generates a minimum of 8.0 diopters (D) by manipulation of a flexible material between a sulcus-fixated rigid plate and a ciliary muscle-operated capsular diaphragm. SETTING: Vissum-Instituto Oftalmológico de Alicante and Miguel Hernández University, Alicante, Spain. METHODS: The feasibility of the concept was tested by a laboratory lens model. An implantable measuring device was constructed to simulate the lens action. The device was implanted in monkey eyes to measure the various parameters involved with such IOLs. Based on these measurements, an accommodating IOL prototype was built and implanted in monkeys' eyes. Pharmacologic agents were used to achieve ciliary relaxation and spasm. Ultrasound biomicroscopy (UBM) imaging was used to document the active changes of the IOL flexible lens curvature as related to the ciliary muscles status. RESULTS: The laboratory model produced more than 50.0 D of accommodation. The UBM demonstrated changes in lens curvature between cyclospasm to cycloplegia of calculated 9.0 to 53.0 D for flexible material with a refractive index of 1.41. CONCLUSIONS: Flexible material is capable of being manipulated when placed between a scleral-fixated rigid plane and the ciliary muscles-operated capsular diaphragm. Such manipulation as used by the IOL concept presented here has generated an active change of more than 40.0 D in the monkey eye.     

Ultrasound biomicroscopic study of sclerotomy sites after implantation of sustained release drug devices

BACKGROUND/AIMS: To evaluate the potential of ultrasound biomicroscopy (UBM) as a tool to study the precise location and changes of sclerotomy sites of the eye with an intraocular drug delivery device. METHODS: Eight eyes of six patients (13 sites) who received ganciclovir implants were examined by UBM. Examinations were performed 1-26 months (mean 12.8 months) postoperatively. Serial transverse and radial sections of the anterior ciliary body around the sclerotomy sites were obtained. RESULTS: The ganciclovir implant contour was successfully viewed using an UBM with high reflectivity. Three implants were deviated anteriorly and they were very close to the ciliary body and the lens (anterior deviation), while four implants were deviated posteriorly and away from the lens (posterior deviation). The other six implants were located at the appropriate position as intended. A solitary homogeneous mass with a medium reflectivity around the suture tab was observed at 12 out of 13 sites in seven eyes. Thick membranes extending from sclerotomy sites to the ora serrata were found at two sites in two eyes. CONCLUSION: UBM is helpful in detecting abnormal manifestations around ganciclovir implants and is a valuable tool to assess the changes of the sclerotomy sites of the sustained released intraocular devices.     

Magnetic resonance imaging of aging, accommodating, phakic, and pseudophakic ciliary muscle diameters

PURPOSE: To quantify in vivo accommodative changes in the aging human ciliary muscle diameter in phakic and pseudophakic eyes. SETTING: Department of Surgery/Bioengineering, UMDNJ-Robert Wood Johnson Medical School, Piscataway, and the Institute of Ophthalmology and Visual Science UMDNJ-New Jersey Medical School, Newark, New Jersey, USA. METHODS: Images were acquired from 48 eyes of 40 people between the ages of 22 and 91 years, 1 eye of 32 phakic volunteers and both eyes of 8 patients who had monocular implantation of a single-piece AcrySof intraocular lens (IOL) (Alcon Laboratories). Images were acquired during physiological accommodation and with accommodation at rest, and the diameter of the ciliary muscle ring was measured. RESULTS: Results show the ciliary muscle remains active throughout life. The accommodative change in its diameter (mean 0.64 mm) (P<.00001) was undiminished by age or IOL implantation. Preliminary data showed that the accommodative decrease in muscle diameter in phakic and pseudophakic eyes was statistically identical. The phakic eyes had a marked decrease in ciliary muscle diameter with advancing age for both accommodative states (P<.000001 and P<.000001), which did not appear to be altered by IOL implantation. The lens equator was constant with age in the unaccommodated human eye, resulting in decreased circumlental space with advancing age in the phakic eyes. CONCLUSION: Although the undiminished ability of the ciliary muscle to decrease its diameter with accommodation can be relied on in strategies for presbyopia correction, even in advanced presbyopia, the decreasing circumlental space and its potential effects on zonular tension must also be considered.