超声生物显微镜暗室激发试验

目的 比较超声生物显微镜（ＵＢＭ）暗室激发试验与传统暗室激发试验在闭角型青光眼筛选中的应用价值。方法 选择２２例（２２只眼）先兆期闭角型青光眼作为患者组,１５例（３０只眼）深前房正常者作为对照组,分别进行传统暗室试验和ＵＢＭ暗室试验。比较两种暗室试验前后房角的变化与眼压差,采用统计学χ＾２检验比较两者的阳性率。结果 两种暗室试验结果显示,闭角型青光眼组２２只眼中,１０只眼试验前后眼压差〉１．０７ｋ     

急性原发性房角关闭对侧眼激光周边虹膜切除术后接触性房角关闭的研究

目的了解急性原发性房角关闭（APAC）对侧眼激光周边虹膜切除术（LPI）后接触性房角关闭的发生率和眼部解剖特征。方法前瞻性研究。选择54例APAC对侧眼没有虹膜前黏连（PAS）的患者作为研究对象,平均年龄（67．1±7．2）岁（54—83岁）。采用超声生物显微镜（UBM）在暗环境下观察LPI后是否发生接触性房角关闭．并比较发生接触性房角关闭与不发生接触性房角关闭患眼的眼压、房角及各项UBM参数,包括房角开放距离。（AOD跏）、房角隐窝面积,。（ARA750）、小梁虹膜夹角（T—I角）、小梁睫状体距离（TCPD）、周边虹膜厚度（IT1）、虹膜悬韧带距离（IZD）、虹膜根部附着位置、中央前房深度（ACD）。对两组数据采用独立样本t检验及两样本秩和检验进行分析。结果LPI后暗环境下UBM检查至少一个象限发生接触性房角关闭的有20例,占37％。反映房角开放程度的指标（AOD500、ARA750、T-I角）和反映睫状体位置的指标（TCPD）：接触性房角关闭（＋）组小于（-）组（t=11．741、11．089、12．175、4．349,P均〈0．01）;反映虹膜形态和位置的指标IT1：接触性房角关闭（＋）组大于（-）组（t=-3．300,P=0．002）;IZD、虹膜根部附着位置及ACD比较,两组差异无统计学意义（t=-1．880,P=0．066;Z=-1．423,P=0．155;t=0．072,P=0．942）。结论APAC对侧眼LPI后在暗环境下仍有一定比例发生接触性房角关闭,房角窄、睫状体前位、周边虹膜厚是LPI后发生接触性房角关闭的解剖学特点,提示LPI后具有这些解剖特点的APAC患者有可能进展为慢性房角关闭。     

A prospective ultrasound biomicroscopy evaluation of changes in anterior segment morphology after laser iridotomy in Asian eyes

PURPOSE: To prospectively quantify changes in anterior segment morphology after laser iridotomy using gonioscopy and ultrasound biomicroscopy (UBM). DESIGN: Prospective comparative observational case series. PARTICIPANTS: Fifty-five fellow eyes of patients presenting with acute primary angle closure (APAC). METHODS: The fellow eyes of patients presenting with APAC were examined with UBM, A-scan ultrasonography, and optical pachymetry at presentation and 2 weeks after sequential argon/neodymium yttrium-aluminum-garnet laser peripheral iridotomy (LPI). UBM images were analyzed using UBM Pro 2000 software. Baseline measurements were made both under standard lighting conditions and in darkness to look for changes in anterior segment findings. MAIN OUTCOME MEASURES: The degree of angle opening was measured using the angle-opening distance (AOD) at 250 and 500 microm from the scleral spur (AOD250 and AOD500, respectively) and angle recess area (ARA). RESULTS: Fifty-five Asian patients were examined; AOD250, AOD500, and ARA all significantly increased after sequential laser iridotomy (P < 0.002). Gonioscopic grading of the angle opening significantly increased in all 4 quadrants (P < 0.001). The Van Herick grade of limbal anterior chamber depth increased (P < 0.001), whereas the number of eyes classified as occludable decreased (73%-33%, P < 0.001). Anterior chamber depth did not change significantly (2.41 mm +/- 0.28 mm vs. 2.42 mm +/- 0.30 mm, P = 0.43) as measured with optical pachymetry. Increased illumination increased the angle-opening measures, but induced a different alteration in peripheral iris morphology. Illumination-induced changes were greater after iridotomy than before laser treatment. CONCLUSIONS: In Asian eyes at high risk of developing APAC, sequential LPI produced a significant widening of the anterior chamber angle without deepening the anterior chamber centrally. LPI produces changes in iris morphology that are different from those caused by an increase in illumination, indicating that different mechanisms account for angle opening under these 2 conditions.     

Long ciliary processes with no ciliary sulcus and appositional angle closure assessed by ultrasound biomicroscopy

PURPOSE: Nonpupil block mechanisms and appositional angle closure after laser iridotomy (LI) have been reported as common findings in Asians. We evaluated the presence of these findings in a cohort of Brazilian patients using ultrasound biomicroscopy (UBM). METHODS: This observational case-control study included 22 open angle eyes and 31 eyes with occludable angles on gonioscopy (defined by 2 examiners). UBM radial scans through a typical ciliary process were obtained in both light and dark conditions, at 6 and 12-o'clock positions. Long ciliary processes with no ciliary sulcus were determined on the basis of a reference line drawn perpendicular to the iris plane passing through a point located 750 mum from scleral spur. Trabecular ciliary processes distance was measured on 6-o'clock UBM images. RESULTS: After LI, 52% of occludable angle eyes had appositional angle closure in both 6 and 12-o'clock UBM images. We also observed this finding in 14% and 23% of the control eyes (in 6 and 12-o'clock UBM images, respectively). A long ciliary process with no ciliary sulcus was observed in 61% of occludable angle eyes, and also in 32% of control eyes (6-o'clock UBM images). Control eyes had longer trabecular ciliary processes distance than occludable angle eyes (P<0.001). CONCLUSIONS: The UBM finding of long ciliary processes associated with the absence of ciliary sulcus is not necessarily related to an anterior positioning of the ciliary processes. Whether UBM appositional angle closure after LI is associated with further angle closure process and/or poor intra-ocular pressure control remains to be evaluated.     

白内障超声乳化摘出术后OCT测量的眼前节结构改变

目前,白内障是世界上主要的致盲眼病,其次是青光眼.年龄相关性白内障未成熟期晶状体膨胀,构成闭角性青光眼发生的危险因素,及早进行白内障超声乳化摘出术是解决该危险因素的最佳手段.选择何时进行手术以及预后效果成为困扰临床医师的问题.本研究纳入17篇应用眼前节OCT(AS-OCT)分别对白内障超声乳化摘出术前后眼前节生物测量不同参数进行定量分析的文献,就白内障超声乳化摘出术对眼前节结构的影响进行综合评价.全部文献累计866患眼;随访时间为术后6个月.术后前房深度(ACD)、前房容积(ACV)、前房角度(ACA)、巩膜突起500 μm房角开放距离(AOD500)、AOD750、巩膜突起500 μm小梁与虹膜接触面积(TISA500)、TISA750、巩膜突起750μm房角隐窝面积(ARA750)均较术前不同程度升高,术后前房宽度(ACW)、巩膜突起750.μm处的虹膜厚度(IT750)均无明显变化,术后虹膜弯曲度(I-Curv)、虹膜横断面面积、虹膜突面积较术前降低.术前LT与术后ACD及术后TISA500均呈高度正相关.术前晶状体拱高(LV)与术后3个月ACD及术后3个月AOD500均呈正相关.综合文献证实,白内障超声乳化摘出术可解除瞳孔阻滞,减小虹膜压迫,使得前房加深和房角增宽.白内障超声乳化摘出联合人工晶状体植入术可用于青光眼的治疗,值得进一步推广.     

激光周边虹膜成形术治疗原发性闭角型青光眼房角相关结构的超声生物显微镜观察

目的应用超声生物显微镜(ultrasoundbiomicroscopy,UBM)观察激光周边虹膜成形术治疗原发性闭角型青光眼房角结构的变化,进一步做疗效评价。方法对原发性闭角型青光眼经虹膜切除术后暗室俯卧试验阳性的31例38眼行激光周边虹膜成形术治疗,治疗前后均行眼前节裂隙灯显微镜、房角镜及UBM检查,对于治疗后无发作性眼压升高且连续两次暗室俯卧试验阴性的病例,应用0.5%托吡卡胺点眼散瞳后再行上述检查。结果36眼(94.7%)成功治愈。表现为:无青光眼发作、连续两次暗室俯卧试验阴性且散瞳试验均阴性。所有病例经治疗后周边前房深度均明显加深,静态房角镜检查小梁网可见范围增宽。UBM检查显示周边虹膜形态较术前明显变薄而平直,500um处小梁虹膜夹角(TIA500)、250um和500um处前房角开放距离(AOD250、AOD500)均较术前显著增加(p<0.01),周边虹膜厚度(IT1)明显变薄(p<0.01)。术后观察(1～2)年,疗效稳定且未见明显并发症。结论激光周边虹膜成形术可有效的改变周边虹膜形态,增加前房角宽度,防止瞳孔散大所造成的周边虹膜堆积,是治疗虹膜切除术后仍有急性发作或激发试验阳性的原发性闭角型青光眼安全、有效的治疗方法。     

Ultrasound biomicroscopic dimensions of the anterior chamber in angle-closure glaucoma patients

In order to evaluate the morphologic types of appositional angle-closure glaucoma, biometric measurements were made in angle-closure glaucoma patients using Ultrasound biomicroscopy (UBM). Twenty-six patients with primary angle-closure glaucoma and 21 cataract patients with as a control group were examined. The angle-closure glaucomatous eyes were classified as type B in which the angle closure started at the bottom of the angle and type S in which the angle closure occurred in the vicinity of Schwalbe's line. The trabecular-ciliary process distance (TCPD, type B; 873.20+/-86.77 microm, type S; 832.52+/-82.96 microm, control; 1233.50+/-73.01 microm, p = 0.000) and the angle opening distance (AOD500, type B; 89.75+/-63.27 microm, type S; 88.85+/-72.95 microm, control; 304.40+/-104.30 microm, p = 0.000) were significantly shorter in patients with angle closure vice control group. No significant difference were noted in the three groups of patients in regards to iris thickness or ciliary process-iris angle. In this study, we have demonstrated that there are two types of appositional angle-closure and have shown the forward rotation of the ciliary process without changes of the ciliary process-iris angle in cases of angle-closure glaucoma.     

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。     

The anterior and posterior biometric characteristics in primary angle-closure disease: Data based on anterior segment optical coherence tomography and swept-source optical coherence tomography

Purpose:Obtaining a better understanding of the pathogenesis of primary angle-closure disease (PACD) still requires studies that provide measurements of anterior and posterior biometric characteristics together and that assess the relationship between them.Methods:In total, 201 eyes were enrolled in this cross-sectional study: 50 normal controls, 49 primary angle-closure suspect (PACS), 38 primary angle closure (PAC), and 64 primary angle-closure glaucoma (PACG) eyes. The anterior and posterior structural features were measured by anterior segment optical coherence tomography and swept-source optical coherence tomography.Results:All PACD groups had smaller anterior chamber depth (ACD), anterior chamber area (ACA), anterior chamber volume (ACV), angle opening distance at 750 μm from the scleral spur (AOD750), trabecular–iris space area at 750 μm from the scleral spur (TISA750), and angle recess area (ARA), as well as a larger lens vault (LV), than controls (all P < 0.001). The PACS and PAC groups had thicker iris thickness at 750 μm from the scleral spur (IT750) than controls (P = 0.017 and P = 0.002, respectively). Choroidal thickness (CT) was not statistically different among normal, PACS, PAC, and PACG eyes. Univariate and multivariate linear regression analysis revealed a significant association between thinner IT750 and increased CT in PACD eyes (P = 0.031, univariate analysis; P = 0.008, multivariate analysis).Conclusion:Thinner iris thickness was associated with increased CT in PACD eyes; however, the underlying mechanism needs further investigation.     

应用超声生物显微镜检查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,以５０ｍＨＺ的超高频超声探关,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、病情轻呈年龄大小,其最主要的病变特征是巩膜突与留心 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患眼的巩膜突虹膜根部附着处平行,眼状突长度和厚度     

Ultrasound Biomicroscopic Dark Room Provocative Test

Purpose : To compare the clinical application value of Ultrasound biomicrsocpic dark room provocative test with the traditional dark room test in screening primary angle closure glaucoma (PACG).Methods: 22 eyes with PACG in prodromal stage and 30 eyes with deep anterior chamber and wide angle of 15 normal persons were observed in this trail. All 52 eyes were performed traditional dark room provocative test and ultrasound biomicorosopic darkroom test respectively. With different positive diagnostic criteria, the sensitivity of the two methods were compared using chi-squared analysis.Results : After staying in the dark room for 2 hours, In case group, IOP in 10 of 22 eyes rose more than 1. 07kPa(1kPa = 7.5mmHg), in 12 eyes less than 1.07kPa or had no changes; appositional angle closure were found by Goldmann gonioscopy in 8 eyes : 3 eyes in two quadrants, 5 eyes in more than two quadrants; the appositional angle closure was found by UBM in 15 eyes; 3 eyes in one quadrants, 5 eyes in two quadrants, 7 eyes     

原发性先天性青光眼眼前段活体结构观察

目的:观察先天性青光眼的超声生物显微镜(UBM)图像特征并探讨先天性青光眼的发病机制。方法:采用高频、高分辨率的超声生物显微镜对6例先天性青光眼患者10只眼的房角、虹膜、睫状体等进行扫描和分析,并与7例正常人或无相关疾病患者的7只眼进行比较。结果:超声生物显微镜检查显示出原发性先天性青光眼的房角、虹膜、睫状体及巩膜突发育不良,虹膜基质薄,睫状体细小,巩膜突解剖特征不明显。原发性先天性青光眼组的虹膜厚度及睫状体大小的测量和统计学比较均明显小于正常对照组。结论:超声生物显微镜可以观察到常规眼科检查观察不到的部位,如睫状体、房角隐窝、虹膜后表面等等。原发性先天性青光眼具有虹膜基质薄、睫状体细小、巩膜突解剖特征不明显等特征,提示原发性先天性青光眼除了房角发育异常外,尚合并存在虹膜、睫状体巩膜突发育不良。其中虹膜、睫状体发育不良可能是先天性青光眼相对比较重要的发病机制。眼科学报1998;14:83—86。     

Peripheral anterior synechiae and ultrasound biomicroscopic parameters in angle-closure glaucoma suspects

PURPOSE: To investigate the correlation between peripheral anterior synechia (PAS) and the quantitative anterior chamber angle parameters measured by ultrasound microscopy (UBM) in angle-closure glaucoma suspect (ACGS) eyes. METHODS: Eyes were defined ACGS as having occludable angles and intraocular pressure less than 21 mm Hg without glaucomatous optic nerve head. The gonioscopic criteria for ACGS were the trabecular meshwork invisible in 3 or more quadrants of the entire angle and the angular width less than 20 degrees by Shaffer classification. Twenty-seven eyes of 20 patients underwent anterior chamber angle and ciliary body imaging with UBM. Angle opening distance (AOD(500)), angle recess area (ARA), trabecular-ciliary process distance (TCPD) and trabecular-iris angle (TIA) were measured from the UBM images at each quadrant. RESULTS: The AOD(500), ARA, and TIA were not significantly different between the eyes with PAS (9 eyes) and without PAS (18 eyes) at each quadrant. However, the TCPD was significantly shorter in the superior quadrant when compared with the eyes without PAS (mean: 405.3+/-70.9 microm vs 536.4+/-140.5 microm) (p<0.05). CONCLUSIONS: The results suggest that the shorter distance from trabecular meshwork to ciliary body or the anterior placement of ciliary process may play a role in the development of PAS in ACGS eyes.     

Narrowing of the anterior chamber angle during Valsalva maneuver: a possible mechanism for angle closure

PURPOSE: To evaluate changes at the anterior chamber angle during Valsalva maneuver in eyes suspected to have a primary adult glaucoma. METHODS: Seventy-six consecutive patients underwent recording of applanation tonometry, measurement of the anterior chamber angle recess, angle opening distance, angle recess area, scleral spur-iris root distance, iris thickness, iridociliary angle, ciliary body thickness, anterior chamber depth, and pupil size on ultrasound biomicroscopy before and during the Valsalva maneuver. The Valsalva maneuver was standardized to a pressure of 40 mmHg for 15 seconds, using a manometer. RESULTS: The mean baseline intraocular pressure changed from 19.5+/-4.1 mmHg to 29.5+/-4.8 mmHg during Valsalva (p<0.0001). The anterior chamber angle recess narrowed from 17.9+/-9.5 to 7.8+/-9.2 degrees (p=0.0001). The angle recess area diminished from 0.15+/-0.14 mm2 to 0.14+/-0.12 mm2 (p=0.03) and the scleral spur to iris distance decreased from 0.19+/-0.2 mm to 0.16+/-0.18 mm (p=0.0001). The iridociliary angle narrowed from 72.6+/-33.5 degrees to 62.5+/-32.8 degrees (p=0.04). There was a significant increase in the thickness of the ciliary body, from 0.99+/-0.19 mm to 1.12+/-0.16 mm (p=0.001) and in iris thickness from 0.47+/-0.07 mm to 0.55+/-0.09 mm (p=0.0001). There was no significant change in the angle opening distance, anterior chamber depth, or pupillary diameter. A significant narrowing of the angle to less than 5 degrees was seen in 37 eyes, with iridocorneal apposition present in 28 eyes. After multivariate regression analysis it was found that the baseline ciliary body thickness and angle recess were significant predictors of narrowing of the angle (R2=96.1%). CONCLUSIONS: Significant elevation of the intraocular pressure, narrowing of the anterior chamber angle recess, thickening of the ciliary body, and increase in the iris thickness is seen during the Valsalva maneuver. The Valsalva maneuver may lead to angle closure in eyes anatomically predisposed to primary angle closure glaucoma.     

Comparison of anterior segment optical coherence tomography and ultrasound biomicroscopy for assessment of the anterior segment

PURPOSE: To compare anterior segment parameters using quantitative imaging by anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM). SETTING: Tertiary-care glaucoma research center. METHODS: Sixty-three eyes of 63 subjects had anterior segment evaluation by AS-OCT (Visante-Zeiss) and UBM (Paradigm). Central corneal thickness (CCT), anterior chamber depth (ACD) (measured from the central corneal endothelium to the anterior lens capsule), and the peripheral iridocorneal angles (temporal and nasal) were assessed and compared. RESULTS: There was an excellent correlation between AS-OCT and UBM measurements for the nasal angle (r = 0.84; P<.0001), temporal angle (r = 0.86; P<.0001), ACD (r = 0.97; P<.0001), and CCT (r = 0.91; P<.0001). There was no significant difference (paired t test) between the mean ACD, CCT, and angle parameters measured by AS-OCT or UBM. The mean values of the parameters measured by AS-OCT and UBM were, respectively, as follows: nasal angle, 26.25 degrees +/- 11.0 (SD) and 28.27 +/- 11.3 degrees (P = .3); temporal angle, 25.1 +/- 11.4 degrees and 28.3 +/- 13.5 degrees (P = .15); ACD, 2.85 +/- 0.5 mm and 2.78 +/- 0.5 mm (P = .2); and CCT, 512 +/- 46 microm and 502 +/- 46 microm (P = .25). The AS-OCT images showed sharper definition of the scleral spur than the UBM images. CONCLUSION: Anterior segment optical coherence tomography and UBM can both be used for anterior segment measurements and yielded comparable results.     

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   

Plateau iris syndrome: changes in angle opening associated with dark, light, and pilocarpine administration.

PURPOSE: To report changes in angle configuration associated with dark, light, and pilocarpine administration in plateau iris syndrome. METHOD: In 10 eyes of 10 patients with plateau iris syndrome and persistent narrow angles after patent peripheral Nd:YAG laser iridotomy, ultrasound biomicroscopy was used to image variations in angle opening, iris thickness, and trabecular-ciliary process distance. Measurements were taken in the dark, in full room light, and after administration of pilocarpine 2%. RESULTS: Average angle opening distance increased in the light compared with the dark (113+/-34 microm vs. 22+/-34 microm, P = .0001) and increased further after pilocarpine administration (171+/-52 microm vs. 113+/-34 microm, P = .0034). Average iris thickness decreased in the light compared with the dark (338+/-34 microm vs. 436+/-58 microm, P = .0009) and decreased further after pilocarpine administration (253+/-48 microm vs. 338+/-34 microm, P = .0002). Average trabecular meshwork-ciliary process distance measurements were smaller than normal and did not change significantly in the light compared with the dark (481+/-42 microm vs. 464+/-44 microm, P = .4001) or after pilocarpine administration compared with light (451+/-67 microm vs. 481+/-42 microm, P = .1304). CONCLUSIONS: In plateau iris syndrome, anteriorly located ciliary processes support the peripheral iris. Changes in angle opening in dark and light are solely related to changes in iris thickness. Pilocarpine produces iris thinning and is an effective method of opening the angle. Ultrasound biomicroscopy can be used to perform a darkroom provocative test, which provides information on whether the angle anatomically closes in the dark.     

明暗光线下超声活体显微镜检查在发现前房角关闭中的作用

目的 探讨明、暗光线下超声活体显微镜(UBM)检杳在发现前房角关闭中的作用.方法 系列病例研究.选择50岁及以上的浅前房和具有解剖的窄前房角人群作为研究对象.应用Van Herick法对受检人群进行周边前房深度检杳,对其中周边前房深度≤1/3角膜厚度者进行前房角镜检查,确定是否为解剖的窄前房角者.对解剖的窄前房角患眼进行明、暗光线下UBM检查,分别观察受检眼上方、颞上方、颞侧、颞下方、下方、鼻下方、鼻侧和鼻上方8个检查部位有无前房角关闭,评估具有解剖的窄前房角患眼前房角关闭率.从UBM图像中测量前房角开放距离.应用SPSS 12.0统计软件包,对研究数据进行分析.明、暗光线下前房角关闭率比较采用配对X2检验,前房角开放距离的比较采用Wilcoxon检验,以P<0.05作为差异有统计学意义.结果 符合入选条件的共有194例(379只眼)患者.以受检眼计算,在明、暗光线下UBM检杏发现的前房角关闭率分别为26.1%和69.7%,显示暗光线下前房角关闭率明显增高,两者间差异有统计学意义(X2=159.148,P=0.000).明、暗光线下均以上方的前房角关闭率最高,分别为21.4%和58.6%.周边前房深度越浅,前房角关闭率越高.周边前房深度<1/4角膜厚度眼在暗光线下前房角关闭率高达98.3%.在明或暗光线下,上、下、鼻、颞4个象限之间前房角开放距离的差异均有统计学意义(Z=-7.471,-15.407,-16.237,-16.782;P=0.000).上方象限前房角开放距离最小,前房角关闭率最高.结论 周边前房越浅,明、暗光线下前房角关闭率越高.明、暗光线下UBM检查是在临床和大规模人群中早期发现前房角关闭的有效和可行方法.(中华眼科杂志,2009,45:8-13)     

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。     

原发性前房角关闭眼激光周边虹膜切开术后前房角形态学变化

目的 定量检测和评价原发性前房角关闭(PAC)眼行激光周边虹膜切开(LPI)术后前房角形态学变化.方法 临床病例系列研究.对入选的31例(54只眼)PAC患者于LPI术前、术后2周、6及12个月,进行眼科常规检查,定量检测超声活体显微镜(UBM)图像中前房角的各项参数.各随访时间点的UBM参数比较采用重复测量的方差分析,巩膜突前750μm与500 μm处各参数的比较采用配对t检验.结果 LPI术后前房深度较术前加深0.10 mm,但差异并无统计学意义(F=3.50,P＞0.05).LPI术前,巩膜突前750 μm处,前房角开放距离(66.2±51.6) μm,小梁网与虹膜间夹角5.0°±3.5°,前房角隐窝面积(0.025±0.017)mm2,小梁网与睫状突距离(571.0±97.2) μm;LPI术后2周、6及12个月,巩膜突前750 μm处,前房角开放距离分别为(165.0±70.3)、(185.8±68.5)及(196.1±77.7)μm,小梁网与虹膜间夹角分别为(11.9±4.9)、(13.3±4.8)及14.0°±5.4°,前房角隐窝面积分别为(0.058±0.024)、(0.065±0.023)及(0.068±0.026)mm2,小梁网与睫状突间距离分别为(647.1±113.0)、(701.8±93.4)及(670.1±95.4) μm,均较LPI术前增加,差异均有统计学意义(前房角开放距离:F =92.60,小梁网与虹膜间夹角:F=92.60,前房角隐窝面积:F=92.60,小梁网与睫状突间距离:F =34.00;P ＜0.05).术后前房角开放距离、小梁网与虹膜间夹角及前房角隐窝面积均较术前增加1倍以上.巩膜突前750 μm处检测参数的增加幅度均较巩膜突前500 μm处大(前房角开放距离:t=5.90,P＜0.05;小梁网与虹膜间夹角:t=2.70,P＜0.05;前房角隐窝面积:t=2.00;P =0.05).结论 LPI能显著增宽PAC眼的周边前房角,且随访观察1年期间前房角仍开放.巩膜突前750 μm处的参数比500μm处参数对评价周边前房角形态变化更为敏感.