低眼压的手术处理

眼前节术后引起持续性低眼压为不常见的重要并发症。睫状体剥离术常并发低眼压。有时房角切开术或小梁切开术后眼压很低,而无伤口瘘形成。在这种情况下,低眼压通常是由于手术不慎所造成的睫状体脱离所致。 Collins(1918)着手对外伤后持续性低眼压的家兔眼进行病理学检查,发现受伤眼都有睫状体与巩膜突分离,造成前房和脉络膜上腔直接沟通。作者对因睫状体剥离术或眼外伤而引起持续性低眼压的13眼施行了睫状体固定术(cyclo     

外伤性睫状体断离的诊断与治疗研究现状

睫状体断离（Dialysis of ciliary body）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,睫状体上腔与前房相通,形成房水引流旁路,导致低眼压。由于睫状体断离后长期的低眼压造成眼球组织和功能的破坏,严重损害视功能,甚至导致眼球萎缩而失明,及时准确的诊断及恰当的治疗是恢复视觉功能、改善预后的关键。     

挫伤性睫状体脱离的手术治疗

眼球挫伤或内眼手术有时出现低眼压,除因脉络膜脱离引起暂时性低眼压外,还可以因发生睫状体脱离而持续性低眼压,药物治疗一般无效,必须采取手术治疗,国内已有不少报告,均获得成功。我院采用睫状体上腔放液,巩膜折叠加电凝治疗外伤性睫状体脱离引起的较长时期的低眼压的病人,获得较满意的效果,报导如下。例1 许××男30岁工人住院号51186 1985年11月,不慎被行李包的皮带打伤右眼。持续性低眼压6个月,于1986年6月5日收入院。     

改良型囊袋张力环与睫状体接触导致反复高眼压一例

临床上囊袋张力环(capsular tension ring,CTR)与睫状体接触导致的反复持续性高眼压较为少见，本文报告一例改良型CTR植入术后反复持续性高眼压的病例，行“巩膜悬吊线松解术”后高眼压状态有效缓解，考虑可能与巩膜固定缝线过紧，造成改良型CTR局部与睫状体相接触，刺激睫状体分泌过量房水有关。     

睫状体分离的诊断与治疗进展

睫状体分离是导致持续性低眼压的原因之一,长时间低眼压可导致视功能的永久性损伤.早期发现并及时采用各种有效方法治疗睫状体分离,能有效提高眼压,恢复视功能.随着超声生物显微镜技术的发展,睫状体分离的诊出率提高,也为睫状体光凝或冷凝、巩膜板层下或全层睫状体固定缝合术、巩膜加压等手术治疗提供了准确的参考依据.     

显微复位缝合术治疗睫状体脱离

眼球钝挫伤后发生睫状体脱离可引起持续性的低眼压 ,其后果为视力锐减 ,而应用药物几乎无效 ,治疗十分棘手。我院 1995年～ 1999年用显微复位缝合术治疗 6例 ,取得显著效果 ,报告如下。一般资料 :本组挫伤性睫状体脱离 6例 6眼 ,均为男性 ,年龄17～ 30岁 ,右眼 4例 ,左眼 2例。病史 2月～半年。均曾给予散瞳、全身应用皮质类固醇及能量合剂治疗无效。裸眼视力为手动至 0 1,眼压均 <3.96ｍｍＨｇ(1ｍｍＨｇ =0 .133ｋＰａ) ,且伴有低眼压的一系列眼部改变。术前缩瞳查房角镜均可见部分睫状体从巩膜突处分离 ,记录下部位及范围作为手术依据。…     

外伤性前房角睫状体解离的氩激光治疗

前房角睫状体解离即低眼压综合症是继发于眼球钝伤或手术后。临床表现为低眼压,浅前房,前节色素膜炎,视乳头水肿,黄斑部视网膜水肿,后极部脉络膜皱褶,晶体混浊等,严重影响视力。除了极少数病情轻者,经过长期药物治疗,可以治愈外,绝大部分病例必须采用手术治疗,其中睫状体部巩膜表面透热或冷冻等,疗效较差;直接把前房角部睫状体或虹膜根部缝合在巩膜突上,或睫状体部巩膜表面压陷或巩膜层间填塞术,效果较好。但这些手术方法均较复杂,且有产生角膜散光,损伤晶体等并发症。近年来采用激光光凝使前房角睫状体解离再粘连,疗效较满意。现把我们治疗的两例介绍如下。     

小范围睫状体脱离的保守治疗

睫状体脱离是睫状体从巩膜突上分离至前房,和脉络膜上腔直接沟通,以低眼压和视力下降为主要表现的一种疾病,多发于外伤和术后并发症。我院自2004年5月至2007年1月共收治该类患者9例10眼,分析报告如下。1资料与方法1.1一般资料我院收治的单纯睫状体脱离(范围≤3个钟点位)患者9例     

兔眼内窥镜与经巩膜睫状体光凝术的组织病理学特点比较

目的比较内窥镜睫状体光凝术（ECP）与经巩膜睫状体光凝术（TSCP）的睫状体组织病理学改变特点,了解ECP的降眼压机制。方法取健康成年青紫蓝兔30只,选择1只眼行ECP,对侧眼行TSCP,另取2只兔为正常对照组。手术后的第1、3、5、7、14、28、42、56灭行裂隙灯及眼压测量。术后第7、14、28、42、56天分别随机抽取6只实验兔处死行组织病理学检查,光镜下观察2组光凝术后睫状体组织结构的改变以及邻近组织的损伤和炎症反应情况。结果与TSCP组相比,ECP组术后眼部炎症反应轻微但品状体混浊。ECP组术后各时间点降低眼压的幅度大于TSCP组（P〈0．01）。ECP组术后早期睫状突水肿、睫状体无色素上皮细胞破坏明显,42d后光镜下可见睫状体上皮细胞排列不规则及睫状突萎缩;TSCP组睫状突水肿、出血、结构破坏,而睫状体上皮细胞层破坏不充分,42d后可见睫状体萎缩、色素上皮和无色素上皮细胞不规则增生、巩膜变薄及睫状体基质瘢痕化。结论与TSCP相比,ECP对睫状突无色素上皮细胞的破坏更彻底,时邻近部位组织损伤轻微,但可引起品状体混浊。     

22例睫状体脱离固定缝合术治疗挫伤性低眼压

２２例睫状体脱离固定缝合术治疗挫伤性低眼压天津眼科医院郭黎娅，高文彬眼球钝挫伤后，可能引起脉络膜脱离，睫状体功能的一时低下所致的暂时性低眼压，还可以因发生睫状体脱离，而形成持续性低眼压，后者保守治疗无效。其表现为：视力不同程度的渐进性减退，前房较对侧...     

应用超声生物显微镜检查及诊断眼部睫状体脱离

目的探讨眼部睫状体脱离的形态学改变及其临床意义。方法应用超声生物显微镜（ｕｌｔｒａｓｏｕｎｄｂｉｏｍｉｃｒｏｓｃｏｐｙ,ＵＢＭ）对１７３例睫状体脱离的患眼与健眼的形态进行观察,并对其测量的相关参数进行统计学分析。结果所有睫状体脱离眼均为３６０°全周脱离,而非某一象限的脱离。ＵＢＭ探查睫状体脱离的特征性表现：巩膜与睫状体间存在无回声区,睫状突位置前移、前旋,睫状体平坦部向玻璃体中轴部位移动,部分患者可见睫状体平坦部呈层间分离。部分患者可显示虹膜、睫状体与巩膜附着点完全脱离,形成睫状体离断,离断的范围可为眼球的某一象限而非眼球全周,致使前房与睫状体上腔之间形成完全沟通的瘘口。脱离眼的前房深度（２１１５±５８９）μｍ较未脱离眼的前房深度（２７３６±４４１）μｍ浅（ｔ＝４．４９,Ｐ＜０．００１）,前房变浅的原因是睫状突前移、前旋导致虹膜根部膨隆。结论应用ＵＢＭ检查可以明确地诊断睫状体脱离,且不受屈光间质条件的限制,将为临床治疗提供可靠的依据。     

Manejo de la hendidura de ciclodiálisis con crioterapia transescleral

A cyclodialysis cleft is a rare disease that is produced as a result of a separation of the longitudinal fibers of the ciliary body muscle from the scleral spur. A stepwise approach is the best course of action to treat cyclodialysis, starting with medical therapy and continuing with more invasive surgical options. We report a case of ocular hypotony due a traumatic cyclodialysis successfully resolved with transscleral cryotherapy.     

Cyclodialysis: an update

Cyclodialysis is the result of the separation of the longitudinal ciliary muscle fibers from the scleral spur, which creates an abnormal pathway for aqueous humor drainage that may lead to ocular hypotony. For many years cyclodialysis was considered a treatment option for glaucoma. However, today it usually occurs as a complication of blunt trauma or more rarely as a complication of anterior segment ocular surgery. Ocular hypotony can lead to cataract development, optic disk swelling, refractive changes, and several retinal complications, making accurate identification and timely intervention of the cleft mandatory. Traditionally gonioscopy was the only available technique to diagnose and localize the cleft. However, other tests such as optical coherence tomography, magnetic resonance imaging, transillumination, and specially ultrasound biomicroscopy are now available for the diagnosis of cyclodialysis. Multiple treatment options are also available for this condition. Although medical treatment can be effective to close small clefts, surgery is needed in most patients to restore ocular pressure.     

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。     

Treatment of a cyclodialysis cleft by means of ophthalmic laser microendoscope endophotocoagulation

PURPOSE: To report on the repair of a cyclodialysis cleft by means of endolaser photocoagulation. METHOD: Case report. We describe treatment of a cyclodialysis cleft by means of endolaser photocoagulation with a diode laser. RESULTS: In a 8-year-old boy with pseudophakia and secondary glaucoma in the right eye, combined trabeculectomy/trabeculotomy was performed. Ten months later, the patient was seen with persistent hypotony with a flat filtration bleb. The hypotony was unresponsive to all forms of medical therapy. Reformation of the anterior chamber along with synechialysis revealed a 2.5 clock-hour cyclodialysis cleft by means of gonioscopy. A laser microendoscope probe was used and laser was applied to both the internal scleral and external ciliary body surfaces within the depths of the cleft. Within 3 weeks after treatment, intraocular pressure increased to 15 mm Hg and has remained at that level as of 9 months after the endolaser photocoagulation procedure. CONCLUSION: Endolaser photocoagulation with the ophthalmic laser microendoscope may be an appropriate procedure, after failure of medical therapy, for the diagnosis and repair of a cyclodialysis cleft, especially in the pediatric population.     

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.     

Diagnosis and management of traumatic cyclodialysis cleft

A 48-year-old man presented with hyphema, iridocyclitis, iridophacodonesis, and maculopathy after a contusive trauma. Ultrasound biomicroscopy identified a 90-degree cyclodialysis cleft with severe damage of the zonular fibers. Echographic B-scan examination revealed intravitreal hemorrhage and a 360-degree choroidal detachment. One month later, phacoemulsification was performed and a single-piece poly(methyl methacrylate) intraocular lens was inserted into the ciliary sulcus, with the haptic rotated toward the cyclodialysis cleft area. Postoperatively, the visual acuity improved and the intraocular pressure returned to normal. Ultrasound biomicroscopy showed closure of the cleft by reattachment of the ciliary body to the scleral spur. Optical coherence tomography revealed complete resolution of the macular and choroidal folds. Ultrasound biomicroscopy is a useful method for appropriate management of traumatic cyclodialysis cleft. In cases of small cyclodialysis clefts, with the surgical method we describe, the lens haptics apply directional force toward the sclera, fostering adherence of the ciliary body fibers.     

Anterior scleral buckling procedure for cyclodialysis cleft with chronic hypotony.

Cyclodialysis clefts occur when the attachment of the ciliary body to the scleral spur is disrupted. The mechanism is usually traumatic or iatrogenic after phacoemulsification or other intraocular manipulation. Treatment becomes necessary when hypotony occurs, with maculopathy being the most visually significant sequela. A patient who failed conventional treatment for hypotony and eventually benefited from a novel surgery to correct his cyclodialysis cleft is described.     

Light and electron microscopy of the anterior chamber angle structures following surgical disinsertion of the ciliary muscle in the cynomolgus monkey.

Light and electron microscopic studies were done on 11 cynomolgus monkey eyes which had undergone total iris removal followed by surgical disinsertion of the ciliary muscle from the scleral spur 4.7 to 14.4 months earlier. Anterior chamber perfusion to measure gross outflow facility had been performed one to nine times postoperatively. Over most of the circumference in most eyes (1) the ciliary muscle had been retrodisplaced from the scleral spur and had reattached to the sclera more posteriorly; (2) ciliary muscle, trabecular meshwork, and Schlemm's canal appeared normal. A cyclodialysis cleft was never seen. Fixation of some eyes in the in vivo and in vitro presence of pilocarpine demonstrated the contractibility of the retrodisplaced muscle. In isolated areas where the ciliary body had been surgically cut, scar tissue of varying thickness connected scleral spur, sclera, ciliary body, zonule, and lens capsule, but did not infiltrate trabecular meshwork or Schlemm's canal. In such sectors, plasma cell-like cells replaced trabecular endothelial cells and were also present in the scar tissue, ciliary muscle, and surrounding vessel walls in the scar and sclera. In sectors of two eyes, a previously existing trabecular operculum extended posteriorly and completely covered the meshwork. The meshwork in these sectors was poorly perfused by aqueous humor, and electron-dense deposits were present beneath the inner wall of Schlemm's canal. Four totally iridectomized and two unoperated eyes from these monkeys were also examined; ciliary muscle, trabecular meshwork, and Schlemm's canal appeared normal in all, despite the numerous anterior chamber perfusions.     

改良式外伤性睫状体解离缝合复位术的临床研究

目的:评估改良式外伤性睫状体解离缝合复位术的手术效果,以探索睫状体解离更理想的手术方案。方法:选取外伤性睫状体解离患者33例33眼,超声生物显微镜(UBM)检查定位离断口范围后,采用改良式睫状体解离缝合复位术。术后随访3~6mo,观察术后睫状体复位、眼压、视力和并发症情况。结果:术后1wk复查UBM,30例30眼睫状体完全复位,3例3眼局部有睫状体浅脱离,术后15d复查UBM睫状体完全复位。术后20例20眼眼压高,早期眼压高17例17眼,3d后眼压恢复正常;1眼1wk后眼压恢复正常;2眼眼压高者药物不能控制至正常,1眼2mo后行抗青光眼手术,1眼行睫状体激光光凝术,术后眼压均控制正常。术后视力均有不同程度改善,未见眼前段缺血并发症和角膜大散光。结论:改良式睫状体解离复位缝合术操作简单安全、疗效可靠、术源性损伤小,并发症少。