玻璃体后脱离临床和超微结构诊断

目的：通过临床、B超和扫描电镜检查玻璃体后脱离（posterior vitreous detachment,PVD)情况，评价各种检查手段诊断PVD的价值。方法：16只新西兰白兔随机分为A、B、C三组各6、6、4只兔，均以右眼 为实验眼，左眼为对照。A组实验眼玻璃体腔内注射纤溶酶0．1ml 1U联合透明质酸酶20U，B组注射0.1ml纤溶酶1U，C组注射透明质酸酶20U， 所有对照眼玻璃体腔内注射0．1mlBSS液。术后7天内裂隙灯前置镜、直接检眼镜、B超观察PVD，术后7天摘除眼球扫描电镜检查PVD。结果：A组实验眼临床诊断完全性PVD66.7%（4／6），B超诊断完全性PVD87．5％（5／6），扫描电镜确诊完全性PVD100％（6／6）。临床和B超诊断之间及它们分别与扫描电镜诊断PVD的非参数Z检验无明显差异（分别P＝0．180，P＝0．317，P＝0．157）。B组实验眼临床检查无PVD（0／6）。B超仅发现一例部分性PVD（1／6），扫描电镜确诊部分性PVD87．5％（5／6），一例完全性PVD。临床和B超诊断的非参数Z检验无明显差异（P＝0．317）， 它们分别与扫描电镜诊断部分性PVD的非参数Z检验差异显著（分别P＝0．020，P＝0．034）。C组临床、B超及扫描电镜诊断均无PVD。结论：临床结合B超检查对于诊断伴有玻璃体液化的PVD是一种安全、方便、经济及可靠性较好的手段。扫描电镜由于能精确分辨玻璃体后界膜及视网膜内界膜组成结构及粘连情况，是证实PVD最可靠的手段。

Clinical and ultrastructure diagnosis of posterior vitreous detachment

Objective Assessing three methods in the diagnosis of posterior vitreous detachment(PVD):(1)clinical examinations including sliplamp biomicroscopy adding+90D aspheric lens and direct ophthalmoscopy;(2)B-ultrasonic examination;(3)scanning electron microscopy.Methods 16 New Zealand rabbits were assigned to three groups(6,6,4 respectively).In group 1,1U plasmin combined with 20U hyaluronidase(0.1ml diluted in BSS) injected into the vitreous of the right eye.In group 2,plasmin 1 U alone.In group 3,hyaluronidase 20U alone.All the left eyes received 0.1ml BSS as a control.Clinical examination and B-ultrasonic examination were performed in the following 7 days after operation.All the rabbits were executed,the eyeballs were enucleated and performed scanning electron microscopy.Results In group 1,the diagnosis of complete PVD by clinical B-Ultrasonic and scanning electron microscopic examination was 66.7%(4/6)?87.5%(5/6)?100%(6/6),respectively.The nonparameter test was no obvious difference among them(P=0.180,P=0.317,P=0.157 respectively).In group 2,no PVD was discovered by clinical diagnosis,only 1 partial PVD was found by B-ultrasound,the scanning election microscopy diagnosis partial PVD was 87.5%(5/6),1 eye was complete PVD.The nonparameter test was no obvious difference between clinical and B-ultrasonic examination(P=0.317),both of them contrast to scanning election microscopy,the nonparameter test was obviously different(P=0.020,P=0.034).In group 3,these three methods were not discovered PVD at all.Conclusions Clinical observations combined with B-ultrasonic examination are safe,convenient,economic and reliable methods to diagnose PVD with liquefaction and syneresis of vitreous.Scanning electron microscopy can accurately distinguish the ultrastructure of vitreoretinal interface,which is the most reliable diagnosis method of PVD.